Bed Space Research Articles

Influence of bedding on fracture toughness and failure patterns of anisotropic shale

The initiation and propagation of hydraulic fractures are closely related to the fracture ability of rocks. Such processes in shale reservoirs are, to a certain extent, controlled by bedding. However, the control mechanism of bedding on the anisotropy of fracture toughness and fracturing behavior remains unclear. In this study, a series of numerical notched semi-circular bend (NSCB) tests are conducted using the discrete element method (DEM) to investigate the influence of bedding properties on the anisotropy of fracture toughness and fracture patterns. Based on the DEM framework, a novel simulation method is proposed to accurately identify two key fracture indicators, the fracture process zone (FPZ) and crack tip opening displacement (CTOD), to reveal the fracture driving mechanism. The results show that the fracture toughness of shale is negatively correlated with bedding angles β but positively correlated with bedding spacing and bedding strength. Both the bedding strength and spacing significantly influence the fracture pattern of the specimens with β = 0°–60°, whereas the specimen with β = 90° is scarcely affected by the bedding planes. The evolution of the CTOD and FPZ in shale exhibits distinct phased characteristics. Due to the strong suppression effect of low-angle bedding planes on pre-peak crack deflection, the CTOD and FPZ exhibit opposite trends with respect to bedding angles before and after the peak load. This study facilitates the understanding of the fracture propagation process of anisotropic shale and could provide guidance for hydraulic fracturing design in shale reservoirs.

SP4.12 - A single centre experience of managing patients admitted for elective Nissen’s Fundoplication as a day case procedure

Abstract Aims Laparoscopic Nissen’s fundoplication (LNF) is an elective procedure used to treat gastro-oesophgeal reflux which cannot be managed effectively with medical and conservative methods. LNF is the most common surgical procedure used to treat reflux in the UK and optimising the discharge process for these patients can therefore prevent excessive admission times for many patients. This study aimed to analyse the success of LNF as a day case procedure in a tertiary centre. Methods The notes from patients who underwent LNF between January 2020 and December 2023 were retrospectively reviewed. The demographics, co-morbidities and the rates of readmission and complications of the patients included were noted. All patients were managed following local and national surgical, anaesthetic and nursing guidelines. Results 67 patients underwent LNF within the time frame studied, each of which were initially planned to be kept in hospital overnight. 41 (61.2%) cases however, were considered to be medically safe for discharge as a day case operation. None of the patients studied required readmission or suffered any complications despite this change in their care plan. Conclusions This single centre experience showed that patient safety was not compromised by encouraging LNF as a day case procedure in selected patients. Day-case protocols should therefore be considered for patients undergoing LNF who have no/few major co-morbidities and can be looked after at home post-operatively in order to reduce healthcare costs and maximise bed space availability.

Comparative Study of Mechanical Properties and Microstructure Between Conventional and Infinite z-Axis Fused Deposition Modeling Printers

Additive Manufacturing (AM) has emerged as a critical technology in shaping manufacturing strategies, offering versatility and efficiency in designing complex structural components. Extensive literature exists on small- to mid-sized product production. However, a significant knowledge gap exists in manufacturing elongated products, such as wind turbine blades and constructional beams. Current AM technology faces limitations in this context, primarily due to the constraints imposed by the conventional 90-degree nozzle head and limited bed space. This study introduces an innovative AM approach called Infinite z-Axis Printing. This novel technique utilizes a belt-driven heated bed and a 45-degree nozzle head to 3D print objects of infinite length. The study compares this groundbreaking approach and the traditional 90-degree nozzle head Fused Deposition Modeling (FDM) method and the associated results. The findings of this research demonstrate that the Infinite z-Axis Printing methodology yields a significant improvement of up to 20% in tensile and compressive strength compared to the currently used FDM process. This advancement can potentially revolutionize on-site operations by enabling the efficient production of elongated structural components, thus contributing significantly to the construction and renewable energy sectors.

