Search results for: unplanned readmission
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 169

Search results for: unplanned readmission

109 An Integrative Review of Changes of Family Relationship and Mental Health that Chinese Men Experience during Transition to Fatherhood

Authors: Mo Zhou, Samantha Ashby, Lyn Ebert

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In China, the changes that men experience in the perinatal period are not well researched. Men are also at risk of maladaptation to parenthood. The aim of this research is to review current studies regarding changes that Chinese men experience during transitioning to parenthood. 5 databases were employed to search relevant papers. The search found 128 articles. Based on the inclusion and exclusion criteria, 35 articles were included in this integrative review. Results showed the changes that Chinese fathers experienced during the transition to parenthood can be divided into two aspects: family relationships and mental problems. During transition to parenthood, fathers usually experienced an increase in their disappointment with marital conflict resolution and decreased sexual intimacy with their partner. Mental health declined, with fathers often feeling depressed and/or anxious during this time. Some men were diagnosed with clinical depression. The predictors of these changes included three domains: personal background (age and income), family background (gender of infant, relationship status and unplanned child) and cultural background (‘doing the month’, Confucianism, policy, social support).

Keywords: China, men, fatherhood, life change, postpartum

Procedia PDF Downloads 131
108 Integrated Grey Rational Analysis-Standard Deviation Method for Handover in Heterogeneous Networks

Authors: Mohanad Alhabo, Naveed Nawaz, Mahmoud Al-Faris

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The dense deployment of small cells is a promising solution to enhance the coverage and capacity of the heterogeneous networks (HetNets). However, the unplanned deployment could bring new challenges to the network ranging from interference, unnecessary handovers and handover failures. This will cause a degradation in the quality of service (QoS) delivered to the end user. In this paper, we propose an integrated Grey Rational Analysis Standard Deviation based handover method (GRA-SD) for HetNet. The proposed method integrates the Standard Deviation (SD) technique to acquire the weight of the handover metrics and the GRA method to select the best handover base station. The performance of the GRA-SD method is evaluated and compared with the traditional Multiple Attribute Decision Making (MADM) methods including Simple Additive Weighting (SAW) and VIKOR methods. Results reveal that the proposed method has outperformed the other methods in terms of minimizing the number of frequent unnecessary handovers and handover failures, in addition to improving the energy efficiency.

Keywords: energy efficiency, handover, HetNets, MADM, small cells

Procedia PDF Downloads 83
107 Spontaneous Message Detection of Annoying Situation in Community Networks Using Mining Algorithm

Authors: P. Senthil Kumari

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Main concerns in data mining investigation are social controls of data mining for handling ambiguity, noise, or incompleteness on text data. We describe an innovative approach for unplanned text data detection of community networks achieved by classification mechanism. In a tangible domain claim with humble secrecy backgrounds provided by community network for evading annoying content is presented on consumer message partition. To avoid this, mining methodology provides the capability to unswervingly switch the messages and similarly recover the superiority of ordering. Here we designated learning-centered mining approaches with pre-processing technique to complete this effort. Our involvement of work compact with rule-based personalization for automatic text categorization which was appropriate in many dissimilar frameworks and offers tolerance value for permits the background of comments conferring to a variety of conditions associated with the policy or rule arrangements processed by learning algorithm. Remarkably, we find that the choice of classifier has predicted the class labels for control of the inadequate documents on community network with great value of effect.

Keywords: text mining, data classification, community network, learning algorithm

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106 Factors Associated with Risky Sexual Behaviour in Adolescent Girls and Young Women in Cambodia: A Systematic Review

Authors: Farwa Rizvi, Joanne Williams, Humaira Maheen, Elizabeth Hoban

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There is an increase in risky sexual behavior and unsafe sex in adolescent girls and young women aged 15 to 24 years in Cambodia, which negatively affects their reproductive health by increasing the risk of contracting sexually transmitted infections and unintended pregnancies. Risky sexual behavior includes ‘having sex at an early age, having multiple sexual partners, having sex while under the influence of alcohol or drugs, and unprotected sexual behaviors’. A systematic review of quantitative research conducted in Cambodia was undertaken, using the theoretical framework of the Social Ecological Model to identify the personal, social and cultural factors associated with risky sexual behavior and unsafe sex in young Cambodian women. PRISMA guidelines were used to search databases including Medline Complete, PsycINFO, CINAHL Complete, Academic Search Complete, Global Health, and Social Work Abstracts. Additional searches were conducted in Science Direct, Google Scholar and in the grey literature sources. A risk-of-bias tool developed explicitly for the systematic review of cross-sectional studies was used. Summary item on the overall risk of study bias after the inter-rater response showed that the risk-of-bias was high in two studies, moderate in one study and low in one study. The search strategy included a combination of subject terms and free text terms. The medical subject headings (MeSH) terms included were; contracept* or ‘birth control’ or ‘family planning’ or pregnan* or ‘safe sex’ or ‘protected intercourse’ or ‘unprotected intercourse’ or ‘protected sex’ or ‘unprotected sex’ or ‘risky sexual behaviour*’ or ‘abort*’ or ‘planned parenthood’ or ‘unplanned pregnancy’ AND ( barrier* or obstacle* or challenge* or knowledge or attitude* or factor* or determinant* or choic* or uptake or discontinu* or acceptance or satisfaction or ‘needs assessment’ or ‘non-use’ or ‘unmet need’ or ‘decision making’ ) AND Cambodia*. Initially, 300 studies were identified by using key words and finally, four quantitative studies were selected based on the inclusion criteria. The four studies were published between 2010 and 2016. The study participants ranged in age from 10-24 years, single or married, with 3 to 10 completed years of education. The mean age at sexual debut was reported to be 18 years. Using the perspective of the Social Ecological Model, risky sexual behavior was associated with individual-level factors including young age at sexual debut, low education, unsafe sex under the influence of alcohol and substance abuse, multiple sexual partners or transactional sex. Family level factors included living away from parents, orphan status and low levels of family support. Peer and partner level factors included peer delinquency and lack of condom use. Low socioeconomic status at the society level was also associated with risky sexual behaviour. There is scant research on sexual and reproductive health of adolescent girls and young women in Cambodia. Individual, family and social factors were significantly associated with risky sexual behaviour. More research is required to inform potential preventive strategies and policies that address young women’s sexual and reproductive health.

