Search results for: hospital wastes

Authors: Marzieh Moosavi-Nasab, Mohsen Gavahian, Ali R. Yousefi, Hamed Askari

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Dextran is a D-glucose polymer which is produced by Leuconostoc mesenteroides grown in a sucrose-rich media. The organism was obtained from the Persian Type Culture Collection (PTCC) and was transferred in MRS broth medium at 30°C and pH 6.8 for 24 h. After preparation of inoculums, organisms were inoculated into five liquid fermentation media containing either molasses or cheese whey or different combinations of cheese whey and molasses. After certain fermentation period, the produced dextran was separated and dried. Dextran yield was calculated and significant differences in different media were observed. Furthermore, FT-IR analysis was performed and the results showed that there were no significant differences in the produced dextran structures.

Keywords: Dextran, Leuconostoc mesenteroides, Molasses, Whey

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Authors: S. R. Shamili, J. Karthikeyan

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Fast development of the total populace and far and wide urbanization has surprisingly expanded the advancement of the construction industry. As a result of these activities, old structures are being demolished to make new buildings. Due to these large-scale demolitions, a huge amount of debris is generated all over the world, which results in a landfill. The use of construction and demolition waste as landfill causes groundwater contamination, which is hazardous. Using construction and demolition waste as aggregate can reduce the use of natural aggregates and the problem of mining. The objective of this study is to provide a detailed overview on how the construction and demolition waste material has been used as aggregate in structural concrete. In this study, the preparation, classification, and composition of construction and demolition wastes are also discussed.

Keywords: Aggregate, construction and demolition waste, landfill, large scale demolition.

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Authors: Baby Joseph, Sankarganesh Palaniyandi

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The enzyme alkaline protease production was determined under solid state fermentation using the soil bacteria Serratia marcescens sp7. The maximum production was obtained from wheat bran medium than ground nut shell and chemically defined medium. The physiological fermentation factors such as pH of the medium (pH 8), Temperature (40oC) and incubation time (48 hrs) played a vital role in alkaline protease production in all the above. 100Mm NaCl has given better resolution during elution of the enzymes. The enzyme production was found to be associated with growth of the bacterial culture.

Keywords: Alkaline protease, Wheat bran, Ground nut shell, Serratia marcescens

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Authors: Riki Mukhaiyar

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The integration between technology of remote sensing, information from the data of digital image, and modeling technology for the simulation of water quality will provide easiness during the observation on the quality of water changes on the river surface. For example, Ciliwung River which is contaminated with non-point source pollutant from household wastes, particularly on its downstream. This fact informed that the quality of water in this river is getting worse. The land use for settlements and housing ranges between 62.84% - 81.26% on the downstream of Ciliwung River, give a significant picture in seeing factors that affected the water quality of Ciliwung River.

Keywords: Digital Image, Digitize, Landuse, Non-Point SourcePollutant, Qual2e Simulation

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Authors: Dorota Stadnicka, Katarzyna Antosz

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The idea of Lean Manufacturing has been known for 20 years. In Polish enterprises its first implementation took place in the automotive industry in the 90s. Many companies, in order to reduce costs, use lower quality materials or overload employees with work and do not notice other possibilities for improving the company’s effectiveness. Enterprises are afraid of the unknown. And that is the problem in many cases with the Lean Manufacturing conception. This article presents the study results conducted in enterprises, the aim of which was to identify waste awareness and the need of lean manufacturing implementation. The authors also wanted to gain information on the most commonly used tools and the way of implementation and the methods of the effects assessment of using the mentioned conception. The study was conducted in large enterprises located on a limited area.

Keywords: Large enterprises, lean manufacturing, tools, wastes elimination.

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Authors: F. Pedron, M. Grifoni, G. Petruzzelli, M. Barbafieri, I. Rosellini, B. Pezzarossa

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Lead contamination of agricultural land mainly vegetated with perennial ryegrass (Lolium perenne) has been investigated. The metal derived from the discharge of sludge from a ceramic industry in the past had used lead paints. The results showed very high values of lead concentration in many soil samples. In order to assess the lead soil contamination, a sequential extraction with H₂O, KNO₃, EDTA was performed, and the chemical forms of lead in the soil were evaluated. More than 70% of lead was in a potentially bioavailable form. Analysis of Lolium perenne showed elevated lead concentration. A Freundlich-like model was used to describe the transferability of the metal from the soil to the plant.

