Search results for: surgical planning

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

Procedia PDF Downloads 61

Authors: Manik Sharma

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Understanding the anatomy and normal anatomical variations of the lower limb arterial system is undeniably important not only to understand the pathology involving the vessels of the lower limb but also as a part of endovascular intervention and surgical planning in cases that demand them as a part of treatment. There have been very few cases of duplication of SFA cited in the literature, close to six worldwide and this being the seventh case in the world and first to be reported in the Indian population. We incidentally came across this normal variant during US lower limb (US-LL) duplex scan in a patient with claudicating pain in bilateral lower limbs hence suspected of having peripheral vascular disease. It was confirmed on CT-Peripheral Angiography (CT-PA), which was done successively.

Keywords: peripheral vascular disease, claudicating pain, normal anatomical variants, endovascular intervention, duplication, CT-peripheral angiography, duplex scan, Iohexol

Procedia PDF Downloads 125

Authors: Michael Dimmer, Holger Flederer

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The basis of realizing a construction project is a technically flawless concept which satisfies conditions regarding environment and costs, as well as static-constructional terms. The presented software system actively supports civil engineers during the setup of optimal designs, by giving advice regarding durability, life-cycle costs, sustainability and much more. A major part of the surrounding conditions of a design process is gathered and assimilated by experienced engineers subconsciously. It is a question about eligible building techniques and their practicability by considering emerging costs. Planning engineers have acquired many of this experience during their professional life and use them for their daily work. Occasionally, the planning engineer should disassociate himself from his experience to be open for new and better solutions which meet the functional demands, as well. The developed expert system gives planning engineers recommendations for preferred design options of new constructions as well as for existing bridge constructions. It is possible to analyze construction elements and techniques regarding sustainability and life-cycle costs. This way the software provides recommendations for future constructions. Furthermore, there is an option to design existing road bridges especially for heavy duty transport. This implies a route planning tool to get quick and reliable information as to whether the bridge support structures of a transport route have been measured sufficiently for a certain heavy duty transport. The use of this expert system in bridge planning companies and building authorities will save costs massively for new and existent bridge constructions. This is achieved by consequently considering parameters like life-cycle costs and sustainability for its planning recommendations.

Keywords: expert system, planning process, road bridges, software system

Procedia PDF Downloads 252

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

Procedia PDF Downloads 218

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

Procedia PDF Downloads 83

Authors: Amirreza Kosari, Hossein Maghsoudi, Malahat Givar

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In this study, the three-dimensional optimal path planning of a flying robot for Terrain Following / Terrain Avoidance (TF/TA) purposes using Direct Collocation has been investigated. To this purpose, firstly, the appropriate equations of motion representing the flying robot translational movement have been described. The three-dimensional optimal path planning of the flying vehicle in terrain following/terrain avoidance maneuver is formulated as an optimal control problem. The terrain profile, as the main allowable height constraint has been modeled using Fractal Generation Method. The resulting optimal control problem is discretized by applying Direct Collocation numerical technique, and then transformed into a Nonlinear Programming Problem (NLP). The efficacy of the proposed method is demonstrated by extensive simulations, and in particular, it is verified that this approach could produce a solution satisfying almost all performance and environmental constraints encountering a low-level flying maneuver

Keywords: path planning, terrain following, optimal control, nonlinear programming

