Search results for: emergency mapping
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2051

Search results for: emergency mapping

1781 Characterization of Chest Pain in Patients Consulting to the Emergency Department of a Health Institution High Level of Complexity during 2014-2015, Medellin, Colombia

Authors: Jorge Iván Bañol-Betancur, Lina María Martínez-Sánchez, María de los Ángeles Rodríguez-Gázquez, Estefanía Bahamonde-Olaya, Ana María Gutiérrez-Tamayo, Laura Isabel Jaramillo-Jaramillo, Camilo Ruiz-Mejía, Natalia Morales-Quintero

Abstract:

Acute chest pain is a distressing sensation between the diaphragm and the base of the neck and it represents a diagnostic challenge for any physician in the emergency department. Objective: To establish the main clinical and epidemiological characteristics of patients who present with chest pain to the emergency department in a private clinic from the city of Medellin, during 2014-2015. Methods: Cross-sectional retrospective observational study. Population and sample were patients who consulted for chest pain in the emergency department who met the eligibility criteria. The information was analyzed in SPSS program vr.21; qualitative variables were described through relative frequencies, and the quantitative through mean and standard deviation ‬or medians according to their distribution in the study population. Results: A total of 231 patients were evaluated, the mean age was 49.5 ± 19.9 years, 56.7% were females. The most frequent pathological antecedents were hypertension 35.5%, diabetes 10,8%, dyslipidemia 10.4% and coronary disease 5.2%. Regarding pain features, in 40.3% of the patients the pain began abruptly, in 38.2% it had a precordial location, for 20% of the cases physical activity acted as a trigger, and 60.6% was oppressive. Costochondritis was the most common cause of chest pain among patients with an established etiologic diagnosis, representing the 18.2%. Conclusions: Although the clinical features of pain reported coincide with the clinical presentation of an acute coronary syndrome, the most common cause of chest pain in study population was costochondritis instead, indicating that it is a differential diagnostic in the approach of patients with pain acute chest.

Keywords: acute coronary syndrome, chest pain, epidemiology, osteochondritis

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1780 Autopsy-Based Study of Abdominal Traffic Trauma Death after Emergency Room Arrival

Authors: Satoshi Furukawa, Satomu Morita, Katsuji Nishi, Masahito Hitosugi

Abstract:

We experience the autopsy cases that the deceased was alive in emergency room on arrival. Bleeding is the leading cause of preventable death after injury. This retrospective study aimed to characterize opportunities for performance improvement identified in patients who died from traffic trauma and were considered by the quality improvement of education system. The Japan Advanced Trauma Evaluation and Care (JATEC) education program was introduced in 2002. We focused the abdominal traffic trauma injury. An autopsy-based cross-sectional study conducted. A purposive sampling technique was applied to select the study sample of 41 post-mortems of road traffic accident between April 1999 and March 2014 subjected to medico-legal autopsy at the department of Forensic Medicine, Shiga University of Medical Science. 16 patients (39.0%) were abdominal trauma injury. The mean period of survival after meet with accident was 13.5 hours, compared abdominal trauma death was 27.4 hours longer. In road traffic accidents, the most injured abdominal organs were liver followed by mesentery. We thought delayed treatment was associated with immediate diagnostic imaging, and so expected to expand trauma management examination.

Keywords: abdominal traffic trauma, preventable death, autopsy, emergency medicine

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1779 The Use of TRIZ to Map the Evolutive Pattern of Products

Authors: Fernando C. Labouriau, Ricardo M. Naveiro

Abstract:

This paper presents a model for mapping the evolutive pattern of products in order to generate new ideas, to perceive emerging technologies and to manage product’s portfolios in new product development (NPD). According to the proposed model, the information extracted from the patent system is filtered and analyzed with TRIZ tools to produce the input information to the NPD process. The authors acknowledge that the NPD process is well integrated within the enterprises business strategic planning and that new products are vital in the competitive market nowadays. In the other hand, it has been observed the proactive use of patent information in some methodologies for selecting projects, mapping technological change and generating product concepts. And one of these methodologies is TRIZ, a theory created to favor innovation and to improve product design that provided the analytical framework for the model. Initially, it is presented an introduction to TRIZ mainly focused on the patterns of evolution of technical systems and its strategic uses, a brief and absolutely non-comprehensive description as the theory has several others tools being widely employed in technical and business applications. Then, it is introduced the model for mapping the products evolutive pattern with its three basic pillars, namely patent information, TRIZ and NPD, and the methodology for implementation. Following, a case study of a Brazilian bike manufacturing is presented to proceed the mapping of a product evolutive pattern by decomposing and analyzing one of its assemblies along ten evolution lines in order to envision opportunities for further product development. Some of these lines are illustrated in more details to evaluate the features of the product in relation to the TRIZ concepts using a comparison perspective with patents in the state of the art to validate the product’s evolutionary potential. As a result, the case study provided several opportunities for a product improvement development program in different project categories, identifying technical and business impacts as well as indicating the lines of evolution that can mostly benefit from each opportunity.

Keywords: product development, patents, product strategy, systems evolution

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1778 Resilience-Based Emergency Bridge Inspection Routing and Repair Scheduling under Uncertainty

Authors: Zhenyu Zhang, Hsi-Hsien Wei

Abstract:

