Search results for: surgical ambulatory assessment unit

Authors: S. Jaikeaw, S. Chavadej

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The objective of this study was to determine the effects of COD loading rate on hydrogen and methane production and micronutrient transportation using a two-stage upflow anaerobic sludge blanket (UASB) system under mesophilic temperature (37°C) with a constant recycle ratio of 1:1 (final effluent flow rate: feed flow rate). The first (hydrogen) UASB unit having 4 L liquid holding volume was controlled at pH 5.5 but the second (methane) UASB unit having 24 L liquid holding volume had no pH control. The two-stage UASB system operated at different COD loading rates from 8 to 20 kg/m³d based on total UASB working volume. The results showed that, at the optimum COD loading rate of 13 kg/m³d, the produced gas from the hydrogen UASB unit contained 1.5% H₂, 16.5% CH₄, and 82% CO₂ with H₂S of 252 ppm and also provided a hydrogen yield of 1.66 mL/g COD removed (or 0.56 mL/g COD applied) and a specific hydrogen production rate of 156.85 ml H₂/LRd (or 5.12 ml H₂/g MLVSS d). Under the optimum COD loading rate, the produced gas from the methane UASB unit mainly contained methane and carbon dioxide without hydrogen of 74 and 26%, respectively with hydrogen sulfide of 287 ppm and the system also provided a maximum methane yield of 407.00 mL/g COD removed (or 263.23 mL/g COD applied) and a specific methane production rate of 2081.44 ml CH₄/LRd (or 99.75 ml CH₄/g MLVSS d). Under the optimum COD loading rate, all micronutrients markedly dropped by the sulfide precipitation reactions. The reduction of micronutrients mostly appeared in the methane UASB unit. Under the studied conditions, both Co and Ni were found to be greatly precipitated out, causing the deficiency to microbial activity. It is hypothesized that an addition of both Co and Ni can improve the methanogenic activity.

Keywords: hydrogen and methane production, ethanol wastewater, a two-stage upflow anaerobic blanket (UASB) system, mesophillic temperature, microbial concentration (MLVSS), micronutrients

Procedia PDF Downloads 266

Authors: Alexandra-Veronica Luca, Letitia Petrescu

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Steel production is a major contributor to global warming potential. An average value of 1.83 tons of CO₂ is emitted for every ton of steel produced, resulting in over 3.3 Mt of CO₂ emissions each year. The present paper is focused on the investigation and comparison of two O₂ separation methods and two CO₂ capture technologies applicable to iron and steel industry. The O₂ used in steel production comes from an Air Separation Unit (ASU) using distillation or from air separation using membranes. The CO₂ capture technologies are represented by a two-stage membrane separation process and the gas-liquid absorption using methyl di-ethanol amine (MDEA). Process modelling and simulation tools, as well as environmental tools, are used in the present study. The production capacity of the steel mill is 4,000,000 tones/year. In order to compare the two CO₂ capture technologies in terms of efficiency, performance, and sustainability, the following cases have been investigated: Case 1: steel production using O₂ from ASU and no CO₂ capture; Case 2: steel production using O₂ from ASU and gas-liquid absorption for CO₂ capture; Case 3: steel production using O₂ from ASU and membranes for CO₂ capture; Case 4: steel production using O₂ from membrane separation method and gas-liquid absorption for CO₂ capture and Case-5: steel production using membranes for air separation and CO₂ capture. The O₂ separation rate obtained in the distillation technology was about 96%, and about 33% in the membrane technology. Similarly, the O₂ purity resulting in the conventional process (i.e. distillation) is higher compared to the O₂ purity obtained in the membrane unit (e.g., 99.50% vs. 73.66%). The air flow-rate required for membrane separation is about three times higher compared to the air flow-rate for cryogenic distillation (e.g., 549,096.93 kg/h vs. 189,743.82 kg/h). A CO₂ capture rate of 93.97% was obtained in the membrane case, while the CO₂ capture rate for the gas-liquid absorption was 89.97%. A quantity of 6,626.49 kg/h CO₂ with a purity of 95.45% is separated from the total 23,352.83 kg/h flue-gas in the membrane process, while with absorption of 6,173.94 kg/h CO₂ with a purity of 98.79% is obtained from 21,902.04 kg/h flue-gas and 156,041.80 kg/h MDEA is recycled. The simulation results, performed using ChemCAD process simulator software, lead to the conclusion that membrane-based technology can be a suitable alternative for CO₂ removal for steel production. An environmental evaluation using Life Cycle Assessment (LCA) methodology was also performed. Considering the electricity consumption, the performance, and environmental indicators, Case 3 can be considered the most effective. The environmental evaluation, performed using GaBi software, shows that membrane technology can lead to lower environmental emissions if membrane production is based on benzene derived from toluene hydrodealkilation and chlorine and sodium hydroxide are produced using mixed technologies.