Procedia PDF Downloads 162

Authors: Jhuang Jin-Jhong, Hsieh Wei-Fan

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Climate change causes natural disasters persistently. Therefore, nowadays environmental planning objective tends to the issues of respecting nature and coexisting with nature. As a result, the natural environment analysis, e.g., the analysis of topography, soil, hydrology, climate, vegetation, is highly emphasized. On the other hand, Feng Shui has been a criterion of site selection for residence in Eastern since the ancient times and has had farther influence on site selection for castles and even for temples and tombs. The primary criterion of site selection is judging the quality of Long: mountain range, Sha: nearby mountains, Shui: hydrology, Xue: foundation, Xiang: aspect, which are similar to the environmental variables of mountain range, topography, hydrology and aspect. For the reason, a lot researchers attempt to probe into the connection between the criterion of Feng Shui and environmental planning factors. Most researches only discussed with the composition and theory of space of Feng Shui, but there is no research which explained Feng Shui through the environmental field. Consequently, this study reviewed the theory of Feng Shui through the environmental planning viewpoint and assembled essential composition factors of Feng Shui. The results of this study point. From literature review and comparison of theoretical meanings, we find that the ideal principles for planning the Feng Shui environment can also be used for environmental planning. Therefore, this article uses 12 ideal environmental features used in Feng Shui to contrast the natural aspects of the environment and make comparisons with previous research and classifies the environmental factors into climate, topography, hydrology, vegetation, and soil.

Keywords: the composition of Feng Shui, environmental planning, site selection, main components of the Feng Shui environment

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Authors: Cinzia Colapinto, Davide La Torre

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Goal Programming (GP) and its variants were applied to marketing and specific marketing issues, such as media scheduling problems in the last decades. The concept of satisfaction functions has been widely utilized in the GP model to explicitly integrate the Decision-Maker’s preferences. These preferences can be guided by the available information regarding the decision-making situation. A GP model with satisfaction functions for media planning decisions is proposed and then illustrated through a case study related to a marketing/media campaign in the Italian market.

Keywords: goal programming, satisfaction functions, media planning, tourism management

Procedia PDF Downloads 371

Authors: Catherine Bernard, Paul Ransom

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Recent events have prompted emergency planners to re-evaluate their emergency response to major incidents and mass casualties. At the Royal Sussex County Hospital, we have adopted a tiered system comprised of three levels, anticipating an increasing P1, P2 or P3 load. This will aid planning in the golden period between Major Incident ‘Standby,’ and ‘Declared’. Each tier offers step-by-step instructions on appropriate patient movement within and out of the department, as well as suggestions for overflow areas and additional staffing levels. This system can be adapted to individual hospitals and provides concise instructions to be followed in a potentially overwhelming situation.

Keywords: disaster planning, emergency preparedness, major incident planning, mass casualty event

Procedia PDF Downloads 348

Authors: Han Song, Tingting Wei, Dong Chen

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The combination of capital and rural areas in China has shown its great significance in promoting urban-rural integration and new-style urbanization, enhancing regional capacity for sustainable rural development and optimizing human settlement environment. The purpose of this study is to find capital operation mechanism in rural area and rural planning guidance in China. Based on case studies in Chinese rural areas, two types of capital operation mechanism in rural areas are summed up: intervention in the field of agriculture promoting the upgrading and innovation of agricultural industry chain, intervention in rural life and leisure areas updating rural connotation and form. In the light of experiences in Japan and Taiwan, it is proposed that government's norms and guidance, rural investment intensity and rural self-organization are three important factors for capital to drive rural development. It is also found that the unique land tenure and rural governance tradition are two important factors effecting the combination of capital and rural regions in China, which requires full attention in rational policy-making and rural planning. It comes to a conclusion as four directions of the overall reform of the rural planning: targeting at enhancing the viability of rural and sustainable capacity, encouraging differences in investment incentives and planning policies, providing land usage in the rural areas with planning support and reforming the village system. Directional guidance is also made for different types of capital investments, suggesting that capital should be rooted in agriculture and rural land to benefit farmers and update human settlements.

