Search results for: radar chart

Authors: K. Genise, S. Murthy

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Introductory Statement: The results of this retrospective chart review suggest the effects of bacterial colonization in critically ill children with viral bronchiolitis, currently unproven, are clinically insignificant. Background: Viral bronchiolitis is one of the most prevalent causes of illness requiring hospitalization among children worldwide and one of the most common reasons for admission to pediatric intensive care. It has been hypothesized that co-infection with bacteria results in more severe clinical outcomes. Conversely, the effects of bacterial colonization in critically ill patients with bronchiolitis are poorly defined. Current clinical management of colonized patients consists primarily of supportive therapies with the role of antibiotics remaining controversial. Methods: A retrospective review of all critically ill children admitted to the BC Children’s Hospital Pediatric Intensive Care Unit (PICU) from 2014-2017 with a diagnosis of bronchiolitis was performed. Routine testing in this time frame consisted of complete pathogen testing, including PCR for Streptococcus pneumoniae. Analyses were performed to determine the impact of bacterial colonization and antibiotic use on a primary outcome of PICU length-of-stay, with secondary outcomes of hospital length-of-stay and duration of ventilation. Results: There were 92 patients with complete pathogen testing performed during the assessed timeframe. A comparison between children with detected Streptococcus pneumoniae (n=22) and those without (n=70) revealed no significant (p=0.20) differences in severity of illness on presentation as per Pediatric Risk of Mortality III scores (mean=3.0). Patients colonized with S. pneumoniae had significantly shorter PICU stays (p=0.002), hospital stays (p=0.0001) and duration of non-invasive ventilation (p=0.002). Multivariate analyses revealed that these effects on length of PICU stay and duration of ventilation do not persist after controlling for antibiotic use, presence of radiographic consolidation, age, and severity of illness (p=0.15, p=0.32). The relationship between colonization and duration of hospital stay persists after controlling for these variables (p=0.008). Conclusions: Children with viral bronchiolitis colonized with S. pneumoniae do not appear to have significantly different PICU length-of-stays or duration of ventilation compared to children who are not colonized. Colonized children appear to have shorter hospital stays. The results of this study suggest bacterial colonization is not associated with increased severity of presenting illness or negative clinical outcomes.

Keywords: bronchiolitis, colonization, critical care, pediatrics, pneumococcal, infection

Procedia PDF Downloads 489

Authors: Luvindran Sugumaran, Mohd Nashrul Mohd Zubir, Kazi Md Salim Newaz, Tuan Zaharinie Tuan Zahari, Suazlan Mt Aznam, Aiman Mohd Halil

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With the fast growth of integrated circuits and the trend towards making electronic devices smaller, the heat dissipation load of electronic devices has continued to go over the limit. The high heat flux element would not only harm the operation and lifetime of the equipment but would also impede the performance upgrade brought about by the iteration of technological updates, which would have a direct negative impact on the economic and production cost benefits of rising industries. Hence, in high-tech industries like radar, information and communication, electromagnetic power, and aerospace, the development and implementation of effective heat dissipation technologies were urgently required. Pool boiling is favored over other cooling methods because of its capacity to dissipate a high heat flux at a low wall superheat without the usage of mechanical components. Enhancing the pool boiling performance by increasing the heat transfer coefficient via surface modification techniques has received a lot of attention. There are several surface modification methods feasible today, but the stability and durability of surface modification are the greatest priority. Thus, laser machining is an interesting choice for surface modification due to its low production cost, high scalability, and repeatability. In this study, different patterns of laser-processed copper surfaces are fabricated to investigate the nucleate pool boiling heat transfer performance of distilled water. The investigation showed that there is a significant enhancement in the pool boiling heat transfer performance of the laser-processed surface compared to the reference surface due to the notable increase in nucleation frequency and nucleation site density. It was discovered that the heat transfer coefficients increased when both the surface area ratio and the ratio of peak-to-valley height of the microstructure were raised. It is believed that the development of microstructures on the surface as a result of laser processing is the primary factor in the enhancement of heat transfer performance.

Keywords: heat transfer coefficient, laser processing, micro structured surface, pool boiling

Procedia PDF Downloads 59

Authors: Sidharth Talan, Devendra Kumar Yadav, Yuvraj Singh Rajput, Subhajit Bhattacharjee

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Mining industry is known for its appetite to spend sizeable capital on mine equipment. However, in the current scenario, the mining industry is challenged by daunting factors of non-uniform geological conditions, uneven ore grade, uncontrollable and volatile mineral commodity prices and the ever increasing quest to optimize the capital and operational costs. Thus, the role of equipment reliability and maintenance planning inherits a significant role in augmenting the equipment availability for the operation and in turn boosting the mine productivity. This paper presents the Risk Based Maintenance (RBM) planning conducted on mine loading equipment namely Load Haul Dumpers (LHDs) at Vedanta Resources Ltd subsidiary Hindustan Zinc Limited operated Sindesar Khurd Mines, an underground zinc and lead mine situated in Dariba, Rajasthan, India. The mining equipment at the location is maintained by the Original Equipment Manufacturers (OEMs) namely Sandvik and Atlas Copco, who carry out the maintenance and inspection operations for the equipment. Based on the downtime data extracted for the equipment fleet over the period of 6 months spanning from 1^st January 2017 until 30^th June 2017, it was revealed that significant contribution of three downtime issues related to namely Engine, Hydraulics, and Transmission to be common among all the loading equipment fleet and substantiated by Pareto Analysis. Further scrutiny through Bubble Matrix Analysis of the given factors revealed the major influence of selective factors namely Overheating, No Load Taken (NTL) issues, Gear Changing issues and Hose Puncture and leakage issues. Utilizing the equipment wise analysis of all the downtime factors obtained, spares consumed, and the alarm logs extracted from the machines, technical design changes in the equipment and pre shift critical alarms checklist were proposed for the equipment maintenance. The given analysis is beneficial to allow OEMs or mine management to focus on the critical issues hampering the reliability of mine equipment and design necessary maintenance strategies to mitigate them.

Keywords: bubble matrix analysis, LHDs, OEMs, Pareto chart analysis, spares consumption matrix, critical alarms checklist

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Authors: Sourabh Jain, S. S. Jain

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Intelligent transportation system (ITS) is the application of technologies for developing a user–friendly transportation system to extend the safety and efficiency of urban transportation systems in developing countries. These systems involve vehicles, drivers, passengers, road operators, managers of transport services; all interacting with each other and the surroundings to boost the security and capacity of road systems. The goal of urban corridor management using ITS in road transport is to achieve improvements in mobility, safety, and the productivity of the transportation system within the available facilities through the integrated application of advanced monitoring, communications, computer, display, and control process technologies, both in the vehicle and on the road. Intelligent transportation system is a product of the revolution in information and communications technologies that is the hallmark of the digital age. The basic ITS technology is oriented on three main directions: communications, information, integration. Information acquisition (collection), processing, integration, and sorting are the basic activities of ITS. In the paper, attempts have been made to present the endeavor that was made to interpret and evaluate the performance of the 27.4 Km long study corridor having eight intersections and four flyovers. The corridor consisting of six lanes as well as eight lanes divided road network. Two categories of data have been collected such as traffic data (traffic volume, spot speed, delay) and road characteristics data (no. of lanes, lane width, bus stops, mid-block sections, intersections, flyovers). The instruments used for collecting the data were video camera, stop watch, radar gun, and mobile GPS (GPS tracker lite). From the analysis, the performance interpretations incorporated were the identification of peak and off-peak hours, congestion and level of service (LOS) at midblock sections and delay followed by plotting the speed contours. The paper proposed the urban corridor management strategies based on sensors integrated into both vehicles and on the roads that those have to be efficiently executable, cost-effective, and familiar to road users. It will be useful to reduce congestion, fuel consumption, and pollution so as to provide comfort, safety, and efficiency to the users.