Keywords: CO₂ capture, gas-liquid absorption, Life Cycle Assessment, membrane separation, steel production

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Authors: Eddy K. Mukadi

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The aim of this study was to provide contributing elements to improve the management of the asthma crisis in the intensive care unit of the General Reference Hospital of Kinshasa. This was a descriptive study of all patients in the intensive care unit presenting with the asthma attack during the period from February 5, 2013 to February 5, 2014. The main data were obtained from consultation registry and medical records. A total of 35 patients, 21 of whom were male (majority) compared to 14 female. Average age of patients was 46.48 plus or minus 16.98 with extremes ranging from 21-75 years. The clinic was dominated by dyspnea in 100% of cases, followed by rales with 91.4% of cases. In spite of the control of the crisis obtained after the treatment with B2 mimetic by inhalation was introduced A 91.5%; 88% corticosteroids; 80% oxygen, the therapeutic principle recommended for the management of asthma attacks was not respected in the majority of cases. This is why we suggest that improving the quality of care to be administered to patients will yield more adequate results.

Keywords: asthma crisis, intensive care, general hospital, Kinshasa

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Authors: Mohammadjavad Yaghoubi, Arul Arulrajah, Mahdi M. Disfani, Suksun Horpibulsuk, Myint W. Bo, Stephen P. Darmawan

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This paper investigates the changes in the strength development of a high water content soft soil stabilised with alkaline activation of fly ash (FA) to use in deep soil mixing (DSM) technology. The content of FA was 20% by dry mass of soil, and the alkaline activator was sodium silicate (Na2SiO3). Samples were cured for 3, 7, 14, 28 and 56 days to evaluate the effect of curing time on strength development. To study the effect of adding slag (S) to the mixture on the strength development, 5% S was replaced with FA. In addition, the effect of the initial unit weight of samples on strength development was studied by preparing specimens with two different static compaction stresses. This was to replicate the field conditions where during implementing the DSM technique, the pressure on the soil while being mixed, increases with depth. Unconfined compression strength (UCS), scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) tests were conducted on the specimens. The results show that adding S to the FA based geopolymer activated by Na2SiO3 decreases the strength. Furthermore, samples prepared at a higher unit weight demonstrate greater strengths. Moreover, samples prepared at lower unit weight reached their final strength at about 14 days of curing, whereas the strength development continues to 56 days for specimens prepared at a higher unit weight.

Keywords: alkaline activation, curing time, fly ash, geopolymer, slag

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Authors: Clemens Bulitta, Sasan Sadrizadeh, Sebastian Buhl

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Introduction: Ventilation technology in operating theatres (OT)is internationally regulated by dif-ferent standards, which define basic specifications for technical equipment and many times also the necessary operating and performance parameters. This confronts the operators of healthcare facilities with the question of finding the best ventilation and air conditioning system for the OT in order to achieve the goal of a large and robust surgicalworkzone with appropriate air quality and climate for patient safety and occupational health. Additionally, energy consumption and the potential need for clothing that limits transmission of bacteria must be considered as well as the total life cycle cost. However, the evaluation methodology of ventilation systems regarding these matters are still a topic of discussion. To date, there are neither any uniform standardized specifications nor any common validation criteria established. Thus, this study aimed to review data in the literature and add ourown research results to compare and assess the performance of different ventilations systems regarding infection preventive effects, energy efficiency, and staff comfort. Methods: We have conducted a comprehensive literature review on OT ventilation-related topics to understand the strengths and limitations of different ventilation systems. Furthermore, data from experimental assessments on OT ventilation systems at the University of Amberg-Weidenin Germany were in-cluded to comparatively assess the performance of Laminar Airflow (LAF), Turbulent Mixing Air-flow(TMA), and Temperature-controlled Airflow (TcAF) with regards to patient and occupational safety as well as staff comfort including indoor climate.CFD simulations from the Royal Institute of Technology in Sweden (KTH) were also studied to visualize the differences between these three kinds of ventilation systems in terms of the size of the surgical workzone, resilience to obstacles in the airflow, and energy use. Results: A variety of ventilation concepts are in use in the OT today. Each has its advantages and disadvantages, and thus one may be better suited than another depend-ing on the built environment and clinical workflow. Moreover, the proper functioning of OT venti-lation is also affected by multiple external and internal interfering factors. Based on the available data TcAF and LAF seem to provide the greatest effects regarding infection control and minimizing airborne risks for surgical site infections without the need for very tight surgical clothing systems. Resilience to obstacles, staff comfort, and energy efficiency seem to be favourable with TcAF. Conclusion: Based on literature data in current publications and our studies at the Technical Uni-versity of Applied Sciences Amberg-Weidenand the Royal Institute of Technoclogy, LAF and TcAF are more suitable for minimizing the risk for surgical site infections leading to improved clin-ical outcomes. Nevertheless, regarding the best management of thermal loads, atmosphere, energy efficiency, and occupational safety, overall results and data suggest that TcAF systems could pro-vide the economically most efficient and clinically most effective solution under routine clinical conditions.

Keywords: ventilation systems, infection control, energy efficiency, operating theatre, airborne infection risks

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Authors: S. Feli, S. Tavousi Tafreshi, A. Ghasemi

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The present paper aims at evaluating the response of three-dimensional buildings with in-plan stiffness irregularities that have been subjected to two-way excitation ground motion records simultaneously. This study is broadly-based fragility assessment with greater emphasis on structural response at in-plan flexible and stiff sides. To this end, three type of three-dimensional 5-story steel building structures with stiffness eccentricities, were subjected to extensive nonlinear incremental dynamic analyses (IDA) utilizing Ibarra-Krawinkler deterioration models. Fragility assessment was implemented for different configurations of braces to investigate the losses in buildings with center of resisting (CR) eccentricities.