Highway network systems play a vital role in disaster response for disaster-damaged areas. Damaged bridges in such network systems can impede disaster response by disrupting transportation of rescue teams or humanitarian supplies. Therefore, emergency inspection and repair of bridges to quickly collect damage information of bridges and recover the functionality of highway networks is of paramount importance to disaster response. A widely used measure of a network’s capability to recover from disasters is resilience. To enhance highway network resilience, plenty of studies have developed various repair scheduling methods for the prioritization of bridge-repair tasks. These methods assume that repair activities are performed after the damage to a highway network is fully understood via inspection, although inspecting all bridges in a regional highway network may take days, leading to the significant delay in repairing bridges. In reality, emergency repair activities can be commenced as soon as the damage data of some bridges that are crucial to emergency response are obtained. Given that emergency bridge inspection and repair (EBIR) activities are executed simultaneously in the response phase, the real-time interactions between these activities can occur – the blockage of highways due to repair activities can affect inspection routes which in turn have an impact on emergency repair scheduling by providing real-time information on bridge damages. However, the impact of such interactions on the optimal emergency inspection routes (EIR) and emergency repair schedules (ERS) has not been discussed in prior studies. To overcome the aforementioned deficiencies, this study develops a routing and scheduling model for EBIR while accounting for real-time inspection-repair interactions to maximize highway network resilience. A stochastic, time-dependent integer program is proposed for the complex and real-time interacting EBIR problem given multiple inspection and repair teams at locations as set post-disaster. A hybrid genetic algorithm that integrates a heuristic approach into a traditional genetic algorithm to accelerate the evolution process is developed. Computational tests are performed using data from the 2008 Wenchuan earthquake, based on a regional highway network in Sichuan, China, consisting of 168 highway bridges on 36 highways connecting 25 cities/towns. The results show that the simultaneous implementation of bridge inspection and repair activities can significantly improve the highway network resilience. Moreover, the deployment of inspection and repair teams should match each other, and the network resilience will not be improved once the unilateral increase in inspection teams or repair teams exceeds a certain level. This study contributes to both knowledge and practice. First, the developed mathematical model makes it possible for capturing the impact of real-time inspection-repair interactions on inspection routing and repair scheduling and efficiently deriving optimal EIR and ERS on a large and complex highway network. Moreover, this study contributes to the organizational dimension of highway network resilience by providing optimal strategies for highway bridge management. With the decision support tool, disaster managers are able to identify the most critical bridges for disaster management and make decisions on proper inspection and repair strategies to improve highway network resilience.

Keywords: disaster management, emergency bridge inspection and repair, highway network, resilience, uncertainty

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1777 Characteristics of Acute Poisoning in Emergency Departments: Multicenter Study in Korea

Authors: Hyuk-Hoon Kim, Young Gi Min

Abstract:

Background: Acute poisoning is the common cause of morbidity and mortality. Characteristics of acute poisoning differ between countries. While other countries operate the database system for poisoning, Korea has not collected the database for acute poisoning. Distribution of incidence of acute poisoning depending on the types of materials have also not studied in Korea. Our aims are to evaluate the etiologic and demographic characteristics of acute poisoning cases and to obtain up-to-date information on acute poisonings. Method: We retrospectively recorded cases of acute poisoning from eight emergency departments of second level or university hospitals from different cities in Gyeonggi province in Korea from April 2006 and March 2015. The distributions of incidence of acute poisoning depending on the types of materials are mapped by geographic information system. Result: A total of 3,449 poisoned cases were analyzed. Mean estimated age of patients was 39.56 ± 22.40 years. Mean male to female ratio of patients was 1:1.4. Mean proportion of intentional poisoning was 57.9%. Common materials are benzodiazepine (16.6%), carbon monoxide (10.5%), pesticide (8.1%) and zolpidem (7.1%) Common route of exposure is ingestion (79.5%) and followed by inhalation (16.5%). Common treatment methods are gastric lavage (20%) and activated charcoal (30%). Most cases had uneventful recovery; 61.4% were treated as outpatients and 0.1% of the poisoning resulted in death in ER. Conclusion: Even though the cases enrolled in our study is not the overall cases of acute poisoning in Korea, our study could be the basis of countermeasures for analysis and prevention of acute poisoning in Korea.

Keywords: acute poisoning, emergency department, epidemiology, Korea

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1776 Artificial Habitat Mapping in Adriatic Sea

Authors: Annalisa Gaetani, Anna Nora Tassetti, Gianna Fabi

Abstract:

The hydroacoustic technology is an efficient tool to study the sea environment: the most recent advancement in artificial habitat mapping involves acoustic systems to investigate fish abundance, distribution and behavior in specific areas. Along with a detailed high-coverage bathymetric mapping of the seabed, the high-frequency Multibeam Echosounder (MBES) offers the potential of detecting fine-scale distribution of fish aggregation, combining its ability to detect at the same time the seafloor and the water column. Surveying fish schools distribution around artificial structures, MBES allows to evaluate how their presence modifies the biological natural habitat overtime in terms of fish attraction and abundance. In the last years, artificial habitat mapping experiences have been carried out by CNR-ISMAR in the Adriatic sea: fish assemblages aggregating at offshore gas platforms and artificial reefs have been systematically monitored employing different kinds of methodologies. This work focuses on two case studies: a gas extraction platform founded at 80 meters of depth in the central Adriatic sea, 30 miles far from the coast of Ancona, and the concrete and steel artificial reef of Senigallia, deployed by CNR-ISMAR about 1.2 miles offshore at a depth of 11.2 m . Relating the MBES data (metrical dimensions of fish assemblages, shape, depth, density etc.) with the results coming from other methodologies, such as experimental fishing surveys and underwater video camera, it has been possible to investigate the biological assemblage attracted by artificial structures hypothesizing which species populate the investigated area and their spatial dislocation from these artificial structures. Processing MBES bathymetric and water column data, 3D virtual scenes of the artificial habitats have been created, receiving an intuitive-looking depiction of their state and allowing overtime to evaluate their change in terms of dimensional characteristics and depth fish schools’ disposition. These MBES surveys play a leading part in the general multi-year programs carried out by CNR-ISMAR with the aim to assess potential biological changes linked to human activities on.

Keywords: artificial habitat mapping, fish assemblages, hydroacustic technology, multibeam echosounder

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1775 Multi-Environment Quantitative Trait Loci Mapping for Grain Iron and Zinc Content Using Bi-Parental Recombinant Inbred Lines in Pearl Millet

Authors: Tripti Singhal, C. Tara Satyavathi, S. P. Singh, Aruna Kumar, Mukesh Sankar S., C. Bhardwaj, Mallik M., Jayant Bhat, N. Anuradha, Nirupma Singh

Abstract:

Pearl millet is a climate-resilient nutritious crop. We report iron and zinc content QTLs from 3 divergent locations. The content of grain Fe in the RILs ranged between 36 and 114 mg/kg, and that of Zn from 20 to 106 mg/kg across the three years at over 3 locations (Delhi, Dharwad, and Jodhpur). We used SSRs to generate a linkage map using 210 F₆ RIL derived from the (PPMI 683 × PPMI 627) cross. The linkage map of 151 loci was 3403.6 cM in length. QTL analysis revealed a total of 22 QTLs for both traits at all locations. Inside QTLs, candidate genes were identified using bioinformatics approaches.