Perspectives on IoT-oriented network simulation systems

The Internet of Things (IoT) paradigm is assumed to be a major component in the present and future Internet, with forecasts claiming a humongous number of devices connected in the near future, and applications fields spanning from agriculture, to healthcare. Despite this, the standardization efforts have not yet resulted in widely adopted standards, and the market is fragmented into multiple solutions both at physical and communication protocol levels. Moreover, IoT systems exacerbate the usual test bed limitations, e.g., scalability (very large number of devices), hardware compatibility, space, and price. Due to the above problems, simulation tools become an extremely interesting tool for studying IoT systems both for academia (new algorithms), standardization (new protocols), and industry (what-if analysis). In this paper we will discuss what are the most relevant features and models that a simulation tool like ns-3 should prioritize to enable the above-mentioned needs from academia, standardization, and industry, and if they are achievable in the short, medium, or long term.

Growing burden of gamma-hydroxybutyrate intoxication on emergency department resource utilisation.

Recreational gamma-hydroxybutyrate (GHB) use is rising in Australia. We aimed to describe ED presentation patterns related to GHB over time and the impact this has on ED resource use. Retrospective review of prospective data collection from two clinical toxicology units based in Queensland and New South Wales. There were 751 GHB-related presentations to the two units (Newcastle, 127; Princess Alexandria, 624), with marked increases in presentations occurring in 2019 and 2023. The major intervention was intubation, with 95 (13%) patients intubated. GHB presentations to ED are rising and the impact on acute bed space and clinical resources is significant.

Productivity and Profitability of Cauliflower (Brassica oleracea var. Botrytis L.) Based Intercropping System for Sorjan Bed System

Cauliflower, scientifically known as Brassica oleracea var. botrytis L., is a highly adaptable vegetable that offers significant nutritional advantages and is cultivated to a varying extent in the Barishal region. An experiment was conducted in Banaripara Upazila, Barishal district, to inspect the selection of a suitable intercrop for cauliflower, with the goal of maximizing the usage of Sorjan bed space and increasing economic benefits for farmers. The study covered two consecutive years, specifically 2021-2022 and 2022-2023. The study included a combination of intercropping treatments, namely Cauliflower as sole crop (T1), Cauliflower + Red amaranth (T2), Cauliflower + coriander leaf (T3), Cauliflower + lettuce (T4), Cauliflower + radish leaf (T5) and Cauliflower + spinach (T6). A randomized complete block design with three replications was used to carry out the study, with treatment effects observed in 3×2.4 m2 of land units. The cauliflower seeds were sown on a nursery bed at October 30th, 2021, and October 29th, 2022. Twenty days older seedlings were undertaken a hardening process for a duration of 2 days. To ensure proper growth, the cauliflower crop received nutrients including N, P, K, S, Zn, B and cow dung at rates of 120, 60, 100, 24, 3.6, 2.1 kg and 3 tons per hectare, respectively. Spanning two consecutive years, the combination of cauliflower and coriander leaf provided the highest land equivalent ratio, with values of 1.68 and 1.62, respectively. Besides, in view of BCR, cauliflower intercropped with spinach resulted the highest BCR values of 1.61 in the first year and 1.50 in the second year. Cauliflower + spinach intercropping system resulted in net returns of 217,410 and 183,950 BDT, respectively. Therefore, it can be suggested that farmers can cultivate their land with a combination of cauliflower and spinach in the interest of maximizing profitability in Sorjan bed cultivation. J Bangladesh Agril Univ 22(2):166-177, 2024

INTRA-ARTICULAR HAEMATOMA BLOCK VERSUS PROCEDURAL SEDATION FOR MANIPULATION OF CLOSED ANKLE FRACTURE DISLOCATIONS: AN EFFICACIOUS, RESOURCE-SPARING SOLUTION?

