Search results for: hospital wastes

Authors: Manisha Rathi, Thierry Chaussalet

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Hospital staff and managers are under pressure and concerned for effective use and management of scarce resources. The hospital admissions require many decisions that have complex and uncertain consequences for hospital resource utilization and patient flow. It is challenging to predict risk of admissions and length of stay of a patient due to their vague nature. There is no method to capture the vague definition of admission of a patient. Also, current methods and tools used to predict patients at risk of admission fail to deal with uncertainty in unplanned admission, LOS, patients- characteristics. The main objective of this paper is to deal with uncertainty in health system variables, and handles uncertain relationship among variables. An introduction of machine learning techniques along with statistical methods like Regression methods can be a proposed solution approach to handle uncertainty in health system variables. A model that adapts fuzzy methods to handle uncertain data and uncertain relationships can be an efficient solution to capture the vague definition of admission of a patient.

Keywords: Admission, Fuzzy, Regression, Uncertainty

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Authors: Hamid Reza Alipour, Ali Mohammadi Torkashvand

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In composting process, N high-organic wastes loss the great part of its nitrogen as ammonia; therefore, using compost amendments can promote the quality of compost due to the decrease in ammonia volatilization. With regard to the effect of pH on composting, microorganisms- activity and ammonia volatilization, sulfuric acid and alkaline wastewater of paper mill (as liming agent with Ca and Mg ions) were used as compost amendments. Study results indicated that these amendments are suitable for reclamation of compost quality properties. These held nitrogen in compost caused to reduce C/N ratio. Both amendments had a significant effect on total nitrogen, but it should be used sulfuric acid in fewer amounts (20 ml/kg fresh organic wastes); and the more amounts of acid is not proposed.

Keywords: Compost, Paper mill wastewater, sulfuric acid, Ammonia Volatilization.

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Authors: Chee-Ming Chan

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In spite of the advent of new materials, clay bricks remain, arguably, the most popular construction materials today. Nevertheless the low cost and versatility of clay bricks cannot always be associated with high environmental and sustainable values, especially in terms of raw material sources and manufacturing processes. At the same time, the worldwide agricultural footprint is fast growing, with vast agricultural land cultivation and active expansion of the agro-based industry. The resulting large quantities of agricultural wastes, unfortunately, are not always well managed or utilised. These wastes can be recycled, such as by retrieving fibres from disposed leaves and fruit bunches, and then incorporated in brick-making. This way the clay bricks are made a 'greener' building material and the discarded natural wastes can be reutilised, avoiding otherwise wasteful landfill and harmful open incineration. This study examined the physical and mechanical properties of clay bricks made by adding two natural fibres to a clay-water mixture, with baked and non-baked conditions. The fibres were sourced from pineapple leaves (PF) and oil palm fruit bunch (OF), and added within the range of 0.25-0.75 %. Cement was added as a binder to the mixture at 5-15 %. Although the two fibres had different effects on the bricks produced, cement appeared to dominate the compressive strength. The non-baked bricks disintegrated when submerged in water, while the baked ones displayed cement-dependent characteristics in water-absorption and density changes. Interestingly, further increase in fibre content did not cause significant density decrease in both the baked and non-baked bricks.

Keywords: natural fibres, clay bricks, strength, water absorption, density.

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Authors: C. Santhana Krishnan, A. M. Mimi Sakinah, Lakhveer Singh, Zularisam A. Wahid

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This study was initiated to evaluate and optimize the conversion of animal fat from tannery wastes into methyl ester. In the pre-treatment stage, animal fats feedstock was hydrolysed and esterified through solid state fermentation (SSF) using Microbacterium species immobilized onto sand silica matrix. After 72 hours of fermentation, predominant esters in the animal fats were found to be with 83.9% conversion rate. Later, esterified animal fats were transesterified at 3 hour reaction time with 1% NaOH (w/v %), 6% methanol to oil ratio (w/v %) to produce 89% conversion rate. C₁₃ NMR revealed long carbon chain in fatty acid methyl esters at 22.2817-31.9727 ppm. Methyl esters of palmitic, stearic, oleic represented the major components in biodiesel.

Keywords: Tannery wastes, fatty animal fleshing, trans-esterification, immobilization, solid state fermentation.