Keywords: yield, pearl millet, QTL mapping, multi-environment, RILs

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1774 Climate Change Effects on Western Coastal Groundwater in Yemen (1981-2020)

Authors: Afrah S. M. Al-Mahfadi

Abstract:

Climate change is a global issue that has significant impacts on water resources, resulting in environmental, economic, and political consequences. Groundwater reserves, particularly in coastal areas, are facing depletion, leading to serious problems in regions such as Yemen. This study focuses on the western coastal region of Yemen, which already faces risks such as water crises, food insecurity, and widespread poverty. Climate change exacerbates these risks by causing high temperatures, sea level rise, inadequate sea level rise, and inadequate environmental policies. Research Aim: The aim of this research is to provide a comprehensive overview of the impact of climate change on the western coastal region of Yemen. Specifically, the study aims to analyze the relationship between climate change and the loss of fresh groundwater resources in this area. Methodology: The research utilizes a combination of a literature review and three case studies conducted through site visits. Arch-GIS mapping is employed to analyze and visualize the relationship between climate change and the depletion of fresh groundwater resources. Additionally, data on precipitation from 1981 to 2020 and scenarios of projected sea level rise (SLR) are considered. Findings: The study reveals several future issues resulting from climate change. It is projected that the annual temperature will increase while the rainfall rate will decrease. Furthermore, the sea level is expected to rise by approximately 0.30 to 0.72 meters by 2100. These factors contribute to the loss of wetlands, the retreat of shorelines and estuaries, and the intrusion of seawater into the coastal aquifer, rendering drinking water from wells increasingly saline. Data Collection and Analysis Procedures: Data for this research are collected through a literature review, including studies on climate change impacts in coastal areas and the hydrogeology of the study region. Furthermore, three case studies are conducted through site visits. Arch-GIS mapping techniques are utilized to analyze the relationship between climate change and the loss of fresh groundwater resources. Historical precipitation data from 1981 to 2020 and scenarios of projected sea level rise are also analyzed. Questions Addressed: (1) What is the impact of climate change on the western coastal region of Yemen? (2) How does climate change affect the availability of fresh groundwater resources in this area? Conclusion: The study concludes that the western coastal region of Yemen is facing significant challenges due to climate change. The projected increase in temperature, decrease in rainfall, and rise in sea levels have severe implications, such as the loss of wetlands, shorelines, and estuaries. Additionally, the intrusion of seawater into the coastal aquifer further exacerbates the issue of saline drinking water. Urgent measures are needed to address climate change, including improving water management, implementing integrated coastal zone planning, raising awareness among stakeholders, and implementing emergency projects to mitigate the impacts. Recommendations: To mitigate the adverse effects of climate change, several recommendations are provided. These include improving water management practices, developing integrated coastal zone planning strategies, raising awareness among all stakeholders, improving health and education, and implementing emergency projects to combat climate change. These measures aim to enhance adaptive capacity and resilience in the face of future climate change impacts.

Keywords: climate change, groundwater, coastal wetlands, Yemen

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1773 Land Use/Land Cover Mapping Using Landsat 8 and Sentinel-2 in a Mediterranean Landscape

Authors: Moschos Vogiatzis, K. Perakis

Abstract:

Spatial-explicit and up-to-date land use/land cover information is fundamental for spatial planning, land management, sustainable development, and sound decision-making. In the last decade, many satellite-derived land cover products at different spatial, spectral, and temporal resolutions have been developed, such as the European Copernicus Land Cover product. However, more efficient and detailed information for land use/land cover is required at the regional or local scale. A typical Mediterranean basin with a complex landscape comprised of various forest types, crops, artificial surfaces, and wetlands was selected to test and develop our approach. In this study, we investigate the improvement of Copernicus Land Cover product (CLC2018) using Landsat 8 and Sentinel-2 pixel-based classification based on all available existing geospatial data (Forest Maps, LPIS, Natura2000 habitats, cadastral parcels, etc.). We examined and compared the performance of the Random Forest classifier for land use/land cover mapping. In total, 10 land use/land cover categories were recognized in Landsat 8 and 11 in Sentinel-2A. A comparison of the overall classification accuracies for 2018 shows that Landsat 8 classification accuracy was slightly higher than Sentinel-2A (82,99% vs. 80,30%). We concluded that the main land use/land cover types of CLC2018, even within a heterogeneous area, can be successfully mapped and updated according to CLC nomenclature. Future research should be oriented toward integrating spatiotemporal information from seasonal bands and spectral indexes in the classification process.

Keywords: classification, land use/land cover, mapping, random forest

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1772 Autonomous Exploration, Navigation and Mapping Payload Integrated on a Quadruped Robot

Authors: Julian Y. Raheema, Michael R. Hess, Raymond C. Provost, Mark Bilinski

Abstract:

The world is rapidly moving towards advancing and utilizing artificial intelligence and autonomous robotics. The ground-breaking Boston Dynamics quadruped robot, SPOT, was designed for industrial and commercial tasks requiring limited autonomous navigation. Out of the box, SPOT has route memorization and playback – it can repeat a path that it has been manually piloted through, but it cannot autonomously navigate an area that has not been previously explored. The presented SPOT payload package is built on ROS framework to support autonomous navigation and mapping of an unexplored environment. The package is fully integrated with SPOT to take advantage of motor controls and collision avoidance that comes natively with the robot. The payload runs all computations onboard, takes advantage of visual odometry SLAM and uses an Intel RealSense depth camera and Velodyne LiDAR sensor to generate 2D and 3D maps while in autonomous navigation mode. These maps are fused into the navigation stack to generate a costmap to enable the robot to safely navigate the environment without causing damage to the surroundings or the robot. The operator defines the operational zone and start location and then sends the explore command to have SPOT explore, generate 2D and 3D maps of the environment and return to the start location to await the operator's next command. The benefit of the presented package is that it is much lighter weight and less expensive than previous approaches and, importantly, operates in GPS-denied scenarios, which is ideal for indoor mapping. There are numerous applications that are hazardous to humans for SPOT enhanced with the autonomy payload, including disaster response, nuclear inspection, mine inspection, and so on. Other less extreme uses cases include autonomous 3D and 2D scanning of facilities for inspection, engineering and construction purposes.