BackgroundProcedural sedation (PS) requires two suitably qualified clinicians and a dedicated monitored bed space. We present the results of intra-articular haematoma blocks (IAHB), using local anaesthetic, for the manipulation of closed ankle fracture dislocations and compared resource use with PS.MethodsPatients received intra-articular ankle haematoma blocks for displaced ankle fractures requiring manipulation between October 2020 to April 2021. The technique used 10ml of 1% lignocaine injected anteromedially into the tibiotalar joint. Pain scores (VAS), time from first x-ray to reduction, and acceptability of reduction were recorded. A comparison was made by retrospective analysis of patients who had undergone PS for manipulation of an ankle fracture over the six month period March – August 2020.ResultsDuring the periods assessed, 25 patients received an IAHB and 28 received PS for ankle fractures requiring manipulation (mean age 57.8yr vs 55.1yr). Time from first x-ray to manipulation was 65.9 min (IAHB) vs 82.9 min (PS) (p = 0.087). In the IAHB group mean pain scores pre, during and post manipulation were 6.1, 4.7 and 2.0 respectively (‘pre’ to ‘during’ p < 0.05; ‘pre’ to ‘post’ p < 0.01). In the IAHB group, 23 (92%) had a satisfactory reduction without need of PS or general anaesthetic. In the PS group 23 (82%) had a satisfactory reduction. There was no significant difference in the number of unsatisfactory first attempt reductions between the groups. There were no cases of deep infection post operatively in either group.ConclusionIntra-articular haematoma block of the ankle appears to be an efficacious, safe and inexpensive means of providing analgesia for manipulation of displaced ankle fractures. Advantages of this method include avoiding the risks of procedural sedation, removing the requirement of designated clinical space and need for qualified clinicians to give sedation, and the ability to re-manipulate under the same block.

Mitigation of Inpatient Standard Class Risk at Hospital X

Background: The Standard Inpatient Class Policy (KRIS) in Indonesia aims to provide equitable healthcare services, ensuring the same standards in inpatient wards across all hospitals in Indonesia. This policy has been issued since 2021 and is mandatory for all hospitals to implement by December 2024. The implementation of the KRIS policy impacts hospitals, necessitating analysis and mitigation of risks arising from its implementation. This study aims to provide an overview of the analysis and mitigation of risks in the standard inpatient class implemented by Hospital X. Method: Qualitative research using Focus Group Discussions (FGDs) in November 2023 involving 7 key informants, including Hospital Directors and Department Heads, regarding the mitigation of risks in the standard inpatient class using risk analysis matrices. Results: There are two criteria for the standard inpatient class that pose a very high level of risk, namely the building components lacking high porosity and the density of ward spaces and bed spacing. Conclusion: Hospital X implements risk mitigation by taking actions to reduce the impact of risks through room improvement based on related room reports, risk reduction mitigation by planning inpatient building renovations, and risk acceptance mitigation by allowing ward areas to be 9.8 square meters per bed.

Experiences of injured patients referred to higher levels of care after initial assessment and management at non-tertiary hospitals in Ghana

BackgroundThe experiences of trauma patients referred from Ghanaian non-tertiary hospitals for definitive care at higher levels is not well-known. Understanding the motivations of injured patients who do not attend their referral for definitive management may inform interventions to improve injury outcomes. MethodsThis study is a follow-up survey of participants of a larger study involving initial management of injured patients presenting to 8 non-tertiary hospitals in Ghana from October 2020 to March 2022. Injured patients referred to higher levels of care were surveyed by phone using a structured questionnaire and patients who could not be reached were excluded. The main outcome was referral non-attendance and differences between patients who attended the referral and those who did not were determined with chi squared tests. Variables with intergroup differences were included in a multivariable logistic regression. Open-ended survey responses were analyzed using thematic content analysis. ResultsOf 335 referred patients surveyed, 17 % did not attend the referral. Factors associated with referral non-attendance included being male (Adjusted odds ratio (AOR)=2.70, p = 0.013), sustaining a fracture (AOR=2.83, p = 0.003), and having less severe injury (AOR 2.84, p = 0.017). Primary drivers of referral non-attendance included financial problems (59 %), family influence (45 %), and lack of transportation (20 %). The majority of patients (77 %) not attending the referral sought treatment from traditional healers, citing lower cost, faster service, and a perception of equivalent outcomes. Reported facilitators of referral attendance included positive hospital staff experiences and treatment while barriers included higher hospital costs, lack of bed space, and poor interhospital communication. ConclusionsAn important proportion of injured patients in Ghana do not attend referrals for definitive management, with many seeking care from traditional healers. Our study identified possible targets for interventions aimed at maintaining the continuum of hospital-based care for injured patients in order to improve outcomes.