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Authors: A. Khelifi, D. Ahmed, R. Salem, N. Ali

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Large patients’ queues at pharmacies and hospitals are a problem that faces the supposedly smooth and healthy environment in United Arab Emirates. As this sometimes leads to dissatisfaction from visiting patients, we tried to solve this problem with additional beneficial functions by developing the Hospital-Pharmacy Management System. The primary purpose of this research is to develop a system that joins the databases of a hospital and a pharmacy together for a better integrated system that provides a better coherent working environment. Three methods are used to design the system. These methods are detailed literature review, an extensive feasibility study and surveys for doctors, hospital IT managers and End-users. Interviews and surveys with related stakeholders were done to depict system’s requirements; design and prototype. The prototype illustrates system’s features and its client and server architecture. The system has a mobile application for visiting patients to, mainly, keep track of their prescriptions and access to their personal information. The server side allows doctors to submit the prescriptions online to pharmacists who will process them. This system is expected to reduce the long waiting queues of patients and increase their satisfaction while also reducing doctors and pharmacists’ stress and facilitating their work. It will be deployed to users of Android devices only. This limitation will be resolved, as one of main future enhancements, once the system finds acceptance from hospitals and pharmacies in United Arab Emirates.

Keywords: Hospital, Information System, Integration, Pharmacy.

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Authors: Emad Alenany, M. Adel El-Baz

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In this paper, the flow of different classes of patients into a hospital is modelled and analyzed by using the queueing network analyzer (QNA) algorithm and discrete event simulation. Input data for QNA are the rate and variability parameters of the arrival and service times in addition to the number of servers in each facility. Patient flows mostly match real flow for a hospital in Egypt. Based on the analysis of the waiting times, two approaches are suggested for improving performance: Separating patients into service groups, and adopting different service policies for sequencing patients through hospital units. The separation of a specific group of patients, with higher performance target, to be served separately from the rest of patients requiring lower performance target, requires the same capacity while improves performance for the selected group of patients with higher target. Besides, it is shown that adopting the shortest processing time and shortest remaining processing time service policies among other tested policies would results in, respectively, 11.47% and 13.75% reduction in average waiting time relative to first come first served policy.

Keywords: Queueing network, discrete-event simulation, health applications, SPT.

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Authors: C. Ardil

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In this paper, a new MCDMA approach, the permanent analytics process is proposed to assess the immovable valuation criteria and their significance in the placement of the healthcare facility. Five decision factors are considered for the value and selection of immovables. In the multiple factor selection problems, the priority vector of the criteria used to compare several immovables is first determined using the permanent analytics method, a mathematical model for the multiple criteria decisionmaking process. Then, to demonstrate the viability and efficacy of the suggested approach, twenty potential candidate locations were evaluated using the hospital site selection problem's decision criteria. The ranking accuracy of estimation was evaluated using composite programming, which took into account both the permanent analytics process and the weighted multiplicative model. 

Keywords: Hospital Facility Location Selection, Permanent Analytics Process, Multiple Criteria Decision Making (MCDM)

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Authors: Aeslina Binti Abdul Kadir, Ahmad Shayuti Bin Abdul Rahim

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Brick is one of the most common masonry units used as building material. Due to the demand, different types of waste have been investigated to be incorporated into the bricks. Many types of sludge have been incorporated in fired clay brick for example marble sludge, stone sludge, water sludge, sewage sludge, and ceramic sludge. The utilization of these waste materials in fired clay bricks usually has positive effects on the properties such as lightweight bricks with improved shrinkage, porosity, and strength. This paper reviews on utilization of different types of sludge wastes into fired clay bricks. Previous investigations have demonstrated positive effects on the physical and mechanical properties as well as less impact towards the environment. Thus, the utilizations of sludge waste could produce a good quality of brick and could be one of alternative disposal methods for the sludge wastes.

Keywords: Fired Clay Brick, Sludge waste, Compressive strength, Shrinkage, Water absorption.

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Authors: D. Nouri, M.R. Sabour, M. Ghanbarzadeh Lak

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Proper management of residues originated from industrial activities is considered as one of the serious challenges faced by industrial societies due to their potential hazards to the environment. Common disposal methods for industrial solid wastes (ISWs) encompass various combinations of solely management options, i.e. recycling, incineration, composting, and sanitary landfilling. Indeed, the procedure used to evaluate and nominate the best practical methods should be based on environmental, technical, economical, and social assessments. In this paper an environmentaltechnical assessment model is developed using analytical network process (ANP) to facilitate the decision making practice for ISWs generated at Gilan province, Iran. Using the results of performed surveys on industrial units located at Gilan, the various groups of solid wastes in the research area were characterized, and four different ISW management scenarios were studied. The evaluation process was conducted using the above-mentioned model in the Super Decisions software (version 2.0.8) environment. The results indicates that the best ISW management scenario for Gilan province is consist of recycling the metal industries residues, composting the putrescible portion of ISWs, combustion of paper, wood, fabric and polymeric wastes as well as energy extraction in the incineration plant, and finally landfilling the rest of the waste stream in addition with rejected materials from recycling and compost production plants and ashes from the incineration unit.