Keywords: adolescents, high-risk sex, sexual activity, unplanned pregnancies

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105 Post-Discharge Oral Nutritional Supplements Following Gastric Cancer Surgery: A systematic Review

Authors: Mohammad Mohammadi, Mohammad Pashmchi

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Background: Malnutrition commonly develops and worsens following gastric cancer surgery, particularly after discharge, which is associated with adverse outcomes. Former studies have primarily focused on patients during their hospital stay period, and there is limited evidence regarding the recommendation of nutritional interventions for patients after discharge from the hospital following gastric cancer surgery. This review is aimed to evaluate the efficiency of post-discharge dietary counseling with oral nutritional supplements (ONS), and dietary counseling alone on post-surgical nutritional outcomes in patients undergoing gastric cancer surgery. Methods: The four databases of Embase, PubMed, web of science, and google scholar were searched up to November 2022 for relevant randomized controlled trials. The Cochrane Collaboration’s assessment tool for randomized trials was used to evaluate the quality of studies. Results: Compared to patients who only received dietary counseling, patients who received both dietary counseling and ONS had considerably higher SMI, BMI, and less weight loss and sarcopenia occurrence rate. The patients who had received dietary counseling and ONS had significantly lower risk of chemotherapy intolerance. No differences in the readmission rate between the two groups was found. In terms of the quality of life, concomitant dietary advice and ONS significantly was associated with lower appetite loss and fatigue rate, but there was no difference in the other outcomes between the two groups. Conclusions: Post-discharge dietary advice with ONS following gastric cancer surgery may improve skeletal muscle maintenance, nutritional outcomes, quality of life variables, and chemotherapy tolerance. This evidence supports the recommendation of post-discharge dietary advice with ONS for patients who underwent gastric cancer surgery.

Keywords: gastric cancer surgery, oral nutritional supplements, malnutrition, gastric cancer

Procedia PDF Downloads 39
104 Restoring, Revitalizing and Recovering Brazilian Rivers: Application of the Concept to Small Basins in the City of São Paulo, Brazil

Authors: Juliana C. Alencar, Monica Ferreira do Amaral Porto

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Watercourses in Brazilian urban areas are constantly being degraded due to the unplanned use of the urban space; however, due to the different contexts of land use and occupation in the river watersheds, different intervention strategies are required to requalify them. When it comes to requalifying watercourses, we can list three main techniques to fulfill this purpose: restoration, revitalization and recovery; each one being indicated for specific contexts of land use and occupation in the basin. In this study, it was demonstrated that the application of these three techniques to three small basins in São Paulo city, listing the aspects involved in each of the contexts and techniques of requalification. For a protected watercourse within a forest park, renaturalization was proposed, where the watercourse is preserved in a state closer to the natural one. For a watercourse in an urban context that still preserves open spaces for its maintenance as a landscape element, an intervention was proposed following the principles of revitalization, integrating the watercourse with the landscape and the population. In the case of a watercourse in a harder context, only recovery was proposed, since the watercourse is found under the road system, which makes it difficult to integrate it into the landscape.

Keywords: sustainable drainage, river restoration, river revitalization, river recovery

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103 A Comprehensive Evaluation of the Bus Rapid Transit Project from Gazipur to Airport at Dhaka Focusing on Environmental Impacts

Authors: Swapna Begum, Higano Yoshiro

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Dhaka is the capital city of Bangladesh. It is considered as one of the traffic congested cities in the world. The growth of the population of this city is increasing day by day. The land use pattern and the increased socio-economic characteristics increase the motor vehicle ownership of this city. The rapid unplanned urbanization and poor transportation planning have deteriorated the transport environment of this city. Also, the huge travel demand with non-motorized traffics on streets is accounted for enormous traffic congestion in this city. The land transport sector in Dhaka is mainly dependent on road transport comprised of both motorized and non-motorized modes of travel. This improper modal mix and the un-integrated system have resulted in huge traffic congestion in this city. Moreover, this city has no well-organized public transport system and any Mass Transit System to cope with this ever increasing demand. Traffic congestion causes serious air pollution and adverse impact on the economy by deteriorating the accessibility, level of service, safety, comfort and operational efficiency. Therefore, there is an imperative need to introduce a well-organized, properly scheduled mass transit system like (Bus Rapid Transit) BRT minimizing the existing problems.

Keywords: air pollution, BRT, mass transit, traffic congestion

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102 Analysis of Street Utilization Patterns in Makurdi, Benue State, Nigeria

Authors: I. D. Mngutyo, T. T. Gyuse, D. S. A. Alaci, J. Atser

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Streets are public spaces that are meaningful to all people because of lack of restriction on streets. Studies show that conditions, activities and people contribute to the success of public spaces. Also, self-organization potential in activity patterns offers a prospect for the revitalization of an urban area. This potential is mostly ignored hence many African streets appear disorganized giving African urban areas an unplanned look. Therefore, this study aims to analyze street utilization patterns and explore the relationship between the pattern of street use and condition of streets in Makurdi.These activity patterns form a data base for the revitalization of public space. Three major and minor arterials streets in nine out of the eleven wards that make up the built up part of Makurdi were purposively selected as units for measurement. A street activity audit was done on streets for activities that can be observed. For activities that cannot be easily observed 4 questionnaires were randomly administered on each of the three streets giving a total of 108 questionnaires. Multivariate statistical tools such as factor analysis and regression will be used to show emerging streets activity patterns and spatial variation among the nine wards.