Keywords: Ibarra-Krawinkler, fragility assessment, flexible and stiff side, center of resisting

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Authors: Abdelfatah Elsenosy, Mahmoud Ebrahim

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Background: Distal radius fractures are commonly encountered in orthopedic practice, especially in elderly patients. A number of clinical papers have supported the idea that anatomic restoration of the distal end of the radius is essential to gain superior results. Aim and objectives: The aim of the study is to systematically review the literature for the management of distal end radius in elderly persons (conservative treatment versus percutaneous wire fixation) as regards radiological and functional outcomes. Subjects and methods: Studies were identified from the Medline, Cochrane, EMBASE, and Google Scholar databases were searched until 2019 using combinations of the following search terms: distal radius fracture, conservative treatment, non-operative treatment, and nonsurgical treatment, surgical treatment, operative, elderly, and older. Reference lists of relevant studies were manually searched. Results: There was no statistical significance difference between CI and PKF groups’ frequency of complication in all of the selected studies. Based on the results, we recommend more analysis regarding every parameter of the radiographic and functional results and specific complications related to each fixation need to be accomplished, which requires more Randomized controlled trials (RCTs) with high quality. Conclusion: Surgical treatment seems to be more effective distal radius fracture compared with conservative treatment when the radiographic outcomes were analyzed, and no significant differences were detected in the functional outcomes and complication rate.

Keywords: radius, fracture, surgical, RCTs, conservative, radiographic, outcomes, orthopedic

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Authors: Matthew J. Zagumny

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The QUEST is an assessment of scientific epistemic beliefs and was developed to measure students’ intellectual development in regards to beliefs about knowledge and knowing. The QUEST utilizes Q-sort methodology, which requires participants to rate the degree to which statements describe them personally. As a measure of personal theories of knowledge, the QUEST instrument is described with the Q-sort distribution and scoring explained. A preliminary demonstration of the QUEST assessment is described with two samples of undergraduate students (novice/lower division compared to advanced/upper division students) being assessed and their average QUEST scores compared. The usefulness of an assessment of epistemology is discussed in terms of the principle that assessment tends to drive educational practice and university mission. The critical need for university and academic programs to focus on development of students’ scientific epistemology is briefly discussed.

Keywords: scientific epistemology, critical thinking, Q-sort method, STEM undergraduates

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Authors: Feng-Ming Fan, Xiu-Hui Wen, Po-Feng Chen, Yi-Ching Tu

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Because of inborn natural conditions and man-made sabotage, the water resources insufficient phenomenon in Taiwan is a very important issue needed to face immediately. The regulations and law of water resources protection and recycling are gradually completed now but still lack of specific water recycling effectiveness checking method. The research focused on the industrial parks that already had been certificated with EIA to establish a professional checking system, carry through and forge ahead to contribute one’s bit in water resources sustainable usage. Taiwan Government Policies of Environmental Impact Assessment established in 1994, some development projects were requested to set certain water recycling ratio for water resources effective usage. The water covers and contains everything because all-inclusive companies enter and be stationed. For control the execution status of industrial park water and waste water recycling ratio about EIA commitment effectively, we invited experts and scholars in this filed to discuss with related organs to formulate the policy and audit plan. Besides, call a meeting to set public version water equilibrium diagrams and recycles parameter. We selected nine industrial parks that were requested set certain water recycling ratio in EIA examination stage and then according to the water usage quantity, we audited 340 factories in these industrial parks with spot and documents examination and got fruitful results – the average water usage of unit area per year of all these examined industrial parks is 31,000 tons/hectare/year, the value is just half of Taiwan industries average. It is obvious that the industrial parks with EIA commitment can decrease the water resources consumption effectively. Taiwan government policies of Environmental Impact Assessment took follow though tracking function into consideration at the beginning. The results of this research verify the importance of the implementing with water recycling to save water resources in EIA commitment. Inducing development units to follow EIA commitment to get the balance between environmental protection and economic development is one of the important EIA value.

Keywords: Taiwan government policies of environmental impact assessment, water recycling ratio of EIA commitment, water resources sustainable usage, water recycling

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Authors: Fatemeh Rezaei, Mohammad H. Yarmohammadian, Masoud Ferdosi, Abbas Haghshnas

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Background: Failure Modes and Effect Analysis is now having known as the main methods of risk assessment and the accreditation requirements for many organizations. The Risk Priority Number (RPN) approach is generally preferred, especially for its easiness of use. Indeed it does not require statistical data, but it is based on subjective evaluations given by the experts about the Occurrence (O i), the Severity (Si) and the Detectability (D i) of each cause of failure. Methods: This study is a quantitative – qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment was conducted to calculate RPN score. Results; We have studied patient’s journey process in surgery ward and the most important phase of the process determined Transport of the patient from the holding area to the operating room. Failures of the phase with the highest priority determined by defining inclusion criteria included severity (clinical effect, claim consequence, waste of time and financial loss), occurrence (time- unit occurrence and degree of exposure to risk) and preventability (degree of preventability and defensive barriers) and quantifying risks priority criteria in the context of RPN index. Ability of improved RPN reassess by root cause (RCA) analysis showed some variations. Conclusions: Finally, It could be concluded that understandable criteria should have been developed according to personnel specialized language and communication field. Therefore, participation of both technical and clinical groups is necessary to modify and apply these models.