Keywords: Analytical Network Process, Disposal Scenario, Gilan Province, Industrial Waste.

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Authors: Mahmoud A. El-Banna

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The need to increase the efficiency of health care systems is becoming an obligation, and one of area of improvement is the discharge process. The objective of this work is to minimize the patients discharge time (for insured patients) to be less than 50 minutes by using six sigma approach, this improvement will also: lead to an increase in customer satisfaction, increase the number of admissions and turnover on the rooms, increase hospital profitability.Three different departments were considered in this study: Female, Male, and Paediatrics. Six Sigma approach coupled with simulation has been applied to reduce the patients discharge time for pediatrics, female, and male departments at hospital. Upon applying these recommendations at hospital: 60%, 80%, and 22% of insured female, male, and pediatrics patients respectively will have discharge time less than the upper specification time i.e. 50 min.

Keywords: Discharge Time, Healthcare, Hospitals, Patients, Process Improvement, Six Sigma, Simulation

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Authors: L. Abukova, O. Abramova, A. Goreva, Y. Yakovlev

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Important executive decisions on oil and gas production stimulation in Eastern Siberia have been recently taken. There are unique and large fields of oil, gas, and gas-condensate in Eastern Siberia. The Talakan, Koyumbinskoye, Yurubcheno-Tahomskoye, Kovykta, Chayadinskoye fields are supposed to be developed first. It will result in an abrupt increase in environmental load on the nature of Eastern Siberia. In Eastern Siberia, the introduction of ecological imperatives in hydrocarbon production is still realistic. Underground water movement is the one of the most important factors of the ecosystems condition management. Oil and gas production is associated with the forced displacement of huge water masses, mixing waters of different composition, and origin that determines the extent of anthropogenic impact on water drive systems and their protective reaction. An extensive hydrogeological system of the depression type is identified in the pre-salt deposits here. Pressure relieve here is steady up to the basement. The decrease of the hydrodynamic potential towards the basement with such a gradient resulted in reformation of the fields in process of historical (geological) development of the Nepsko-Botuobinskaya anteclise. The depression hydrodynamic systems are characterized by extremely high isolation and can only exist under such closed conditions. A steady nature of water movement due to a strictly negative gradient of reservoir pressure makes it quite possible to use environmentally-harmful liquid substances instead of water. Disposal of the most hazardous wastes is the most expedient in the deposits of the crystalline basement in certain structures distant from oil and gas fields. The time period for storage of environmentally-harmful liquid substances may be calculated by means of the geological time scales ensuring their complete prevention from releasing into environment or air even during strong earthquakes. Disposal of wastes of chemical and nuclear industries is a matter of special consideration. The existing methods of storage and disposal of wastes are very expensive. The methods applied at the moment for storage of nuclear wastes at the depth of several meters, even in the most durable containers, constitute a potential danger. The enormous size of the depression system of the Nepsko-Botuobinskaya anteclise makes it possible to easily identify such objects at the depth below 1500 m where nuclear wastes will be stored indefinitely without any environmental impact. Thus, the water drive system of the Nepsko-Botuobinskaya anteclise is the ideal object for large-volume injection of environmentally harmful liquid substances even if there are large oil and gas accumulations in the subsurface. Specific geological and hydrodynamic conditions of the system allow the production of hydrocarbons from the subsurface simultaneously with the disposal of industrial wastes of oil and gas, mining, chemical, and nuclear industries without any environmental impact.

Keywords: Eastern Siberia, formation pressure, underground water, waste burial.

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Authors: O. Alelweet, S. Pavia

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In order to face current compelling environmental problems affecting the planet, the construction industry needs to adapt. It is widely acknowledged that there is a need for durable, high-performance, low-greenhouse gas emission binders that can be used as an alternative to Portland cement (PC) to lower the environmental impact of construction. Alkali activated materials (AAMs) are considered a more sustainable alternative to PC materials. The binders of AAMs result from the reaction of an alkali metal source and a silicate powder or precursor which can be a calcium silicate or an aluminosilicate-rich material. This paper evaluates the particle size, specific surface area, chemical and mineral composition and amorphousness of silicate materials (most industrial waste locally produced in Ireland and Saudi Arabia) to develop alkali-activated binders that can replace PC resources in specific applications. These include recycled ceramic brick, bauxite, illitic clay, fly ash and metallurgical slag. According to the results, the wastes are reactive and comply with building standards requirements. The study also evidenced that the reactivity of the Saudi bauxite (with significant kaolinite) can be enhanced on thermal activation; and high calcium in the slag will promote reaction; which should be possible with low alkalinity activators. The wastes evidenced variable water demands that will be taken into account for mixing with the activators. Finally, further research is proposed to further determine the reactive fraction of the clay-based precursors.