Keywords: capital, rural areas, rural planning, rural governance

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Authors: Samuel Knox, Verdon Crann, Peyman Amiri, William Crowther

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There exists a shortage of open-source firmware for allowing researchers to focus on implementing high-level planning and control strategies for multi aerial robotic systems in simulation and experiment. Within this body of work, practical firmware is presented, which performs all supplementary tasks, including communications, pre and post-experiment procedures, and emergency safety measures. This allows researchers to implement high-level planning and control algorithms for path planning, traffic management, flight formation and swarming of aerial robots. The framework is built in Python using the MAVSDK library, which is compatible with flight controllers running PX4 firmware and onboard computers based on Linux. Communication is performed using Wi-Fi and the MQTT protocol, currently implemented using a centralized broker. Finally, a graphical user interface (GUI) has been developed to send general commands and monitor the agents. This framework enables researchers to prepare customized planning and control algorithms in a modular manner. Studies can be performed experimentally and in simulation using PX4 software in the loop (SITL) and the Gazebo simulator. An example experimental use case of the framework is presented using novel distributed planning and control strategies. The demonstration is performed using off-the-shelf components and minimal setup.

Keywords: aerial robotics, distributed framework, experimental, planning and control

Procedia PDF Downloads 88

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

Procedia PDF Downloads 54

Authors: Yen-Sheng Ho

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It is important to actively adjust the legal system of land use in archaeological sites and the reward system to meet the needs of modern society and to solve the dilemma of government management. Under the principle of administration according to law and the principle of the clarity of law, human rights, legal orders and legitimate expectation shall be regulated. The Cultural Heritage Preservation Act has many norms related to archaeological sites in Taiwan. However, in practice, the preservation of archaeological sites still encounters many challenges. For instance, some archaeological sites have ‘management and maintenance plans’. The restrictions of land uses are not clearly defined making it difficult to determine how planting types and cultivation methods will impact the underground relics. In addition, there are questions as follows. How to coordinate the ‘site preservation plan’ with the Regional Planning Act and the Urban Planning Act? How to define preservation of land, preservation area and other uses of land or area? How to define land use in practice? How to control land use? After selecting three sites for the case investigation, this study will analyze the site’s land use status and propose the direction of land use and control methods. This study suggests that the prerequisite to limit the use of land is to determine the public interest in the preservation of the site. Another prerequisite is to establish a mechanism for permitting the use of the site and for setting the site preservation and zoning maintenance practices according to the Regional Planning Act, Urban Planning Act and other relevant rules, such as, land use zoning, land use control, land management, land maintenance, regional development and management and etc.

Keywords: archaeological site, land use and site preservation plan, regional planning, urban planning

Procedia PDF Downloads 239

Authors: Zhen Wu, David Lupien St-Pierre, Georges Abdul-Nour

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In decision making under strict uncertainty, decision makers have to choose a decision without any information about the states of nature. The classic criteria of Laplace, Wald, Savage, Hurwicz and Starr are introduced and compared in a case study of sewer network planning. Furthermore, results from different criteria are discussed and analyzed. Moreover, this paper discusses the idea that decision making under strict uncertainty (DMUSU) can be viewed as a two-player game and thus be solved by a solution concept in game theory: Nash equilibrium.

Keywords: decision criteria, decision making, sewer network planning, decision making, strict uncertainty

Procedia PDF Downloads 521

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

Procedia PDF Downloads 65

Authors: Elahe Memari, Ahmad Aslizadeh, Ahmad Memari

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Today strategic planning is counted as the most important duties of senior directors in each organization. Strategic planning allows the organizations to implement compiled strategies and reach higher competitive benefits than their competitors. The present research work tries to prepare and rank the strategies form effective factors on strategic planning in fulfillment of the State Road Management and Transportation Organization in order to indicate the role of organizational factors in efficiency of the process to organization managers. Connection between six main factors in fulfillment of State Road Management and Transportation Organization were studied here, including Improvement of Strategic Thinking in senior managers, improvement of the organization business process, rationalization of resources allocation in different parts of the organization, coordination and conformity of strategic plan with organization needs, adjustment of organization activities with environmental changes, reinforcement of organizational culture. All said factors approved by implemented tests and then ranked using fuzzy multivariate decision-making technique.