Keywords: failure mode, effects analysis, risk priority number(RPN), health system, risk assessment

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Authors: L. Hoade, O. O. Onafowokan, K. Anderson, G. E. Bartlett, E. D. Fern, M. R. Norton, R. G. Middleton

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Aims: Femoroacetabular impingement (FAI) was first recognised as a potential driver for hip pain at the turn of the last millennium. While there is an increasing trend towards surgical management of FAI by arthroscopic means, open surgical hip dislocation and debridement (SHD) remains the Gold Standard of care in terms of reported outcome measures. (1) Long-term functional and survivorship outcomes of SHD as a treatment for FAI are yet to be sufficiently reported in the literature. This study sets out to help address this imbalance. Methods: We undertook a retrospective review of our institutional database for all patients who underwent SHD for FAI between January 2003 and December 2008. A total of 223 patients (241 hips) were identified and underwent a ten year review with a standardised radiograph and patient-reported outcome measures questionnaire. The primary outcome measure of interest was survivorship, defined as progression to total hip arthroplasty (THA). Negative predictive factors were analysed. Secondary outcome measures of interest were survivorship to further (non-arthroplasty) surgery, functional outcomes as reflected by patient reported outcome measure scores (PROMS) scores, and whether a learning curve could be identified. Results: The final cohort consisted of 131 females and 110 males, with a mean age of 34 years. There was an overall native hip joint survival rate of 85.4% at ten years. Those who underwent a THA were significantly older at initial surgery, had radiographic evidence of preoperative osteoarthritis and pre- and post-operative acetabular undercoverage. In those whom had not progressed to THA, the average Non-arthritic Hip Score and Oxford Hip Score at ten year follow-up were 72.3% and 36/48, respectively, and 84% still deemed their surgery worthwhile. A learning curve was found to exist that was predicated on case selection rather than surgical technique. Conclusion: This is only the second study to evaluate the long-term outcomes (beyond ten years) of SHD for FAI and the first outside the originating centre. Our results suggest that, with correct patient selection, this remains an operation with worthwhile outcomes at ten years. How the results of open surgery compared to those of arthroscopy remains to be answered. While these results precede the advent of collison software modelling tools, this data helps set a benchmark for future comparison of other techniques effectiveness at the ten year mark.

Keywords: femoroacetabular impingement, hip pain, surgical hip dislocation, hip debridement

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Authors: G. I. Onwuka, A. Danbaba, S. U. Gulumbe

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This study investigated of Infant Mortality Rate as observed at a general hospital in Kaduna-South, Kaduna State, North West Nigeria. The causes of infant Mortality were examined. The data used for this analysis were collected at the statistics unit of the Hospital. The analysis was carried out on the data using Multiple Linear regression Technique and this showed that there is linear relationship between the dependent variable (death) and the independent variables (malaria, measles, anaemia, and coronary heart disease). The resultant model also revealed that a unit increment in each of these diseases would result to a unit increment in death recorded, 98.7% of the total variation in mortality is explained by the given model. The highest number of mortality was recorded in July, 2005 and the lowest mortality recorded in October, 2009.Recommendations were however made based on the results of the study.

Keywords: infant mortality rate, multiple linear regression, diseases, serial correlation

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Authors: Ali Baker, Russel Krawitz

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This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.

Keywords: acute-abdomen, MIS, COVID-19, ICU

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Authors: Jasmin S. Nurkovic, Ljubisa Dj. Jovasevic, Zana C. Dolicanin, Zoran S. Bajin

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Ruptured muscles and tendons very often must be repatriated by open operation in young persons. In young, muscles are ruptured more often than tendons, at the sane time in older persons are more exposed to rupture than muscles. Ruptured of the calcaneus are the most present of all ruptures. Sometime the rupture is complete, but very often the incomplete rupture can be noticed. During six years, from 2006 to 2012, we treated nineteen male patients and three female patients with the rupture of tendon Achilles. The youngest patient was aged thirty two, and the oldest was also managed sixty four. The youngest female patient was forty one and the oldest was forty six. One of our patients who was under corticosteroid treatment did not take any part in sport activities but she was, as she told us, going for a long walk, the same was with other two patients one man and one woman. We had nineteen male patients age 32 to 64 and three female patients age 41, 44 and 46. Conservative treatment by cast was applied in five patients and very good results were in three of them. In two patients surgical treatment failed in patient’s age 53 and 64. Only one of all patients treated by surgery had healing problems because of necrotic changes of the skin where incision was made. One of our female patients age 45 was under steroid treatment for almost 20 years because of asthmatic problems. We suggested her wearing boots with 8cm long heels by day and by night eight weeks. The final results were satisfactory and all the time she was able to work and to walk. It was the only case we had with bilateral tendon rupture. After eight weeks the cast is removed and psychiatric treatment started, patient is using crutches with partial weight bearing over a period of two weeks. Quite the same treatment conservative treatment, only the cast is not removed after two but after four weeks. Everyday activities after the surgical treatment started ten weeks and sport activities can start after fourteen to sixteen weeks. An increased activity of our patient without previous preparing for forces activity can result, as we already see, with tendon rupture. Treatment is very long and very often surgical. We find that surgical treatment resulted as safer and better solution for patients. We also had a patient with spontaneous rupture of tendon during longer walking but this patient was under prolonged corticosteroid treatment.