Keywords: streets, utilization patterns, revitalization, urban design, urban, areas, developing countries

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101 Sustainable Urban Landscape Practices: A New Concept to Reduce Ecological Degradation

Authors: Manjari Rai

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Urbanization is an inevitable process of development of human society and an outcome of economic development and scientific and technological progress. While urbanization process in promoting the development of human civilization, also no doubt, urban landscape has been a corresponding impact. Urban environment has suffered unprecedented damage majorly due to the increase in urban population density and heavy migration rate, traffic congestion, and environmental pollution. All this have however led to a major ecological degradation and imbalance. As lands are used for the rapid and unplanned urbanization, the green lands are diminished, and severe pollution is created by waste products. Plastic, the most alarming waste at landfill sites, is yet uncontrolled. Therefore, initiatives must be taken to reduce plastic mediated pollution and increase green application. However, increasing green land is not possible due to the landfill by urban structures. In order to create a harmonious environment, sustainable development in the urban landscape becomes a matter of prime focus. This paper thus discusses the concept of ecological design combined with the urban landscape design, green landscape design on urban structures and sustainable development through the use of recyclable waste materials which is also a low costing approach of urban landscape design.

Keywords: ecological, degradation sustainable, landscape, urban

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100 A Review of Literature on Theories of Construction Accident Causation Models

Authors: Samuel Opeyemi Williams, Razali Bin Adul Hamid, M. S. Misnan, Taki Eddine Seghier, D. I. Ajayi

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Construction sites are characterized with occupational risks. Review of literature on construction accidents reveals that a lot of theories have been propounded over the years by different theorists, coupled with multifarious models developed by different proponents at different times. Accidents are unplanned events that are prominent in construction sites, involving materials, objects and people with attendant damages, loses and injuries. Models were developed to investigate the causations of accident with the aim of preventing its occurrence. Though, some of these theories were criticized, most especially, the Heinrich Domino theory, being mostly faulted for placing much blame on operatives rather than the management. The purpose of this paper is to unravel the significant construction accident causation theories and models for the benefit of understanding of the theories, and consequently enabling construction stakeholders identify the possible potential hazards on construction sites, as all stakeholders have significant roles to play in preventing accident. Accidents are preventable; hence, understanding the risk factors of accident and the causation theories paves way for its prevention. However, findings reveal that still some gaps missing in the existing models, while it is recommended that further research can be made in order to develop more models in order to maintain zero accident on construction sites.

Keywords: domino theory, construction site, site safety, accident causation model

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99 The Cost of Innovation in Software Development Projects

Authors: Mihai Liviu Despa

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The paper tackles the topic of determining the cost of innovation in software development projects. Innovation can be achieved either in a planned or unplanned manner. The paper approaches the scenarios were innovation is planned for. As a starting point an innovative software development project is analyzed. The project is depicted step by step as it was implemented, from inception to delivery. Costs that are proprietary to innovation in software development are isolated based on the author’s personal experience in managing the above mentioned project. Innovation costs components identified by the author are then validated using open discussions with software development professionals and projects managers on LinkedIn groups. In order to receive relevant feedback only groups that focus on software development and innovation management are targeted. Additional innovation cost components suggested by software development professionals and projects managers are also considered. Based on the identified cost components an indicator is built. The indicator is meant to formalize the process of determining the cost of innovation in a software development project. The indicator aggregates all the innovation cost components that are identified in the research process. The process of calculating each cost component is also described. Conclusions are formulated and new related research topics are submitted for debate.

Keywords: innovation cost, IT project management, software development, innovation management

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98 Rethinking Everyday Urban Spaces Using Principles of Resilient Urbanism: A Case of Flooding in Thiruvalla

Authors: Prejily Thomas John

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Flooding of urban areas often has an adverse impact on the dense population residing in cities. The vulnerable areas are the most affected due to flooding, which even results in loss of life. The increasing trend of urban floods is a universal phenomenon and leads to a vital loss in the physical, economic, social, and environmental dimensions. The shift from floods being natural disasters to man-made disasters due to unplanned urban growth is evident from national and international reports. Thiruvalla, bordered by the Manimala River in the Pathanamthitta district, is an important urban node and a drainage point of various estuaries. The city is often faced with flash floods and overflow from rivers since it is a low-lying land. The need for urban flood resilience for planned urban development is a necessity for livability in consideration of the topography. The paper focuses on developing an urban design framework in everyday urban spaces through the principles of resilient urbanism. The principles guide the creation of flood-resilient spaces and productive urban landscapes for the city to enable better and safer living conditions. A flood-resilient city not only prepares the city for disasters but also improves the ecological and economic conditions.

