Search results for: hospital discharge

Authors: Andrew Read, Alice Parry, Kate Woods

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Since the advent of the SARS-CoV-2 pandemic, the search for medications that can reduce mortality and morbidity has been a global research priority. Several multi-center trials have recently demonstrated improved mortality associated with the use of Tocilizumab, an interleukin-6 receptor antagonist, in patients with severe SARS-CoV-2 pneumonia. Initial data supported the administration in patients requiring respiratory support (non-invasive or invasive ventilation), but more recent data has shown benefit in all hypoxic patients. At the height of the second wave of COVID-19 infections in London, our hospital introduced the use of Tocilizumab for patients with severe COVID-19. Tocilizumab is licensed for use in chronic inflammatory conditions and has been associated with an increased risk of severe bacterial and fungal infections, as well as reactivation of chronic viral infections (e.g., hepatitis B). It is a specialist drug that suppresses the formation of C-reactive protein (CRP) for 6 – 12 weeks. It is not widely used by the general medical community. We aimed to assess Tocilizumab use in our hospital and to implement changes to the protocol as required to ensure administration was safe and appropriate. A retrospective study design was used to assess prescriptions over an initial 3-week period in both intensive care and on the medical wards. This amounted to a total of 13 patients. The initial data collection identified four key areas of concern: adherence to national and local inclusion & exclusion criteria; a collection of appropriate screening blood prior to administration; documentation of informed consent or best interest decision and documentation of Tocilizumab administration on patient discharge information, to alert future healthcare providers that typical measures of inflammation and infection, such as CRP, are unreliable for up to 3-months. Data were collected from electronic notes, blood results and observation charts, and cross referenced with pharmacy data. Initial results showed that all four key areas were completed in approximately 50% of cases. Of particular concern was adherence to exclusion criteria, such as current evidence of bacterial infection, and ensuring the correct screening blood was sent to exclude infections such as hepatitis. To remedy this and improve patient safety, the initial data was presented to relevant healthcare professionals. Subsequently, three interventions were introduced and education on each provided to hospital staff. An electronic ‘order set’ collating the appropriate screening blood was created simplifying the screening process. Pre-formed electronic documentation which can be inserted into the notes was created to provide a framework for consent discussions and reduce the time needed for junior doctors to complete this task. Additionally, a ‘Tocilizumab’ administration card was created and administered via pharmacy. This was distributed to each patient on discharge to ensure future healthcare professionals were aware of the potential effects of Tocilizumab administration, including suppression of CRP. Following these changes, repeat data collection over two months illustrated that each of the 4 safety aspects was met with a 100% success rate in every patient. Although this demonstrates good progress and effective interventions the challenge will be to maintain this progress. The audit data collection is ongoing

Keywords: education, patient safety , SARS-CoV-2, Tocilizumab

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Authors: M. Y. Saleh, G. M. ELanany, M. H. Elzahar, M. Z. Elshikhipy

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Industrial wastewater discharge, which carries high concentrations of dissolved solids and iron, could be treated by high rate activated sludge stage of the multiple-stage sludge treatment plant, a system which is characterized by high treatment efficiency, optimal prices, and small areas compared with conventional activated sludge treatment plants. A pilot plant with an influent industrial discharge flow of 135 L/h was designed following the activated sludge system to simulate between the biological and chemical treatment with the addition of dosages 100, 150, 200 and 250 mg/L alum salt to the aeration tank. The concentrations of total dissolved solids (TDS) and iron (Fe) in industrial discharge flow had an average range of 140000 TDS and 4.5 mg/L iron. The optimization of the chemical-biological process using a dosage of 200 mg/L alum succeeded to improve the removal efficiency of TDS and total iron to 48.15% and 68.11% respectively.

Keywords: wastewater, activated sludge, TDS, total iron

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Authors: Keisuke Konishi, Yoshinari Hiroshiro, Kento Terashima, Atsushi Tsutsumi