Keywords: ITS strategies, congestion, planning, mobility, safety

Procedia PDF Downloads 156

Authors: Kambiz Teimour Najad

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The basic methodology of GPR involves the use of a transmitting antenna to send electromagnetic waves into the subsurface, which then bounce back to the surface and are detected by a receiving antenna. The transmitter and receiver antennas are typically placed on the ground surface and moved across the area of interest to create a profile of the subsurface. The GPR system consists of a control unit that powers the antennas and records the data, as well as a display unit that shows the results of the survey. The control unit sends a pulse of electromagnetic energy into the ground, which propagates through the soil or rock until it encounters a change in material or structure. When the electromagnetic wave encounters a buried object or structure, some of the energy is reflected back to the surface and detected by the receiving antenna. The GPR data is then processed using specialized software that analyzes the amplitude and travel time of the reflected waves. By interpreting the data, GPR can provide information on the depth, location, and nature of subsurface features and structures. GPR has several advantages over other geophysical survey methods, including its ability to provide high-resolution images of the subsurface and its non-invasive nature, which minimizes disruption to the site. However, the effectiveness of GPR depends on several factors, including the type of soil or rock, the depth of the features being investigated, and the frequency of the electromagnetic waves used. In environmental hazard assessments, GPR can be used to detect buried structures, such as underground storage tanks, pipelines, or utilities, which may pose a risk of contamination to the surrounding soil or groundwater. GPR can also be used to assess soil stability by identifying areas of subsurface voids or sinkholes, which can lead to the collapse of the surface. Additionally, GPR can be used to map the extent and movement of groundwater contamination, which is critical in designing effective remediation strategies. the methodology of GPR in environmental hazard assessments involves the use of electromagnetic waves to create high of the subsurface, which are then analyzed to provide information on the depth, location, and nature of subsurface features and structures. This information is critical in identifying and mitigating environmental hazards, and the non-invasive nature of GPR makes it a valuable tool in this field.

Keywords: GPR, hazard, landslide, rock fall, contamination

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Authors: Lyka Selene Magnayi, Marcos Vinas, Roseanne Ramos

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As the real estate industry continually grows in the Philippines, Geographic Information Systems (GIS) provide advantages in generating spatial databases for efficient delivery of information and services. The real estate sector is not only providing qualitative data about real estate properties but also utilizes various spatial aspects of these properties for different applications such as hazard mapping and assessment. In this study, a three-dimensional (3D) model and a spatial database of real estate properties in Fort Bonifacio, Taguig City are developed using GIS and SketchUp. Spatial datasets include political boundaries, buildings, road network, digital terrain model (DTM) derived from Interferometric Synthetic Aperture Radar (IFSAR) image, Google Earth satellite imageries, and hazard maps. Multiple model layers were created based on property listings by a partner real estate company, including existing and future property buildings. Actual building dimensions, building facade, and building floorplans are incorporated in these 3D models for geovisualization. Hazard model layers are determined through spatial overlays, and different scenarios of hazards are also presented in the models. Animated maps and walkthrough videos were created for company presentation and evaluation. Model evaluation is conducted through client surveys requiring scores in terms of the appropriateness, information content, and design of the 3D models. Survey results show very satisfactory ratings, with the highest average evaluation score equivalent to 9.21 out of 10. The output maps and videos obtained passing rates based on the criteria and standards set by the intended users of the partner real estate company. The methodologies presented in this study were found useful and have remarkable advantages in the real estate industry. This work may be extended to automated mapping and creation of online spatial databases for better storage, access of real property listings and interactive platform using web-based GIS.

Keywords: geovisualization, geographic information systems, GIS, real estate, spatial database, three-dimensional model

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Authors: Nizamuddin Zainuddin, Adam Mohd Saifudin, Ahmad Yusni Bahaudin, Mohd Hanizan Zalazilah, Roslan Jamaluddin

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Students’ enhanced experience through simulation is a crucial factor that brings reality to the classroom. The enhanced experience is all about developing, enriching and applications of a generic process flow in the field of logistics and transportations. As educational technology has improved, the effective use of simulations has greatly increased to the point where simulations should be considered a valuable, mainstream pedagogical tool. Additionally, in this era of ongoing (some say never-ending) assessment, simulations offer a rich resource for objective measurement and comparisons. Simulation is not just another in the long line of passing fads (or short-term opportunities) in educational technology. It is rather a real key to helping our students understand the world. It is a way for students to acquire experience about how things and systems in the world behave and react, without actually touching them. In short, it is about interactive pretending. Simulation is all about representing the real world which includes grasping the complex issues and solving intricate problems. Therefore, it is crucial before stimulate the real process of inbound and outbound logistics and transportation a generic process flow shall be developed. The paper will be focusing on the validization of the process flow by looking at the inputs gains from the sample. The sampling of the study focuses on multi-national and local manufacturing companies, third party companies (3PL) and government agency, which are selected in Peninsular Malaysia. A simulation flow chart was proposed in the study that will be the generic flow in logistics and transportation. A qualitative approach was mainly conducted to gather data in the study. It was found out from the study that the systems used in the process of outbound and inbound are System Application Products (SAP) and Material Requirement Planning (MRP). Furthermore there were some companies using Enterprises Resources Planning (ERP) and Electronic Data Interchange (EDI) as part of the Suppliers Own Inventories (SOI) networking as a result of globalized business between one countries to another. Computerized documentations and transactions were all mandatory requirement by the Royal Custom and Excise Department. The generic process flow will be the basis of developing a simulation program that shall be used in the classroom with the objective of further enhanced the students’ learning experience. Thus it will contributes to the body of knowledge on the enrichment of the student’s employability and also shall be one of the way to train new workers in the logistics and transportation filed.

Keywords: enhancement, simulation, process flow, logistics, transportation

Procedia PDF Downloads 308

Authors: H. M. Liman, Y. M. Suleiman A. A. David

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Poor air quality often considered one of the greatest environmental threats facing the world today is caused majorly by the emission of carbon monoxide into the atmosphere. The principal air pollutant is carbon monoxide. One prominent source of carbon monoxide emission is the transportation sector. Not much was known about the emission levels of carbon monoxide, the primary pollutant from the road transportation in the study area. Therefore, this study assessed the levels of carbon monoxide emission from road transportation in the Minna, Niger State. The database shows the carbon monoxide data collected. MSA Altair gas alert detector was used to take the carbon monoxide emission readings in Parts per Million for the peak and off-peak periods of vehicular movement at the road intersections. Their Global Positioning System (GPS) coordinates were recorded in the Universal Transverse Mercator (UTM). Bar chart graphs were plotted by using the emissions level of carbon dioxide as recorded on the field against the scientifically established internationally accepted safe limit of 8.7 Parts per Million of carbon monoxide in the atmosphere. Further statistical analysis was also carried out on the data recorded from the field using the Statistical Package for Social Sciences (SPSS) software and Microsoft excel to show the variance of the emission levels of each of the parameters in the study area. The results established that emissions’ level of atmospheric carbon monoxide from the road transportation in the study area exceeded the internationally accepted safe limits of 8.7 parts per million. In addition, the variations in the average emission levels of CO between the four parameters showed that morning peak is having the highest average emission level of 24.5PPM followed by evening peak with 22.84PPM while morning off peak is having 15.33 and the least is evening off peak 12.94PPM. Based on these results, recommendations made for poor air quality mitigation via carbon monoxide emissions reduction from transportation include Introduction of the urban mass transit would definitely reduce the number of traffic on the roads, hence the emissions from several vehicles that would have been on the road. This would also be a cheaper means of transportation for the masses and Encouraging the use of vehicles using alternative sources of energy like solar, electric and biofuel will also result in less emission levels as the these alternative energy sources other than fossil fuel originated diesel and petrol vehicles do not emit especially carbon monoxide.