Keywords: autonomous, SLAM, quadruped, mapping, exploring, ROS, robotics, navigation

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1771 A Novel Multi-Block Selective Mapping Scheme for PAPR Reduction in FBMC/OQAM Systems

Authors: Laabidi Mounira, Zayani Rafk, Bouallegue Ridha

Abstract:

Filter Bank Multicarrier with Offset Quadrature Amplitude Modulation (FBMC/OQAM) is presently known as a sustainable alternative to conventional Orthogonal Frequency Division Multiplexing (OFDM) for signal transmission over multi-path fading channels. Like all multicarrier systems, FBMC/OQAM suffers from high Peak to Average Power Ratio (PAPR). Due to the symbol overlap inherent in the FBMC/OQAM system, the direct application of conventional OFDM PAPR reduction scheme is far from being effective. This paper suggests a novel scheme termed Multi-Blocks Selective Mapping (MB-SLM) whose simulation results show that its performance in terms of PAPR reduction is almost identical to that of OFDM system.

Keywords: FBMC/OQAM, multi-blocks, OFDM, PAPR, SLM

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1770 The Mapping of Pastoral Area as a Basis of Ecological for Beef Cattle in Pinrang Regency, South Sulawesi, Indonesia

Authors: Jasmal A. Syamsu, Muhammad Yusuf, Hikmah M. Ali, Mawardi A. Asja, Zulkharnaim

Abstract:

This study was conducted and aimed in identifying and mapping the pasture as an ecological base of beef cattle. A survey was carried out during a period of April to June 2016, in Suppa, Mattirobulu, the district of Pinrang, South Sulawesi province. The mapping process of grazing area was conducted in several stages; inputting and tracking of data points into Google Earth Pro (version 7.1.4.1529), affirmation and confirmation of tracking line visualized by satellite with a variety of records at the point, a certain point and tracking input data into ArcMap Application (ArcGIS version 10.1), data processing DEM/SRTM (S04E119) with respect to the location of the grazing areas, creation of a contour map (a distance of 5 m) and mapping tilt (slope) of land and land cover map-making. Analysis of land cover, particularly the state of the vegetation was done through the identification procedure NDVI (Normalized Differences Vegetation Index). This procedure was performed by making use of the Landsat-8. The results showed that the topography of the grazing areas of hills and some sloping surfaces and flat with elevation vary from 74 to 145 above sea level (asl), while the requirements for growing superior grass and legume is an altitude of up to 143-159 asl. Slope varied between 0 - > 40% and was dominated by a slope of 0-15%, according to the slope/topography pasture maximum of 15%. The range of NDVI values for pasture image analysis results was between 0.1 and 0.27. Characteristics of vegetation cover of pasture land in the category of vegetation density were low, 70% of the land was the land for cattle grazing, while the remaining approximately 30% was a grove and forest included plant water where the place for shelter of the cattle during the heat and drinking water supply. There are seven types of graminae and 5 types of legume that was dominant in the region. Proportionally, graminae class dominated up 75.6% and legume crops up to 22.1% and the remaining 2.3% was another plant trees that grow in the region. The dominant weed species in the region were Cromolaenaodorata and Lantana camara, besides that there were 6 types of floor plant that did not include as forage fodder.

Keywords: pastoral, ecology, mapping, beef cattle

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1769 Blood Ketones as a Point of Care Testing in Paediatric Emergencies

Authors: Geetha Jayapathy, Lakshmi Muthukrishnan, Manoj Kumar Reddy Pulim , Radhika Raman

Abstract:

Introduction: Ketones are the end products of fatty acid metabolism and a source of energy for vital organs such as the brain, heart and skeletal muscles. Ketones are produced in excess when glucose is not available as a source of energy or it cannot be utilized as in diabetic ketoacidosis. Children admitted in the emergency department often have starvation ketosis which is not clinically manifested. Decision on admission of children to the emergency room with subtle signs can be difficult at times. Point of care blood ketone testing can be done at the bedside even in a primary level care setting to supplement and guide us in our management decisions. Hence this study was done to explore the utility of this simple bedside parameter as a supplement in assessing pediatric patients presenting to the emergency department. Objectives: To estimate blood ketones of children admitted in the emergency department. To analyze the significance of blood ketones in various disease conditions. Methods: Blood ketones using point of care testing instrument (ABOTTprecision Xceed Pro meters) was done in patients getting admitted in emergency room and in out-patients (through sample collection centre). Study population: Children aged 1 month to 18 years were included in the study. 250 cases (In-patients) and 250 controls (out-patients) were collected. Study design: Prospective observational study. Data on details of illness and physiological status were documented. Blood ketones were compared between the two groups and all in patients were categorized into various system groups and analysed. Results: Mean blood ketones were high in in-patients ranging from 0 to 7.2, with a mean of 1.28 compared to out-patients ranging from 0 to 1.9 with a mean of 0.35. This difference was statistically significant with a p value < 0.001. In-patients with shock (mean of 4.15) and diarrheal dehydration (mean of 1.85) had a significantly higher blood ketone values compared to patients with other system involvement. Conclusion: Blood ketones were significantly high (above the normal range) in pediatric patients who are sick requiring admission. Patients with various forms of shock had very high blood ketone values as found in diabetic ketoacidosis. Ketone values in diarrheal dehydration were moderately high correlating to the degree of dehydration.

Keywords: admission, blood ketones, paediatric emergencies, point of care testing

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1768 Extracting Spatial Information Using Stereo Imageries for Mapping Slum Areas in Karachi, Pakistan

Authors: Mohammed Raza Mehdi, Kamran Ahmed

Abstract:

Mega-city Karachi has numerous unplanned slum areas and squatter settlements with irregular growth of building structures. Due to weak development policy and lack of development control, such settlements are increasing at a rapid pace. Mapping such areas for planning and infrastructure development requires an integrated approach of socio-spatial and technological tools. Therefore in this study, an attempt is made to create GIS information layers on complex inbound built-up areas of slums at the coastal belt of Karachi by using a stereo pair of satellite images. The outcome expected is technological application to aid planning institutions for crisis management and infrastructure development in irregularly developed slum areas of Karachi, Pakistan.