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Imazu Bay plays an important role for endangered species such as horseshoe crabs and black-faced spoonbills that stay in the bay for spawning or the passing of winter. However, this bay is semi-enclosed with slow water exchange, which could lead to eutrophication under the condition of excess nutrient inflow to the bay. Therefore, quantification of nutrient inflow is of great importance. Generally, analysis of nutrient inflow to the bays takes into consideration nutrient inflow from only the river, but that from groundwater should not be ignored for more accurate results. The main objective of this study is to estimate the amounts of nutrient inflow from river and groundwater to Imazu Bay by analyzing water budget in Zuibaiji River Basin and loads of T-N, T-P, NO3-N and NH4-N. The water budget computation in the basin is performed using groundwater recharge model and quasi three-dimensional two-phase groundwater flow model, and the multiplication of the measured amount of nutrient inflow with the computed discharge gives the total amount of nutrient inflow to the bay. In addition, in order to evaluate nutrient inflow to the bay, the result is compared with nutrient inflow from geologically similar river basins. The result shows that the discharge is 3.50×107 m3/year from the river and 1.04×107 m3/year from groundwater. The submarine groundwater discharge accounts for approximately 23 % of the total discharge, which is large compared to the other river basins. It is also revealed that the total nutrient inflow is not particularly large. The sum of NO3-N and NH4-N loadings from groundwater is less than 10 % of that from the river because of denitrification in groundwater. The Shin Seibu Sewage Treatment Plant located below the observation points discharges treated water of 15,400 m3/day and plans to increase it. However, the loads of T-N and T-P from the treatment plant are 3.9 mg/L and 0.19 mg/L, so that it does not contribute a lot to eutrophication.

Keywords: Eutrophication, groundwater recharge model, nutrient inflow, quasi three-dimensional two-phase groundwater flow model, submarine groundwater discharge

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Authors: Shivam Dubey, Vinit Srivastava, Abhay Singh Thakur, Rahul Vaish

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The presence of organic dyes in water is a critical issue that poses a significant threat to the environment and human health. We have investigated the use of corona discharge as a potential method for degrading organic dyes in water. Methylene Blue dye was exposed to corona discharge, and its photo-absorbance was measured over time to determine the extent of degradation. The results depicted a decreased absorbance for the dye and the loss of the characteristic colour of methylene blue. The effects of various parameters, including current, voltage, gas phase, salinity, and electrode spacing, on the reaction rates, were investigated. The highest reaction rates were observed at the highest current and voltage (up to 10kV), lowest salinity, smallest electrode spacing, and an environment containing enhanced levels of oxygen. These findings have possible applications for science education curriculum. By investigating the use of corona discharge for destroying organic dyes, we can provide students with a practical application of scientific principles that they can apply to real-world problems. This research can demonstrate the importance of understanding the chemical and physical properties of organic dyes and the effects of corona discharge on their degradation and provide a holistic understanding of the applications of scientific research. Moreover, our study also emphasizes the importance of considering the various parameters that can affect reaction rates. By investigating the effects of current, voltage, matter phase, salinity, and electrode spacing, we can provide students with an opportunity to learn about the importance of experimental design and how to evade constraints that can limit meaningful results. In conclusion, this study has the potential to provide valuable insights into the use of corona discharge for destroying organic dyes in water and has significant implications for science education. By highlighting the practical applications of scientific principles, experimental design, and the importance of considering various parameters, this research can help students develop critical thinking skills and prepare them for future careers in science and engineering.

Keywords: dye degradation, corona discharge, science education, hands-on learning, chemical education

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Authors: Routsukol Sunalai

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

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

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Authors: Selin Top, Raul Marcos, M. Sinan Bilgili

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Although there have been several studies related to collection, temporary storage, handling and disposal of solid wastes generated by hospitals, there are only a few studies related to liquid wastes generated by hospitals or hospital wastewaters. There is an important amount of water consumptions in hospitals. While minimum domestic water consumption per person is 100 L/day, water consumption per bed in hospitals is generally ranged between 400-1200 L. This high amount of consumption causes high amount of wastewater. The quantity of wastewater produced in a hospital depends on different factors: bed numbers, hospital age, accessibility to water, general services present inside the structure (kitchen, laundry, laboratory, diagnosis, radiology, and air conditioning), number and type of wards and units, institution management policies and awareness in managing the structure in safeguarding the environment, climate and cultural and geographic factors. In our country, characterization of hospital wastewaters conducted by classical parameters in a very few studies. However, as mentioned above, this type of wastewaters may contain different compounds than domestic wastewaters. Hospital Wastewater (HWW) is wastewater generated from all activities of the hospital, medical and non medical. Nowadays, hospitals are considered as one of the biggest sources of wastewater along with urban sources, agricultural effluents and industrial sources. As a health-care waste, hospital wastewater has the same quality as municipal wastewater, but may also potentially contain various hazardous components due to using disinfectants, pharmaceuticals, radionuclides and solvents making not suitable the connection of hospital wastewater to the municipal sewage network. These characteristics may represent a serious health hazard and children, adults and animals all have the potential to come into contact with this water. Therefore, the treatment of hospital wastewater is an important current interest point to focus on. This paper aims to approach on the investigation of hospital wastewater treatment by membrane systems. This study aim is to determined hospital wastewater’s characterization and also evaluates the efficiency of hospital wastewater treatment by high pressure filtration systems such as ultrafiltration (UF). Hospital wastewater samples were taken directly from sewage system from Şişli Etfal Training and Research Hospital, located in the district of Şişli, in the European part of Istanbul. The hospital is a 784 bed tertiary care center with a daily outpatient department of 3850 patients. Ultrafiltration membrane is used as an experimental treatment and the influence of the pressure exerted on the membranes was examined, ranging from 1 to 3 bar. The permeate flux across the membrane was observed to define the flooding membrane points. The global COD and BOD5 removal efficiencies were 54% and 75% respectively for ultrafiltration, all the SST removal efficiencies were above 90% and a successful removal of the pathological bacteria measured was achieved.