Power-efficient mass transfer of a novel pulsating multi-packed bed liquid - liquid extractor

This paper presents the development and performance evaluation of a new pulsating packed bed contactor designed for optimized diffusion-controlled liquid-liquid operations. Targeting applications like aromatics separation in petroleum, phenol removal from wastewater, and heat-sensitive material extraction (e.g., antibiotics), the contactor offers substantial advantages over traditional mechanical systems – notably, lower power consumption for equivalent production rates. Using the widely studied extraction of acetic acid from toluene-acetic acid by water as a model system, this work comprehensively investigates the factors impacting mass transfer within the pulsating contactor. Key variables explored include physical properties of the feed solution, oscillation frequency and amplitude, initial concentration of solute, flow rates, bed height, packing diameter, and bed spacing. Results reveal a significant enhancement in mass transfer with increasing frequency, amplitude, initial concentration, continuous phase flow rate, and dispersed phase flow rate. Interestingly, while increasing bed height initially improves mass transfer up to a specific point, further height increase exhibits a diminishing return. Packing sphere diameter shows minimal impact, while bed spacing has a negligible effect. A novel dimensionless equation effectively correlates the pulsating multi-packed bed data for broader applicability. To assess economic viability, the study also measures the mechanical power consumption under various operating conditions. Finally, diverse potential applications across pharmaceuticals, chemicals, biochemicals, petroleum, and nuclear fuel reprocessing are highlighted, showcasing the broad utility of this innovative mass transfer technology.

Community-Based Psychiatric Care Provision in Hungary: Trends and Steps towards Progress.

Psychiatric care has undergone several cycles of profound changes in the past centuries all over the world. In Hungary, community-based outpatient care has been showing signs of evolution since the 1950s. Initially, the system centered on assertive outreach and family involvement, especially for those with serious mental health problems. Such services remain available throughout the country, but the emphasis in the past decades has shifted towards mass care provision. In many places, community-based services are no longer provided, and where they are the approach is biomedical and less asuming of recovery. In other centers, the services provided are conceived with the eventuality of rehabilitation in mind and in close cooperation with community-based care providers. Community-based services providers, as part of the social fabric, offer as many psychiatric and rehabilitation services as possible for those with mental disorders within their communities. The main objective of community-based care is to achieve community re-integration and recovery from mental disorders. Today in Hungary, deinstitutionalisation and the introduction of community-based psychiatric care have been adopted even by large inpatient institutions. The replacement of institutional bed space and the provision of subsidised housing further underscore the importance of community-based psychiatric care provision. There is the opinion that, as a further course of development, the emphasis needs to now shift towards the nurturing of a community of experienced experts and creastion of user-led programs. In this new paradigm, the ability of a person with a mental disorder to make decisions and the bolstering of that ability are seen as vital. In order to achieve these objectives, it is essential that health and social seervices professionals cooperate. Hands-on experience is key in the provision and development of such services.

The design of the Inpatient Care Monitoring and Evaluation System for the Executive Report at X Hospital

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>One of the information systems needed in a hospital to support services is the inpatient information system. Several field constraints that often occur and can impede patient services include: limited bed space, hindered coordination between units or rooms, sudden changes in bed space requirements, the lack of integration of information systems, incomplete and inaccurate documentation of patient mobilization, the length of the patient discharge process, unavailable facilities in rooms, and the existence of hospital service indicators that must be achieved. Based on the above, a real-time and integrated information system is required, starting from the registration of inpatients to their discharge, in order to improve the quality of service and patient satisfaction. The design of the Inpatient Monitoring and Evaluation System for the Executive Report is an enhancement of the hospital information system that integrates all inpatient patient service activities, including supporting facilities, to generate useful information for monitoring and developing inpatient care services. This information can be used as a basis for decision-making by the leaders. The design of the Inpatient Monitoring and Evaluation System for the Executive Report utilizes the Systems Development Life Cycle (SDLC) method in the form of a prototype, with the drafting phase starting from design to development. The final result of this information system design consists of comprehensive, integrated, and real-time information related to patient activities from admission to discharge, presented in a dashboard that is useful for monitoring and evaluating inpatient care services. It can also serve as a basis for decision-making by hospital leaders and achieving hospital indicators.</em></p><p><em> </em></p></td></tr></tbody></table></div><p><strong><em>Keywords: Bed management, dashboard, information, inpatient, integration</em></strong></p>