Keywords: Bioavailability, Freundlich-like equation, sequential extraction, soil lead contamination.

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Authors: Tarek Fatouh, Chehab Elbelehy, Alaa Abdelsalam, Eman Elakkad, Alaa Abdelshafie

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This paper aims to explore the possibility of time compression in Engineer to Order production networks. A case study research method is used in a Norwegian shipbuilding project by implementing a value stream mapping lean tool with total cycle time as a unit of analysis. The analysis resulted in demonstrating the time deviations for the planned tasks in one of the processes in the shipbuilding project. So, authors developed a future state map by removing time wastes from value stream process.

Keywords: Engineer to order, total cycle time, value stream mapping, shipbuilding.

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Authors: Petri Kouvo, Aino Kainulainen, Kimmo Koivunen

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Separate collection system for recyclable wastes in the Helsinki region was ranked second best of European capitals. The collection system includes paper, cardboard, glass, metals and biowaste. Residual waste is collected and used in energy production. The collection system excluding paper is managed by the Helsinki Region Environmental Services HSY, a public organization owned by four municipalities (Helsinki, Espoo, Kauniainen and Vantaa). Paper collection is handled by the producer responsibility scheme. The efficiency of the collection system in the Helsinki region relies on a good coverage of door-to-door-collection. All properties with 10 or more dwelling units are required to source separate biowaste and cardboard. This covers about 75% of the population of the area. The obligation is extended to glass and metal in properties with 20 or more dwelling units. Other success factors include public awareness campaigns and a fee system that encourages recycling. As a result of waste management regulations for source separation of recyclables and biowaste, nearly 50 percent of recycling rate of household waste has been reached. For households and small and medium size enterprises, there is a sorting station fleet of five stations available. More than 50 percent of wastes received at sorting stations is utilized as material. The separate collection of plastic packaging in Finland will begin in 2016 within the producer responsibility scheme. HSY started supplementing the national bring point system with door-to-door-collection and pilot operations will begin in spring 2016. The result of plastic packages pilot project has been encouraging. Until the end of 2016, over 3500 apartment buildings have been joined the piloting, and more than 1800 tons of plastic packages have been collected separately. In the summer 2015 a novel partial flow digestion process combining digestion and tunnel composting was adopted for source separated household and commercial biowaste management. The product gas form digestion process is converted in to heat and electricity in piston engine and organic Rankine cycle process with very high overall efficiency. This paper describes the efficient collection system and discusses key success factors as well as main obstacles and lessons learned as well as the partial flow process for biowaste management.

Keywords: Biowaste, HSY, MSW, plastic packages, recycling, separate collection.

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Authors: Isabel Brás, Artur Figueirinha, Bruno Esteves, Luísa P. Cruz-Lopes

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The agriculture lignocellulosic by-products are receiving increased attention, namely in the search for filter materials that retain contaminants from water. These by-products, specifically almond and hazelnut shells are abundant in Portugal once almond and hazelnuts production is a local important activity. Hazelnut and almond shells have as main constituents lignin, cellulose and hemicelluloses, water soluble extractives and tannins. Along the adsorption of heavy metals from contaminated waters, water soluble compounds can leach from shells and have a negative impact in the environment. Usually, the chemical characterization of treated water by itself may not show environmental impact caused by the discharges when parameters obey to legal quality standards for water. Only biological systems can detect the toxic effects of the water constituents. Therefore, the evaluation of toxicity by biological tests is very important when deciding the suitability for safe water discharge or for irrigation applications.

The main purpose of the present work was to assess the potential impacts of waters after been treated for heavy metal removal by hazelnut and almond shells adsorption systems, with short term acute toxicity tests.

To conduct the study, water at pH 6 with 25 mg.L^-1 of lead, was treated with 10 g of shell per litre of wastewater, for 24 hours. This procedure was followed for each bark. Afterwards the water was collected for toxicological assays; namely bacterial resistance, seed germination, Lemna minor L. test and plant grow. The effect in isolated bacteria strains was determined by disc diffusion method and the germination index of seed was evaluated using lettuce, with temperature and humidity germination control for 7 days. For aquatic higher organism, Lemnas were used with 4 days contact time with shell solutions, in controlled light and temperature. For terrestrial higher plants, biomass production was evaluated after 14 days of tomato germination had occurred in soil, with controlled humidity, light and temperature.