Keywords: hospital wastewater, membrane, ultrafiltration, treatment

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Authors: Ahmad Shahfarhat, Ashraf Mohammadzade, Reza Saeedi, Hadi Hesari

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Background: Mothers of infants admitted at NICU are vulnerable to depression (affecting 10 to 20% of mothers during the first year after delivery) As you know, about half of women with prominent postpartum depression (PPD) symptoms are not diagnosed. The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening instrument for PPD. In this study, we checked EPDS score of 12 or more on the second day (D2), discharge, day 28(D28), and day42 (D42) postpartum to determine the risk factors as well as the prevalence of PPD in a sample of mothers of NICU admitted neonates. Methods: A sample of 682 women used the EPDS on admission and at discharge. An assessment for PPD was performed on D28 and D42 by a telephone interview. Results: On admission, the average score on EPDS was 9.72 (SD = 4.4), and 27.4% of women (187) had an EPDS score ≥12. On Discharge, 4weeks and 6weeks postpartum the average score was ordinary 9.34 (SD = 3.8), 9.12 (SD = 3.7), 8.52(SD = 3.36), and (173)25.4 %,( 141)23.3 %,( 88)15.3% of women presented with PPD. a positive correlation was found between scores on EPDS on admission and D42 (P = 0.001). An analysis shows that mothers of twins (P = 0.001) and higher age mothers (P=0.001) are significantly associated with PPD. Conclusion: Women with EPDS score more than 12 and/or older will benefit from a closer follow-up during the rest of the post-partum period, and it is better to be under psychological support.

Keywords: NICU, depression, pregnancy, mothers

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Authors: A. Lemzadmi

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Rotational and vibrational temperatures of the SF6-N2 gas mixture are spectroscopically measured over a pressure range of 2-14 bars. The spectra obtained of the light emission of the corona discharge were recorded with different values of pressure, voltage and current together with the variation of the position of the tip electrode. The emission of N2 is very dominant for different gas concentration and the second positive system 2S+ is the most important. The convolution method is used for the determination of the temperature. The Rotational temperature measurements of the plasma reveal gas temperatures in the range of 450-650°K and vibrational temperatures in the range of 1800-2200°K.

Keywords: rotational temperatures, corona discharges, SF6-N2 gas mixture, vibrational temperatures

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Authors: Faisal Saleem, Kui Zhang, Adam Harvey

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The role of N₂ carrier gas towards the conversion of tar analogue was studied in a non-thermal plasma dielectric barrier discharge (DBD) reactor. The important parameters such as power (5-40W), residence time (1.41-4.23 s), concentration (20-82 g/Nm³), and temperature (Ambient-400°C) were explored. The present study demonstrated that plasma power and residence time played a key role in the decomposition of toluene, and almost complete removal of toluene was observed at 40w and 4.23 s. H₂ is obtained as a major gaseous product with a maximum selectivity of 40% along with some lighter hydrocarbons (5.5%). The removal efficiency of toluene slightly decreases with increasing the concentration of toluene from 20 g/Nm³ to 82 g/Nm³. The solid residue formation takes place inside the plasma reactor. The selectivity of LHC (lower hydrocarbons) increased up to 15% by increasing the temperature to 400°C. Introducing H₂ to the gas at elevated temperature opens up new reaction routes to raise the selectivity to lower hydrocarbons. The selectivity to methane reaches to 42% using 35% H₂ at 400°C and total selectivity of LHC increases to 57%.

Keywords: biomass gasification tar, non-thermal plasma, dielectric barrier discharge, residence time

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Authors: Lesley Clack, Rachel Ellison, Elizabeth Chambers

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

Keywords: health care, disparities, management, executives

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Authors: Ayesha Asif, Muhammad Zeeshan

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

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

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Authors: B. Van Kessel, P. T. Kockelkorn, T. R. Speelman, T. C. Wierikx, C. Mai Van, T. A. Bogaard