Keywords: Reactivity, water demand, alkali-activated materials, brick, bauxite, illitic clay, fly ash, slag.

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Authors: Nareelux Suwannobol, Supap Chobkhayan

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The aim of this study was to investigate the pregnancy outcomes of teenage mothers at DanKhunThot hospital, Nakhon Ratchasima, Thailand. A retrospective descriptive study was conducted in 573 of teenage pregnant from charts reviewed from 1st October 2010-31st March, 2012. Data were analyzed by frequency distribution, mean and Standard Deviation. The results shown several problems and negatives outcomes of pregnancy in teenager such as not attended prenatal care, Low birth weight infants, death fetus in utero and other complications. The results of this study can be utilized in the development of prenatal, perinatal and post natal care services, especially in DanKhunthot Hospital contexts. Moreover, the results were present to the District Health Care committees in order to enhance health care service system for teenage pregnancy of DanKhunthot District in further.

Keywords: Teenage mothers, Pregnancy outcome, Neonatal outcomes, Maternal outcomes.

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Authors: Adilah Shariff, Nur Syairah Mohamad Aziz, Norsyahidah Md Saleh, Nur Syuhada Izzati Ruzali

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The first objective of this study is to investigate the suitability of coconut frond (CF) and coconut husk (CH) as feedstocks using a laboratory-scale slow pyrolysis experimental setup. The second objective is to investigate the effect of pyrolysis temperature on the biochar yield. The properties of CF and CH feedstocks were compared. The properties of the CF and CH feedstocks were investigated using proximate and elemental analysis, lignocellulosic determination, and also thermogravimetric analysis (TGA). The CF and CH feedstocks were pyrolysed at 300, 400, 500, 600 and 700 °C for 2 hours at 10 °C/min heating rate. The proximate analysis showed that CF feedstock has 89.96 mf wt% volatile matter, 4.67 mf wt% ash content and 5.37 mf wt% fixed carbon. The lignocelluloses analysis showed that CF feedstock contained 21.46% lignin, 39.05% cellulose and 22.49% hemicelluloses. The CH feedstock contained 84.13 mf wt% volatile matter, 0.33 mf wt% ash content, 15.54 mf wt% fixed carbon, 28.22% lignin, 33.61% cellulose and 22.03% hemicelluloses. Carbon and oxygen are the major component of the CF and CH feedstock compositions. Both of CF and CH feedstocks contained very low percentage of sulfur, 0.77% and 0.33%, respectively. TGA analysis indicated that coconut wastes are easily degraded. It may be due to their high volatile content. Between the temperature ranges of 300 and 800 °C, the TGA curves showed that the weight percentage of CF feedstock is lower than CH feedstock by 0.62%-5.88%. From the D TGA curves, most of the weight loss occurred between 210 and 400 °C for both feedstocks. The maximum weight loss for both CF and CH are 0.0074 wt%/min and 0.0061 wt%/min, respectively, which occurred at 324.5 °C. The yield percentage of both CF and CH biochars decreased significantly as the pyrolysis temperature was increased. For CF biochar, the yield decreased from 49.40 wt% to 28.12 wt% as the temperature increased from 300 to 700 °C. The yield for CH biochars also decreased from 52.18 wt% to 28.72 wt%. The findings of this study indicated that both CF and CH are suitable feedstock for slow pyrolysis of biochar.

Keywords: Biochar, biomass, coconut wastes, slow pyrolysis.

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Authors: M. E. Silva, I. Brás

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The aim of this work was to study the viability of recycling the residual yeast and diatomaceous earth (RYDE) slurry generated by the beer brewing industry by composting with animal manures, as well as to evaluate the quality of the composts obtained. Two pilot composting trials were carried out with different mixes: cow manure/RYDE slurry (Pile CM) and sheep manure/RYDE slurry (Pile SM). For all piles, wood chips were applied as bulking agent. The process was monitored by evaluating standard physical and chemical parameters. The compost quality was assessed by the heavy metals content and phytotoxicity. Both piles reached a thermophilic phase in the first day, however having different trends. The pH showed a slight alkaline character. The C/N reached values lower than 19 at the end of composting process. Generally, all the piles exhibited absence of heavy metals. However, the pile SM exhibited phytotoxicity. This study showed that RYDE slurry can be valorized by composting with cow manure.

Keywords: Beer brewing wastes, compost; quality, valorization.