Keywords: tendon, Achilles, rupture, sport

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Authors: Celeste Labuschagne, Sam Ramaila, Thasmai Dhurumraj

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Although formative assessment is acknowledged as crucial for teachers to gauge students’ understanding of subject content, applying formative assessment in an online context is more challenging than in a traditional Physical Sciences classroom. This study examines challenges experienced by Grade 10 Physical Sciences teachers when enacting online formative assessment. The empirical investigation adopted a generic qualitative design and involved three purposively selected Grade 10 Physical Sciences teachers from three different schools and quintiles within the Tshwane North District in South Africa. Data were collected through individual and focus group interviews. Technological, pedagogical, and content knowledge (TPACK) was utilised as a theoretical framework underpinning the study. The study identified a myriad of challenges experienced by Grade 10 Physical Sciences teachers when enacting online formative assessment. These challenges include the utilisation of Annual Teaching Plans, lack of technological knowledge, and internet connectivity. The Department of Basic Education faces the key imperative to provide continuous teacher professional development and concomitant online learning materials that can facilitate meaningful enactment of online formative assessment in various educational settings.

Keywords: COVID-19, challenges, online formative assessment, physical sciences, TPACK

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Authors: Ade Dwi Utami

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Pedagogic competence is the basic competence of teachers to perform their tasks as educators. The ability to assess has become one of the demands in teachers pedagogic competence. Teachers ability to assess is related to curriculum instructions and applications. This research is aimed at obtaining data concerning teachers ability to assess that comprises of understanding assessment, determining assessment type, tools and procedure, conducting assessment process, and using assessment result information. It uses mixed method of explanatory technique in which qualitative data is used to verify the quantitative data obtained through a survey. The technique of quantitative data collection is by test whereas the qualitative data collection is by observation, interview and documentation. Then, the analyzed data is processed through a proportion study technique to be categorized into high, medium and low. The result of the research shows that teachers ability to assess can be grouped into 3 namely, 2% of high, 4% of medium and 94% of low. The data shows that teachers ability to assess is still relatively low. Teachers are lack of knowledge and comprehension in assessment application. The statement is verified by the qualitative data showing that teachers did not state which aspect was assessed in learning, record children’s behavior, and use the data result as a consideration to design a program. Teachers have assessment documents yet they only serve as means of completing teachers administration for the certification program. Thus, assessment documents were not used with the basis of acquired knowledge. The condition should become a consideration of the education institution of educators and the government to improve teachers pedagogic competence, including the ability to assess.

Keywords: assessment, early childhood education, pedagogic competence, teachers

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Authors: Nassim Salmi

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Postoperative mobilization is an important part of fundamental care. Increased mobilization has a positive effect on recovery, but immobilization is still a challenge in postoperative care. Aims: To report how the establishment of a national nursing database was used to measure postoperative mobilization in patients undergoing surgery for ovarian cancer. Mobilization was defined as at least 3 hours out of bed on postoperative day 1, with the goal set at achieving this in 60% of patients. Clinical nurses on 4400 patients with ovarian cancer performed data entry. Findings: 46.7% of patients met the goal for mobilization on the first postoperative day, but variations in duration and type of mobilization were observed. Of those mobilized, 51.8% had been walking in the hallway. A national nursing database creates opportunities to optimize fundamental care. By comparing nursing data with oncological, surgical, and pathology data, it became possible to study mobilization in relation to cancer stage, comorbidity, treatment, and extent of surgery.

Keywords: postoperative care, gynecology, nursing documentation, database

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Authors: Mary Butler

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Background: Screening programmes for older drivers in Europe (though not the UK), and in many states in the US and in Australia are based on medical assessment of fitness to drive. These programmes require physicians (including general practitioners) to carry out an assessment of fitness to drive in their offices. In 2006, New Zealand changed from doing on-road driving tests with all older drivers from the age of 80, to a screening programme that uses medical assessment of fitness to drive only. Aim: This study set out to understand the experience of New Zealand GPs as they manage the process of medical assessment of fitness to drive assessments for older people. In particular, it aimed to establish how GPs understand the role of specialist driving assessment and rehabilitation carried out by occupational therapists. Design and setting: The study used an interpretive descriptive approach to analyze data from ten interviews with GPs in New Zealand. Results: The results indicated that GPs lack understanding about how occupational therapists can assist their patients, and tend to refer only when there is a disagreement with the patient. Conclusion: There are problems with the medical assessment of fitness to drive carried out by GPs, and there is a need for a more comprehensive community approach to driving cessation. Patients, families and the multidisciplinary team all have a role in deciding when driving cessation should occur. Occupational therapists have a particular responsibility for strategic leadership in this area of practice.