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Saltwater intrusion is a common problem in estuaries around the world, as it could hinder the freshwater supply of coastal zones. This problem is likely to grow due to climate change and sea-level rise. The influence of these factors on the saltwater intrusion was investigated for the Cai River in the Khanh Hoa province in Vietnam. In addition, the Cai River has high seasonal fluctuations in discharge, leading to increased saltwater intrusion during the dry season. Sea level rise, river discharge changes, river mouth widening and a proposed saltwater intrusion prevention dam can have influences on the saltwater intrusion but have not been quantified for the Cai River estuary. This research used both an analytical and numerical model to investigate the effect of the aforementioned factors. The analytical model was based on a model proposed by Savenije and was calibrated using limited in situ data. The numerical model was a 3D hydrodynamic model made using the Delft3D4 software. The analytical model and numerical model agreed with in situ data, mostly for tidally average data. Both models indicated a roughly similar dependence on discharge, also agreeing that this parameter had the most severe influence on the modeled saltwater intrusion. Especially for discharges below 10 m/s3, the saltwater was predicted to reach further than 10 km. In the models, both sea-level rise and river widening mainly resulted in salinity increments up to 3 kg/m3 in the middle part of the river. The predicted sea-level rise in 2070 was simulated to lead to an increase of 0.5 km in saltwater intrusion length. Furthermore, the effect of the saltwater intrusion dam seemed significant in the model used, but only for the highest position of the gate.

Keywords: Cai River, hydraulic models, river discharge, saltwater intrusion, tidal barriers

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Authors: M. Rashid Hussain, Shady S. Refaat

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The high voltage power transformer is the most essential part of the electrical power utilities. Reliability on the transformers is the utmost concern, and any failure of the transformers can lead to catastrophic losses in electric power utility. The causes of transformer failure include insulation failure by partial discharge, core and tank failure, cooling unit failure, current transformer failure, etc. For the study of power transformer defects, finite element analysis (FEA) can provide valuable information on the severity of defects. FEA provides a more accurate representation of complex geometries because they consider thermal, electrical, and environmental influences on the insulation models to obtain basic characteristics of the insulation system during normal and partial discharge conditions. The purpose of this paper is the time domain analysis of defects 3D model of high voltage power transformer using FEA to study the electric field distribution at different points on the defects.

Keywords: power transformer, finite element analysis, dielectric response, partial discharge, insulation

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Authors: I. Mentziou, C. Delezos, D. Krikidis, A. Nestoridou, G. Boskou

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Introduction: The systems of production and distribution of meals can have a significant impact on the food intake of hospital patients who are likely to develop malnutrition. In hospitals, the consequences of food borne infections can range from annoying to life-threatening for a patient, since they can lead up to death in vulnerable groups Aim: The aim of the present study was the evaluation of food safety management systems implementation, as well as the general evaluation of the total quality management systems in Greek hospitals. Methods: This is a multifocal study on the implementation and evaluation of the food safety management systems in the Greek hospitals of Attica region. Eleven hospitals from the city of Athens were chosen for this purpose. The sample was derived from the high rank personnel of the nutritional department (dietician, head-chef, food technologist, public health inspector). Tailor made questionnaires on hygiene regulations were used as tools for the interviews. Results: Overall, 30 employees in the field of hospital nutrition participated. Most of the replies implied that almost always the hygiene regulations are implemented. Nevertheless, only 30% stated that there is a Hazard Analysis Critical Control Points HACCP system (HACCP) in the hospital. In a small number of questionnaires there were proposals for changes by the staff. Conclusion: Measurement of the opinion of the personnel about the provided food services within a hospital can further lead to continuous improvement of the hospital nutrition.

Keywords: evaluation, food service, HACCP, hospital, personnel

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Authors: Olusola Bamisile, Ferdinard Dika, Mustafa Dagbasi, Serkan Abbasoglu

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The aim of this study was to model an air conditioning system that brings about effective cooling and reduce fossil fuel consumption with solar energy as an alternative source of energy. The objective of the study is to design a system with high COP, low usage of electricity and to integrate solar energy into AC systems. A hybrid solar assisted air conditioning system is designed to produce 30kW cooling capacity and R744 (CO₂) is used as a refrigerant. The effect of discharge pressure on the performance of the system is studied. The subcool temperature, evaporating temperature (5°C) and suction gas return temperature (12°C) are kept constant for the four different discharge pressures considered. The cooling gas temperature is set at 25°C, and the discharge pressure includes 80, 85, 90 and 95 bars. Copeland Scroll software is used for the simulation. A pressure-enthalpy graph is also used to deduce each enthalpy point while numerical methods were used in making other calculations. From the result of the study, it is observed that a higher COP is achieved with the use of solar assisted systems. As much as 46% of electricity requirements will be save using solar input at compressor stage.