Keywords: carbon monoxide, climate change emissions, road transportation, vehicular

Procedia PDF Downloads 353

Authors: Tuji Mohammed Sani

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Back ground: An open tibial fracture is an injury where the fractured bone directly communicates with the outside environment. Due to the specific anatomical features of the tibia (limited soft tissue coverage), more than quarter of its fractures are classified as open, representing the most common open long-bone injuries. Open tibial fractures frequently cause significant bone comminution, periosteal stripping, soft tissue loss, contamination and are prone to bacterial entry with biofilm formation, which increases the risk of deep bone infection. Objective: The main objective of the study was to determine Prevalence of infection and its associated factors in surgically treated open tibial fracture in Addis Ababa Burn Emergency and Trauma (AaBET) center. Method: A facility based retrospective cross-sectional study was conducted among patient treated for open tibial fracture at AaBET center from September 2018 to September 2021. The data was collected from patient’s chart using structured data collection form, and Data was entered and analyzed using SPSS version 26. Bivariable and multiple binary logistic regression were fitted. Multicollinearity was checked among candidate variables using variance inflation factor and tolerance, which were less than 5 and greater than 0.2, respectively. Model adequacy were tested using Hosmer-Lemeshow goodness of fitness test (P=0.711). AOR at 95% CI was reported, and P-value < 0.05 was considered statistically significant. Result: This study found that 33.9% of the study participants had an infection. Initial IV antibiotic time (AOR=2.924, 95% CI:1.160- 7.370) and time of wound closure from injury (AOR=3.524, 95% CI: 1.798-6.908), injury to admission time (AOR=2.895, 95% CI: 1.402 – 5.977). and definitive fixation method (AOR=0.244, 95% CI: 0.113 – 0.4508) were the factors found to have a statistically significant association with the occurrence of infection. Conclusion: The rate of infection in open tibial fractures indicates that there is a need to improve the management of open tibial fracture treated at AaBET center. Time from injury to admission, time from injury to first debridement, wound closure time, and initial Intra Venous antibiotic time from the injury are an important factor that can be readily amended to improve the infection rate. Whether wound closed before seven days or not were more important factor associated with occurrences of infection.

Keywords: infection, open tibia, fracture, magnitude

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Authors: Hayley Lawrence, Nabi Shah, Sarah Dyer

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Aims: Lumbar punctures are a common bedside procedure performed in acute medicine. Published guidance exists on the standardised documentation of invasive procedures in order to reduce the risk of complications. The audit aim was to assess current standards of documentation in accordance with both the GMC and the National Standards for Invasive Procedures guidelines. A second cycle was conducted after introducing a standardised sticker created using current guidelines. This would assess whether the sticker improved documentation, aiming for 100% standard in each step of the procedure. Methods: An initial prospective audit of current practice was conducted over a 3-month period. Patients were identified by their presenting complaints and by colleagues assessing acute medical patients. Initial findings were presented locally, and a further prospective audit was conducted following the implementation of a standardised sticker. Results: 19 lumbar punctures were included in the first cycle and 13 procedures in the second. Pre-procedure documentation was collected for each cycle, whereby documentation of ‘Indication’ improved from 5.3% to 84.6%, ‘Consent’ from 84.2% to 100%, ‘Coagulopathy’ from 0% to 61.5%, ‘Drug Chart checked’ from 0% to 100%, ‘Position of patient’ from 26.3% to 100% and use of ‘Aseptic Technique’ from 83.3% to 100% from the first to the second cycle respectively. ‘Level of Doctor’ and ‘Supervision’ decreased from 53% to 31% and 53% to 46%, respectively, in the second cycle. Documentation of the procedure itself also demonstrated improvements, with ‘Level of Insertion’ 15.8% to 100%, ‘Name of Antiseptic Used’ 11.1% to 69.2%, ‘Local Anaesthetic Used’ 26.3% to 53.8%, ‘Needle Gauge’ 42.1% to 76.9%, ‘Number of Attempts’ 78.9% to 100% and ‘Traumatic/Atraumatic’ procedure 26.3% to 92.3%, respectively. A similar number of opening pressures were documented in each cycle at 57.9% and 53.8%, respectively, but its documentation was deemed ‘Not Applicable’ in a higher number of patients in the second cycle. Post-procedure documentation improved, with ‘Number of Samples obtained’ increasing from 52.6% to 92.3% and documentation of ‘Immediate Complications’ increasing from 78.9% to 100%. ‘Dressing Applied’ was poorly documented in the first cycle at 16.7%. This was not included on the standardised sticker, resulting in 0% documentation in the second cycle. Documentation of Clinicians’ Name and Bleep reduced from 63.2% to 15.4%, but when the name only was analysed, this increased to 84.6%. Conclusions: Standardised stickers for lumbar punctures do improve documentation and hence should result in improved patient safety. There is still room for improvement to reach 100% standard in each area, especially with respect to the clinician’s name and contact details being documented. Final adjustments will be made to the sticker before being included in a lumbar puncture kit, which will be made readily available in the acute medical wards. Future audits could be extended to include other common bedside procedures performed in acute medicine to ensure documentation of all these procedures reaches 100% standard.

Keywords: invasive procedure, lumbar puncture, medical record keeping, procedure checklist, procedure documentation, standardised documentation

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Authors: Ece Cigdem Mutlu, Burak Alakent

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Maintaining the quality of manufactured products at a desired level depends on the stability of process dispersion and location parameters and detection of perturbations in these parameters as promptly as possible. Shewhart control chart is the most widely used technique in statistical process monitoring to monitor the quality of products and control process mean and variability. In the application of Xbar control charts, sample standard deviation and sample mean are known to be the most efficient conventional estimators in determining process dispersion and location parameters, respectively, based on the assumption of independent and normally distributed datasets. On the other hand, there is no guarantee that the real-world data would be normally distributed. In the cases of estimated process parameters from Phase I data clouded with outliers, efficiency of traditional estimators is significantly reduced, and performance of Xbar charts are undesirably low, e.g. occasional outliers in the rational subgroups in Phase I data set may considerably affect the sample mean and standard deviation, resulting a serious delay in detection of inferior products in Phase II. For more efficient application of control charts, it is required to use robust estimators against contaminations, which may exist in Phase I. In the current study, we present a simple approach to construct robust Xbar control charts using average distance to the median, Qn-estimator of scale, M-estimator of scale with logistic psi-function in the estimation of process dispersion parameter, and Harrell-Davis qth quantile estimator, Hodge-Lehmann estimator and M-estimator of location with Huber psi-function and logistic psi-function in the estimation of process location parameter. Phase I efficiency of proposed estimators and Phase II performance of Xbar charts constructed from these estimators are compared with the conventional mean and standard deviation statistics both under normality and against diffuse-localized and symmetric-asymmetric contaminations using 50,000 Monte Carlo simulations on MATLAB. Consequently, it is found that robust estimators yield parameter estimates with higher efficiency against all types of contaminations, and Xbar charts constructed using robust estimators have higher power in detecting disturbances, compared to conventional methods. Additionally, utilizing individuals charts to screen outlier subgroups and employing different combination of dispersion and location estimators on subgroups and individual observations are found to improve the performance of Xbar charts.

Keywords: average run length, M-estimators, quality control, robust estimators

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Authors: Soroush Pakniyat-Jahromi, Jessica Bucciarelli, Souparno Mitra, Neda Motamedi, Ralph Amazan, Samuel Rothman, Jose Tiburcio, Douglas Reich, Vicente Liz

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Violence is defined as an act of physical force that is intended to cause harm and may lead to physical and/or psychological damage. Violence toward healthcare workers (HCWs) is more common in psychiatric settings, emergency departments, and nursing homes; however, healthcare workers in medical setting are not spared from such events. Workplace violence has a huge burden in the healthcare industry and has a major impact on the physical and mental wellbeing of staff. The purpose of this study is to compare the prevalence of patient agitation and violence in medical-surgical settings in BronxCare Hospital (BCH) Bronx, New York, one year before and during the COVID-19 pandemic. Data collection occurred between June 2021 and August 2021, while the sampling time was from 2019 to 2021. The data were separated into two separate time categories: pre-COVID-19 (03/2019-03/2020) and COVID-19 (03/2020-03/2021). We created frequency tables for 19 variables. We used a chi-square test to determine a variable's statistical significance. We tested all variables against “restraint type”, determining if a patient was violent or became violent enough to restrain. The restraint types were “chemical”, “physical”, or both. This analysis was also used to determine if there was a statistical difference between the pre-COVID-19 and COVID-19 timeframes. Our data shows that there was an increase in incidents of violence in COVID-19 era (03/2020-03/2021), with total of 194 (62.8%) reported events, compared to pre COVID-19 era (03/2019-03/2020) with 115 (37.2%) events (p: 0.01). Our final analysis, completed using a chi-square test, determined the difference in violence in patients between pre-COVID-19 and COVID-19 era. We then tested the violence marker against restraint type. The result was statistically significant (p: 0.01). This is the first paper to systematically review the prevalence of violence in medical-surgical units in a hospital in New York, pre COVID-19 and during the COVID-19 era. Our data is in line with the global trend of increased prevalence of patient agitation and violence in medical settings during the COVID-19 pandemic. Violence and its management is a challenge in healthcare settings, and the COVID-19 pandemic has brought to bear a complexity of circumstances, which may have increased its incidence. It is important to identify and teach healthcare workers the best preventive approaches in dealing with patient agitation, to decrease the number of restraints in medical settings, and to create a less restrictive environment to deliver care.