Keywords: assessment, driving, older people, occupational therapy

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Authors: Mikhail Bouniaev

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The paper reviews design and implementation of a Calculus Course required for the Biomedical Competency Based Program developed as a joint project between The University of Texas Rio Grande Valley, and the University of Texas’ Institute for Transformational Learning, from the theoretical perspective as presented in scholarly work on active learning, formative assessment, and on-line teaching. Following a four stage curriculum development process (objective, content, delivery, and assessment), and theoretical recommendations that guarantee effectiveness and efficiency of assessment in active learning, we discuss the practical recommendations on how to incorporate a strong formative assessment component to address disciplines’ needs, and students’ major needs. In design and implementation of this project, we used Constructivism and Stage-by-Stage Development of Mental Actions Theory recommendations.

Keywords: active learning, assessment, calculus, cognitive demand, mathematics, stage-by-stage development of mental action theory

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Authors: Yen-Hsia Lin, Ya-Fang Cheng, Hui-Zhu Chen, Chi-Hui Tiao

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This is a case study of a 70-year-old man suffering from Type 2 diabetes mellitus and hyperglycemia hyperosmolarity state. He was admitted into the intensive care unit from the 20th to 26th of October, 2015. After receiving relevant information through open-ended conversations, observation, and physical assessment, as well as the psychological, social and spiritual holistic nursing assessment, several clinical health problems such as unstable blood sugar, impaired skin integrity and lack of self-care management knowledge were identified by the author. During the period of care, the patient was encouraged to share and express his feelings, an active listening and initiating approach from the nursing team had led to the understanding of why the patient refused to use insulin. This knowledge enabled the nursing team to manage patient care by educating the patient with self-care management skills, such as foot wound care and insulin injection skills to slow the deterioration of complications. Also, the implementation of appropriate diet and exercise routine to improve patients’ style. By enhancing self-care ability in diabetic patients, they are able to return home with the skill to improve better quality life style.

Keywords: hyperglycemia hyperosmolar state, type2 diabetes Mellitu, diabetes Mellitu foot care, intensive care

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Authors: Karlygash Adamova

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This article is focused on the KazTest as one of the most important high-stakes tests and the key tool in Kazakh language assessment. The research will also include the brief introduction to the language policy in Kazakhstan. Particularly, it is going to be changed significantly and turn from bilingualism (Kazakh, Russian) to multilingual policy (three languages - Kazakh, Russian, English). Therefore, the current status of the abovementioned languages will be described. Due to the various educational reforms in the country, the language evaluation system should also be improved and moderated. The research will present the most significant test of Kazakhstan – the KazTest, which is aimed to evaluate the Kazakh language proficiency. Assessment is an ongoing process that encompasses a wide area of knowledge upon the productive performance of the learners. Test is widely defined as a standardized or standard method of research, testing, diagnostics, verification, etc. The two most important characteristics of any test, as the main element of the assessment - validity and reliability - will also be described in this paper. Therefore, the preparation and design of the test, which is assumed to be an indicator of knowledge, and it is highly important to take into account all these properties.

Keywords: multilingualism, language assessment, testing, language policy

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Authors: Qing Cao

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Generally speaking, China has a relatively high level of intellectual property (IP) infringement. Risk assessment is indispensable in the strategic planning process. To complement the current literature in international business, the paper sheds the light on how to assess IP risk for foreign companies in planning market entry to China. Evaluating internal and external IP environment, proposed in the paper, consists of external analysis, internal analysis and further internal analysis. Through position the company’s IP environment, the risk assessment approach enables the foreign companies to either build the corresponding IP strategies or abort the entry plan beforehand to minimize the IP risks.

Keywords: intellectual property, IP environment, risk assessment

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Authors: B. M. Alshammari, M. A. El-Kady

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This paper presents a unified framework for assessment of reserve-based reliability levels in electric power systems. The unified approach is based on reserve-based analysis and assessment of the relationship between available generation capacities and required demand levels. The developed approach takes into account the load variations as well as contingencies which occur randomly causing some generation and/or transmission capacities to be lost (become unavailable). The calculated reserve based indices, which are important to assess the reserve capabilities of the power system for various operating scenarios are therefore probabilistic in nature. They reflect the fact that neither the load levels nor the generation or transmission capacities are known with absolute certainty. They are rather subjects to random variations and consequently. The calculated reserve-based reliability indices are all subjects to random variations where only expected values of these indices can be evaluated. This paper presents a unified approach to reserve-based reliability assessment of power systems using various reserve assessment criteria. Practical applications are also presented for demonstration purposes to the Saudi electricity power grid.

Keywords: assessment, power system, reserve, reliability

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Authors: Saman Khairani

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Assessment is a pivotal component of the teaching and learning process, serving as a critical tool for evaluating student progress, diagnosing learning needs, and informing instructional decisions. In the context of English Language Teaching (ELT), effective assessment practices are essential to promote meaningful learning experiences and foster continuous improvement in language proficiency. This paper delves into various assessment strategies, explores associated challenges, and highlights best practices for assessing student learning in ELT. The paper begins by examining the diverse forms of assessment, including formative assessments that provide timely feedback during the learning process and summative assessments that evaluate overall achievement. Additionally, alternative methods such as portfolios, self-assessment, and peer assessment play a significant role in capturing various aspects of language learning. Aligning assessments with learning objectives is crucial. Educators must ensure that assessment tasks reflect the desired language skills, communicative competence, and cultural awareness. Validity, reliability, and fairness are essential considerations in assessment design. Challenges in assessing language skills—such as speaking, listening, reading, and writing—are discussed, along with practical solutions. Constructive feedback, tailored to individual learners, guides their language development. In conclusion, this paper synthesizes research findings and practical insights, equipping ELT practitioners with the knowledge and tools necessary to design, implement, and evaluate effective assessment practices. By fostering meaningful learning experiences, educators contribute significantly to learners’ language proficiency and overall success.