Keywords: air conditioning, solar energy, performance, energy saving

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

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

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

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Authors: Pushpendra S. Bharti

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Process yield of electric discharge machining (EDM) is directly related to optimal combination(s) of process parameters. Optimization of process parameters of EDM is a multi-objective optimization problem owing to the contradictory behavior of performance measures. This paper employs Grey Relation Analysis (GRA) method as a multi-objective optimization technique for the optimal selection of process parameters combination. In GRA, multi-response optimization is converted into optimization of a single response grey relation grade which ultimately gives the optimal combination of process parameters. Experiments were carried out on die-sinking EDM by taking D2 steel as work piece and copper as electrode material. Taguchi's orthogonal array L36 was used for the design of experiments. On the experimental values, GRA was employed for the parametric optimization. A significant improvement has been observed and reported in the process yield by taking the parametric combination(s) obtained through GRA.

Keywords: electric discharge machining, grey relation analysis, material removal rate, optimization

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Authors: Manar Aslan, Ayse Yildiz

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

Keywords: institutionalization, hospital, manager, evaluation

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Authors: S. Ben Fredj, H. Ghali, M. Ben Rejeb, S. Layouni, S. Khefacha, L. Dhidah, H. Said

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Background: The Intensive Care Unit (ICU) provides continuous care and uses a high level of treatment technologies. Although developed country hospitals allocate only 5–10% of beds in critical care areas, approximately 20% of nosocomial infections (NI) occur among patients treated in ICUs. Whereas in the developing countries the situation is still less accurate. The aim of our study is to assess mortality rates in ICUs and to determine its predictive factors. Methods: We carried out a nested case-control study in a 630-beds public tertiary care hospital in Eastern Tunisia. We included in the study all patients hospitalized for more than two days in the surgical or medical ICU during the entire period of the surveillance. Cases were patients who died before ICU discharge, whereas controls were patients who survived to discharge. NIs were diagnosed according to the definitions of ‘Comité Technique des Infections Nosocomiales et les Infections Liées aux Soins’ (CTINLIS, France). Data collection was based on the protocol of Rea-RAISIN 2009 of the National Institute for Health Watch (InVS, France). Results: Overall, 301 patients were enrolled from medical and surgical ICUs. The mean age was 44.8 ± 21.3 years. The crude ICU mortality rate was 20.6% (62/301). It was 35.8% for patients who acquired at least one NI during their stay in ICU and 16.2% for those without any NI, yielding an overall crude excess mortality rate of 19.6% (OR= 2.9, 95% CI, 1.6 to 5.3). The population-attributable fraction due to ICU-NI in patients who died before ICU discharge was 23.46% (95% CI, 13.43%–29.04%). Overall, 62 case-patients were compared to 239 control patients for the final analysis. Case patients and control patients differed by age (p=0,003), simplified acute physiology score II (p < 10-3), NI (p < 10-3), nosocomial pneumonia (p=0.008), infection upon admission (p=0.002), immunosuppression (p=0.006), days of intubation (p < 10-3), tracheostomy (p=0.004), days with urinary catheterization (p < 10-3), days with CVC ( p=0.03), and length of stay in ICU (p=0.003). Multivariate analysis demonstrated 3 factors: age older than 65 years (OR, 5.78 [95% CI, 2.03-16.05] p=0.001), duration of intubation 1-10 days (OR, 6.82 [95% CI, [1.90-24.45] p=0.003), duration of intubation > 10 days (OR, 11.11 [95% CI, [2.85-43.28] p=0.001), duration of CVC 1-7 days (OR, 6.85[95% CI, [1.71-27.45] p=0.007) and duration of CVC > 7 days (OR, 5.55[95% CI, [1.70-18.04] p=0.004). Conclusion: While surveillance provides important baseline data, successful trials with more active intervention protocols, adopting multimodal approach for the prevention of nosocomial infection incited us to think about the feasibility of similar trial in our context. Therefore, the implementation of an efficient infection control strategy is a crucial step to improve the quality of care.

Keywords: intensive care unit, mortality, nosocomial infection, risk factors

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Authors: A. Fordham, A. Hudson

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

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

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Authors: Roozbeh Aghamajidi

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Shaft spillways are circling spillways used generally for emptying unexpected floods on earth and concrete dams. There are different types of shaft spillways: Stepped and Smooth spillways. Stepped spillways pass more flow discharges through themselves in comparison to smooth spillways. Therefore, awareness of flow behavior of these spillways helps using them better and more efficiently. Moreover, using vortex breaker has great effect on passing flow through shaft spillway. In order to use more efficiently, the risk of flow pressure decreases to less than fluid vapor pressure, called cavitations, should be prevented as far as possible. At this research, it has been tried to study different behavior of spillway with different vortex shapes on spillway crest on flow. From the viewpoint of the effects of flow regime changes on spillway, changes of step dimensions, and the change of type of discharge will be studied effectively. Therefore, two spillway models with three different vortex breakers and three arrangements have been used to assess the hydraulic characteristics of flow. With regard to the inlet discharge to spillway, the parameters of pressure and flow velocity on spillway surface have been measured at several points and after each run. Using these kinds of information leads us to create better design criteria of spillway profile. To achieve these purposes, optimization has important role and genetic algorithm are utilized to study the emptying discharge. As a result, it turned out that the best type of spillway with maximum discharge coefficient is smooth spillway with ogee shapes as vortex breaker and 3 number as arrangement. Besides it has been concluded that the genetic algorithm can be used to optimize the results.