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Authors: Mudafara S Bengleil

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Estimation of the magnitude and causes of poisoning was the objective of the current study. A retrospective study of medical records of all poisoning children admitted to Benghazi Children Hospital in Libya from January 2008 up to December 2010. Number of children admitted was 244; the age ranged from less than one to 13 years old. Most of cases were admitted with mild symptom and the majority of them were boys. Only few cases admitted to intensive care unit and there was no mortality recorded through the period of study. Age group 1 to 3 years (50.8%) had the highest frequency of admission and the peak of admission was during summer. The most common cause of admission was due to ingestion of medication (53.69%), House hold product exposure (26.64%) was the second causes of admission while, 19.67% of admissions were due to Food poisoning. Almost all admitted cases were accidental and medicines were the most consumed substances in addition, improper storage of toxic agents were the first risk factor of poisoning. Present results indicated that, children poisoning seems to be a common pediatric care problem which need to control and prevent.

Keywords: Children, hospital, poisoning.

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Authors: Trevor Kroeger, Hayden Williams, Edward Holzinger, David Coleman, Brian Haberman

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The network connectivity of medical devices is increasing at a rapid rate. Many medical devices, such as vital sign monitors, share information via wireless or wired connections. However, these connectivity options suffer from a variety of well-known limitations. Wireless connectivity, especially in the unlicensed radio frequency bands, can be disrupted. Such disruption could be due to benign reasons, such as a crowded spectrum, or to malicious intent. While wired connections are less susceptible to interference, they inhibit the mobility of the medical devices, which could be critical in a variety of scenarios. This work explores the application of Light Fidelity (Li-Fi) communication to enhance the security, performance, and mobility of medical devices in connected healthcare scenarios. A simple bridge for connected devices serves as an avenue to connect traditional medical devices to the Li-Fi network. This bridge was utilized to conduct bandwidth tests on a small Li-Fi network installed into a Mock-ICU setting with a backend enterprise network similar to that of a hospital. Mobile and stationary tests were conducted to replicate various different situations that might occur within a hospital setting. Results show that in room Li-Fi connectivity provides reasonable bandwidth and latency within a hospital like setting.

Keywords: Hospital, light fidelity, Li-Fi, medical devices, security.

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Authors: Ibrahim Abubakar Alkali, Abubakar Sarkile Kawuwa, Ibrahim Sani Khalil

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The concept of space and function forms the bedrock for spatial configuration in architectural design. Thus, the effectiveness and functionality of an architectural product depends their cordial relationship. This applies to all buildings especially to a hospital ward setting designed to accommodate various complex and diverse functions. Health care facilities design, especially an inpatient setting, is governed by many regulations and technical requirements. It is also affected by many less defined needs, particularly, response to culture and the need to provide for patient families’ presence and participation. The spatial configuration of the hospital ward setting in developing countries has no consideration for the patient’s families despite the significant role they play in promoting recovery. Attempts to integrate facilities for patients’ families have always been challenging, especially in developing countries like Nigeria, where accommodation for inpatients is predominantly in an open ward system. In addition, the situation is compounded by culture, which significantly dictates healthcare practices in Africa. Therefore, achieving such a hospital ward setting that is patient and family-centered requires careful assessment of family care actions and transaction spaces so as to arrive at an evidence based solution. Therefore, the aim of this study is to identify how hospital ward spaces can be reconfigured to provide for sustainable family integration. In achieving this aim, a qualitative approach using the principles of behavioral mapping was employed in male and female medical wards of the Federal Teaching Hospital (FTH) Gombe, Nigeria. The data obtained was analysed using classical and comparative content analysis. Patients’ families have been found to be a critical component of hospital ward design that cannot be undermined. Accordingly, bedsides, open yards, corridors and foyers have been identified as patient families’ transaction spaces that require design attention. Arriving at sustainable family integration can be achieved by revisiting the design requirements of the family transaction spaces based on the findings in order to avoid the rowdiness of the wards and uncoordinated sprawl.

Keywords: Caregiving, design basics, family integration, hospital ward, sustainability.

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Authors: Nouha Mhimdi, Wahiba Ben Abdessalem Karaa, Henda Ben Ghezala

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Many methods are used to collect data like questionnaires, surveys, focus group interviews. Or the collection of poor-quality data resulting, for example, from poorly designed questionnaires, the absence of good translators or interpreters, and the incorrect recording of data allow conclusions to be drawn that are not supported by the data or to focus only on the average effect of the program or policy. There are several solutions to avoid or minimize the most frequent errors, including obtaining expert advice on the design or adaptation of data collection instruments; or use technologies allowing better "anonymity" in the responses. In this context, and to overcome the aforementioned problems, we suggest in this paper an approach to achieve the collection of relevant data, by carrying out a large-scale questionnaire-based survey. We have been able to collect good quality, consistent and practical data on hospital emergencies to improve emergency services in hospitals, especially in the case of epidemics or pandemics.