Keywords: everyday urban spaces, flood resilience, resilient urbanism, productive urban landscapes

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97 A Saudi Woman with Tokophobia: A Case Report

Authors: Wid Kattan, Rahaf Albarraq

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Background: Tokophobia is a pathological fear of pregnancy that can lead to the avoidance of childbirth. It is classified as primary or secondary. This report describes a patient with tokophobia, as well as her presentation, risk factors, comorbidities, and treatment. Case Presentation: A 43-year-old Saudi woman experienced tokophobia upon becoming pregnant for the fifth time. She was assessed in two clinical interviews by a consultant psychiatrist specializing in women’s mental health. In addition, she completed several questionnaires for assessment of different aspects of her mental health: overall depression, perinatal depression, generalized anxiety, maternal functioning, and fear of childbirth (FOC). Several risk factors and comorbidities that may have contributed to the development of tokophobia in this patient were discussed, including traumatic experiences in previous deliveries, the unplanned nature of the pregnancy, perinatal depression, and pronounced symptoms of anxiety. A collaborative decision to perform a C-section was made, in line with obstetric guidelines and good mental health practice. Full symptomatic recovery was achieved immediately after delivery. Conclusions: We hope to increase clinical awareness of the assessment and management of tokophobia, which is a relatively new concept and, as yet, understudied.

Keywords: tokophobia, fear of childbirth, mental health, anxiety, case report, depression, fear of delivery, psychiatry, cesarean section, perinatal depression

Procedia PDF Downloads 111
96 Use of Vapor Corrosion Inhibitor for Tank Bottom Protection

Authors: Muhammad Arsalan Khan Sherwani

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The use of Volatile Corrosion Inhibitors (VCI) to protect Aboveground Storage Tank (AST) bottom plates against soil-side corrosion is one of the emerging corrosion prevention methods, specifically for tanks constructed on oily sand pad. Oily sand pad and the presence of air gaps underneath the bottom plates lead to severe corrosion and high metal thickness loss. In such cases, the cathodic protection cannot be fully considered as effective due to Cathodic Protection (CP) current shielding. These situations sometimes result in serious failures on multiple fronts, such as; containment losses, system shutdowns, extensive repairs, environmental impact and safety concerns in case of flammable fluids. Recently, East West Pipeline Department (EWPD) of Saudi Aramco has deployed this technology to one of the crude oil storage tanks, which showed high metal thickness loss during its out of service inspection. Soil-side corrosion rustled in major repairs of bottom plates and ultimately caused enormous unplanned activities in term of time as well as cost. This paper mainly focuses on the methodology of VCI installation, corrosion monitoring system and the expected results of protection.

Keywords: Vapor Corrosion Inhibitor, Soil Side Corrosion, External Corrosion, Above Grade Storage Tank

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95 Optimizing Scribe Resourcing to Improve Hospitalist Workloads

Authors: Ahmed Hamzi, Bryan Norman

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Having scribes help document patient records in electronic health record systems can improve hospitalists’ productivity. But hospitals need to determine the optimum number of scribes to hire to maximize scribe cost effectiveness. Scribe attendance uncertainty due to planned and unplanned absences is a primary challenge. This paper presents simulation and analytical models to determine the optimum number of scribes for a hospital to hire. Scribe staffing practices vary from one context to another; different staffing scenarios are considered where having extra attending scribes provides or does not provide additional value and utilizing on-call scribes to fill in for potentially absent scribes. These staffing scenarios are assessed for different scribe revenue ratios (ratio of the value of the scribe relative to scribe costs) ranging from 100% to 300%. The optimum solution depends on the absenteeism rate, revenue ratio, and desired service level. The analytical model obtains solutions easier and faster than the simulation model, but the simulation model is more accurate. Therefore, the analytical model’s solutions are compared with the simulation model’s solutions regarding both the number of scribes hired and cost-effectiveness. Additionally, an Excel tool has been developed to facilitate decision-makers in easily obtaining solutions using the analytical model.

Keywords: hospitalists, workload, optimization cost, economic analysis

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94 Mild Hypothermia Versus Normothermia in Patients Undergoing Cardiac Surgery: A Propensity Matched Analysis

Authors: Ramanish Ravishankar, Azar Hussain, Mahmoud Loubani, Mubarak Chaudhry

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Background and Aims: Currently, there are no strict guidelines in cardiopulmonary bypass temperature management in cardiac surgery not involving the aortic arch. This study aims to compare patient outcomes undergoing mild hypothermia and normothermia. The aim of this study was to compare patient outcomes between mild hypothermia and normothermia undergoing on-pump cardiac surgery not involving the aortic arch. Methods: This was a retrospective cohort study from January 2015 until May 2023. Patients who underwent cardiac surgery with cardiopulmonary bypass temperatures ≥32oC were included and stratified into mild hypothermia (32oC – 35oC) and normothermia (>35oC) cohorts. Propensity matching was applied through the nearest neighbour method (1:1) using the risk factors detailed in the EuroScore using RStudio. The primary outcome was mortality. Secondary outcomes included post-op stay, intensive care unit readmission, re-admission, stroke, and renal complications. Patients who had major aortic surgery and off-pump operations were excluded. Results: Each cohort had 1675 patients. There was a significant increase in overall mortality with the mild hypothermia cohort (3.59% vs. 2.32%; p=0.04912). There was also a greater stroke incidence (2.09% vs. 1.13%; p=0.0396) and transient ischaemic attack (TIA) risk (3.1% vs. 1.49%; p=0.0027). There was no significant difference in renal complications (9.13% vs. 7.88%; p=0.2155). Conclusions: Patient’s who underwent mild hypothermia during cardiopulmonary bypass have a significantly greater mortality, stroke, and transient ischaemic attack incidence. Mild hypothermia does not appear to provide any benefit over normothermia and does not appear to provide any neuroprotective benefits. This shows different results to that of other major studies; further trials and studies need to be conducted to reach a consensus.