Keywords: shaft spillway, vortex breaker, flow, genetic algorithm

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Authors: Kyung-Hoon Jang, Jae-Hyo Park, Kwang-Yeop Jang, Dongjin Kim

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The Tesla coil is an electrical resonant transformer circuit designed by inventor Nikola Tesla in 1891. It is used to produce high voltage, low current and high frequency alternating current electricity. Tesla experimented with a number of different configurations consisting of two or sometimes three coupled resonant electric circuits. This paper focuses on development and high voltage education to apply a Tesla coil to cuisine for high quality flavor and taste conditioning as well as high voltage education under 50 kV corona discharge. The result revealed that the velocity of roasted black belly pork by Tesla coil is faster than that of conventional methods such as hot grill and steel plate etc. depending on applied voltage level and applied voltage time. Besides, carbohydrate and crude protein increased, whereas natrium and saccharides significantly decreased after lightning surge by Tesla coil. This idea will be useful in high voltage education and high voltage application.

Keywords: corona discharge, Tesla coil, high voltage application, high voltage education

Procedia PDF Downloads 295

Authors: Najih Amina

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Our study focuses on monitoring the spatial evolution of a number of physico-chemical parameters of wells waters located at different distances from the discharge of the city of Khouribga (S0 upstream station, S1, S2 et S3 are respectively located at 5.5, 7.5, 11 Km away from solid waste discharge of the city). The absence of a source of drinking water in this region involves the population to feeding on its groundwater wells. Through the results, we note that most of the analyzed parameters exceed the potable water standards from S1. At this source of water, we find that the conductivity (1290 μmScm-1; Standard 1000 μmScm-1), Total Hardness TH (67.2°F/ Standard 50° F), Ca2 + (146 mg l-1 standard 60 mg l-1), Cl- (369 mg l-1 standard 150 mg l-1), NaCl (609 mgl-1), Methyl orange alakanity “M. alk” (280 mg l-1) greatly exceed the drinking water standards. By following these parameters, it is obvious that some values have decreased in the downstream stations, while others become important. We find that the conductivity is always higher than 950 μmScm-1; the TH registers 72°F in S3; Ca 2+ is in the range of 153 mg l-1 in S3, Cl- and NaCl- reached 426 mg l-1 and 702 mg l-1 respectively in S2, M alk becomes higher and reaches 430 to 350 in S3. At the wells S2, we found that the nitrites are well beyond the standard 1.05 mg l-1. Whereas, at the control station S0, the values are lower or at the limit of drinking water standards: conductivity (452 μmScm-1), TH (34 F°), Ca2+ (68 mg l-1), Cl- (157 mg l-1), NaCl- (258 mg l-1), M alk (220 mg l-1). Thus, the diagnosis reveals the presence of a high pollution caused by the leachates of the household waste discharge and by the effluents of the sewage waste water plant (SWWP). The phenomenon of the water hardness could, also, be generated by the processes of erosion, leaching and soil infiltration in the region (phosphate layers, intercalated layers of marl and limestone), phenomenons also caused by the acidity due to this surrounding pollution. The source S1 is the nearest surrounding site of the discharge and the most affected by the phenomenon of pollution, especially, it is near to a superficial water source S’1 polluted by the effluents coming from the sewage waste water plant of the city. In the light of these data, we can deduce that the consumption of this water from S1 does not conform the standards of drinking waters, and could affect the human health.

Keywords: physico-chemical parameters, ground water wells, infiltration, leaching, pollution, leachate discharge effluent SWWP, human health.