Keywords: slum, satellite imageries, GIS, Karachi, Pakistan

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1767 Impact of Emergency Medicine Department Crowding on Mortality

Authors: Morteza Gharibi, Abdolghader Pakniat, Somayeh Bahrampouri

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Introduction: Emergency department (E.R.) crowding is a serious widespread problem in hospitals that leads to irregularities, a slower rate of delivery of services to patients, and a long-term stay. In addition, the long-term stay in the E.D. reduces the possibility of providing services with appropriate quality to other patients who are undergoing medical emergencies, which leads to dissatisfaction among patients. This study aimed to determine the relationship between ED-crowding and the mortality rate of the patients referred to the E.D. In a retrospective cohort study, all patients who expired in first 24 hours of admission were enrolled in the study. Crowding index at the moment of admission was calculated using Edwin Score. The data including history and physical examination, time of arrival in the E.D., diagnosis (using ICD 10 code), time of death, cause of death, demographic information was recoded based on triage forms on admission and patients’ medical files. Data analysis was performed by using descriptive statistics and chi square test, ANOVA tests using SPSS ver. 19. The time of arrival in E.D. to death in crowded E.D. conditions, with an average of five hours and 25 minutes, was significantly higher than the average admission Time of arrival in E.D. to death in active and crowded E.D. conditions. More physicians and nurses can be employed during crowded times to reduce staff fatigue and improve their performance during these hours.

Keywords: mortality, emergency, department, crowding

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1766 Land Cover Mapping Using Sentinel-2, Landsat-8 Satellite Images, and Google Earth Engine: A Study Case of the Beterou Catchment

Authors: Ella Sèdé Maforikan

Abstract:

Accurate land cover mapping is essential for effective environmental monitoring and natural resources management. This study focuses on assessing the classification performance of two satellite datasets and evaluating the impact of different input feature combinations on classification accuracy in the Beterou catchment, situated in the northern part of Benin. Landsat-8 and Sentinel-2 images from June 1, 2020, to March 31, 2021, were utilized. Employing the Random Forest (RF) algorithm on Google Earth Engine (GEE), a supervised classification categorized the land into five classes: forest, savannas, cropland, settlement, and water bodies. GEE was chosen due to its high-performance computing capabilities, mitigating computational burdens associated with traditional land cover classification methods. By eliminating the need for individual satellite image downloads and providing access to an extensive archive of remote sensing data, GEE facilitated efficient model training on remote sensing data. The study achieved commendable overall accuracy (OA), ranging from 84% to 85%, even without incorporating spectral indices and terrain metrics into the model. Notably, the inclusion of additional input sources, specifically terrain features like slope and elevation, enhanced classification accuracy. The highest accuracy was achieved with Sentinel-2 (OA = 91%, Kappa = 0.88), slightly surpassing Landsat-8 (OA = 90%, Kappa = 0.87). This underscores the significance of combining diverse input sources for optimal accuracy in land cover mapping. The methodology presented herein not only enables the creation of precise, expeditious land cover maps but also demonstrates the prowess of cloud computing through GEE for large-scale land cover mapping with remarkable accuracy. The study emphasizes the synergy of different input sources to achieve superior accuracy. As a future recommendation, the application of Light Detection and Ranging (LiDAR) technology is proposed to enhance vegetation type differentiation in the Beterou catchment. Additionally, a cross-comparison between Sentinel-2 and Landsat-8 for assessing long-term land cover changes is suggested.

Keywords: land cover mapping, Google Earth Engine, random forest, Beterou catchment

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1765 Creation of Computerized Benchmarks to Facilitate Preparedness for Biological Events

Authors: B. Adini, M. Oren

Abstract:

Introduction: Communicable diseases and pandemics pose a growing threat to the well-being of the global population. A vital component of protecting the public health is the creation and sustenance of a continuous preparedness for such hazards. A joint Israeli-German task force was deployed in order to develop an advanced tool for self-evaluation of emergency preparedness for variable types of biological threats. Methods: Based on a comprehensive literature review and interviews with leading content experts, an evaluation tool was developed based on quantitative and qualitative parameters and indicators. A modified Delphi process was used to achieve consensus among over 225 experts from both Germany and Israel concerning items to be included in the evaluation tool. Validity and applicability of the tool for medical institutions was examined in a series of simulation and field exercises. Results: Over 115 German and Israeli experts reviewed and examined the proposed parameters as part of the modified Delphi cycles. A consensus of over 75% of experts was attained for 183 out of 188 items. The relative importance of each parameter was rated as part of the Delphi process, in order to define its impact on the overall emergency preparedness. The parameters were integrated in computerized web-based software that enables to calculate scores of emergency preparedness for biological events. Conclusions: The parameters developed in the joint German-Israeli project serve as benchmarks that delineate actions to be implemented in order to create and maintain an ongoing preparedness for biological events. The computerized evaluation tool enables to continuously monitor the level of readiness and thus strengths and gaps can be identified and corrected appropriately. Adoption of such a tool is recommended as an integral component of quality assurance of public health and safety.

Keywords: biological events, emergency preparedness, bioterrorism, natural biological events

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1764 The Usefulness of Medical Scribes in the Emengecy Department

Authors: Victor Kang, Sirene Bellahnid, Amy Al-Simaani

Abstract:

Efficient documentation and completion of clerical tasks are pillars of efficient patient-centered care in acute settings such as the emergency department (ED). Medical scribes aid physicians with documentation, navigation of electronic health records, results gathering, and communication coordination with other healthcare teams. However, the use of medical scribes is not widespread, with some hospitals even continuing to discontinue their programs. One reason for this could be the lack of studies that have outlined concrete improvements in efficiency and patient and provider satisfaction in emergency departments before and after incorporating scribes. Methods: We conducted a review of the literature concerning the implementation of a medical scribe program and emergency department performance. For this review, a narrative synthesis accompanied by textual commentaries was chosen to present the selected papers. PubMed was searched exclusively. Initially, no date limits were set, but seeing as the electronic medical record was officially implemented in Canada in 2013, studies published after this date were preferred as they provided insight into the interplay between its implementation and scribes on quality improvement. Results: Throughput, efficiency, and cost-effectiveness were the most commonly used parameters in evaluating scribes in the Emergency Department. Important throughput metrics, specifically door-to-doctor and disposition time, were significantly decreased in emergency departments that utilized scribes. Of note, this was shown to be the case in community hospitals, where the burden of documentation and clerical tasks would fall directly upon the attending physician. Academic centers differ in that they rely heavily on residents and students; so the implementation of scribes has been shown to have limited effect on these metrics. However, unique to academic centers was the provider’s perception of incrased time for teaching was unique to academic centers. Consequently, providers express increased work satisfaction in relation to time spent with patients and in teaching. Patients, on the other hand, did not demonstrate a decrease in satisfaction in regards to the care that was provided, but there was no significant increase observed either. Of the studies we reviewed, one of the biggest limitations was the lack of significance in the data. While many individual studies reported that medical scribes in emergency rooms improved relative value units, patient satisfaction, provider satisfaction, and increased number of patients seen, there was no statistically significant improvement in the above criteria when compiled in a systematic review. There is also a clear publication bias; very few studies with negative results were published. To prove significance, data from more emergency rooms with scribe programs would need to be compiled which also includes emergency rooms who did not report noticeable benefits. Furthermore, most data sets focused only on scribes in academic centers. Conclusion: Ultimately, the literature suggests that while emergency room physicians who have access to medical scribes report higher satisfaction due to lower clerical burdens and can see more patients per shift, there is still variability in terms of patient and provider satisfaction. Whether or not this variability exists due to differences in training (in-house trainees versus contractors), population profile (adult versus pediatric), setting (academic versus community), or which shifts scribe work cannot be determined based on the studies that exist. Ultimately, more scribe programs need to be evaluated to determine whether these variables affect outcomes and prove whether scribes significantly improve emergency room efficiency.