Toxicity tests of water treated with shells revealed in some extent effects in the tested organisms, with the test assays showing a close behaviour as the control, leading to the conclusion that its further utilization may not be considered to create a serious risk to the environment.

Keywords: Acute toxicity tests, adsorption, lignocellulosic wastes, risk assessment.

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Authors: Ayaka Kamiyama, Akihiro Iijima

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On March 11, 2011, the East coast of Japan was hit by one of the strongest earthquakes in history, followed by a devastating tsunami. Although most lifelines, infrastructure, and public facilities have been restored gradually, recovery efforts in terms of disposal of disaster waste and revival of primary industry are lagging. This study presents a summary of the damage inflicted by the earthquake and the current status of reconstruction in the disaster area. Moreover, we discuss the current trends and future perspectives on recently implemented eco-friendly reconstruction projects and focus on the pro-environmental behavior of disaster victims which is emerging as a result of the energy shortage after the earthquake. Finally, we offer ideas for initiatives for the next stage of the reconstruction policies.

Keywords: Agriculture, Disaster wastes, Pro-environmental behavior, Reconstruction policies.

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Authors: Linh Thi Truc Doan, Yousef Amer, Sang-Heon Lee, Phan Nguyen Ky Phuc

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During the last few decades, with the high-speed upgrade of electronic products, electronic waste (e-waste) has become one of the fastest growing wastes of the waste stream. In this context, more efforts and concerns have already been placed on the treatment and management of this waste. To mitigate their negative influences on the environment and society, it is necessary to establish appropriate strategies for e-waste management. Hence, this paper aims to review and analysis some useful strategies which have been applied in several countries to handle e-waste. Future perspectives on e-waste management are also suggested. The key findings found that, to manage e-waste successfully, it is necessary to establish effective reverse supply chains for e-waste, and raise public awareness towards the detrimental impacts of e-waste. The result of the research provides valuable insights to governments, policymakers in establishing e-waste management in a safe and sustainable manner.

Keywords: E-waste, e-waste management, life cycle assessment, recycling regulations.

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Authors: Patcharin Worathanakul, Wisaroot Payubnop, Akhapon Muangpet

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Utilization of bagasse ash for silica sources is one of the most common application for agricultural wastes and valuable biomass byproducts in sugar milling. The high percentage silica content from bagasse ash was used as silica source for sodium silicate solution. Different heating temperature, time and acid treatment were studies for silica extraction. The silica was characterized using various techniques including X-ray fluorescence, X-ray diffraction, Scanning electron microscopy, and Fourier Transform Infrared Spectroscopy method,. The synthesis conditions were optimized to obtain the bagasse ash with the maximum silica content. The silica content of 91.57 percent was achieved from heating of bagasse ash at 600°C for 3 hours under oxygen feeding and HCl treatment. The result can be used as value added for bagasse ash utilization and minimize the environmental impact of disposal problems.

Keywords: Bagasse ash, synthesis, silica, extraction, posttreatment

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Authors: M.S. Dhanya, N. Gupta, H.C. Joshi, Lata

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The present investigation was undertaken to explore the biogas potentiality of Jatropha (Jatropha curcas, Euphorbiaceae) Fruit Coat (JFC) alone and in combination with cattle dung (CD) in various proportions at 15 per cent total solids by batch phase anaerobic digestion for a period of ten weeks HRT (Hydraulic Retention Time) under a temperature of 35°C+1°C. The maximum biogas production was noticed in Cattle dung and Jatropha Fruit Coat in 2:1 ratio with 403.84 L/kg dry matter followed by 3:1,1:2, 1:1 and 1:3 having 329.66, 219.77, 217.79, 203.64 L /kg dm respectively as compared to 178.49 L/kg dm in CD alone. The JFC alone found to produce 91 per cent of total biogas that obtained from Cattle dung. The per cent methane content of the biogas in all the treatments was found on par with Cattle dung.