Keywords: Data collection, survey, database, data analysis, hospital emergencies.

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Authors: F. Iscan, C. Yagci

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Rapid population growth, urbanization and industrialization are known as the most important factors of environment problems. Elimination and management of solid wastes are also within the most important environment problems. One of the main problems in solid waste management is the selection of the best site for elimination of solid wastes. Lately, Geographical Information System (GIS) has been used for easing selection of landfill area. GIS has the ability of imitating necessary economic, environmental and political limitations. They play an important role for the site selection of landfill area as a decision support tool. In this study; map layers will be studied for minimum effect of environmental, social and cultural factors and maximum effect for engineering/economic factors for site selection of landfill areas and using GIS for a decision support mechanism in solid waste landfill areas site selection will be presented in Aksaray/Turkey city, Güzelyurt district practice.

Keywords: GIS, landfill, solid waste, spatial analysis.

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Authors: Merve Sogancioglu, Esra Yel, Ferda Tartar, Nihan Canan Iskender

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Waste polyethylene (PE) is classified as waste low density polyethylene (LDPE) and waste high density polyethylene (HDPE) according to their densities. Pyrolysis of plastic waste may have an important role in dealing with the enormous amounts of plastic waste produced all over the world, by decreasing their negative impact on the environment. This waste may be converted into economically valuable hydrocarbons, which can be used both as fuels and as feed stock in the petrochemical industry. End product yields and properties depend on the plastic waste composition. Pyrolytic biochar is one of the most important products of waste plastics pyrolysis. In this study, HDPE and LDPE plastic wastes were co-pyrolyzed together with waste olive pomace. Pyrolysis runs were performed at temperature 700°C with heating rates of 5°C/min. Higher pyrolysis oil and gas yields were observed by the using waste olive pomace. The biochar yields of HDPE- olive pomace and LDPEolive pomace were 6.37% and 7.26% respectively for 50% olive pomace doses. The calorific value of HDPE-olive pomace and LDPE-olive pomace of pyrolysis oil were 8350 and 8495 kCal.

Keywords: Biochar, co-pyrolysis, waste plastic, waste olive pomace.

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Authors: Mourtou Efstratia, Abdel-Badeeh M. Salem, Pavlidis George

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Hierarchical high-level PNs (HHPNs) with time versions are a useful tool to model systems in a variety of application domains, ranging from logistics to complex workflows. This paper addresses an application domain which is receiving more and more attention: procedure that arranges the final inpatient charge in payment-s office and their management. We shall prove that Petri net based analysis is able to improve the delays during the procedure, in order that inpatient charges could be more reliable and on time.

Keywords: eHealth, Petri-Nets, Hospital Services, InpatientCharges, Workflow Modeling.

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Authors: Napisporn Memongkol, Runchana Sinthavalai, Nattapong Seneeratanaprayune Weerawat Ounsaneha, Chanisada Choosuk

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The objective of this research is to develop the performance indicators (PIs) in operational level for the Pre-hospital Emergency Medical Service (EMS) system employing in Thailand. This research started with ascertaining the current pre-hospital care system. The team analyzed the strategies of Narerthorn, a government unit under the ministry of public health, and the existing PIs of the pre-hospital care. Afterwards, the current National Strategic Plan of EMS development (2008-2012) of the Emergency Medical Institute of Thailand (EMIT) was considered using strategic analysis to developed Strategy Map (SM) and identified the Success Factors (SFs). The analysis results from strategy map and SFs were used to develop the Performance Indicators (PIs). To verify the set of PIs, the team has interviewed with the relevant practitioners for the possibilities to implement the PIs. To this paper, it was to ascertain that all the developed PIs support the objectives of the strategic plan. Nevertheless, the results showed that the operational level PIs suited only with the first dimension of National Strategic Plan (infrastructure and information technology development). Besides, the SF was the infrastructure development (to contribute the EMS system to people throughout with standard and efficiency both in normally and disaster conditions). Finally, twenty-nine indicators were developed from the analysis results of SM and SFs.