Keywords: ELT, formative, summative, fairness, validity, reliability

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Authors: Gabriela Wasileski, Debra L. Stanley

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Maryland efforts to decrease the juvenile criminality and recidivism shifts towards evidence based sentencing. While in theory the evidence based sentencing has an impact on the reduction of juvenile delinquency and drug abuse; the assessment of juveniles’ risk and needs usually lacks crucial information about juvenile’s prior victimization. The Maryland Comprehensive Assessment and Service Planning (MCASP) Initiative is the primary tool for developing and delivering a treatment service plan for juveniles at risk. Even though it consists of evidence-based screening and assessment instruments very little is currently known regarding the effectiveness and the impact of the assessment in general. In keeping with Maryland’s priority to develop successful evidence-based recidivism reduction programs, this study examined results of assessments based on MCASP using a representative sample of the juveniles at risk and their assessment results. Specifically, it examined: (1) the results of the assessments in an electronic database (2) areas of need that are more frequent among delinquent youth in a system/agency, (3) the overall progress of youth in an agency’s care (4) the impact of child victimization and trauma experiences reported in the assessment. The project will identify challenges regarding the use of MCASP in Maryland, and will provide a knowledge base to support future research and practices.

Keywords: Juvenile Justice, assessment of risk and need, victimization and crime, recidivism

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Authors: Mansur Agzamov, Valery Bersnev, Natalia Ivanova, Istam Agzamov, Timur Khayrullaev, Yulduz Agzamova

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Objectives. Treatment of hypertensive intracerebral hematoma (ICH) is controversial. Advantage of one surgical method on other has not been established. Recent reports suggest a favorable effect of minimally invasive surgery. We conducted a small comparative study of different surgical methods. Methods. We analyzed the result of surgical treatment of 176 patients with intracerebral hematomas at the age from 41 to 78 years. Men were been113 (64.2%), women - 63 (35.8%). Level of consciousness: conscious -18, lethargy -63, stupor –55, moderate coma - 40. All patients on admission and in the dynamics underwent computer tomography (CT) of the brain. ICH was located in the putamen in 87 cases, thalamus in 19, in the mix area in 50, in the lobar area in 20. Ninety seven patients of them had an intraventricular hemorrhage component. The baseline volume of the ICH was measured according to a bedside method of measuring CT intracerebral hematomas volume. Depending on the intervention of the patients were divided into three groups. Group 1 patients, 90 patients, operated open craniotomy. Level of consciousness: conscious-11, lethargy-33, stupor–18, moderate coma -18. The hemorrhage was located in the putamen in 51, thalamus in 3, in the mix area in 25, in the lobar area in 11. Group 2 patients, 22 patients, underwent smaller craniotomy with endoscopic-assisted evacuation. Level of consciousness: conscious-4, lethargy-9, stupor–5, moderate coma -4. The hemorrhage was located in the putamen in 5, thalamus in 15, in the mix area in 2. Group 3 patients, 64 patients, was conducted minimally invasive removal of intracerebral hematomas using the original device (patent of Russian Federation № 65382). The device - funnel cannula - which after the special markings introduced into the hematoma cavity. Level of consciousness: conscious-3, lethargy-21, stupor–22, moderate coma -18. The hemorrhage was located in the putamen in 31, in the mix area in 23, thalamus in 1, in the lobar area in 9. Results of treatment were evaluated by Glasgow outcome scale. Results. The study showed that the results of surgical treatment in three groups depending on the degree of consciousness, the volume and localization of hematoma. In group 1, good recovery observed in 8 cases (8.9%), moderate disability in 22 (24.4%), severe disability - 17 (18.9%), death-43 (47.8%). In group 2, good recovery observed in 7 cases (31.8%), moderate disability in 7 (31.8%), severe disability - 5 (29.7%), death-7 (31.8%). In group 3, good recovery was observed in 9 cases (14.1%), moderate disability-17 (26.5%), severe disability-19 (29.7%), death-19 (29.7%). Conclusions. The method of using cannulae allowed to abandon from open craniotomy of the majority of patients with putaminal hematomas. Minimally invasive technique reduced the postoperative mortality and improves treatment outcomes of these patients.