Short-lasting tentorial herniation may cause cortical blindness. A case report and systematic literature review

Cortical blindness occurs with bilateral damage to the visual cortex. It can be caused by various reasons, including the posterior cerebral arteries stroke due to the tentorial herniation. A case of a 40-year-old patient with a large right-sided sphenoidal meningioma. A systematic review on the problem of cortical blindness after tentorial herniation according to the PRISMA guideline. Subtotal removal of dense meningioma. At night after the operation, there was an acute headache, then a coma. Immediately dehydration therapy, tracheal intubation, mechanical ventilation. CT scan showed a small hemorrhage in the tumor bed and subarachnoid space, brain edema and dislocation. After 53 minutes, ventricular drainage was installed, intracranial pressure was normal and ranged from 6 to 14 mmHg. After sedation withdrawal, cortical blindness was detected, which did not regress for 1.5 years. There are no other neurological symptoms, the patient walks, serves herself. Radiation therapy in a total of 54 Gy for the remainder of the grade 1 meningioma ensured tumor control. The time window for restoration of the cerebral blood flow, according to the European Stroke Organization guidelines, is 4.5 hours. In this case, compression of the posterior cerebral arteries lasted less than 53 minutes, however, irreversible ischemia developed in their territory; the outcome on the modified Rankine scale was 4 points. Similar cases are not described in the literature. Patients should be warned about even the non-obvious risks of neurosurgical intervention, since even timely measures taken do not always avoid complications.

Implementation and demonstration of digital twin system for plant factory

This study described the results of implementing the framework of the digital twin system for the digitization of plant factories. The purpose of this invention is to implement a system based on digital twins that can control and monitor the optimal environment for foliage containing functional components grown in plant factories. In this paper, for the realization of such a system, a digital twin framework that can be applied universally to plant factories was designed. This design structure was largely designed by dividing it into 1) the physical world layer, 2) the cyber and physical interaction layer, 3) the digital twin system layer, and 4) the application layer. In this study, the plant factory digital twin framework designed in this way was demonstrated in the test bed space of a company operating a plant factory in Chungcheongnam-do.

End of life care at home: The role of critical care transfer services.

Most people would rather die at home than in hospital but only 18% of patients do so. Palliative care focuses on the physical, spiritual and psychosocial wellbeing of patients and their families, which should include facilitating transfers home when possible. Patients can have more autonomy over their care and be surrounded by loved ones which can have a significant impact on their quality of life. In this article we describe two cases of home repatriation for palliation. Case 1 describes the transfer of a patient with difficulties and gaps in planning, but with a safe transfer ultimately. Case 2 recounts a more comprehensive planning process emphasising collaboration between teams. Facilitating home-based care aligns with patients' desires for familiar surroundings and emotional support. A secondary benefit is that releasing a bed space allows another patient to receive critical care treatment. Challenges of palliative critical care transfers include needing a highly trained team and thorough planning. Early discussion with the family and community palliative care teams makes this a more feasible option for patients. A multidisciplinary team of hospital and community healthcare professionals working with the patient and their family can facilitate the transfer from intensive care to allow them to die at a place of their choosing. We should aim to fulfil these wishes at the end of life as it can greatly improve the patient's and their family's physical and emotional wellbeing during this difficult time.