Keywords: Emergency Medical Service, Performance Indicator, Success Factor, Thailand

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Authors: Nasir Baba Ahmed, Nicolas Daclin, Marc Olivaux, Gilles Dusserre

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The Mobile field hospital is critical in terms of managing emergencies in crisis. It is a sub-section of the main hospitals and the health sector, tasked with delivering responsive, immediate, and efficient medical services during a crisis. With the aim to prevent further crisis, the assessment of the cyber assets follows different methods, to distinguish its strengths and weaknesses, and in turn achieve cyber resiliency. The work focuses on assessments of cyber resilience in field hospitals with trends growing in both the field hospital and the health sector in general. This creates opportunities for the adverse attackers and the response improvement objectives for attaining cyber resilience, as the assessments allow users and stakeholders to know the level of risks with regards to its cyber assets. Thus, the purpose is to show the possible threat vectors which open up opportunities, with contrast to current trends in the assessment of the mobile field hospitals’ cyber assets.

Keywords: Assessment framework, cyber resilience, cyber security, Mobile Field Hospital.

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Authors: D. Tedesco, G. Feletti, P. Trucco

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The present study aims to develop a Decision Support System (DSS) to support operational decisions in Emergency Medical Service (EMS) systems regarding the assignment of medical emergency requests to Emergency Departments (ED). This problem is called “hospital selection” and concerns the definition of policies for the selection of the ED to which patients who require further treatment are transported by ambulance. The employed research methodology consists of a first phase of review of the technical-scientific literature concerning DSSs to support the EMS management and, in particular, the hospital selection decision. From the literature analysis, it emerged that current studies mainly focused on the EMS phases related to the ambulance service and consider a process that ends when the ambulance is available after completing a mission. Therefore, all the ED-related issues are excluded and considered as part of a separate process. Indeed, the most studied hospital selection policy turned out to be proximity, thus allowing to minimize the travelling time and to free-up the ambulance in the shortest possible time. The purpose of the present study consists in developing an optimization model for assigning medical emergency requests to the EDs also considering the expected time performance in the subsequent phases of the process, such as the case mix, the expected service throughput times, and the operational capacity of different EDs in hospitals. To this end, a Discrete Event Simulation (DES) model was created to compare different hospital selection policies. The model was implemented with the AnyLogic software and finally validated on a realistic case. The hospital selection policy that returned the best results was the minimization of the Time To Provider (TTP), considered as the time from the beginning of the ambulance journey to the ED at the beginning of the clinical evaluation by the doctor. Finally, two approaches were further compared: a static approach, based on a retrospective estimation of the TTP, and a dynamic approach, focused on a predictive estimation of the TTP which is determined with a constantly updated Winters forecasting model. Findings reveal that considering the minimization of TTP is the best hospital selection policy. It allows to significantly reducing service throughput times in the ED with a negligible increase in travel time. Furthermore, an immediate view of the saturation state of the ED is produced and the case mix present in the ED structures (i.e., the different triage codes) is considered, as different severity codes correspond to different service throughput times. Besides, the use of a predictive approach is certainly more reliable in terms on TTP estimation, than a retrospective approach. These considerations can support decision-makers in introducing different hospital selection policies to enhance EMSs performance.

Keywords: Emergency medical services, hospital selection, discrete event simulation, forecast model.

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Authors: M. Saidi, F. Ait-Medjber, B. Safi, M. Samar

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This work is focused on the study of valuation of recycled concrete aggregates, by measuring certain properties of concrete in the fresh and hardened state. In this study, rheological tests and physic-mechanical characterization on concretes and mortars were conducted with recycled concrete whose geometric properties were identified aggregates. Mortars were elaborated with recycled fine aggregate (0/5mm) and concretes were manufactured using recycled coarse aggregates (5/12.5 mm and 12.5/20 mm). First, a study of the mortars was conducted to determine the effectiveness of polycarboxylate superplasticizer on the workability of these and their action deflocculating of the recycled sand. The rheological behavior of mortars based on fine aggregate recycled was characterized. The results confirm that the mortars composed of different fractions of recycled sand (0 /5) have a better mechanical properties (compressive and flexural strength) compared to normal mortar. Also, the mechanical strengths of concretes made with recycled aggregates (5/12.5 mm and 12.5/20 mm), are comparable to those of conventional concrete with conventional aggregates, provided that the implementation can be improved by the addition of a superplasticizer.

Keywords: Demolition wastes, recycled coarse aggregate, concrete, workability, mechanical strength, porosity/water absorption.

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Authors: Wei-Wen Liu, Feng-Chuan Pan, Pei-Chi Wen, Sen-Ji Chen, Su-Hui Lin

Abstract:

Nurses in an Armed Force Hospital (AFH) expose to stronger stress than those in a civil hospital, especially in an emergency department (ED). Ironically, stresses of these nurses received few if any attention in academic research in the past. This study collects 227 samples from the emergency departments of four armed force hospitals in central and southern Taiwan. The research indicates that the top five stressors are a massive casualty event, delayed physician support, overloads of routine work, overloads of assignments, and annoying paper work. Excessive work loading was found to be the primary source of stress. Nurses who were perceived to have greater stress levels were more inclined to deploy emotion-oriented approaches and more likely to seek job rotations. Professional stressors and problem-oriented approaches were positively correlated. Unlike other local studies, this study concludes that the excessive work-loading is more stressful in an AFH.