Keywords: emergency medicine, medical scribe, scribe, documentation

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1763 Developing an Effectual Logic through a Visual Mind Mapping

Authors: Alberti Pascal, Mustapha Mouloua

Abstract:

Companies are confronted with complex and competitive markets. The dynamics of these markets are becoming more and more fluid, requiring companies to provide competitive, definite and technological responses within increasingly short timeframes. To meet this demand, companies must rely on the cognitive abilities of actors of creativity to provide tangible answers to current contextual problems. It therefore seems appropriate to provide instruments to support this particular stage of innovation. Various methods and tools can meet this requirement. For a number of years we have been conducting experiments on the use of mind maps in the context of innovation projects with teams of different nationalities. After presenting the main research carried out on this theme, we discuss the possible correlation between the different uses of iconic tools and certain types of innovation. We then provide a link with different cognitive logic. Finally, we conclude by putting our research into perspective.

Keywords: creativity, innovation, causal logic, effectual logic, mind mapping

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1762 Slope Instability Study Using Kinematic Analysis and Lineament Density Mapping along a Part of National Highway 58, Uttarakhand, India

Authors: Kush Kumar, Varun Joshi

Abstract:

Slope instability is a major problem of the mountainous region, especially in parts of the Indian Himalayan Region (IHR). The on-going tectonic, rugged topography, steep slope, heavy precipitation, toe erosion, structural discontinuities, and deformation are the main triggering factors of landslides in this region. Besides the loss of life, property, and infrastructure caused by a landslide, it also results in various environmental problems, i.e., degradation of slopes, land use, river quality by increased sediments, and loss of well-established vegetation. The Indian state of Uttarakhand, being a part of the active Himalayas, also faces numerous cases of slope instability. Therefore, the vulnerable landslide zones need to be delineated to safeguard various losses. The study area is focused in Garhwal and Tehri -Garhwal district of Uttarakhand state along National Highway 58, which is a strategic road and also connects the four important sacred pilgrims (Char Dham) of India. The lithology of these areas mainly comprises of sandstone, quartzite of Chakrata formation, and phyllites of Chandpur formation. The greywacke and sandstone rock of Saknidhar formation dips northerly and is overlain by phyllite of Chandpur formation. The present research incorporates the lineament density mapping using remote sensing satellite data supplemented by a detailed field study via kinematic analysis. The DEM data of ALOS PALSAR (12.5 m resolution) is resampled to 10 m resolution and used for preparing various thematic maps such as slope, aspect, drainage, hill shade, lineament, and lineament density using ARCGIS 10.6 software. Furthermore, detailed field mapping, including structural mapping, geomorphological mapping, is integrated for kinematic analysis of the slope using Dips 6.0 software of Rockscience. The kinematic analysis of 40 locations was carried out, among which 15 show the planar type of failure, five-show wedge failure, and rest, 20 show no failures. The lineament density map is overlapped with the location of the unstable slope inferred from kinematic analysis to infer the association of the field information and remote sensing derived information, and significant compatibility was observed. With the help of the present study, location-specific mitigation measures could be suggested. The mitigation measures would be helping in minimizing the probability of slope instability, especially during the rainy season, and reducing the hampering of road traffic.

Keywords: Indian Himalayan Region, kinematic analysis, lineament density mapping, slope instability

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1761 Latest Generation Conducted Electrical Weapon Dart Design: Signature Marking and Removal for the Emergency Medicine Professional

Authors: J. D. Ho, D. M. Dawes, B. Driver

Abstract:

Introduction: TASER Conducted Electrical Weapons (CEWs) are the dominant CEWs in use and have been used in modern police and military operations since the late 1990s as a form of non-lethal weaponry. The 3rd generation of CEWs has been recently introduced and is known as The TASER 7. This new CEW will be replacing current CEW technology and has a new dart design that is important for emergency medical professionals to be familiar with because it requires a different method of removal and will leave a different marking pattern in human tissue than they may have been previously familiar with. features of this new dart design include: higher velocity impact, larger impact surface area, break away dart body segment, dual back-barb retention, newly designed removal process. As the TASER 7 begins to be deployed by the police and military personnel, these new features make it imperative that emergency medical professionals become familiar with the signature markings that this new dart design will make on human tissue and how to remove them. Methods: Multiple observational studies using high speed photography were used to record impact patterns of the new dart design on fresh tissue and also the newly recommended dart removal process. Both animal and human subjects were used to test this dart design prior to production release. Results: Data presented will include dart design overview, flight pattern accuracy, impact analysis, and dart removal example. Tissue photographs will be presented to demonstrate examples of signature TASER 7 dart markings that emergency medical professionals can expect to see. Conclusion: This work will provide the reader with an understanding of this newest generation CEW dart design, its key features, its signature marking pattern that can be expected and a recommendation of how to remove it from human tissue.