Keywords: cardiac surgery, therapeutic hypothermia, neuroprotection, cardiopulmonary bypass

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93 Assessment of Land Surface Temperature Using Satellite Remote Sensing

Authors: R. Vidhya, M. Navamuniyammal M. Sivakumar, S. Reeta

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The unplanned urbanization affects the environment due to pollution, conditions of the atmosphere, decreased vegetation and the pervious and impervious soil surface. Considered to be a cumulative effect of all these impacts is the Urban Heat Island. In this paper, the urban heat island effect is studied for the Chennai city, TamilNadu, South India using satellite remote sensing data. LANDSAT 8 OLI and TIRS DATA acquired on 9th September 2014 were used to Land Surface Temperature (LST) map, vegetation fraction map, Impervious surface fraction, Normalized Difference Water Index (NDWI), Normalized Difference Building Index (NDBI) and Normalized Difference Vegetation Index (NDVI) map. The relationship among LST, Vegetation fraction, NDBI, NDWI, and NDVI was calculated. The Chennai city’s Urban Heat Island effect is significant, and the results indicate LST has strong negative correlation with the vegetation present and positive correlation with NDBI. The vegetation is the main factor to control urban heat island effect issues in urban area like Chennai City. This study will help in developing measures to land use planning to reduce the heat effects in urban area based on remote sensing derivatives.

Keywords: land surface temperature, brightness temperature, emissivity, vegetation index

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92 Day-Case Ketamine Infusions in Patients with Chronic Pancreatitis

Authors: S. M. C. Kelly, M. Goulden

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Introduction: Chronic Pancreatitis is an increasing problem worldwide. Pain is the main symptom and the main reason for hospital readmission following diagnosis, despite the use of strong analgesics including opioids. Ketamine infusions reduce pain in complex regional pain syndrome and other neuropathic pain conditions. Our centre has trialed the use of ketamine infusions in patients with chronic pancreatitis. We have evaluated this service to assess whether ketamine reduces emergency department admissions and analgesia requirements. Methods: This study collected retrospective data from 2010 in all patients who received a ketamine infusion for chronic pain secondary to a diagnosis of chronic pancreatitis. The day-case ketamine infusions were initiated in theatre by an anaesthetist, with standard monitoring and the assistance of an anaesthetic practitioner. A bolus dose of 0.5milligrams/kilogram was given in theatre. The infusion of 0.5 milligrams/kilogram per hour was then administered over a 6 hour period in the theatre recovery area. A study proforma detailed the medical history, analgesic use and admissions to hospital. Patients received a telephone follow up consultation. Results: Over the last eight years, a total of 30 patients have received intravenous ketamine infusions, with a total of 92 ketamine infusions being administered. 53% of the patients were male with the average age of 47. A total of 27 patients participated with the telephone consultation. A third of patients reported a reduction in hospital admissions with pain following the ketamine infusion. Analgesia requirements were reduced by an average of 48.3% (range 0-100%) for an average duration of 69.6 days (range 0-180 days.) Discussion: This service evaluation illustrates that ketamine infusions can reduce analgesic requirements and the number of hospital admissions in patients with chronic pancreatitis. In the light of increasing pressures on Emergency departments and the increasing evidence of the dangers of long-term opioid use, this is clearly a useful finding. We are now performing a prospective study to assess the long-term effectiveness of ketamine infusions in reducing analgesia requirements and improving patient’s quality of life.

Keywords: acute-on-chronic pain, intravenous analgesia infusion, ketamine, pancreatitis

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91 Analyzing Spatio-Structural Impediments in the Urban Trafficscape of Kolkata, India

Authors: Teesta Dey

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Integrated Transport development with proper traffic management leads to sustainable growth of any urban sphere. Appropriate mass transport planning is essential for the populous cities in third world countries like India. The exponential growth of motor vehicles with unplanned road network is now the common feature of major urban centres in India. Kolkata, the third largest mega city in India, is not an exception of it. The imbalance between demand and supply of unplanned transport services in this city is manifested in the high economic and environmental costs borne by the associated society. With the passage of time, the growth and extent of passenger demand for rapid urban transport has outstripped proper infrastructural planning and causes severe transport problems in the overall urban realm. Hence Kolkata stands out in the world as one of the most crisis-ridden metropolises. The urban transport crisis of this city involves severe traffic congestion, the disparity in mass transport services on changing peripheral land uses, route overlapping, lowering of travel speed and faulty implementation of governmental plans as mostly induced by rapid growth of private vehicles on limited road space with huge carbon footprint. Therefore the paper will critically analyze the extant road network pattern for improving regional connectivity and accessibility, assess the degree of congestion, identify the deviation from demand and supply balance and finally evaluate the emerging alternate transport options as promoted by the government. For this purpose, linear, nodal and spatial transport network have been assessed based on certain selected indices viz. Road Degree, Traffic Volume, Shimbel Index, Direct Bus Connectivity, Average Travel and Waiting Tine Indices, Route Variety, Service Frequency, Bus Intensity, Concentration Analysis, Delay Rate, Quality of Traffic Transmission, Lane Length Duration Index and Modal Mix. Total 20 Traffic Intersection Points (TIPs) have been selected for the measurement of nodal accessibility. Critical Congestion Zones (CCZs) are delineated based on one km buffer zones of each TIP for congestion pattern analysis. A total of 480 bus routes are assessed for identifying the deficiency in network planning. Apart from bus services, the combined effects of other mass and para transit modes, containing metro rail, auto, cab and ferry services, are also analyzed. Based on systematic random sampling method, a total of 1500 daily urban passengers’ perceptions were studied for checking the ground realities. The outcome of this research identifies the spatial disparity among the 15 boroughs of the city with severe route overlapping and congestion problem. North and Central Kolkata-based mass transport services exceed the transport strength of south and peripheral Kolkata. Faulty infrastructural condition, service inadequacy, economic loss and workers’ inefficiency are the most dominant reasons behind the defective mass transport network plan. Hence there is an urgent need to revive the extant road based mass transport system of this city by implementing a holistic management approach by upgrading traffic infrastructure, designing new roads, better cooperation among different mass transport agencies, better coordination of transport and changing land use policies, large increase in funding and finally general passengers’ awareness.