Keywords: Jatropha Fruit Coat, Cattle dung, Hydraulic Retention Time, Dry matter

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Authors: Tanapoom Phuncharoen, Tawiwat Sriwongsa, Kanita Boonruang, Apichit Svang-ariyaskul

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The production of Dimethyl acetal, Isovaleradehyde and Pyridine were simulated using Aspen Plus simulation. Upgrading cleaning water from wine industrial production is the main objective of the project. The winery waste composes of Acetaldehyde, Methanol, Ethyl Acetate, 1-propanol, water, iso-amyl alcohol and iso-butyl alcohol. The project is separated into three parts; separation, reaction, and purification. Various processes were considered to maximize the profit along with obtaining high purity and recovery of each component with optimum heat duty. The results show a significant value of the product with purity more than 75% and recovery over 98%.

Keywords: Dimethyl acetal, Pyridine, wine, Aspen Plus, Isovaleradehyde, polymeric precursors.

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Authors: D. Bheenick, M. Young, M. Elmussareh, A. Ali

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Coronavirus disease 2019 (COVID-19) has had unprecedented effects on the healthcare system in the UK. The pandemic has impacted every service within secondary care, including urology. Our objective is to determine how COVID-19 has influenced acute urology admissions in a busy district general hospital in the UK. To conduct the study, retrospective data of patients presenting acutely to the urology department were collected between January 13 to March 22, 2020 (pre-lockdown period) and March 23 to May 31, 2020 (lockdown period). The nature of referrals, types of admission encountered, and management required in accordance with the new set of protocols established during the lockdown period were analysed and compared to the same data prior to UK lockdown. Included in the study were 1092 patients. The results show that an overall reduction of 32.5% was seen in the total number of admissions. A marked decrease was seen in non-urological pathology as compared to other categories. Urolithiasis showed the highest proportional increase. Treatment varied proportionately to the diagnosis, with conservative management accounting for the most likely treatment during lockdown. However, the proportion of patients requiring interventions during the lockdown period increased overall. No comparative differences were observed during the two periods in terms of source of referral, length of stay and patient age. The results of the study concluded that the admission rate showed a decrease, with no significant difference in the nature and timing of presentation. Our department was able to continue providing effective management to patients presenting acutely during the COVID-19 outbreak.

Keywords: COVID-19, lockdown, admissions, urology

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Authors: Do Thi Ha, Khanitta Nuntaboot

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Background: Competency of nurses is vital to safe nursing practice as well as essential component to drive quality of nursing services. There exists little up to date information concerning actual competency among Vietnamese nurses. Purposes: The purpose of this study is to identify the actual nursing competency among nurses in clinical settings in Vietnam. Methods: A qualitative study, ethnographic method, comprised of the participant-observation, in-depth interview, and focus group discussion with multidisciplinary groups of nurses employing in Cho Ray hospital, Vietnam, managers/administrators, nurse teachers, medical doctors, other health care providers, patients and family members which derived from purposeful sampling technique. Content analysis was used for data analysis. Results: Five essential themes of nursing competencies among nurses were identified include (1) knowledge, (2) skills, (3) attitude and value-based nursing practice, (4) legal and ethical competencies, and (5) transcultural competencies. Basic and advanced knowledge were identified as further two dimensions of knowledge. There were five sub themes identified as further dimensions of skills include technical skills, communication skills, organizing and management skills, teamwork and interrelationship, and critical thinking skills. Conclusions: The findings from this study provide valuable information and understanding of the actual competency among nurses in clinical settings in Vietnam. It is expected that this understanding would assist in developing a guide to nursing education and training, nursing practice and relevant policy regulation used for promoting nursing competency among nurses.

Keywords: Nursing competency, qualitative design, ethnographic method, Vietnam.

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Authors: Hongzhi Wang, Jianzhong Li, Hong Gao

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XML is an important standard of data exchange and representation. As a mature database system, using relational database to support XML data may bring some advantages. But storing XML in relational database has obvious redundancy that wastes disk space, bandwidth and disk I/O when querying XML data. For the efficiency of storage and query XML, it is necessary to use compressed XML data in relational database. In this paper, a compressed relational database technology supporting XML data is presented. Original relational storage structure is adaptive to XPath query process. The compression method keeps this feature. Besides traditional relational database techniques, additional query process technologies on compressed relations and for special structure for XML are presented. In this paper, technologies for XQuery process in compressed relational database are presented..