Keywords: TASER 7, conducted electrical weapon, dart mark, dart removal

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1760 Examining the Impact of De-Escalation Training among Emergency Department Nurses

Authors: Jonathan D. Recchi

Abstract:

Introduction: Workplace violence is a major concern for nurses throughout the United States and is a rising occupational health hazard that has been exacerbated by both the Covid-19 pandemic and increasing patient and family member incivility. De-escalation training has been found to be an evidence-based tool for emergency department nurses to help avoid or mitigate high-risk situations that could lead to workplace violence. Many healthcare organizations either do not provide de-escalation training to their staff or only provide it sparingly, such as during new employee orientation. There is limited research in the literature on the psychological benefits of de-escalation training. Purpose: The purpose of this study is to determine if there are psychological and organizational advantages to providing emergency department nurses with de-escalation training. Equipping emergency department nurses with skills that are essential to de-escalate violent or potentially violent patients may help prevent physical, mental, and/or psychological damage to the nurse because of violence and/or threatening acts. The hypothesis is that providing de-scalation training to emergency department nurses will lead to increased nurse confidence in dealing with aggressive patients, increased resiliency, increased professional quality of life, and increased intention to stay with their current organization. This study aims to show that organizations would benefit from providing de-escalation training to all nurses operating in high-risk areas on a regular basis. Significance: Showing psychological benefits to providing evidence-based de-escalation training can provide healthcare organizations with the ability to retain a more resilient and prepared workforce. Method: This study uses a pre-experimental cross-sectional pre-/post-test design using a convenience sample of emergency department registered nurses employed across Jefferson Health Northeast (Jefferson Torresdale, Jefferson Bucks, and Jefferson Frankford. Inclusion criteria include registered nurses who work full or part-time, with 51% or more of their clinical time spent in direct clinical care. Excluded from participation are registered nurses in orientation, per-diem nurses, temporary and/or travel nurses, nurses who spend less than 51% of their time in direct patient care, and nurses who have received de-escalation training within the past two years. This study uses the Connor-Davidson Resilience Scale 10 (CD-RISC-10), the Clinician Confidence in Coping with Patient Aggression Scale, the Press Ganey Intention To Stay question, and the Professional Quality of Life Scale. Results: A Paired t-Test will be used to analyze the mean scores of the three scales and one question pre and post-intervention to determine if there is a statistically significant difference in RN resiliency, confidence in coping with patient aggression, intention to stay, and professional quality of life. Discussion and Conclusions: Upon completion, the outcomes of this intervention will show the importance of providing evidence-based de-escalation training to all nurses operating within the emergency department.

Keywords: de-escalation, nursing, emergency department, workplace violence

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1759 Sensing to Respond & Recover in Emergency

Authors: Alok Kumar, Raviraj Patil

Abstract:

The ability to respond to an incident of a disastrous event in a vulnerable area is very crucial an aspect of emergency management. The ability to constantly predict the likelihood of an event along with its severity in an area and react to those significant events which are likely to have a high impact allows the authorities to respond by allocating resources optimally in a timely manner. It provides for measuring, monitoring, and modeling facilities that integrate underlying systems into one solution to improve operational efficiency, planning, and coordination. We were particularly involved in this innovative incubation work on the current state of research and development in collaboration. technologies & systems for a disaster.

Keywords: predictive analytics, advanced analytics, area flood likelihood model, area flood severity model, level of impact model, mortality score, economic loss score, resource allocation, crew allocation

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1758 Mapping Tunnelling Parameters for Global Optimization in Big Data via Dye Laser Simulation

Authors: Sahil Imtiyaz

Abstract:

One of the biggest challenges has emerged from the ever-expanding, dynamic, and instantaneously changing space-Big Data; and to find a data point and inherit wisdom to this space is a hard task. In this paper, we reduce the space of big data in Hamiltonian formalism that is in concordance with Ising Model. For this formulation, we simulate the system using dye laser in FORTRAN and analyse the dynamics of the data point in energy well of rhodium atom. After mapping the photon intensity and pulse width with energy and potential we concluded that as we increase the energy there is also increase in probability of tunnelling up to some point and then it starts decreasing and then shows a randomizing behaviour. It is due to decoherence with the environment and hence there is a loss of ‘quantumness’. This interprets the efficiency parameter and the extent of quantum evolution. The results are strongly encouraging in favour of the use of ‘Topological Property’ as a source of information instead of the qubit.

Keywords: big data, optimization, quantum evolution, hamiltonian, dye laser, fermionic computations

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1757 Disaster and Crisis Management Using Geographical Information System (GIS) during the Operation and Maintenance Stages of the Hyderabad Metro Rail in India

Authors: Sai Rajeev Reddy, Ishita Roy, M. Anji Reddy

Abstract:

The paper describes the importance of preventive measures and immediate Emergency logistics during accidents and unfortunate Disasters for the Hyderabad Metro Rails in their various stages of construction. This is the need of the modern generation where accidents, explosions, attacks and sudden crisis are frequent casualties which take huge tolls of life in the present world. The paper utilizes the workflow and application of Geographical information System (GIS) to provide information about problems and crisis structures for efficient Metro Transportation in the city. The study analyzes the difficulties and problems which cause accidents during operation and maintenance stages of the Metro Rail. The paper focuses upon the intermediate and firsthand information of Crisis with the help of GIS technology to share Disaster data for effective measures by the Cyber Police stations, Emergency Responders, Hospitals and First Aid Centre to act immediately and save lives. The results and conclusions have nevertheless proved very informative and useful for the safety board authorities of the Hyderabad Metro Rail. The operation and Maintenance are integral stages in the development of any Multipurpose transportation Projects and are usually prone to various Disasters and tragedies. Hence, the GIS technologies help in distribution of information among the masses with the web Technologies and advanced software developed to prevent and manage crisis widely and in a cost-benefits manner.

Keywords: Geographical Information System, emergency assessment, accident zones, surveillance

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1756 Optimization Based Extreme Learning Machine for Watermarking of an Image in DWT Domain

Authors: RAM PAL SINGH, VIKASH CHAUDHARY, MONIKA VERMA

Abstract:

In this paper, we proposed the implementation of optimization based Extreme Learning Machine (ELM) for watermarking of B-channel of color image in discrete wavelet transform (DWT) domain. ELM, a regularization algorithm, works based on generalized single-hidden-layer feed-forward neural networks (SLFNs). However, hidden layer parameters, generally called feature mapping in context of ELM need not to be tuned every time. This paper shows the embedding and extraction processes of watermark with the help of ELM and results are compared with already used machine learning models for watermarking.Here, a cover image is divide into suitable numbers of non-overlapping blocks of required size and DWT is applied to each block to be transformed in low frequency sub-band domain. Basically, ELM gives a unified leaning platform with a feature mapping, that is, mapping between hidden layer and output layer of SLFNs, is tried for watermark embedding and extraction purpose in a cover image. Although ELM has widespread application right from binary classification, multiclass classification to regression and function estimation etc. Unlike SVM based algorithm which achieve suboptimal solution with high computational complexity, ELM can provide better generalization performance results with very small complexity. Efficacy of optimization method based ELM algorithm is measured by using quantitative and qualitative parameters on a watermarked image even though image is subjected to different types of geometrical and conventional attacks.