Keywords: carbon footprint, critical congestion zones, direct bus connectivity, integrated transport development

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90 Hybrid Weighted Multiple Attribute Decision Making Handover Method for Heterogeneous Networks

Authors: Mohanad Alhabo, Li Zhang, Naveed Nawaz

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Small cell deployment in 5G networks is a promising technology to enhance capacity and coverage. However, unplanned deployment may cause high interference levels and high number of unnecessary handovers, which in turn will result in an increase in the signalling overhead. To guarantee service continuity, minimize unnecessary handovers, and reduce signalling overhead in heterogeneous networks, it is essential to properly model the handover decision problem. In this paper, we model the handover decision according to Multiple Attribute Decision Making (MADM) method, specifically Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS). In this paper, we propose a hybrid TOPSIS method to control the handover in heterogeneous network. The proposed method adopts a hybrid weighting, which is a combination of entropy and standard deviation. A hybrid weighting control parameter is introduced to balance the impact of the standard deviation and entropy weighting on the network selection process and the overall performance. Our proposed method shows better performance, in terms of the number of frequent handovers and the mean user throughput, compared to the existing methods.

Keywords: handover, HetNets, interference, MADM, small cells, TOPSIS, weight

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89 Designing Bird-Friendly Kolkata city

Authors: Madhumita Roy

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Kolkata, the city of joy, is an organic city with 45 lakhs of people till date. The increasing population stress is creating a constant pressure on the ground surface which in turn reducing the possible area for plantation. Humans, plants, and birds have a mutualistic relationship, and all are dependent on each other for their survival. Vegetation structure is very important for a bird life because it can be used as a residence, foraging, life cycle, and shelter from predators. On the other hand, in urban areas, buildings and structures also plays a major role for birds habitat w.r.t, nesting, resting, etc. City birds are constantly upgrading their adaptative mechanism with changing urban pattern with modern architectural designs. Urbanisation and unplanned development lead to environmental degradation and bird habitat fragmentation, which have impacts on the degradation of the quality and quantity of bird habitat. Declining green cover and habitat loss affects the diversity and population structure of birds. Their reducing number is an increasing threat not only to the bird community but also to the city as birds are considered as one of the most important environmental indicator. This study aims to check the present avian status like species richness, relative abundance, and diversity of bird species in the context of changing urban pattern in Kolkata city. Nesting strategy in the urban habitat of the avian community is another avenue of interest.

Keywords: urbanisation, avian species, kolkata metropolis, planning

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88 Utilization of Safety Measures in Prevention of Site Accidents in Nigerian Construction Industry

Authors: Samuel Opeyemi Williams, Razali Adul Hamid, Mohd Saidin Misman, Dominic Ileyemi Ajayi, Taki Eddine Seghier

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Construction industry is famous with hazardous and high-risk environment with operatives facing a greater risk of work-related fatality or injury than operatives in other industries. It is characterised with different types of accident, ranging from electrocution, trip and slip, fall from height, struck-by, explosion, trench collapse, to scaffolding accidents, with each type being caused by different factors. However, accidents are unplanned, unforeseeable and unexpected events, but regardless of the high-risk nature of the industry, accidents are preventable. The aim of the paper is to determine the extent of the utilization of the safety measures, as well as identifying the factors underlining the non-usage. A research methodology consisting of a literature review was used to identify the types and causes of site accidents, while a well-structured questionnaire was used to determine the level of the usage of safety measures on site. The data were analysed with the results revealing the use of protective clothing, safety helmet, first aid, protective shoe, safety belt, and face shield to aid safety of workers, as well as ascribing non-usage of safety measures to cost, ignorance, lack of experts and non-inclusion in contract document. Recommendations are included in the paper suggesting the enforcement of the utilization of safety measures in reducing the spate of accident occurrence on construction sites.

Keywords: construction industry, safety measures, accident, prevention

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87 To Investigate a Discharge Planning Connect with Long Term Care 2.0 Program in a Medical Center in Taiwan

Authors: Chan Hui-Ya, Ding Shin-Tan

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Background and Aim: The discharge planning is considered helpful to reduce the hospital length of stay and readmission rate, and then increased satisfaction with healthcare for patients and professionals. In order to decrease the waiting time of long-term care and boost the care quality of patients after discharge from the hospital, the Ministry of Health and Welfare department in Taiwan initiates a program “discharge planning connects with long-term care 2.0 services” in 2017. The purpose of this study is to investigate the outcome of the pilot of this program in a medical center. Methods: By purpose sampling, the study chose five wards in a medical center as pilot units. The researchers compared the beds of service, the numbers of cases which were transferred to the long-term care center and transferred rates per month between the pilot units and the other units, and analyze the basic data, the long-term care service needs and the approval service items of cases transfer to the long-term care center in pilot units. Results: From June to September 2017, a total of 92 referrals were made, and 51 patients were enrolled into the pilot program. There is a significant difference of transferring rate between the pilot units and the other units (χ = 702.6683, p < 0.001). Only 20 cases (39.2% success rate) were approved to accept the parts of service items of long-term care in the pilot units. The most approval item was respite care service (n = 13; 65%), while it was third at needs ranking of service lists during linking services process. Among the reasons of patients who cancelled the request, 38.71% reasons were related to the services which could not match the patients’ needs and expectation. Conclusion: The results indicate there is a requirement to modify the long-term care services to fit the needs of cases. The researchers suggest estimating the potential cases by screening data from hospital informatics systems and to hire more case manager according the service time of potential cases. Meanwhile, the strategies shortened the assessment scale and authorized hospital case managers to approve some items of long-term care should be considered.