Keywords: nontraumatic intracerebral hematoma, minimal invasive surgical technique, funnel canula, differentiated surcical treatment

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Authors: Tetyana Kendzerska, David T. Zhu, Michael Pugliese, Douglas Manuel, Mohsen Sadatsafavi, Marcus Povitz, Therese A. Stukel, Teresa To, Shawn D. Aaron, Sunita Mulpuru, Melanie Chin, Claire E. Kendall, Kednapa Thavorn, Rebecca Robillard, Andrea S. Gershon

Abstract:

The impact of the COVID-19 pandemic on the management of ambulatory care sensitive conditions (ACSCs) remains unknown. To compare observed and expected (projected based on previous years) trends in all-cause mortality and healthcare use for ACSCs in the first year of the pandemic (March 2020 - March 2021). A population-based study using provincial health administrative data.General adult population (Ontario, Canada). Monthly all-cause mortality, and hospitalizations, emergency department (ED) and outpatient visit rates (per 100,000 people at-risk) for seven combined ACSCs (asthma, COPD, angina, congestive heart failure, hypertension, diabetes, and epilepsy) during the first year were compared with similar periods in previous years (2016-2019) by fitting monthly time series auto-regressive integrated moving-average models. Compared to previous years, all-cause mortality rates increased at the beginning of the pandemic (observed rate in March-May 2020 of 79.98 vs. projected of 71.24 [66.35-76.50]) and then returned to expected in June 2020—except among immigrants and people with mental health conditions where they remained elevated. Hospitalization and ED visit rates for ACSCs remained lower than projected throughout the first year: observed hospitalization rate of 37.29 vs. projected of 52.07 (47.84-56.68); observed ED visit rate of 92.55 vs. projected of 134.72 (124.89-145.33). ACSC outpatient visit rates decreased initially (observed rate of 4,299.57 vs. projected of 5,060.23 [4,712.64-5,433.46]) and then returned to expected in June 2020. Reductions in outpatient visits for ACSCs at the beginning of the pandemic combined with reduced hospital admissions may have been associated with temporally increased mortality—disproportionately experienced by immigrants and those with mental health conditions. The Ottawa Hospital Academic Medical Organization

Keywords: COVID-19, chronic disease, all-cause mortality, hospitalizations, emergency department visits, outpatient visits, modelling, population-based study, asthma, COPD, angina, heart failure, hypertension, diabetes, epilepsy

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Authors: Yang Luo, Beibei Wang

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In this paper, we present a design methodology of lightweight register transfer level (RTL) hardware threat implemented based on a MAX II FPGA platform. The dynamic power consumed by the toggling of the various bit of registers as well as the dynamic power consumed per unit of logic circuits were analyzed. The hardware threat was designed taking advantage of the differences in dynamic power consumed per unit of logic circuits to hide the transfer information. The experiment result shows that the register hardware threat was successfully implemented by using different dynamic power consumed per unit of logic circuits to hide the key information of DES encryption module. It needs more than 100000 sample curves to reduce the background noise by comparing the sample space when it completely meets the time alignment requirement. In additional, an external trigger signal is playing a very important role to detect the hardware threat in this experiment.

Keywords: side-channel analysis, hardware Trojan, register transfer level, dynamic power

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Authors: Tedman Cheuk-Yiu Chau, Xavier Harvey, Hung Nguyen

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Defunctioning ileostomies are frequently used as an adjunct to low anterior resection in the surgical treatment of rectal cancer. Despite reducing the rate of clinically relevant anastomotic leak, the burden of defunctioning ileostomy is significant, with up to two-thirds of patients reporting stoma-related morbidity. International data have demonstrated an increased risk of bowel dysfunction and lower quality of life in patients with delayed closure (greater than six months post-surgery). While timely reversal is safe and cost-effective, the time to the reversal in Australian and New Zealand public hospitals is not described in the published literature. Thus, it is important to assess the current timeliness of ileostomy closure in the Australian regional context and examine the reasons for the delay. A retrospective analysis of ileostomy closure in Launceston General Hospital (LGH) patients treated with low/ultra low anterior resection for rectal cancer between 2012 and 2019 was undertaken. 94 cases of rectal adenocarcinoma undergoing ultralow anterior resection were examined over the years between 2012-2019. Amongst these, 21 cases (22.3%) were not reversed due to disease progress, death prior to reversal, or surgical complication. Demographics, disease status, surgical technique, and hospital inpatient events of these cases were examined. An average waiting time of 213.2 days was noted. Reasons for the delay include non-specified/prolonged hospital waiting time (54%), delayed or complicated chemotherapy course (13%), surgical complication (11%), advanced age, and frailty(5%). Complication of a delayed ileostomy reversal includes post-operation ileus and the development of an incisional hernia. We conclude that a delayed reversal of ileostomy can contribute to a higher incidence of stoma-related co-morbidities and contribute to a longer hospital stay and therefore use of public hospital resources.

Keywords: anterior resection, colorectal surgery, ileostomy reversal, rectal cancer

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Authors: Maziyar Nouraee

Abstract:

Electronic markets in recent decades contribute remarkably in business transactions. Many organizations consider traditional ways of trade non-economical and therefore they do trade only through electronic markets. There are different categorizations of electronic markets functions. In one classification, functions of electronic markets are categorized into classes as information, transactions, and value added. In the present paper, effects of the three classes on the two major elements of the supply chain management are measured. The two elements are decrease in the product unit cost and reduction in response time to the customer. The results of the current research show that among nine minor elements related to the three classes of electronic markets functions, six factors and three factors influence on reduction of the product unit cost and reduction of response time to the customer, respectively.

Keywords: electronic commerce, electronic market, B2B trade, supply chain management

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