Procedia PDF Downloads 385

Authors: Sajad Haghanifar, Seyed-Farshid Kashani Bozorg

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Nano-crystalline Mg2Ni-based powder was produced by mechanical alloying technique using binary and ternary powder mixtures with stoichiometric compositions of Mg2Ni, Mg1.9C0.1Ni and Mg2C0.1Ni0.9. The structures and morphologies of the milled products were studied by XRD, SEM and HRTEM. Their electrochemical hydrogen storage characteristics were investigated in 6 M KOH solution. X-Ray diffraction, scanning and transmission electron microscopy of the milled products showed the formation of Mg2Ni-based nano-crystallites after 5, 15 and 30 h of milling using the initial powder mixtures of Mg1.9C0.1Ni, Mg2Ni and Mg2C0.1Ni0.9, respectively. It was found that partial substitution of C for Mg has beneficial effect on the formation kinetic of nano-crystalline Mg2Ni. Contrary to this, partial substitution of C for Ni was resulted in retardation of formation kinetic of nano-crystalline Mg2Ni. In addition, the negative electrode made from Mg1.9C0.1Ni ternary milled product after 30 hour of milling exhibited the highest initial discharge capacity and longest discharge life. Thus, partial substitution of C for Mg is beneficial to electrode properties of the Mg2Ni-based crystallites. The relation between the discharge capacity and cycling number of mechanically alloyed products was proposed on the basis of the fact that the degradation of discharge capacity was mainly caused by the oxidation of magnesium and nickel. The experimental data fitted the deduced equation well.

Keywords: Mg2Ni, hydrogen absorbing materials, electrochemical properties, nano-crystalline, amorphous, mechanical alloying, carbon

Procedia PDF Downloads 408

Authors: Nannapus Saramad, Rewwadee Petsirasan, Jom Suwanno

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Background: This retrospective study design was to describe average blood pressure, blood pressure level, target blood pressure control rate post-stroke BP control in the year following discharge from Sichon hospital, Sichon District, Nakhon Si Thammarat province. The secondary data analysis was employed from the patient’s health records with patient or caregiver interview. A total of 232 eligible post-acute ischemic strokes in the year following discharge (2017-2018) were recruited. Methods: Data analyses were applied to identify the relationship values of single variables were determined through univariate analyses: The Chi-square test, Fisher exact test, the variables found to have a p-value < 0.2 were analyzed by the binary logistic regression Results: Most of the patients in this study were men 61.6%, an average age of 65.4 ± 14.8 years. Systolic blood pressure levels were in the grade 1-2 hypertension and diastolic pressure at optimal and normal at all times during the initial treatment through the present. The results revealed 25% among the groups under the age of 60 achieved BP control; 36.3% for older than 60 years group; and 27.9% for diabetic group. The multivariate analysis revealed the final relationship of four significant variables: 1) receiving calcium-channel blocker (p =.027); 2) medication adherence of antihypertensive (p = .024) 3) medication adherence of antiplatelet ( p = .020); and 4) medication behavior ( p = . 010) . Conclusion: The medical nurse and health care provider should promote their adherence to behavior to improve their blood pressure control.

Keywords: acute ischemic stroke, target blood pressure control, medication adherence, recurrence stroke

Procedia PDF Downloads 94

Authors: Inna Vinokurova, N. Savvina

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The goal of research: to study the organization of multi-field hospital’s work environment in the Republic of Sakha (Yakutia), Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine. Results: Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine is a multidisciplinary, specialized hospital complex that provides specialized and high-tech medical care to children and adults in the Republic of Sakha (Yakutia) of the Russian Federation. There are 5 diagnostic and treatment centers (advisory and diagnostic, clinical, pediatric, perinatal, Republican cardiologic dispensary) with 45 clinical specialized departments with 727 cots, 5 resuscitation departments, 20 operating rooms and out-patient department with 905 visits in alternation in the National Center of Medicine. Annually more than 20,000 patients receive treatment in the hospital of the Republican Hospital of the Republic of Sakha (Yakutia), more than 70,000 patients visit out-patient sections, more than 2 million researches are done, more than 12,000 surgeries are performed, more than 2 thousand babies are delivered. National Center of Medicine has a great influence with such population’s health indicators as total mortality, birth rate, maternal, infant and perinatal mortality, circulatory system incidence. The work environment of the Republican Hospital of the Republic of Sakha (Yakutia) is represented by the following structural departments: pharmacy, blood transfusion department, sterilization department, laundry, dietetic department, infant-feeding centre, material and technical supply. More than 200 employees work in this service. The main function of these services is to provide on-time and fail-safe supply with all necessary: wear parts, medical supplies, donated blood and its components, foodstuffs, hospital linen , sterile instruments, etc. Thus, the activity of medical organization depends on the work environment, including quality health care, so it is a main part of multi-field hospital activity.

Keywords: organization of multi-field hospital’s, work environment, quality health care, pharmacy, blood transfusion department, sterilization department

Procedia PDF Downloads 217

Authors: Tribhuvan N. Soorya

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Charging and discharging of a capacitor through a resistor can be shown as exponential curve. Theoretically, it takes infinite time to fully charge or discharge a capacitor. The flow of charge is due to electrons having finite and fixed value of charge. If we carefully examine the charging and discharging process after several time constants, the points on q vs t graph become discrete and curve become discontinuous. Moreover for all practical purposes capacitor with charge (q0-e) can be taken as fully charged, as it introduces an error less than one part per million. Similar is the case for discharge of a capacitor, where the capacitor with the last electron (charge e) can be taken as fully discharged. With this, we can estimate the finite value of time for fully charging and discharging a capacitor.