Keywords: discharge planning, long-term care, case manager, patient care

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86 Developing Academic English through Interaction

Authors: John Bankier

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Development of academic English occurs not only in communities of practice but also within wider social networks, referred to by Zappa-Hollman and Duff as individual networks of practice. Such networks may exist whether students are developing academic English in English-dominant contexts or in contexts in which English is not a majority language. As yet, little research has examined how newcomers to universities interact with a variety of social ties in such networks to receive academic and emotional support as they develop the academic English necessary to succeed in local and global academia. The one-year ethnographic study described in this presentation followed five Japanese university students enrolled on an academic English program in their home country. We graphically represent participants’ individual networks of practice related to academic English and display the role of interaction in these networks to socialization. Specific examples of academic practices will be linked to specific instances of social interaction. Interaction supportive of the development of academic practices often occurred during unplanned interactions outside the classroom and among small groups of close friends who were connected to each other in more than one way, such as those taking multiple classes together. These interactions occurred in study spaces, in hallways between class periods, at lunchtimes, and online. However, constraints such as differing accommodation arrangements, class scheduling and the hierarchical levelling of English classes by test scores discouraged some participants both from forming strong ties related to English and from interacting with existing ties. The presentation will briefly describe ways in which teachers in all contexts can maximise interaction outside the classroom.

Keywords: academic, english, practice, network

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85 Incentive Policies to Promote Green Infrastructure in Urban Jordan

Authors: Zayed Freah Zeadat

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The wellbeing of urban dwellers is strongly associated with the quality and quantity of green infrastructure. Nevertheless, urban green infrastructure is still lagging in many Arab cities, and Jordan is no exception. The capital city of Jordan, Amman, is becoming more urban dense with limited green spaces. The unplanned urban growth in Amman has caused several environmental problems such as urban heat islands, air pollution, and lack of green spaces. This study aims to investigate the most suitable drivers to leverage the implementation of urban green infrastructure in Jordan through qualitative and quantitative analysis. The qualitative research includes an extensive literature review to discuss the most common drivers used internationally to promote urban green infrastructure implementation in the literature. The quantitative study employs a questionnaire survey to rank the suitability of each driver. Consultants, contractors, and policymakers were invited to fill the research questionnaire according to their judgments and opinions. Relative Importance Index has been used to calculate the weighted average of all drivers and the Kruskal-Wallis test to check the degree of agreement among groups. This study finds that research participants agreed that indirect financial incentives (i.e., tax reductions, reduction in stormwater utility fee, reduction of interest rate, density bonus, etc.) are the most effective incentive policy whilst granting sustainability certificate policy is the least effective driver to ensure widespread of UGI is elements in Jordan.

Keywords: urban green infrastructure, relative importance index, sustainable urban development, urban Jordan

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84 Study of Growth Patterns of the Built-Up Area in Tourism Destinations in Relation to Sustainable Development

Authors: Tagore Sai Priya Nunna, Ankhi Banerjee

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The rapid growth of the tourism industry in India in the last few years after the economic crisis in 2009 has been one of the significant causes that led to the Land Use Land Cover change (LULC) of most tourism destinations. The tourist regions are subjected to significant increase in built-up due to increased construction activities for developing accommodation facilities further boosting tourism demand. This research attempts to analyse the changing LULC and the growth pattern of the built-up area within tourist destinations. Four popular tourist destinations, which promises various types of tourism activity and which are significantly dependent on tourism for economic growth, are selected for the study. The study uses remotely sensed data for analysis of land use change through supervised segmentation into five broad classes. Further, the landuse map is reclassified into binary classes to extract the built-up area. The growth patterns of the built-up are analysed in terms of size, shape, direction and form of growth, through a set of spatial metrics. Additionally, a detailed analysis of the existing development pattern corresponding to planned development zones was performed to identify unplanned growth spots in the study regions. The findings of the study provide insights into how tourism has contributed to significant changes in LULC around tourist sites. Also, the study highlights the growth pattern of built-up areas with respect to the type of tourism activity and geographical characteristics. The research attempts to address the need of integrating spatial metrics for the development of sustainable tourism plans as part of the goals of sustainable development.

Keywords: built-up, growth, patterns, tourism, sustainable

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83 Analysis of the Level of Production Failures by Implementing New Assembly Line

Authors: Joanna Kochanska, Dagmara Gornicka, Anna Burduk

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The article examines the process of implementing a new assembly line in a manufacturing enterprise of the household appliances industry area. At the initial stages of the project, a decision was made that one of its foundations should be the concept of lean management. Because of that, eliminating as many errors as possible in the first phases of its functioning was emphasized. During the start-up of the line, there were identified and documented all production losses (from serious machine failures, through any unplanned downtime, to micro-stops and quality defects). During 6 weeks (line start-up period), all errors resulting from problems in various areas were analyzed. These areas were, among the others, production, logistics, quality, and organization. The aim of the work was to analyze the occurrence of production failures during the initial phase of starting up the line and to propose a method for determining their critical level during its full functionality. There was examined the repeatability of the production losses in various areas and at different levels at such an early stage of implementation, by using the methods of statistical process control. Based on the Pareto analysis, there were identified the weakest points in order to focus improvement actions on them. The next step was to examine the effectiveness of the actions undertaken to reduce the level of recorded losses. Based on the obtained results, there was proposed a method for determining the critical failures level in the studied areas. The developed coefficient can be used as an alarm in case of imbalance of the production, which is caused by the increased failures level in production and production support processes in the period of the standardized functioning of the line.