Keywords: BER, DWT, extreme leaning machine (ELM), PSNR

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1755 Effect of Experience on Evacuation of Mice in Emergency Conditions

Authors: Teng Zhang, Shenshi Huang, Gang Xu, Xuelin Zhang, Shouxiang Lu

Abstract:

With the acceleration of urbanization and the increasing of the population in the city, the evacuation of pedestrians suffering from disaster environments such as fire in a room or other limited space becomes a vital issue in modern society. Mice have been used in experimental crowd evacuation in recent years for its good similarities to human in physical structure and stress reaction. In this study, the effect of experience or memory on the collective behavior of mice was explored. To help mice familiarize themselves with the design of the space and the stimulus caused by smoke, we trained them repeatedly for 2 days so that they can escape from the emergency conditions as soon as possible. The escape pattern, trajectories, walking speed, turning angle and mean individual escape time of mice in each training trail were analyzed. We found that mice can build memory quickly after the first trial on the first day. On the second day, the evacuation of mice was maintained in a stable and efficient state. Meanwhile, the group with size of 30 (G30) had a shorter mean individual escape time compared with G12. Furthermore, we tested the experience of evacuation skill of mice after several days. The results showed that the mice can hold the experience or memory over 3 weeks. We proposed the importance of experience of evacuation skill and the research of training methods in experimental evacuation of mice. The results can deepen our understanding of collective behavior of mice and conduce to the establishment of animal models in the study of pedestrian crowd dynamics in emergency conditions.

Keywords: experience, evacuation, mice, group size, behavior

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1754 Implications of Meteorological Parameters in Decision Making for Public Protective Actions during a Nuclear Emergency

Authors: M. Hussaina, K. Mahboobb, S. Z. Ilyasa, S. Shaheena

Abstract:

Plume dispersion modeling is a computational procedure to establish a relationship between emissions, meteorology, atmospheric concentrations, deposition and other factors. The emission characteristics (stack height, stack diameter, release velocity, heat contents, chemical and physical properties of the gases/particle released etc.), terrain (surface roughness, local topography, nearby buildings) and meteorology (wind speed, stability, mixing height, etc.) are required for the modeling of the plume dispersion and estimation of ground and air concentration. During the early phase of Fukushima accident, plume dispersion modeling and decisions were taken for the implementation of protective measures. A difference in estimated results and decisions made by different countries for taking protective actions created a concern in local and international community regarding the exact identification of the safe zone. The current study is focused to highlight the importance of accurate and exact weather data availability, scientific approach for decision making for taking urgent protective actions, compatible and harmonized approach for plume dispersion modeling during a nuclear emergency. As a case study, the influence of meteorological data on plume dispersion modeling and decision-making process has been performed.

Keywords: decision making process, radiation doses, nuclear emergency, meteorological implications

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1753 Circle of Learning Using High-Fidelity Simulators Promoting a Better Understanding of Resident Physicians on Point-of-Care Ultrasound in Emergency Medicine

Authors: Takamitsu Kodama, Eiji Kawamoto

Abstract:

Introduction: Ultrasound in emergency room has advantages of safer, faster, repeatable and noninvasive. Especially focused Point-Of-Care Ultrasound (POCUS) is used daily for prompt and accurate diagnoses, for quickly identifying critical and life-threatening conditions. That is why ultrasound has demonstrated its usefulness in emergency medicine. The true value of ultrasound has been once again recognized in recent years. It is thought that all resident physicians working at emergency room should perform an ultrasound scan to interpret signs and symptoms of deteriorating patients in the emergency room. However, a practical education on ultrasound is still in development. To resolve this issue, we established a new educational program using high-fidelity simulators and evaluated the efficacy of this course. Methods: Educational program includes didactic lectures and skill stations in half-day course. Instructor gives a lecture on POCUS such as Rapid Ultrasound in Shock (RUSH) and/or Focused Assessment Transthoracic Echo (FATE) protocol at the beginning of the course. Then, attendees are provided for training of scanning with cooperation of normal simulated patients. In the end, attendees learn how to apply focused POCUS skills at clinical situation using high-fidelity simulators such as SonoSim® (SonoSim, Inc) and SimMan® 3G (Laerdal Medical). Evaluation was conducted through surveillance questionnaires to 19 attendees after two pilot courses. The questionnaires were focused on understanding course concept and satisfaction. Results: All attendees answered the questionnaires. With respect to the degree of understanding, 12 attendees (number of valid responses: 13) scored four or more points out of five points. High-fidelity simulators, especially SonoSim® was highly appreciated to enhance learning how to handle ultrasound at an actual practice site by 11 attendees (number of valid responses: 12). All attendees encouraged colleagues to take this course because the high level of satisfaction was achieved. Discussion: Newly introduced educational course using high-fidelity simulators realizes the circle of learning to deepen the understanding on focused POCUS by gradual stages. SonoSim® can faithfully reproduce scan images with pathologic findings of ultrasound and provide experimental learning for a growth number of beginners such as resident physicians. In addition, valuable education can be provided if it is used combined with SimMan® 3G. Conclusions: Newly introduced educational course using high-fidelity simulators is supposed to be effective and helps in providing better education compared with conventional courses for emergency physicians.

Keywords: point-of-care ultrasound, high-fidelity simulators, education, circle of learning

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1752 Complications of Contact Lens-Associated Keratitis: A Refresher for Emergency Departments

Authors: S. Selman, T. Gout

Abstract:

Microbial keratitis is a serious complication of contact lens wear that can be vision and eye-threatening. Diverse presentations relating to contact lens wear include dry corneal surface, corneal infiltrate, ulceration, scarring, and complete corneal melt leading to perforation. Contact lens wear is a major risk factor and, as such, is an important consideration in any patient presenting with a red eye in the primary care setting. This paper aims to provide an overview of the risk factors, common organisms, and spectrum of contact lens-associated keratitis (CLAK) complications. It will highlight some of the salient points relevant to the assessment and workup of patients suspected of CLAK in the emergency department based on the recent literature and therapeutic guidelines. An overview of the management principles will also be provided.

Keywords: microbial keratitis, corneal pathology, contact lens-associated complications, painful vision loss

Procedia PDF Downloads 75