Keywords: charging, discharging, RC Circuit, capacitor

Procedia PDF Downloads 416

Authors: J. Satya Eswari, J. Sekhar Babub, Meena Murmu, Govardhan Bhat

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Electrical Discharge Machining (EDM) is an unconventional manufacturing process based on removal of material from a part by means of a series of repeated electrical sparks created by electric pulse generators at short intervals between a electrode tool and the part to be machined emmersed in dielectric fluid. In this paper, a study will be performed on the influence of the factors of peak current, pulse on time, interval time and power supply voltage. The output responses measured were material removal rate (MRR) and surface roughness. Finally, the parameters were optimized for maximum MRR with the desired surface roughness. RSM involves establishing mathematical relations between the design variables and the resulting responses and optimizing the process conditions. RSM is not free from problems when it is applied to multi-factor and multi-response situations. Design of experiments (DOE) technique to select the optimum machining conditions for machining AISI 4140 using EDM. The purpose of this paper is to determine the optimal factors of the electro-discharge machining (EDM) process investigate feasibility of design of experiment techniques. The work pieces used were rectangular plates of AISI 4140 grade steel alloy. The study of optimized settings of key machining factors like pulse on time, gap voltage, flushing pressure, input current and duty cycle on the material removal, surface roughness is been carried out using central composite design. The objective is to maximize the Material removal rate (MRR). Central composite design data is used to develop second order polynomial models with interaction terms. The insignificant coefficients’ are eliminated with these models by using student t test and F test for the goodness of fit. CCD is first used to establish the determine the optimal factors of the electro-discharge machining (EDM) for maximizing the MRR. The responses are further treated through a objective function to establish the same set of key machining factors to satisfy the optimization problem of the electro-discharge machining (EDM) process. The results demonstrate the better performance of CCD data based RSM for optimizing the electro-discharge machining (EDM) process.

Keywords: electric discharge machining (EDM), modeling, optimization, CCRD

Procedia PDF Downloads 315

Authors: Gholam Reza Mirzaei, Mehran Roost

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This research was conducted with the aim of predicting the relationship between coronavirus anxiety and psychological hardiness in employees working at Shahid Beheshti Hospital in Shiraz. The current research design was descriptive and correlational. The statistical population of the research consisted of all the employees of Shahid Beheshti Hospital in Shiraz in 2021. From among the statistical population, 220 individuals were selected and studied based on available sampling. To collect data, Kobasa's psychological hardiness questionnaire and coronavirus anxiety questionnaire were used. After collecting the data, the scores of the participants were analyzed using Pearson's correlation coefficient multiple regression analysis and SPSS-24 statistical software. The results of Pearson's correlation coefficient showed that there is a significant negative correlation between psychological hardiness and its components (challenge, commitment, and control) with coronavirus anxiety; also, psychological hardiness with a beta coefficient of 0.20 could predict coronavirus anxiety in hospital employees. Based on the results, plans can be made to enhance psychological hardiness through educational workshops to relieve the anxiety of the healthcare staff.

Keywords: the corona virus, commitment, hospital employees, psychological hardiness

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Authors: M. S. M. Prahastomi, Riki Sunaryo, Lorasa Ximanes

Abstract:

The research takes place in EP Area, in the Northern part of Buton, Southeast Sulawesi Province, Indonesia. It is one example of karst areas that have good water resources potential. The landscape is in the form of valleys and hills which is good enough for recharge zone and discharge zones of groundwater. However, the geological characteristics of karst dissolution and a complex geological structure are quite influential to the groundwater flow system in the region. The Discharge of groundwater to the surface can be caused by a fracture in the rock, Underground River due to dissolution, and the contact between permeable rocks with impermeable rocks. In the concept of hydrogeology, groundwater is one of the components of the hydrological cycle which is closely linked to the availability of water under the surface, precipitation, infiltration, percolation, evapotranspiration, and surface runoff. Conceptually, the condition of recharge and discharge areas can be identified through a research distribution springs in a region. The understanding of the condition and the nature of the potential catchment area of groundwater flow, mainly from the catchment area to the discharge area, is urgently needed. This research aimed to assess the general geological conditions of the study area, which is expected to provide an overview of groundwater flow events that used by the public as well as industry. Behavioral characteristics of groundwater become an integral part in the search for potential groundwater in the study area. As for the research methods used hydrogeology mapping and laboratory works.

Keywords: Buton Island, groundwater conservation, hydrogeochemistry preliminary, karst

Procedia PDF Downloads 306