Keywords: COVID-19 pandemic, patient agitation, restraints, violence

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Authors: Sharifullah Ahmed, Sarwar Jahan Md. Yasin

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Shallow foundations on unimproved soft natural soils can undergo a high consolidation and secondary settlement. For low and medium rise building projects on such soil condition, pile foundation may not be cost effective. In such cases an alternative to pile foundations may be shallow strip footings placed on a double layered improved soil system soil. The upper layer of this system is untreated or cement treated compacted sand and underlying layer is natural soft clay. This system will reduce the settlement to an allowable limit. The current research has been conducted with the settlement of a rigid plane-strain strip footing of 2.5 m width placed on the surface of a soil consisting of an untreated or cement treated sand layer overlying a bed of homogeneous soft clay. The settlement of the mentioned shallow foundation has been studied considering both cases with the thicknesses of the sand layer are 0.3 to 0.9 times the width of footing. The response of the clay layer is assumed as undrained for plastic loading stages and drained during consolidation stages. The response of the sand layer is drained during all loading stages. FEM analysis was done using PLAXIS 2D Version 8.0. A natural clay deposit of 15 m thickness and 18 m width has been modeled using Hardening Soil Model, Soft Soil Model, Soft Soil Creep Model, and upper improvement layer has been modeled using only Hardening Soil Model. The groundwater level is at the top level of the clay deposit that made the system fully saturated. Parametric study has been conducted to determine the effect of thickness, density, cementation of the sand mat and density, shear strength of the soft clay layer on the settlement of strip foundation under the uniformly distributed vertical load of varying value. A set of the chart has been established for designing shallow strip footing on the sand mat over thick, soft clay deposit through obtaining the particular thickness of sand mat for particular subsoil parameter to ensure no punching shear failure and no settlement beyond allowable level. Design guideline in the form of non-dimensional charts has been developed for footing pressure equivalent to medium-rise residential or commercial building foundation with strip footing on soft inorganic Normally Consolidated (NC) soil of Bangladesh having void ratio from 1.0 to 1.45.

Keywords: design charts, ground improvement, PLAXIS 2D, primary and secondary settlement, sand mat, soft clay

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Authors: Michael Vieth, Aric Schadler, Hubert Ballard, J. A. Bauer, Pratibha Thakkar

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Introduction: Congenital diaphragmatic hernia (CDH) is a condition characterized by the herniation of abdominal contents into the thoracic cavity requiring postnatal surgical repair. Previous literature suggests improved CDH outcomes at high-volume regional referral centers compared to low-volume centers. The purpose of this study was to examine CDH outcomes at Kentucky Children’s Hospital (KCH), a low-volume center, compared to the Congenital Diaphragmatic Hernia Study Group (CDHSG). Methods: A retrospective chart review was performed at KCH from 2007-2019 for neonates with CDH, and then subdivided into two cohorts: those requiring ECMO therapy and those not requiring ECMO therapy. Basic demographic data and measures of mortality and morbidity including ventilator days and length of stay were compared to the CDHSG. Measures of morbidity for the ECMO cohort including duration of ECMO, clinical bleeding, intracranial hemorrhage, sepsis, need for continuous renal replacement therapy (CRRT), need for sildenafil at discharge, timing of surgical repair, and total ventilator days were collected. Statistical analysis was performed using IBM SPSS Statistics version 28. One-sample t-tests and one-sample Wilcoxon Signed Rank test were utilized as appropriate.Results: There were a total of 27 neonatal patients with CDH at KCH from 2007-2019; 9 of the 27 required ECMO therapy. The birth weight and gestational age were similar between KCH and the CDHSG (2.99 kg vs 2.92 kg, p =0.655; 37.0 weeks vs 37.4 weeks, p =0.51). About half of the patients were inborn in both cohorts (52% vs 56%, p =0.676). KCH cohort had significantly more Caucasian patients (96% vs 55%, p=<0.001). Unadjusted mortality was similar in both groups (KCH 70% vs CDHSG 72%, p =0.857). Using ECMO utilization (KCH 78% vs CDHSG 52%, p =0.118) and need for surgical repair (KCH 95% vs CDHSG 85%, p =0.060) as proxy for severity, both groups’ mortality were comparable. No significant difference was noted for pulmonary outcomes such as average ventilator days (KCH 43.2 vs. CDHSG 17.3, p =0.078) and home oxygen dependency (KCH 44% vs. CDHSG 24%, p =0.108). Average length of hospital stay for patients treated at KCH was similar to CDHSG (64.4 vs 49.2, p=1.000). Conclusion: Our study demonstrates that outcome in CDH patients is independent of center’s case volume status. Management of CDH with a standardized approach in a low-volume center can yield similar outcomes. This data supports the treatment of patients with CDH at low-volume centers as opposed to transferring to higher-volume centers.

Keywords: ECMO, case volume, congenital diaphragmatic hernia, congenital diaphragmatic hernia study group, neonate

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Authors: Veruska C. Dutra, Lucio F.M. Adorno, Mary L. G. S. Senna

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Since it recognized the importance of planning sustainable tourism, which has been discussed effective methods of monitoring tourist. In this sense, the indicators, can transmit a set of information about complex processes, events or trends, showing up as an important monitoring tool and aid in the environmental assessment, helping to identify the progress of it and to chart future actions, contributing, so for decision making. The World Tourism Organization - WTO recognizes the importance of indicators to appraise the tourism activity in the point of view of sustainability, launching in 1995 eleven Keys Indicators of Sustainable Tourism to assist in the monitoring of tourist destinations. So we propose a case study to examine the applicability or otherwise of a monitoring methodology and aid in the understanding of tourism sustainability, analyzing the effectiveness of local indicators on the approach defined by the WTO. The study was applied to the Lagoa da Confusão City, in the state of Tocantins - North Brazil. The case study was carried out in 2006/2007, with the guiding deductive method. The indicators were measured by specific methodologies adapted to the study site, so that could generate quantitative results which could be analyzed at the proposed scale WTO (0 to 10 points). Applied indicators: Attractive Protection – AP (level of a natural and cultural attractive protection), Sociocultural Impact–SI (level of socio-cultural impacts), Waste Management - WM (level of management of solid waste generated), Planning Process-PP (trip planning level) Tourist Satisfaction-TS (satisfaction of the tourist experience), Community Satisfaction-CS (satisfaction of the local community with the development of local tourism) and Tourism Contribution to the Local Economy-TCLE (tourist level of contribution to the local economy). The city of Lagoa da Confusão was presented as an important object of study for the methodology in question, as offered condition to analyze the indicators and the complexities that arose during the research. The data collected can help discussions on the sustainability of tourism in the destination. The indicators TS, CS, WM , PP and AP appeared as satisfactory as allowed the measurement "translating" the reality under study, unlike TCLE and the SI indicators that were not seen as reliable and clear and should be reviewed and discussed for an adaptation and replication of the same. The application and study of various indicators of sustainable tourism, give better able to analyze the local tourism situation than monitor only one of the indicators, it does not demonstrate all collected data, which could result in a superficial analysis of the tourist destination.