Keywords: Fuzzy TOPSIS, improvement of organization business process, multivariate decision-making, strategic planning

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Authors: Ramya Rathan, Miral N. F. Salama

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The variations in the arteries have been drawing attention of anatomists for a long time because of their clinical significance. The brachial artery is the principal artery of the arm which is the continuation of the axillary artery from the lower border of the Teres Major. It terminates into the radial and ulnar arteries below the elbow joint at the neck radius. The present study aims at exploring the clinical significance of the high termination of the brachial artery. During the routine cadaveric dissection of the arm, for the undergraduate students of medicine at our university, we observed a high bifurcation of the radial and the ulnar artery at the midshaft of the humerus. The median nerve was seen passing between these two junctions. Further, the course and the relations of this artery were studied. The accurate knowledge regarding these kinds of variation in the blood vessels is mandatory for planning of designing. General physicians, surgeons and radiologists should keep in mind the variations in the branching pattern of the arteries in their daily medical, diagnostic and therapeutic procedures to avoid complications in diagnostic and surgical procedures.

Keywords: brachial artery, high termination, radial artery, ulnar artery

Procedia PDF Downloads 143

Authors: Mohammad Talei, Neda Ranjbar Nosheri, Reza Kazemi Gorzadini

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Today municipalities are searching for the new tools for increasing the public participation in different levels of urban planning. This approach of urban planning involves the community in planning process using participatory approaches instead of the long traditional top-down planning methods. These tools can be used to obtain the particular problems of urban furniture form the residents’ point of view. One of the tools that is designed with this goal is public participation GIS (PPGIS) that enables citizen to record and following up their feeling and spatial knowledge regarding main problems of the city, specifically urban furniture, in the form of maps. However, despite the good intentions of PPGIS, its practical implementation in developing countries faces many problems including the lack of basic supporting infrastructure and services and unavailability of sophisticated public participatory models. In this research we develop a PPGIS using of Web 2 to collect voluntary geodataand to perform spatial analysis based on Spatial OnLine Analytical Processing (SOLAP) and Spatial Data Mining (SDM). These tools provide urban planners with proper informationregarding the type, spatial distribution and the clusters of reported problems. This system is implemented in a case study area in Tehran, Iran and the challenges to make it applicable and its potential for real urban planning have been evaluated. It helps decision makers to better understand, plan and allocate scarce resources for providing most requested urban furniture.

Keywords: PPGIS, spatial information, urbanizing futures, urban planning

Procedia PDF Downloads 695

Authors: Khalid Abdelghany

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Additive Manufacturing (AM) is the manufacturing technology that is used to fabricate fast products direct from CAD models in very short time and with minimum operation steps. Jointly with the advancement in medical computer modeling, AM proved to be a very efficient tool to help physicians, orthopedic surgeons and dentists design and fabricate patient-tailored surgical guides, templates and customized implants from the patient’s CT / MRI images. AM jointly with computer-assisted designing/computer-assisted manufacturing (CAD/CAM) technology have enabled medical practitioners to tailor physical models in a patient-and purpose-specific fashion and helped to design and manufacture of templates, appliances and devices with a high range of accuracy using biocompatible materials. In developing countries, there are some technical and financial limitations of implementing such advanced tools as an essential portion of medical applications. CMRDI institute in Egypt has been working in the field of Medical Additive Manufacturing since 2003 and has assisted in the recovery of hundreds of poor patients using these advanced tools. This paper focuses on the surgical and dental use of 3D printing technology in Egypt as a developing country. The presented case studies have been designed and processed using the software tools and additive manufacturing machines in CMRDI through cooperative engineering and medical works. Results showed that the implementation of the additive manufacturing tools in developed countries is successful and could be economical comparing to long treatment plans.