Incidence of Microbial Pattern Pre and Post Infection Control Training at Newly Established Teaching Centre; Experience from Pakistan

Abstract Introduction Healthcare associated infection (HAI) is global health problem and main reasons behind these infections are suboptimal infection control practices along with excessive antibiotics consumption [1]. On the other hand, environmental factors including inadequate ventilation, bed spacing, contaminated water supply, environmental surfaces and improper disposal of waste are other concerns. The HAI risk can be minimized by implementation of infection prevention and control program, which is comprised of activities directed to dig out problems and applying various techniques to bring about a change in healthcare workers attitude in order to improve infection control practices [2].In the last decade infection prevention and control at hospital has been significantly improved globally. Measures such as hand hygiene, environmental cleaning, culture based screening are implemented in order to minimize hospital stay, morbidity and mortality. Objective The study was conducted to compare the difference in infection control at our hospital before and after taking measurement at our newly established centre. Material and Method It was an analytical cross-sectional study carried out at our new campus. The study was conducted from February 2018 to January 2019.Ethical approval was taken from research committee prior to the study and informed consent was taken from the patients and staff. The study was fabricated in two phases i.e. initial and later six months of hospital establishment. Based on the results obtained in the initial six months, we assigned an infection control team, along with facilitation of training sessions for our staff. Culture samples were taken from patients, patient’s rooms, patient’s wards, accessories inside the patient’s room, from counters and corridors. Blood cultures were performed using the BACTEC blood culture system. Organisms were identified according to routine bacteriological procedures and disc diffusion method was used for interpreting antibiotic susceptibility. Data were included cultures reports taken from the laboratory. For statistical analysis, SPSS version 23.0 was used. Descriptive statistics was applied for categorical variables and Chi square test was used to observe the association with significance level as p=<0.05. Results A total of 1151 cultures were sent including patients, staff and environmental cultures. Out of which 681 (59%) were sent in initial phase and 470 (41%) were sent in later phase. The number of samples sent in initial and later phase and its distribution is depicted in Table 1. The growth of organisms was observed in initial and later phase from the samples and it was found out that there was increased rate of fungal growth in environment cultures in initial and later phase. In majority of the patient’s samples, no bacterial growth was reported in initial and later phase. (Table 2)Overall, absence of any organisms was found to be statistically same in both phases. However, bacterial and fungal growth reduced in later than the initial phase and the reduction in fungal growth was statistically significant as shown in Table 3 The samples taken from the patients and environment in initial and later phase were compared and are depicted in table 4. The growth of organism from the environment, accessories inside the patient’s room, nursing counter, and patients was found statistically non-significant. Conclusion Our study revealed that the number of organisms isolated in initial phase was greater than the later phase but the reduction was not significant. Bringing about a change in healthcare workers attitude is always a big challenge. Constant reinforcement is impending for compliance of healthcare professionals towards infection control and prevention. Referernces 1) Shelanah A. Fernando GT, Thomas G. Healthcare-acquired infections: prevention strategies. Int J Gen Med 2017; 47:1341-51. 2) Lee MH, Lee GA, Lee SH, Park YH. Effectiveness and core components of infection prevention and control programmes in long-term care facilities: a systematic review. J Hosp Infect 2019; 102: 377-393

Hospital at Home meets need for new dialysis patients.

The COVID-19 pandemic has had lingering effects in healthcare. During the pandemic, inpatient bed shortages became a major barrier to providing care, and access to outpatient dialysis was delayed due to a shortage of staff. This resulted in lengthy admissions to the hospital while awaiting outpatient dialysis placement in a time when hospital bedspace was a scarce resource. In this report we describe the use of the Hospital at Home program for inpatient dialysis care as a novel method to both provide high quality patient care at home and also open inpatient beds in the hospital. Here, we present two cases where this program served both the needs of the patient and the hospital system by providing dialysis care to patients participating in the Hospital at Home program. One was a patient with a recent kidney transplant awaiting improvement in kidney function following transplant. The other was a new mother who was diagnosed with atypical hemolytic uremic syndrome and was awaiting recovery from her acute kidney injury after receiving complement inhibitor therapy. This program has been functional for the past 13 months and has served 37 patients and saved 1,007 inpatient days during that period. Each inpatient day provided by Hospital at Home represents bed space that was made available to another patient in need.