Keywords: indicators, Lagoa da Confusão, Tocantins, Brazil, monitoring, sustainability

Procedia PDF Downloads 372

Authors: Tamadu Perry Egedegu

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Rapid growth in the use of electronic data has affected both the employee and work place. Our experience shows that jobs that have multiple risk factors have a greater likelihood of causing Work Related Musculoskeletal Disorder (WRMSDs), depending on the duration, frequency and/or magnitude of exposure to each. The study investigated musculoskeletal disorder among office workers. Thus, it is important that ergonomic risk factors be considered in light of their combined effect in causing or contributing to WRMSDs. Fast technological growth in the use of electronic system; have affected both workers and the work environment. Awkward posture and long hours in front of these visual display terminals can result in work-related musculoskeletal disorders (WRMSD). The study shall contribute to the awareness creation on the causes and consequences of WRMSDs due to lack of ergonomics training. The study was conducted using an observational cross-sectional design. A sample of 109 respondents was drawn from the target population through purposive sampling method. The sources of data were both primary and secondary. Primary data were collected through questionnaires and secondary data were sourced from journals, textbooks, and internet materials. Questionnaires were the main instrument for data collection and were designed in a YES or NO format according to the study objectives. Content validity approval was used to ensure that the variables were adequately covered. The reliability of the instrument was done through test-retest method, yielding a reliability index at 0.84. The data collected from the field were analyzed with a descriptive statistics of chart, percentage and mean. The study found that the most affected body regions were the upper back, followed by the lower back, neck, wrist, shoulder and eyes, while the least affected body parts were the knee calf and the ankle. Furthermore, the prevalence of work-related 'musculoskeletal' malfunctioning was linked with long working hours (6 - 8 hrs.) per day, lack of back support on their seats, glare on the monitor, inadequate regular break, repetitive motion of the upper limbs, and wrist when using the computer. Finally, based on these findings some recommendations were made to reduce the prevalent of WRMSDs among office workers.

Keywords: work related musculoskeletal disorder, Nigeria, office computer users, ergonomic risk factor

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Authors: Nathaniel Bayode Eniolorunda, Murtala Abubakar Gada, Sheikh Danjuma Abubakar

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The challenge of erosion in the study area is persistent, suggesting the need for a better understanding of the mechanisms that drive it. Thus, the study evolved a predictive erosion model (RUSLE_Sok), deploying Remote Sensing (RS) and Geographical Information System (GIS) tools. The nature and pattern of the factors of erosion were characterized, while soil losses were quantified. Factors’ impacts were also measured, and the morphometry of gullies was described. Data on the five factors of RUSLE and distances to settlements, rivers and roads (K, R, LS, P, C, DS DRd and DRv) were combined and processed following standard RS and GIS algorithms. Harmonized World Soil Data (HWSD), Shuttle Radar Topographical Mission (SRTM) image, Climate Hazards Group InfraRed Precipitation with Station data (CHIRPS), Sentinel-2 image accessed and processed within the Google Earth Engine, road network and settlements were the data combined and calibrated into the factors for erosion modeling. A gully morphometric study was conducted at some purposively selected sites. Factors of soil erosion showed low, moderate, to high patterns. Soil losses ranged from 0 to 32.81 tons/ha/year, classified into low (97.6%), moderate (0.2%), severe (1.1%) and very severe (1.05%) forms. The multiple regression analysis shows that factors statistically significantly predicted soil loss, F (8, 153) = 55.663, p < .0005. Except for the C-Factor with a negative coefficient, all other factors were positive, with contributions in the order of LS>C>R>P>DRv>K>DS>DRd. Gullies are generally from less than 100m to about 3km in length. Average minimum and maximum depths at gully heads are 0.6 and 1.2m, while those at mid-stream are 1 and 1.9m, respectively. The minimum downstream depth is 1.3m, while that for the maximum is 4.7m. Deeper gullies exist in proximity to rivers. With minimum and maximum gully elevation values ranging between 229 and 338m and an average slope of about 3.2%, the study area is relatively flat. The study concluded that major erosion influencers in the study area are topography and vegetation cover and that the RUSLE_Sok well predicted soil loss more effectively than ordinary RUSLE. The adoption of conservation measures such as tree planting and contour ploughing on sloppy farmlands was recommended.

Keywords: RUSLE_Sok, Sokoto, google earth engine, sentinel-2, erosion

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Authors: Mette Pedersen

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This paper outlines the criteria that assessment specialists use when they design the 'Persuasive Essay' task for the four Advanced Placement World Language and Culture Exams (AP French, German, Italian, and Spanish). The 'Persuasive Essay' is a free-response, source-based, standardized measure of presentational writing. Each 'Persuasive Essay' item consists of three sources (an article, a chart, and an audio) and a prompt, which is a statement of the topic phrased as an interrogative sentence. Due to its richness of source materials and due to the amount of time that test takers are given to prepare for and write their responses (a total of 55 minutes), the 'Persuasive Essay' is the free-response task on the AP World Language and Culture Exams that goes to the greatest lengths to unleash the test takers' proficiency potential. The author focuses on the work that goes into designing the 'Persuasive Essay' task, outlining best practices for the selection of topics and sources, the interplay that needs to be present among the sources and the thinking behind the articulation of prompts for the 'Persuasive Essay' task. Using released 'Persuasive Essay' items from the AP World Language and Culture Exams and accompanying data on test taker performance, the author shows how different passages, and features of passages, have succeeded (and sometimes not succeeded) in eliciting writing proficiency among test takers over time. Data from approximately 215.000 test takers per year from 2014 to 2017 and approximately 35.000 test takers per year from 2012 to 2013 form the basis of this analysis. The conclusion of the study is that test taker performance improves significantly when the sources that test takers are presented with express directly opposing viewpoints. Test taker performance also improves when the interrogative prompt that the test takers respond to is phrased as a yes/no question. Finally, an analysis of linguistic difficulty and complexity levels of the printed sources reveals that test taker performance does not decrease when the complexity level of the article of the 'Persuasive Essay' increases. This last text complexity analysis is performed with the help of the 'ETS TextEvaluator' tool and the 'Complexity Scale for Information Texts (Scale)', two tools, which, in combination, provide a rubric and a fully-automated technology for evaluating nonfiction and informational texts in English translation.

Keywords: advanced placement world language and culture exams, designing presentational writing assessments, large-scale standardized assessments of written language proficiency, source-based language testing

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Authors: Bryan Clark B. Hernandez, Eugene C. Herrera, Kazuo Nadaoka

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Mangrove forests thriving in intertidal zones in tropical and subtropical regions of the world offer a range of ecosystem services including carbon storage and sequestration. They can regulate the detrimental effects of climate change due to carbon releases two to four times greater than that of mature tropical rainforests. Moreover, they are effective natural defenses against storm surges and tsunamis. However, their proliferation depends significantly on the prevailing hydroperiod at the coast. In the Philippines, these coastal ecosystems have been severely threatened with a 50% decline in areal extent observed from 1918 to 2010. The highest decline occurred in 1950 - 1972 when national policies encouraged the development of fisheries and aquaculture. With the intensive land use conversion upstream, changes in the freshwater-saltwater envelope at the coast may considerably impact mangrove growth conditions. This study investigates a developing urban watershed in Kalibo, Aklan province with a 220-hectare mangrove forest replanted for over 30 years from coastal mudflats. Since then, the mangrove forest was sustainably conserved and declared as protected areas. Hybrid land cover classification technique was used to classify Landsat images for years, 1990, 2010, and 2017. Digital elevation model utilized was Interferometric Synthetic Aperture Radar (IFSAR) with a 5-meter resolution to delineate the watersheds. Using numerical modelling techniques, the hydrologic and hydraulic analysis of the influence of land cover change to flow and sediment dynamics was simulated. While significant land cover change occurred upland, thereby increasing runoff and sediment loads, the mangrove forests abundance adjacent to the coasts for the urban watershed, was somehow sustained. However, significant alteration of the coastline was observed in Kalibo through the years, probably due to the massive land-use conversion upstream and significant replanting of mangroves downstream. Understanding the hydrologic-hydraulic response of these watersheds to change land cover is essential to helping local government and stakeholders facilitate better management of these mangrove ecosystems.