Keywords: additive manufacturing, dental and orthopeadic stents, patient specific surgical tools, titanium implants

Procedia PDF Downloads 283

Authors: Lisa Bennett, Cynthia Walters, Cynthia Argani, Andy Satin, Geeta Sood, Kerri Huber, Lisa Grubb, Woodrow Noble, Melissa Eichelberger, Darlene Zinalabedini, Eric Ausby, Jeffrey Snyder, Kevin Kirchoff

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Background: Surgical site infections (SSIs) within the obstetric population pose a variety of complications, creating clinical and personal challenges for the new mother and her neonate during the postpartum period. Our journey to achieve compliance with the SSI core measure for cesarean sections revealed many opportunities to improve these outcomes. Objective: Achieve and sustain core measure compliance keeping surgical site infection rates below the national benchmark pooled mean of 1.8% in post-operative patients, who delivered via cesarean section at the Johns Hopkins Bayview Medical Center. Methods: A root cause analysis was performed and revealed several environmental, pharmacologic, and clinical practice opportunities for improvement. A multidisciplinary approach led by the OB Safety Nurse, OB Medical Director, and Infectious Disease Department resulted in the implementation of fourteen interventions over a twenty-month period. Interventions included: post-operative dressing changes, standardizing operating room attire, broadening pre-operative antibiotics, initiating vaginal preps, improving operating room terminal cleaning, testing air quality, and re-educating scrub technicians on technique. Results: Prior to the implementation of our interventions, the SSI quarterly rate in Obstetrics peaked at 6.10%. Although no single intervention resulted in dramatic improvement, after implementation of all fourteen interventions, the quarterly SSI rate has subsequently ranged from to 0.0% to 2.70%. Significance: Taking an introspective look at current practices can reveal opportunities for improvement which previously were not considered. Collectively the benefit of these interventions has shown a significant decrease in surgical site infection rates. The impact of this quality improvement project highlights the synergy created when members of the multidisciplinary team work in collaboration to improve patient safety, and achieve a high quality of care.

Keywords: cesarean section, surgical site infection, collaboration and teamwork, patient safety, quality improvement

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Authors: Kyle Burke Pfeiffer, Carmella Burdi, Karen Marsh

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The evacuation and shelter-in-place planning process employed by most jurisdictions within the United States is not informed by a scientifically-derived framework that is inclusive of the behavioral and policy-related indicators of public compliance with evacuation orders. While a significant body of work exists to define these indicators, the research findings have not been well-integrated nor translated into useable planning factors for public safety officials. Additionally, refinement of the planning factors alone is insufficient to support science-based evacuation planning as the behavioral elements of evacuees—even with consideration of policy-related indicators—must be examined in the context of specific regional transportation and shelter networks. To address this problem, the Federal Emergency Management Agency and Argonne National Laboratory developed an agent-based model to support regional analysis of zone-based evacuation in southeastern Georgia. In particular, this model allows public safety officials to analyze the consequences that a range of hazards may have upon a community, assess evacuation and shelter-in-place decisions in the context of specified evacuation and response plans, and predict outcomes based on community compliance with orders and the capacity of the regional (to include extra-jurisdictional) transportation and shelter networks. The intention is to use this model to aid evacuation planning and decision-making. Applications for the model include developing a science-driven risk communication strategy and, ultimately, in the case of evacuation, the shortest possible travel distance and clearance times for evacuees within the regional boundary conditions.

Keywords: agent-based modeling for evacuation, decision-support for evacuation planning, evacuation planning, human behavior in evacuation

Procedia PDF Downloads 207

Authors: Hsin-Yi Huang, Ming-Sheng Liu, Jiun-Yan Shiau

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Planning the order picking lists of warehouses to achieve when the costs associated with logistics on the operational performance is a significant challenge. In e-commerce era, this task is especially important productive processes are high. Nowadays, many order planning techniques employ supervised machine learning algorithms. However, the definition of which features should be processed by such algorithms is not a simple task, being crucial to the proposed technique’s success. Against this background, we consider whether unsupervised algorithms can enhance the planning of order-picking lists. A Zone2 picking approach, which is based on using clustering algorithms twice, is developed. A simplified example is given to demonstrate the merit of our approach.