Keywords: Emergency nurse, Job stressor, Coping behavior, Armed force hospital.

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Authors: Charles Chikwendu Okpala, Christopher Chukwutoo Ihueze

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As a technique that reduces variation in a product by lessening the sensitivity of the design to sources of variation, rather than by controlling their sources, Taguchi Robust Design entails the designing of ideal goods, by developing a product that has minimal variance in its characteristics and also meets the desired exact performance. This paper examined the concept of the manufacturing approach and its application to brake pad product of an automotive parts manufacturing company. Although the firm claimed that only defects, excess inventory, and over-production were the few wastes that grossly affect their productivity and profitability, a careful study and analysis of their manufacturing processes with the application of Single Minute Exchange of Dies (SMED) tool showed that the waste of waiting is the fourth waste that bedevils the firm. The selection of the Taguchi L9 orthogonal array which is based on the four parameters and the three levels of variation for each parameter revealed that with a range of 2.17, that waiting is the major waste that the company must reduce in order to continue to be viable. Also, to enhance the company’s throughput and profitability, the wastes of over-production, excess inventory, and defects with ranges of 2.01, 1.46, and 0.82, ranking second, third, and fourth respectively must also be reduced to the barest minimum. After proposing -33.84 as the highest optimum Signal-to-Noise ratio to be maintained for the waste of waiting, the paper advocated for the adoption of all the tools and techniques of Lean Production System (LPS), and Continuous Improvement (CI), and concluded by recommending SMED in order to drastically reduce set up time which leads to unnecessary waiting.

Keywords: Taguchi Robust Design, signal to noise ratio, Single Minute Exchange of Dies, lean production system, waste.

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Authors: Farzaneh Tahmoorian, Bijan Samali, John Yeaman

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Road networks are increasingly expanding all over the world. The construction and maintenance of the road pavements require large amounts of aggregates. Considerable usage of various natural aggregates for constructing roads as well as the increasing rate at which solid waste is generated have attracted the attention of many researchers in the pavement industry to investigate the feasibility of the application of some of the waste materials as alternative materials in pavement construction. Among various waste materials, construction and demolition wastes, including Recycled Construction Aggregate (RCA) constitute a major part of the municipal solid wastes in Australia. Creating opportunities for the application of RCA in civil and geotechnical engineering applications is an efficient way to increase the market value of RCA. However, in spite of such promising potentials, insufficient and inconclusive data and information on the engineering properties of RCA had limited the reliability and design specifications of RCA to date. In light of this, this paper, as a first step of a comprehensive research, aims to investigate the feasibility of the application of RCA obtained from construction and demolition wastes for the replacement of part of coarse aggregates in asphalt mixture. As the suitability of aggregates for using in asphalt mixtures is determined based on the aggregate characteristics, including physical and mechanical properties of the aggregates, an experimental program is set up to evaluate the physical and mechanical properties of RCA. This laboratory investigation included the measurement of compressive strength and workability of RCA, particle shape, water absorption, flakiness index, crushing value, deleterious materials and weak particles, wet/dry strength variation, and particle density. In addition, the comparison of RCA properties with virgin aggregates has been included as part of this investigation and this paper presents the results of these investigations on RCA, basalt, and the mix of RCA/basalt.

Keywords: Asphalt, basalt, pavement, recycled aggregate.

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Authors: S. Kurien, S. Satpathy, S. K. Gupta, S. K. Arya, D. K. Sharma

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Advances in the use of health care technology have resulted in increased adverse events (AEs) related to the use of medical devices. The study focused on the existing reporting systems. This study was conducted in a tertiary care public sector hospital. Devices included Syringe infusion pumps, Cardiac monitors, Pulse oximeters, Ventilators and Defibrillators. A total of 211 respondents were recruited. Interviews were held with 30 key informants. Medical records were scrutinized. Relevant statistical tests were used. Resident doctors reported maximum frequency of AEs, followed by nurses; and least by consultants. A significant association was found between the cadre of health care personnel and awareness that the patients and bystanders have a risk of sustaining AE. Awareness regarding reporting of AEs was low, and it was generally done verbally. Other critical findings are discussed in the light of the barriers to reporting, reasons for non-compliance, recording system, and so on.

Keywords: Adverse events, health care technology, public sector hospital, reporting systems.

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