Keywords: coastal mangroves, hydrologic model, land cover change, Philippines

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Authors: Jacklyn Yek, Clara Tong, Shin Yuet Chong, Yee Yian Ong

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Background: While emergency manuals and cognitive aids (CA) have been used in high-hazard industries for decades, this has been a nascent field in healthcare. CAs can potentially offset the large cognitive load involved in crisis resource management and possibly facilitate the efficient performance of key steps in treatment. A crisis manual was developed based on local guidelines and the latest evidence-based information and introduced to a tertiary hospital setting in Singapore. Hence, the objective of this study is to evaluate the effectiveness of the crisis manual in guiding response and management of critical events. Methods: 7 surgical teams were recruited to participate in a series of simulated emergencies in high-fidelity operating room simulator over the period of April to June 2018. All teams consisted of a surgical consultant and medical officer/registrar, anesthesia consultant and medical officer/registrar; as well as a circulating, scrub and anesthetic nurse. Each team performed a simulated operation in which 1 or more of the crisis events occurred. The teams were randomly assigned to a scenario of the crisis manual and all teams were deemed to be equal in experience and knowledge. Before the simulation, teams were instructed on proper checklist use but the use of the checklist was optional. Results: 7 simulation sessions were performed, consisting of the following scenarios: Airway fire, Massive Transfusion Protocol, Malignant Hyperthermia, Eclampsia, and Difficult Airway. Out of the 7 surgical teams, 2 teams made use of the crisis manual – of which both teams had encountered a ‘Malignant Hyperthermia’ scenario. These team members reflected that the crisis manual assisted allowed them to work in a team, especially being able to involve the surgical doctors who were unfamiliar with the condition and management. A run chart plotted showed a possible upward trend, suggesting that with increasing awareness and training, staff would become more likely to initiate the use of the crisis manual. Conclusion: Despite the high volume load in this tertiary hospital, certain crises remain rare and clinicians are often caught unprepared. A crisis manual is an effective tool and easy-to-use repository that can improve patient outcome and encourage teamwork. With training, familiarity would allow clinicians to be increasingly comfortable with reaching out for the crisis manual. More simulation training would need to be conducted to determine its effectiveness.

Keywords: crisis resource management, high fidelity simulation training, medical errors, visual aids

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Authors: P. Uma Devi, S. Sujith, K. Rahul, T. S. Dipu, V. Anil Kumar , Vidya Menon

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Introduction: Candida is an important cause of bloodstream infections (BSIs), causing significant mortality and morbidity. The epidemiology of Candida infection is also changing, mainly in relation to the number of episodes caused by species Candida non-albicans. However, in India, the true burden of candidemia is not clear. Thus, this study was conducted to evaluate the clinical characteristics, species distribution, antifungal susceptibility and outcome of candidemia at our hospital. Methodology: Between January 2012 and April 2014, adult patients with at least one positive blood culture for Candida species were identified through the microbiology laboratory database (for each patient only the first episode of candidemia was recorded). Patient data was collected by retrospective chart review of clinical characteristics including demographic data, risk factors; species distribution, resistance to antifungals and survival. Results: A total of 165 episodes of Candida BSI were identified, with 115 episodes occurring in adult patients. Most of the episodes occurred in males (69.6%). Nearly 82.6% patients were between 41 to 80 years and majority of the patients were in the intensive care unit (65.2%) at the time of diagnosis. On admission, 26.1% and 18.3% patients had pneumonia and urinary tract infection, respectively. Majority of the candidemia episodes were found in the general medicine department (23.5%) followed by gastrointestinal surgery (13.9%) and medical oncology & haematology (13%). Risk factors identified were prior hospitalization within one year (83.5%), antibiotic therapy within the last one month (64.3%), indwelling urinary catheter (63.5%), central venous catheter use (59.1%), diabetes mellitus (53%), severe sepsis (45.2%), mechanical ventilation (43.5%) and surgery (36.5%). C. tropicalis (30.4%) was the leading cause of infection followed by C. parapsilosis (28.7%) and C. albicans (13%). Other non-albicans species isolated included C. haemulonii (7.8%), C. glabrata (7%), C. famata (4.3%) and C. krusei (1.7%). Antifungal susceptibility to fluconazole was 87.9% (C. parapsilosis), 100% (C. tropicalis) and 93.3% (C. albicans). Mortality was noted in 51 patients (44.3%). Early mortality (within 7 days) was noted in 32 patients while late mortality (between 7 and 30 days) was noted in 19 patients. Conclusion: In recent years, candidemia has been flourishing in critically ill patients. Comparison of data from our own hospital from 2005 shows a doubling of the incidence. Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious BSI. High index of suspicion and sensitive diagnostics are essential to improve outcomes in resource limited settings with emergence of non-albicans Candida.

Keywords: antifungal susceptibility, candida albicans, candidemia, non-albicans candida

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Authors: Ana Campina, José Caramelo Gomes, Maria Emília Teixeira, Cristina Costa-Lobo

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In the pursuit of educational equity within Human Rights and European Fundamental Laws, the reality presents serious problems based on the psychologic, social understanding. Take into account the miscellaneous cultures in the global context and the nowadays numbers of Human mobilities, there are serious problems affecting the societies. This justifies the diagnosed need of a renew pedagogical and social education strategy to achieve the integration positive context preventing violence and discrimination, especially in Education systems. Consequently, it is important to have in mind the respect, acceptance, and integration of special needs students in all study degrees, as it is law but a complex reality. Despite the UN and International Human Rights, European Fundamental Chart, and all EU Treats, as the 28th EU State Member’s fundamental laws forecast the right of Education, the respect, the action and promotion of different cultures and the Education for ‘Difference’ integration – cultures; ideologies, Special Needs Students/Citizens – there are different and severe problems. Firstly, there are questions/contexts/problems not denounced by the lack of investments, political, social or ‘powers’ pressures, so, consequently, the authorities don’t have the action as laws demand and the transgressors haven´t any juridical or judicial punishment. Secondly, and our most important point: Governments, authorities and even victims hide these violations/violence/problems what disable the effective protection and law enforcement. Finally, the official and non-official strategies to get around the duties, break away the laws, failing the victims protection and consequently enable the problems increase dramatically. With this research, we observed that there are international Organizations/regions and States acting without respect to the Education right despite their democratic ideology and the generated external ‘image’ of law-abiding and Human Rights defenders. Nevertheless, it is urgent to develop a consistent Human Rights Education program aiming to protect, promote and implement the Right to be different and be respected by the law, the governments, institutions official and non-official, adapted to the needs in each society. The background of this research is the International and European laws, in accordance with the state’s legal systems. The approaches and the differences of the Education for Human and Fundamental Rights execution in the different EU countries, studying the pedagogy and social inclusion programs/strategies, with particular analysis of the Special Needs students. The results aim to construct a European Education profiling, with the governments and EU interventions need, as well as the panorama of the Special Needs Students effective integration achieving a renewed strategy to promote the respect of the Differences and an Inclusive School life.

Keywords: international human rights, culture, differences, European education profiling

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Authors: Hooriya Sadr Dadras, Shiva Seyed Erfani

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Speaking skills merit meticulous attention both on the side of the learners and the teachers. In particular, accuracy is a critical component to guarantee the messages to be conveyed through conversation because a wrongful change may adversely alter the content and purpose of the talk. Different types of tasks have served teachers to meet numerous educational objectives. Besides, negotiation of meaning and the use of different strategies have been areas of concern in socio-cultural theories of SLA. Negotiation of meaning is among the conversational processes which have a crucial role in facilitating the understanding and expression of meaning in a given second language. Conversational strategies are used during interaction when there is a breakdown in communication that leads to the interlocutor attempting to remedy the gap through talk. Therefore, this study was an attempt to investigate if there was any significant difference between the effect of reasoning gap tasks and information gap tasks on the frequency of conversational strategies used in negotiation of meaning in classrooms on one hand, and on the accuracy in speaking of Iranian intermediate EFL learners on the other. After a pilot study to check the practicality of the treatments, at the outset of the main study, the Preliminary English Test was administered to ensure the homogeneity of 87 out of 107 participants who attended the intact classes of a 15 session term in one control and two experimental groups. Also, speaking sections of PET were used as pretest and posttest to examine their speaking accuracy. The tests were recorded and transcribed to estimate the percentage of the number of the clauses with no grammatical errors in the total produced clauses to measure the speaking accuracy. In all groups, the grammatical points of accuracy were instructed and the use of conversational strategies was practiced. Then, different kinds of reasoning gap tasks (matchmaking, deciding on the course of action, and working out a time table) and information gap tasks (restoring an incomplete chart, spot the differences, arranging sentences into stories, and guessing game) were manipulated in experimental groups during treatment sessions, and the students were required to practice conversational strategies when doing speaking tasks. The conversations throughout the terms were recorded and transcribed to count the frequency of the conversational strategies used in all groups. The results of statistical analysis demonstrated that applying both the reasoning gap tasks and information gap tasks significantly affected the frequency of conversational strategies through negotiation. In the face of the improvements, the reasoning gap tasks had a more significant impact on encouraging the negotiation of meaning and increasing the number of conversational frequencies every session. The findings also indicated both task types could help learners significantly improve their speaking accuracy. Here, applying the reasoning gap tasks was more effective than the information gap tasks in improving the level of learners’ speaking accuracy.