Keywords: XML, compression, query processing

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Authors: H. Ahmed, A. Persson, L. Sundqvist, B. Biorkman

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Numerous amounts of metallurgical dusts and sludge containing iron as well as some other valuable elements such as Zn, Pb and C are annually produced in the steelmaking industry. These alternative iron ore resources (fines) with unsatisfying physical and metallurgical properties are difficult to recycle. However, agglomerating these fines to be further used as a feed stock for existing iron and steelmaking processes is practiced successfully at several plants but for limited extent.

In the present study, briquettes of integrated steelmaking industry waste materials (namely, BF-dust and sludge, BOF-dust and sludge) were used as feed stock to produce direct reduced iron (DRI). Physical and metallurgical properties of produced briquettes were investigated by means of TGA/DTA/QMS in combination with XRD. Swelling, softening and melting behavior were also studied using heating microscope.

Keywords: Iron and Steel Wastes, Recycling, Self-Reducing Briquettes, Thermogravimetry.

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Authors: B. Muhammadani

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Health workforce is a fundamental component of health system and plays a significant role in delivering effective health care services. However, there is a crucial shortage of skilled personnel which make them prone to work in stressful conditions. In spite of excessively high workload and burnout among the staff, little attention is given to their job satisfaction level which has serious implications on the productivity and effective performance of staff to achieve organizational goals. Therefore, this study aims to explore the job satisfaction of midwives working in the labor ward of the Lady Dufferin Hospital, Karachi. A cross-sectional survey was conducted. The short version of Minnesota Job Satisfaction Questionnaire was administered on a convenient sample group of 22 midwives to gather information on their job satisfaction. The results demonstrated that midwives were overall satisfied with their job. The level of job satisfaction was however found different in various positions within midwifery cadre. The head of midwives was highly satisfied as compared to midwifery staff who works under the supervision of head. The level of satisfaction of team leaders fall between the head and staff of midwifery. Similar trends were observed for both intrinsic and extrinsic job satisfaction. Such evidences on these issues are essential and useful as it helps explore the attitudes of individuals towards work which has direct implications on access to quality care services. Strategic interventions are required at organizational level to provide motivators and satisfiers to health workers for their work related satisfaction and enhanced motivation.

Keywords: Health workforce, job satisfaction, motivation, workload, burnout, midwives, health system.

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Authors: V. Chahal, A. Nagpal, Y. B. Pakade, J. K. Katnoria

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Soil is a complex physical and biological system that provides support, water, nutrients and oxygen to the plants. Apart from these, it acts as a connecting link between inorganic, organic and living components of the ecosystem. In recent years, presence of xenobiotics, alterations in the natural soil environment, application of pesticides/inorganic fertilizers, percolation of contaminated surface water as well as leachates from landfills to subsurface strata and direct discharge of industrial wastes to the land have resulted in soil pollution which in turn has posed severe threats to human health especially in terms of causing carcinogenicity by direct DNA damage. The present review is an attempt to summarize literature on sources of soil pollution, characterization of pollutants and their consequences in different living systems.

Keywords: Soil Pollution, Contaminants, Heavy metals, Pesticides, Bioassays.

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Authors: Nareelux Suwannobol, JintanaTapin, Khuanchanok Narachan

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The objective of this study was to determine the accuracy to estimation fetal weight by Johnson-s method and compares it with actual birth weight. The sample group was 126 infants delivered in Dan KhunThot hospital from January March 2012. Fetal weight was estimated by measuring fundal height according to Johnson-s method. The information was collected by studying historical delivery records and then analyzed by using the statistics of frequency, percentage, mean, and standard deviation. Finally, the difference was analyzed by a paired t-test.The results showed had an average birth weight was 3093.57 ± 391.03 g (mean ± SD) and 3,455 ± 454.55 g average estimated fetal weight by Johnson-s method higher than average actual birth weight was 384.09 grams. When classifying the infants according to birth weight found that low birth weight (<2500 g) and the appropriate birth weight (2500-3999g) actual birth weight less than estimate fetal weight . But the high birth weight (> 4000 g) actual birth weight was more than estimated fetal weight. The difference was found between actual birth weight and estimation fetal weight of the minimum weight in high birth weight ( > 4000 g) , the appropriate birth weight (2500-3999g) and low birth weight (<2500 g) respectively. The rate of estimates fetal weight within 10% of actual birth weight was 35.7%. Actual birth weight were compared with the found that the difference is statistically significant (p <.000). Employing Johnson-s method to estimate fetal weight can estimate initial fetal weight before passing to special examinations, which may require excessive high cost. A variety of methods should be employed to estimate fetal weight more precisely, which will help plan care for mother-s and infant-s safety.