Keywords: order picking, warehouse, clustering, unsupervised learning

Procedia PDF Downloads 123

Authors: Olivera Lupescu, Taina Elena Avramescu, Mihail Nagea, Alexandru Dimitriu

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Acetabular fractures represent a real challenge due to their impact upon the long term function of the hip joint, and due to the risk of intra- and peri-operative complications especially that they affect young, active people. That is why treating these fractures require certain skills which must be exercised, regarding the pre-operative planning, as well as the execution of surgery.The authors retrospectively analyse 38 cases with acetabular fractures operated using the posterior approach in our hospital between 01.01.2013- 01.01.2015 for which complete medical records ensure a follow-up of 24 months, in order to establish the main causes of potential errors and to underline the methods for preventing them. This target is included in the Erasmus + project ‘Collaborative learning for enhancing practical skills for patient-focused interventions in gait rehabilitation after orthopedic surgery COR-skills’. This paper analyses the pitfalls revealed by these cases, as well as the measures necessary to enhance the practical skills of the surgeons who perform acetabular surgery. Pre-op planning matched the intra and post-operative outcome in 88% of the analyzed points, from 72% at the beginning to 94% in the last case, meaning that experience is very important in treating this injury. The main problems detected for the posterior approach were: nervous complications - 3 cases, 1 of them a complete paralysis of the sciatic nerve, which recovered 6 months after surgery, and in other 2 cases intra-articular position of the screws was demonstrated by post-operative CT scans, so secondary screw removal was necessary in these cases. We analysed this incident, too, due to lack of information about the relationship between the screws and the joint secondary to this approach. Septic complications appeared in 3 cases, 2 superficial and 1 profound (requiring implant removal). The most important problems were the reduction of the fractures and the positioning of the screws so as not to interfere with the the articular space. In posterior acetabular fractures, pre-op complex planning is important in order to achieve maximum treatment efficacy with minimum of risk; an optimal training of the surgeons insisting on the main points of potential mistakes ensure the success of the procedure, as well as a favorable outcome for the patient.

Keywords: acetabular fractures, articular congruency, surgical skills, vocational training

Procedia PDF Downloads 186

Authors: N. Musayeva, N. Rustamova, N. Bagirov, S. Ibadov

Abstract:

Purpose: to analyze the long-term results of external dacryocystorhinostomy (DCR), which remains the preferred primary procedure in the surgical treatment of lacrimal duct obstruction in chronic dacryocystitis. Methodology: long-term results of external DCR (after 3 years) performed on 90 patients (90 eyes) with chronic dacryocystitis from 2018 to 2020 were evaluated. The Azerbaijan National Center of Ophthalmology, named after acad. Zarifa Aliyeva. 15 of the patients were men, 75 – women. The average age was 45±3.2 years. Surgical operations were performed under local anesthesia. All patients suffered from diabetes mellitus for more than 3 years. All patients underwent external DCR and silicone drainage (tube) was implanted. In the postoperative period (after 3 years), lacrimation, purulent discharge, and the condition of the scar at the operation site were assessed. Results: All patients were under observation for more than 18 months. In general, the effectiveness of the surgical operation was 93.34%. Recurrence of disease was observed in 6 patients and in 3 patients (3.33%), the scar at the site of the operation was rough (non-cosmetic). In 3 patients (3.33%) – the surgically formed anastomosis between the lacrimal sac and the nasal bone was obstructed by scar tissue. These patients were reoperated by trans canalicular laser DCR. Conclusion: Despite the long-term (more than a hundred years) use of external DCR, it remains one of the primary techniques in the surgery of chronic dacryocystitis. Due to the high success rate and good long-term results of DCR in the treatment of chronic dacryocystitis in patients suffering from diabetes mellitus, we recommend external DCR for this group of patients.