Keywords: accuracy in speaking, conversational strategies, information gap tasks, reasoning gap tasks

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Authors: Esam Roshdy, Saleh AlRashdi, Turki Alharbi, Rawan Eskandarani, Zurina Cabilo

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Introduction/ background: Consultation in the Emergency Department constitute a major part of the work flow every day. Any delay in the consultation process have a major impact on the length of stay and patient disposition and thus affect the total waiting time of patients in the ED. King Fahad medical City in Riyadh City, Saudi Arabia is considered a major Tertiary hospital where there is high flow of patients of different categories visiting the ED. The importance of decreasing consultation time and decision for final disposition of patients was recognized and interpreted in this project to find ways to improve the patient flow in the department and thus the total patient disposition and outcome. Aim / Objectives: 1. To monitor the time of consultation for patients in the Emergency department and its impact on the length of stay of patients in the ED. 2. To detect and assess the problems that lead to long consultation times in the ED, and reach a targeted time of 2 hours for final disposition of patients, according to recognized international and our institutional consultation policy, to reach the final goal of decreasing total length of stay and thus improve the patient flow in the ED. Methods: Data was collected retrospectively for a 92 charts of consultations done in the ED over 2 month’s period. The data was analyzed to get the median of Total Consultation Time. A survey was conducted among all ED staff to determine the level of knowledge about the total consultation time and the compliance to the institutional policy target of 2 hours. A second Data sample of 168 chart was collected after awareness campaign and education of all ED staff about the importance of reaching the target consultation time and compliance to the institutional policy. Results: We have found that there is room for improvement in our overall consultation time. This was found to be more frequent with certain specialties. Our surveys have showed that many ED staff are not familiar or not compliant with our consultation policy which was not clear for everyone. Post-intervention data have showed that awareness of the importance to decrease the total consultation time and compliance alone to the targeted goal have had a huge impact on overall improvement and decreasing the time of final decision and disposition of the patient and the overall patient length of stay in the ED. Conclusion: Working on improving Consultation time in the Emergency Department is a major factor in improving overall length of stay and patient flow. This improvement helps in the overall patient disposition and satisfaction. Plan: As a continuation of our project we are planning to focus on the conflict of admission cases where more than one specialty is involved in the care of patients. We are planning to collect data on the time it takes to resolve and reach final disposition of those patients, and its impact on the length of stay and our department flow and the overall patient outcome and satisfaction.

Keywords: consultation time, impact, length of stay, in the ED

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Authors: Noppadol Poomvises, Prateep Pakdeerod, Anchalee Kongsuk

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In the middle of September 2017, a tropical storm named ‘DOKSURI’ swept through Udon Thani, Northeastern Thailand. The storm dumped heavy rain for many hours and caused large amount of water flowing into Huai Phueng reservoir. Level of impounding water increased rapidly, and the extra water flowed over a service spillway, morning-glory type constructed by concrete material for about 50 years ago. Subsequently, a sinkhole was formed on the dam crest and five points of water piping were found on downstream slope closely to spillway. Three techniques of geophysical investigation were carried out to inspect cause of failures; Electrical Resistivity Imaging (ERI), Multichannel Analysis of Surface Wave (MASW), and Ground Penetrating Radar (GPR), respectively. Result of ERI clearly shows evidence of overtop event and heterogeneity around spillway that implied possibility of previous shape of sinkhole around the pipe. The shear wave velocity of subsurface soil measured by MASW can numerically convert to undrained shear strength of impervious clay core. Result of GPR clearly reveals partial settlements of freeboard zone at top part of the dam and also shaping new refilled material to plug the sinkhole back to the condition it should be. In addition, the GPR image is a main answer to confirm that there are not any sinkholes in the survey lines, only that found on top of the spillway. Integrity interpretation of the three results together with several evidences observed during a field walk-through and data from drilled holes can be interpreted that there are four main causes in this account. The first cause is too much water flowing over the spillway. Second, the water attacking morning glory spillway creates cracks upon concrete contact where the spillway is cross-cut to the center of the dam. Third, high velocity of water inside the concrete pipe sucking fine particle of embankment material down via those cracks and flushing out to the river channel. Lastly, loss of clay material of the dam into the concrete pipe creates the sinkhole at the crest. However, in case of failure by piping, it is possible that they can be formed both by backward erosion (internal erosion along or into embedded structure of spillway walls) and also by excess saturated water of downstream material.

Keywords: dam inspection, GPR, MASW, resistivity

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Authors: Nazia Muhsin, Tofael Ahamed, Ryozo Noguchi, Tomohiro Takigawa

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One of the most challenging issues to achieve sustainable development on food security is land use changes. The crisis of lands for agricultural production mainly arises from the unplanned transformation of agricultural lands to infrastructure development i.e. urbanization and industrialization. Land use without sustainability assessment could have impact on the food security and environmental protections. Bangladesh, as the densely populated country with limited arable lands is now facing challenges to meet sustainable food security. Agricultural lands are using for economic growth by establishing industries. The industries are spreading from urban areas to the suburban areas and using the agricultural lands. To minimize the agricultural land losses for unplanned industrialization, compact economic zones should be find out in a scientific approach. Therefore, the purpose of the study was to find out suitable sites for industrial growth by land suitability analysis (LSA) by using Geographical Information System (GIS) and multi-criteria analysis (MCA). The goal of the study was to emphases both agricultural lands and industries for sustainable development in land use. The study also attempted to analysis the agricultural land use changes in a suburban area by statistical data of agricultural lands and primary data of the existing industries of the study place. The criteria were selected as proximity to major roads, and proximity to local roads, distant to rivers, waterbodies, settlements, flood-flow zones, agricultural lands for the LSA. The spatial dataset for the criteria were collected from the respective departments of Bangladesh. In addition, the elevation spatial dataset were used from the SRTM (Shuttle Radar Topography Mission) data source. The criteria were further analyzed with factors and constraints in ArcGIS®. Expert’s opinion were applied for weighting the criteria according to the analytical hierarchy process (AHP), a multi-criteria technique. The decision rule was set by using ‘weighted overlay’ tool to aggregate the factors and constraints with the weights of the criteria. The LSA found only 5% of land was most suitable for industrial sites and few compact lands for industrial zones. The developed LSA are expected to help policy makers of land use and urban developers to ensure the sustainability of land uses and agricultural production.