Keywords: production failures, level of production losses, new production line implementation, assembly line, statistical process control

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82 Facets of an Upcoming Urban Industrial Hub: A Case Study of Gurgaon-Manesar

Authors: Raman Kumar Singh

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Urbanization and economic growth are considered to be the most striking features of the past century. There is currently a radical demographic shift in progress worldwide, wherein people are moving from rural to urban areas at an increasing rate. The UN-Habitat report 2005 indicates that in 2025, 61 per cent of the 5 billion world population will reside in the urban areas with about 85 per cent of the development process taking place in the urban hinterlands widely referred to as ‘peri-urban’, ‘suburbs’, ‘urban fringe’, ‘city edge’, ‘metropolitan shadow’, or ‘urban sprawl’. In this context the study is broadly concerned with understanding the development of the industrial hub in the Gurgaon and its impact on the immediate neighbourhood. However studies have revealed that with the increase of industrial development the growth pattern changes rapidly, not only the growth of the urban area but the overall economy shifts from more agrarian to non-agrarian, with the change in the occupational pattern of the people. The process is mainly known as tertiarization, where a number of tertiary activities increase in comparison to primary or secondary. The change in the occupational pattern creates a pull factor on its immediate neighbourhood, which triggers the in- migrations from the rural areas as people come in the core urban area in search of the better job opportunities and increased standards of living. But this gives way to the unplanned growth of the urban fringe and the villages which tend to accommodate the migrants and in turn the pressure on the socio-economic infrastructure increases. Therefore, it becomes increasing necessary for the government institution and policy level intervention to provide an overall socio-economic growth along with rapid industrial growth.

Keywords: policy intervention, urban morphology, urban industrial hub, livelihood transformation

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81 Urban Change Detection and Pattern Analysis Using Satellite Data

Authors: Shivani Jha, Klaus Baier, Rafiq Azzam, Ramakar Jha

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In India, generally people migrate from rural area to the urban area for better infra-structural facilities, high standard of living, good job opportunities and advanced transport/communication availability. In fact, unplanned urban development due to migration of people causes seriou damage to the land use, water pollution and available water resources. In the present work, an attempt has been made to use satellite data of different years for urban change detection of Chennai metropolitan city along with pattern analysis to generate future scenario of urban development using buffer zoning in GIS environment. In the analysis, SRTM (30m) elevation data and IRS-1C satellite data for the years 1990, 2000, and 2014, are used. The flow accumulation, aspect, flow direction and slope maps developed using SRTM 30 m data are very useful for finding suitable urban locations for industrial setup and urban settlements. Normalized difference vegetation index (NDVI) and Principal Component Analysis (PCA) have been used in ERDAS imagine software for change detection in land use of Chennai metropolitan city. It has been observed that the urban area has increased exponentially in Chennai metropolitan city with significant decrease in agriculture and barren lands. However, the water bodies located in the study regions are protected and being used as freshwater for drinking purposes. Using buffer zone analysis in GIS environment, it has been observed that the development has taken place in south west direction significantly and will do so in future.

Keywords: urban change, satellite data, the Chennai metropolis, change detection

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80 Carbapenem Usage in Medical Wards: An Antibiotic Stewardship Feedback Project

Authors: Choon Seong Ng, P. Petrick, C. L. Lau

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Background: Carbapenem-resistant isolates have been increasingly reported recently. Carbapenem stewardship is designed to optimize its usage particularly among medical wards with high prevalence of carbapenem prescriptions to combat such emerging resistance. Carbapenem stewardship programmes (CSP) can reduce antibiotic use but clinical outcome of such measures needs further evaluation. We examined this in a prospective manner using feedback mechanism. Methods: Our single-center prospective cohort study involved all carbapenem prescriptions across the medical wards (including medical patients admitted to intensive care unit) in a tertiary university hospital setting. The impact of such stewardship was analysed according to the accepted and the rejected groups. The primary endpoint was safety. Safety measure applied in this study was the death at 1 month. Secondary endpoints included length of hospitalisation and readmission. Results: Over the 19 months’ period, input from 144 carbapenem prescriptions was analysed on the basis of acceptance of our CSP recommendations on the use of carbapenems. Recommendations made were as follows : de-escalation of carbapenem; stopping the carbapenem; use for a short duration of 5-7 days; required prolonged duration in the case of carbapenem-sensitive Extended Spectrum Beta-Lactamases bacteremia; dose adjustment; and surgical intervention for removal of septic foci. De-escalation, shorten duration of carbapenem and carbapenem cessation comprised 79% of the recommendations. Acceptance rate was 57%. Those who accepted CSP recommendations had no increase in mortality (p = 0.92), had a shorter length of hospital stay (LOS) and had cost-saving. Infection-related deaths were found to be higher among those in the rejected group. Moreover, three rejected cases (6%) among all non-indicated cases (n = 50) were found to have developed carbapenem-resistant isolates. Lastly, Pitt’s bacteremia score appeared to be a key element affecting the carbapenem prescription’s behaviour in this trial. Conclusions: Carbapenem stewardship program in the medical wards not only saves money, but most importantly it is safe and does not harm the patients with added benefits of reducing the length of hospital stay. However, more time is needed to engage the primary clinical teams by formal clinical presentation and immediate personal feedback by senior Infectious Disease (ID) personnel to increase its acceptance.

Keywords: audit and feedback, carbapenem stewardship, medical wards, university hospital

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