Keywords: chronic dacryocystitis, diabetes mellitus, external dacryocystorhinostomy, long-term results

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Authors: Mohammed Sulaiman, Hexu Liu, Mohamed Binalhaj, William W. Liou, Osama Abudayyeh

Abstract:

Emerging technologies such as camera-equipped unmanned aerial vehicles (UAVs) are increasingly being applied in building fire rescue to provide real-time visualization and 3D reconstruction of the entire fireground. However, flight planning of camera-equipped UAVs is usually a manual process, which is not sufficient to fulfill the needs of emergency management. This research proposes a Geographic Information System (GIS)-based approach to automatic flight planning of camera-equipped UAVs for building fire emergency response. In this research, Haversine formula and lawn mowing patterns are employed to automate flight planning based on geometrical and spatial information from GIS. The resulting flight mission satisfies the requirements of 3D reconstruction purposes of the fireground, in consideration of flight execution safety and visibility of camera frames. The proposed approach is implemented within a GIS environment through an application programming interface. A case study is used to demonstrate the effectiveness of the proposed approach. The result shows that flight mission can be generated in a timely manner for application to fire emergency response.

Keywords: GIS, camera-equipped UAVs, automatic flight planning, fire emergency response

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Authors: Sun Ailu, Zhao Wanmin

Abstract:

Since the reform and opening, the urbanization process of China has entered a rapid development period. In recent years, the authors participated in some projects of urban master planning in China and found a phenomenon that the rapid urbanization area of China is experiencing frequent adjustment process of urban master planning. This phenomenon is not the natural process of urbanization development. It may be caused by different government roles from different levels. Through the methods of investigation, data comparison and case study, this paper aims to explore the reason why the rapid urbanization area is experiencing frequent adjustment of master planning and give some solution strategies. Firstly, taking Changshou district of Chongqing city as an example, this paper wants to introduce the phenomenon about frequent adjustment process in China. And then, discuss distinct roles in the process between national government, provincial government and local government of China. At last, put forward preliminary solutions strategies for this area in China from the aspects of land use, intergovernmental cooperation and so on.

Keywords: urban master planning, frequent adjustment, urbanization development, problems and strategies, China

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Authors: Erika Yamaguchi, Sirawadee Arunyanrt, Shunichi Ohmori, Kazuho Yoshimoto

Abstract:

In this paper, we suggest a simulation tool to make a decision of monthly production planning for maximizing a profit of Specialty store retailer of Private label Apparel (SPA) firms. Most of SPA firms are fabless and make outsourcing deals for productions with factories of their subcontractors. Every month, SPA firms make a booking for production lines and manpower in the factories. The booking is conducted a few months in advance based on a demand prediction and a monthly production planning at that time. However, the demand prediction is updated month by month, and the monthly production planning would change to meet the latest demand prediction. Then, SPA firms have to change the capacities initially booked within a certain range to suit to the monthly production planning. The booking system is called “capacity-booking”. These days, though it is an issue for SPA firms to make precise monthly production planning, many firms are still conducting the production planning by empirical rules. In addition, it is also a challenge for SPA firms to match their products and factories with considering their demand predictabilities and regulation abilities. In this paper, we suggest a model for considering these two issues. An objective is to maximize a total profit of certain periods, which is sales minus costs of production, inventory, and capacity-booking penalty. To make a better monthly production planning at SPA firms, these points should be considered: demand predictabilities by random trends, previous and next month’s production planning of the target month, and regulation abilities of the capacity-booking. To decide matching products and factories for outsourcing, it is important to consider seasonality, volume, and predictability of each product, production possibility, size, and regulation ability of each factory. SPA firms have to consider these constructions and decide orders with several factories per one product. We modeled these issues as a linear programming. To validate the model, an example of several computational experiments with a SPA firm is presented. We suppose four typical product groups: basic, seasonal (Spring / Summer), seasonal (Fall / Winter), and spot product. As a result of the experiments, a monthly production planning was provided. In the planning, demand predictabilities from random trend are reduced by producing products which are different product types. Moreover, priorities to produce are given to high-margin products. In conclusion, we developed a simulation tool to make a decision of monthly production planning which is useful when the production planning is set every month. We considered the features of capacity-booking, and matching of products and factories which have different features and conditions.