Keywords: Johnson's method, Fetal weight estimate, Delivery Room, Student nurse.

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Authors: Aarati Susan Mathew, Radhika Narendra Patel, Jiji Mathew

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A retrospective study conducted at Christian Medical College (CMC) Teaching Hospital, Vellore, India on 14th August 2014 to assess the accuracy of clinically estimated foetal weight upon labour admission. Estimating foetal weight is a crucial factor in assessing maternal and foetal complications during and after labour. Medical notes of ninety-eight postnatal women who fulfilled the inclusion criteria were studied to evaluate the correlation between their recorded Estimated Foetal Weight (EFW) on admission and actual birth weight (ABW) of the newborn after delivery. Data concerning maternal and foetal demographics was also noted. Accuracy was determined by absolute percentage error and proportion of estimates within 10% of ABW. Actual birth weights ranged from 950-4080g. A strong positive correlation between EFW and ABW (r=0.904) was noted. Term deliveries (≥40 weeks) in the normal weight range (2500-4000g) had a 59.5% estimation accuracy (n=74) compared to pre-term (<40 weeks) with an estimation accuracy of 0% (n=2). Out of the term deliveries, macrosomic babies (>4000g) were underestimated by 25% (n=3) and low birthweight (LBW) babies were overestimated by 12.7% (n=9). Registrars who estimated foetal weight were accurate in babies within normal weight ranges. However, there needs to be an improvement in predicting weight of macrosomic and LBW foetuses. We have suggested the use of an amended version of the Johnson’s formula for the Indian population for improvement and a need to re-audit once implemented.

Keywords: Clinical palpation, estimated foetal weight, pregnancy, India, Johnson’s formula.

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Authors: Essa Alenazi, Zulfikar Adamu

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The Kingdom of Saudi Arabia (KSA) is not an exception in relying on the growth of its construction industry to support rapid population growth. However, its need for infrastructure development is constrained by low productivity levels and cost overruns caused by factors such as delays to project completion. Delays in delivering a construction project are a global issue and while theories such as Optimism Bias have been used to explain such delays, in KSA, client-related causes of delays are also significant. The objective of this paper is to develop a framework-based approach to explore how the country’s construction industry can manage and reduce delays in construction projects through building information modelling (BIM) in order to mitigate the cost consequences of such delays.  It comprehensively and systematically reviewed the global literature on the subject and identified gaps, critical delay factors and the specific benefits that BIM can deliver for the delay management.  A case study comprising of nine hospital projects that have experienced delay and cost overruns was also carried out. Five critical delay factors related to the clients were identified as candidates that can be mitigated through BIM’s benefits. These factors are: Ineffective planning and scheduling of the project; changes during construction by the client; delay in progress payment; slowness in decision making by the client; and poor communication between clients and other stakeholders. In addition, data from the case study projects strongly suggest that optimism bias is present in many of the hospital projects. Further validation via key stakeholder interviews and documentations are planned.

Keywords: BIM, client perspective, delay management, optimism bias, public sector projects.

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Authors: Z. Nurzaireena, K. Azalea, T. Azirawaty, S. Jameela, G. Muralitharan

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The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.

Keywords: Anemia, haemoglobinopathies, pregnancy, sickle cell disease.