Keywords: AHP (analytical hierarchy process), GIS (geographic information system), LSA (land suitability analysis), MCA (multi-criteria analysis)

Procedia PDF Downloads 235

Authors: Jamal Alkoteesh, Mohammed Zeki, Mouza Alnaqbi

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Objective: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. Design: Retrospective study. In this study, most women opted for UFE as a fertility treatment after failure of myomectomy or in vitro fertilization, or because hysterectomy was the only suggested option. Background. Myomectomy is the standard approach in patients with fibroids desiring a future pregnancy. However, myomectomy may be difficult in cases of numerous interstitial and/or submucous fibroids.In these cases, UFE has the advantage of embolizing all fibroids in one procedure. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids. Study Methods: A retrospective study of 210 patients treated with UFE for symptomatic uterine fibroids between 2011-2016 was performed. UFE was performed using ((PVA; Embozen, Beadblock) (500-900 µm in diameter). Pregnancies were identified using screening questionnaires and the study database. Of the 210 patients who received UFE treatment, 35 women younger than the age of 40 wanted to conceive and had been unable. All women in our study were advised to wait six months or more after UFE before attempting to become pregnant, of which the reported time range before attempting to conceive was seven to 33 months (average 20 months). RESULTS: In a retrospective chart review of patients younger than the age of 40 (35 patients,18 patients reported 23 pregnancies, of which five were miscarriages. Two more pregnancies were complicated by premature labor. Of the 23 pregnancies, 16 were normal full-term pregnancies, 15 women had conceived once, and four had become pregnant twice. The remaining patients did not conceive. In the study, there was no reported intrauterine growth retardation in the prenatal period, fetal distress during labor, or problems related to uterine integrity. Two patients reported minor problems during pregnancy that were borderline oligohydramnios and low-lying placenta. In the cohort of women who did conceive, overall, 16 out of 18 births proceeded normally without any complications (86%). Eight women delivered by cesarean section, and 10 women had normal vaginal delivery. In this study of 210 women, UFE had a fertility rate of 47%. Our group of 23 pregnancies was small, but did confirm successful pregnancy after UFE. The 45.7% pregnancy rate in women below the age of 40 years old who completed a term pregnancy compares favorably with women who underwent myomectomy via other method. Of the women in the cohort who did conceive, subsequent birth proceeded normally (86%). Conclusion: Pregnancy after UFE is well-documented. The risks of infertility following embolization, premature menopause, and hysterectomy are small, as is the radiation exposure during embolization. Fertility rates appear similar to patients undergoing myomectomy.UFE should not be contraindicated in patients who want to conceive and they should be able to choose between surgical options and UFE.

Keywords: fibroid, pregnancy, therapeutic embolization, uterine artery

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Authors: D. M. Lewis, L. Frisby, U. Stead

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Objective: Many patients are receiving invasive treatments in acute care or are dying in hospital without having had comprehensive goals of care conversations. Some of these treatments may not align with the patient’s wishes, may be futile, and may cause unnecessary suffering. While many staff may recognize the benefits of engaging patients and families in Serious Illness Conversations (a goal of care framework developed by Ariadne Labs in Boston), few staff feel confident and/or competent in having these conversations in acute care. Another barrier to having these conversations may be due to a lack of incorporation in the current workflow. An educational exercise, titled the Two Question Challenge, was initiated on four medical units across two Vancouver Coastal Health (VCH) hospitals in attempt to engage the entire interdisciplinary team in asking patients and families questions around goals of care and to improve the documentation of these expressed wishes and preferences. Methods: Four acute care units across two separate hospitals participated in the Two Question Challenge. On each unit, over the course of two eight-hour shifts, all members of the interdisciplinary team were asked to select at least two questions from a selection of nine goals of care questions. They were asked to pose these questions of a patient or family member throughout their shift and then asked to document their conversations in a centralized Advance Care Planning/Goals of Care discussion record in the patient’s chart. A visual representation of conversation outcomes was created to demonstrate to staff and patients the breadth of conversations that took place throughout the challenge. Staff and patients were interviewed about their experiences throughout the challenge. Two palliative approach leads remained present on the units throughout the challenge to support, guide, or role model these conversations. Results: Across four acute care medical units, 47 interdisciplinary staff participated in the Two Question Challenge, including nursing, allied health, and a physician. A total of 88 questions were asked of patients, or their families around goals of care and 50 newly documented goals of care conversations were charted. Two code statuses were changed as a result of the conversations. Patients voiced an appreciation for these conversations and staff were able to successfully incorporate these questions into their daily care. Conclusion: The Two Question Challenge proved to be an effective way of having teams explore the goals of care of patients and families in an acute care setting. Staff felt that they gained confidence and competence. Both staff and patients found these conversations to be meaningful and impactful and felt they were notably different from their usual interactions. Documentation of these conversations in a centralized location that is easily accessible to all care providers increased significantly. Application of the Two Question Challenge in non-medical units or other care settings, such as long-term care facilities or community health units, should be explored in the future.

Keywords: advance care planning, goals of care, interdisciplinary, palliative approach, serious illness conversations

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Authors: Natalie Rinfret, Francine Tougas, Ann Beaton

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Conventions No. 100 and 111 of the International Labor Organization, passed in 1951 and 1958 respectively, established the principles of equal pay for men and women for work of equal value and freedom from discrimination in employment. Governments of different countries followed suit. For example, in 1964, the Civil Rights Act was passed in the United States and in 1972, Canada ratified Convention 100. Thus, laws were enacted and programs were implemented to combat discrimination in the workplace and, over time, more than 90% of the member countries of the International Labour Organization have ratified these conventions by implementing programs such as employment equity in Canada aimed at groups recognized as being discriminated against in the labor market, including women. Although legislation has been in place for several decades, employment discrimination has not gone away. In this study, we pay particular attention to the hidden side of the effects of employment discrimination. This is the emergence of subtle forms of discrimination that often fly under the radar but nevertheless, have adverse effects on the attitudes and behaviors of members of targeted groups. Researchers have identified two forms of racial and gender bias. On the one hand, there are traditional prejudices referring to beliefs about the inferiority and innate differences of women and racial minorities compared to White men. They have the effect of confining these two groups to job categories suited to their perceived limited abilities and can result in degrading, if not violent and hateful, language and actions. On the other hand, more subtle prejudices are more suited to current social norms. However, this subtlety harbors a conflict between values of equality and remnants of negative beliefs and feelings toward women and racial minorities. Our literature review also takes into account an overlooked part of the groups targeted by the programs in place, senior workers, and highlights the quantifiable and observable effects of prejudice and discriminatory behaviors in employment. The study proposes a hybrid model of interventions, taking into account the organizational system (employment equity practices), discriminatory attitudes and behaviors, and the type of leadership to be advocated. This hybrid model includes, in the first instance, the implementation of initiatives aimed at both promoting employment equity and combating discrimination and, in the second instance, the establishment of practices that foster inclusion, the full and complete participation of all, including seniors, in the mission of their organization.

Keywords: employment discrimination, gender bias, the hybrid model of interventions, senior workers

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Authors: Sundaresan Soundararajan, Chor Ngee Tan

Abstract:

Introduction: Pyogenic spondylitis, otherwise treated conservatively with long term antibiotics, would require surgical debridement and reconstruction in about 10% to 20% of cases. The classical approach adopted many surgeons have always been anterior approach in ensuring thorough and complete debridement. This, however, comes with high rates of morbidity due to the nature of its access. Direct lateral retroperitoneal approach, which has been growing in usage in degenerative lumbar diseases, has the potential in treating pyogenic spondylitis with its ease of approach and relatively low risk of complications. Aims/Objectives: The objective of this study was to evaluate the effectiveness and clinical outcome of using lateral approach surgery in the surgical management of pyogenic spondylitis of the lumbar spine. Methods: Retrospective chart analysis was done on all patients who presented with pyogenic spondylitis (lumbar discitis/vertebral osteomyelitis) and had undergone direct lateral retroperitoneal lumbar vertebral debridement and posterior instrumentation between 2014 and 2016. Data on blood loss, surgical operating time, surgical complications, clinical outcomes and fusion rates were recorded. Results: A total of 6 patients (3 male and 3 female) underwent this procedure at a single institution by a single surgeon during the defined period. One patient presented with infected implant (PLIF) and vertebral osteomyelitis while the other five presented with single level spondylodiscitis. All patients underwent lumbar debridement, iliac strut grafting and posterior instrumentation (revision of screws for infected PLIF case). The mean operating time was 308.3 mins for all 6 cases. Mean blood loss was reported at 341cc (range from 200cc to 600cc). Presenting symptom of back pain resolved in all 6 cases while 2 cases that presented with lower limb weakness had improvement of neurological deficits. One patient had dislodged strut graft while performing posterior instrumentation and needed graft revision intraoperatively. Infective markers normalized for all patients subsequently. All subjects also showed radiological evidence of fusion on 6 months follow up. Conclusions: Lateral approach in treating pyogenic spondylitis is a viable option as it allows debridement and reconstruction without the risk that comes with other anterior approaches. It allows efficient debridement, short surgical time, moderate blood loss and low risk of vascular injuries. Clinical outcomes and fusion rates by this approach also support its use as practical MIS option surgery for such infection cases.

Keywords: lateral approach, minimally invasive, pyogenic spondylitis, XLIF

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