Keywords: capacity-booking, SPA, monthly production planning, linear programming

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Authors: Ghoul Rachid Brahim

Abstract:

Introduction: Back pain is a real public health problem with a significant socio-economic impact. It is the consequence of a degeneration of the lumbar intervertebral disc (IVD). This often asymptomatic pathology is compatible with an active life. As soon as it becomes symptomatic, conservative treatment is recommended in the majority of cases. The physical or functional disability is resistant to well-monitored conservative treatment, which justifies a surgical alternative which imposes a well-studied reflection on the objectives to be achieved. Objective: Evaluate the indication and short and medium term contribution of surgery in the management of painful degenerative lumbar disc disease. To prove the effectiveness of surgical treatment in the management of painful lumbar degenerative disc disease. Materials and methods: This is a prospective descriptive mono-centric study without comparison group, comprising a series of 104 patients suffering from lumbar painful degenerative disc disease treated surgically. Retrospective analysis of data collected prospectively. Comparison between pre and postoperative clinical status, by pain self-assessment scores and on the impact on pre and postoperative quality of life (3, 6 to 12 months). Results: This study showed that patients who received surgical treatment had great improvements in symptoms, function and several health-related quality of life in the first year after surgery. Conclusions: The surgery had a significantly positive impact on patients' pain, disability and quality of life. Overall, 97% of the patients were satisfied.

Keywords: degenerative disc disease, intervertebral disc, several health-related quality, lumbar painful

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Authors: Fatih Eren

Abstract:

This research aims to find an answer to the question of which knowledge and skills do the Turkish urban planners need in their business practice. Understanding change in cities, making a prediction, making an urban decision and putting it into practice, working together with actors from different organizations from various academic disciplines, persuading people to accept something and developing good personal and professional relationships have become very complex and difficult in today’s world. The truth is that urban planners work in many institutions under various positions which are not similar to each other by field of activity and all planners are forced to develop some knowledge and skills for success in their business in Turkey. This study targets to explore what urban planners do in the global information age. The study is the product of a comprehensive nation-wide research. In-depth interviews were conducted with 174 experienced urban planners, who work in different public institutions and private companies under varied positions in the Turkish Planning System, to find out knowledge and skills needed by next-generation urban planners. The main characteristics of next-generation urban planners are defined; skills that planners needed today are explored in this paper. Findings show that the positivist (traditional) planning approach has given place to anti-positivist planning approaches in the Turkish Planning System so next-generation urban planners who seek success and want to carve out a niche for themselves in business life have to equip themselves with innovative skills. The result section also includes useful and instructive findings for planners about what is the meaning of being an urban planner and what is the ideal content and context of planning education at universities in the global age.

Keywords: global information age, Turkish Planning System, the institutional approach, urban planners, roles, skills, values

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Authors: Rayeheh Khatami, Toktam Hanaei, Mohammad Reza Mansouri Daneshvar

Abstract:

Today, many local and national governments are developing urban agriculture as an effective tool in responding to challenges such as food security, poverty and environmental problems. In fact, urban agriculture plays an important role in food system, which can provide citizens' income and become one of the components of economic, social and environmental systems. The purpose of this paper is to analyze the urban agriculture and urban food systems in order to understand the impact of urban foods production on environmental planning in non-western city region context. To achieve such objective, we carry out a case study in Mashhad city of Iran by using qualitative approaches. A survey on documentary studies and planning tools integrate with face to face interview with experts which explain the role of food system in environmental planning process. The paper extends the use of food in the environmental planning, specifically to examine this role to create agricultural garden as a mean to improve agricultural system in non-western country. The paper is concluded with a set of recommendations for researchers and policymakers who seek to create spaces in order to implement urban agriculture in cities for food justice.

Keywords: urban agriculture , agricultural park, city region food system, Mashhad

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