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Authors: Laila Seada, Ashraf Ibrahim, Amjad Al Shammari

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Background and Objectives: Breast carcinoma is the most common cancer of females in Hail region, accounting for 31% of all diagnosed cancer cases followed by thyroid carcinoma (25%) and colorectal carcinoma (13%). Methods: In the present retrospective study, all cases of breast lesions received at the histopathology department in King Khalid Hospital, Hail, during the period from May 2011 to April 2016 have been retrieved from department files. For all cases, a trucut biopsy, lumpectomy, or modified radical mastectomy was available for histopathologic diagnosis, while 105/140 (75%) had, as well, preoperative fine needle aspirates (FNA). Results: 49 cases out of 140 (35%) breast lesions were carcinomas: 44/49 (89.75%) was invasive ductal, 2/49(4.1%) invasive lobular carcinomas, 1/49(2.05%) intracystic low grade papillary carcinoma and 2/49 (4.1%) ductal carcinoma in situ (DCIS). Mean age for malignant cases was 45.06 (+/-10.58): 32.6% were below the age of 40 and 30.6 below 50 years, 18.3% below 60 and 16.3% below 70 years. For the benign group, mean age was 32.52 (+/10.5) years. Benign lesions were in order of frequency: 34 fibroadenomas, 14 fibrocystic disease, 12 chronic mastitis, five granulomatous mastitis, three intraductal papillomas, and three benign phyllodes tumor. Tubular adenoma, lipoma, skin nevus, pilomatrixoma, and breast reduction specimens constituted the remaining specimens. Conclusion: Breast lesions are common in our series and invasive carcinoma accounts for more than 1/3^rd of the lumps, with 63.2% incidence in pre-menopausal ladies, below the age of 50 years. FNA as a non-invasive procedure, proved to be an effective tool in diagnosing both benign and malignant/suspicious breast lumps and should continue to be used as a first assessment line of palpable breast masses.

Keywords: Age incidence, breast carcinoma, fine needle aspiration, Hail Region.

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Authors: Sharan Badiger, Prema T. Akkasaligar, P. Amith Kumar

Abstract:

Upper gastrointestinal endoscopy is a commonly performed diagnostic and therapeutic procedure and has many adverse effects like cardiopulmonary complications, complications related to sedation, infectious complications, bleeding and perforation. So this study was undertaken to evaluate important variables like patient’s age, gender and stage of the procedure in relation to the cardiopulmonary changes during diagnostic upper gastrointestinal endoscopy by monitoring oxygen saturation, blood pressure, heart rate and electrocardiogram. This is a prospective longitudinal hospital based study involving a total of 140 consecutive patients, at Sri. B. M. Patil Medical College, Hospital and Research Centre. Cardiopulmonary changes during upper gastrointestinal endoscopy are more common in the age groups of 51-60 years, with equal frequency in both male and female. Oxygen saturation levels decreased by about 4% in both sexes during introduction of endoscopy. Mild to moderate hypoxia was found in 32% of the study group. Severe hypoxia was found in 5% of the patients, mostly in those patients who are above 50 years of age. Tachycardia was noted in 88% of the study group patients. Blood pressure increased to hypertension levels in 22 patients (15.7%) which returned to normal within few minutes after the procedure. S-T depression was noticed in 4% of patients and T wave inversion in 8% of patients during upper gastrointestinal endoscopy. All these changes disappeared after 10 minutes after the endoscopy. Cardiopulmonary changes are common during upper gastrointestinal endoscopy. Maximum changes in oxygen saturation, heart rate and blood pressure occurred immediately after the introduction of endoscope. The cardiopulmonary changes did not manifest into any identifiable clinical symptoms. The rate of recovery was faster in younger age groups and women.

Keywords: Blood Pressure, Cardio-Pulmonary, Heart Rate, Oxygen Saturation, Upper Gastrointestinal Endoscopy.

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Authors: Noor Azlina Mohd Salleh, Salmiah Kasolang, Ahmed Jaffar

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Integrated Total Quality Management (TQM) with Lean Manufacturing (LM) is a system comprises of TQM with LM principles and is associated with financial and nonfinancial performance measurement indicators. The ultimate goal of this system is to focus on achieving total customer satisfaction by removing eight wastes available in any process in an organization. A survey questionnaire was developed and distributed to 30 highly active automotive vendors in Malaysia and analyzed by PASW Statistics 18. It was found out that these vendors have been practicing and measuring the effectiveness TQM and LM implementation. More involvement of all Malaysian automotive vendors will represent the exact status of current Malaysian automotive industry in implementing TQM and LM and can determine whether the industry is ready for integrated TQM and LM system. This is the first study that combined 4 awards practices, ISO/TS16949, Toyota Production System and SAEJ4000.

Keywords: Automotive Industry, Lean Manufacturing, Operational Engineering Management, Total Quality Management

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Authors: Pranee Suecharoen, Jaturat Kanpittaya

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Background: The incidence of adverse reactions to iodinated contrast media has risen. The dearth of reports on reactions to the administration of iso- and low-osmolar contrast media should be addressed. We, therefore, studied the profile of adverse reactions to iodinated contrast media; viz., (a) the body systems affected (b) causality, (c) severity, and (d) preventability. Objective: To study adverse reactions (causes and severity) to iodinated contrast media at Srinagarind Hospital. Method: Between March and July, 2015, 1,101 patients from the Department of Radiology were observed and interviewed for the occurrence of adverse reactions. The patients were classified per Naranjo’s algorithm and through use of an adverse reactions questionnaire. Results: A total of 105 cases (9.5%) reported adverse reactions (57% male; 43% female); among whom 2% were iso-osmolar vs. 98% low-osmolar. Diagnoses included hepatoma and cholangiocarcinoma (24.8%), colorectal cancer (9.5%), breast cancer (5.7%), cervical cancer (3.8%), lung cancer (2.9%), bone cancer (1.9%), and others (51.5%). Underlying diseases included hypertension and diabetes mellitus type 2. Mild, moderate, and severe adverse reactions accounted for 92, 5 and 3%, respectively. The respective groups of escalating symptoms included (a) mild urticaria, itching, rash, nausea, vomiting, dizziness, and headache; (b) moderate hypertension, hypotension, dyspnea, tachycardia and bronchospasm; and (c) severe laryngeal edema, profound hypotension, and convulsions. All reactions could be anticipated per Naranjo’s algorithm. Conclusion: Mild to moderate adverse reactions to low-osmolar contrast media were most common and these occurred immediately after administration. For patient safety and better outcomes, improving the identification of patients likely to have an adverse reaction is essential.

Keywords: Adverse reactions, contrast media, computed tomography, iodinated contrast agents.

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Authors: O. I. Nkwonta, G. M. Ochieng

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Surface water pollution is one of the serious environmental problems in rural areas of South Africa due to discharge of household waste into the streams, turning them into open sewers. In this study, samples of water were collected from a stream in Soshanguve and analysed. The result showed that pollution in the area was caused by man and its activities. The water quality in the area was found to have deterioted significantly after water runoff from farms and household wastes. The result shows, fertilizer runoff contributes 50% of the pollution while pesticides and sediments contribute up to 10% respectively in the streams, while household waste contributes up to 30%. This study gives an outline of the sources of water pollution in the area and provides a process of creating a clean and unpolluted environment for Soshanguve community in Pretoria north in order to achieve the 7th aim of the millennium development goals by 2015, which is ensuring environmental sustainability.

Keywords: Fertilizer, Household waste, Pollution, Roughing filters.

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Authors: A. Sherif, H. Sabry, A. Elzafarany, M. Gadelhak, R. Arafa, M. Aly

Abstract:

This paper addresses the design of hospital Intensive Care Unit windows for the achievement of visual comfort and energy savings. The aim was to identify the window size and shading system configurations that could fulfill daylighting adequacy, avoid glare and reduce energy consumption. The study focused on addressing the effect of utilizing different shading systems in association with a range of Window-to-Wall Ratios (WWR) in different orientations under the desert clear-sky of Cairo, Egypt. The results of this study demonstrated that solar penetration is a critical concern affecting the design of ICU windows in desert locations, as in Cairo, Egypt. Use of shading systems was found to be essential in providing acceptable daylight performance and energy saving. Careful positioning of the ICU window towards a proper orientation can dramatically improve performance. It was observed that ICU windows facing the north direction enjoyed the widest range of successful window configuration possibilities at different WWRs. ICU windows facing south enjoyed a reasonable number of configuration options as well. By contrast, the ICU windows facing the east orientation had a very limited number of options that provide acceptable performance. These require additional local shading measures at certain times due to glare incidence. Moreover, use of horizontal sun breakers and solar screens to protect the ICU windows proved to be more successful than the other alternatives in a wide range of Window to Wall Ratios. By contrast, the use of light shelves and vertical shading devices seemed questionable.

Keywords: Daylighting, Desert, Energy Efficiency, Shading.

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