A49Five Year Review of Paediatric Multidisciplinary In-Situ Simulation on a General Paediatric Ward

In the United Kingdom, trainee doctors rotate through different specialities during their training. They are often unfamiliar with systems, environments, and personnel. Working on a general paediatric ward in a district general hospital can be anxiety inducing for those new to paediatrics. Fortnightly low-fidelity simulation scenarios are embedded in our local teaching schedule to improve confidence amongst the medical and nursing team. These are performed on the ward addressing varied scenarios, aiming to increase confidence with clinical cases, improve local environment and systems awareness, and enhance communication between professionals. Fortnightly 30-minute simulation sessions are run by the paediatric simulation team on the paediatric ward at our trust. The wider multidisciplinary team are invited, including nurses and health care assistants. The emergency buzzer from a bed space is pulled, and those involved attend and a scenario is undertaken. The scenario is structured to involve the wider team to improve interdisciplinary working and non-technical skills, as well as address clinical outcomes. Equipment is provided using a grab bag. Once the scenario has ended, a debrief is performed involving candidates and observers of all disciplines, to discuss technical and non-technical skills. Post session feedback was collected on each occasion with quantitative data via Likert scales and qualitative data by free text questions. In-situ simulation has been part of the departmental paediatric teaching rota since 2009 but has been a regular fortnightly occurrence since 2018. This is because it has been rostered into our working hours before the medical team assume clinical duties. We have collected feedback since September 2018. We have had 616 participants and delivered 82 scenarios in the clinical environment. This includes during the Covid pandemic. The weighted average confidence recorded by candidates pre-scenario was 2.51 with confidence post-scenario recorded as 3.69. 83% reported improved confidence following the scenario. This is an important finding as 45% had never encountered the scenario before in their practice. Thematic analysis has highlighted key aspects including communication, escalation, teamwork and available resources. In-situ, low fidelity simulation is an effective tool to improve human factors amongst the multidisciplinary team on a paediatric ward. By regularly simulating clinical practice in their daily working environment, all candidates have demonstrated improved clinical confidence and better familiarity with the ward environment. Additionally, the fortnightly in-situ simulation has improved working relationships through recognition of the roles of the ward multidisciplinary team, communication skills and team and leaderships skills. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A93Addressing patient-safety themes and fostering cohesive teamwork through weekly multidisciplinary in-situ simulation in an Acute Care Unit

The Acute Care Unit (ACU) is the busy admissions ward at the trust. Many junior doctors rotate through the ACU for their acute medicine training and the department frequently welcomes newly-qualified nurses or nurses new to the NHS. All staff are involved in managing acutely unwell admissions with a range of presentations. In this dynamic environment, ensuring time is dedicated to teaching is an important part of staff development. In addition, it is important to create opportunities for team-building between disciplines, and evidence shows that this improves outcomes for patients [1]. Teaching for different professional disciplines is often delivered separately. Whilst sometimes preferable, we recognized the department could benefit from simulation sessions involving all members of the clinical team to represent realistic clinical practice. The aims were to: Address recent clinical incidents Practice managing common medical emergencies as a multidisciplinary team Build a greater sense of team between the ACU staff. We designed and implemented a programme of weekly multidisciplinary in-situ simulation on ACU. Sessions involve a range of nursing and medical staff and students and are delivered in an empty bed space on the ACU. Simulations focus on clinical scenarios that might reasonably arise in the department. We use iSimulate technology and re-use the simulation suite’s equipment to reduce resource burden and maintain sustainability. Feedback is collected after each session to quality assure and improve the sessions, and 2 further quality improvement reviews completed to explore how to maximize engagement and learning. This has led to coordination of scenarios with the established weekly seminar-based departmental teaching, to consolidate learning across settings and this is reinforced with a ‘learning point of the week’. Sessions have been successfully delivered on a near-weekly basis throughout the year, despite significant clinical pressures. This has been achieved through coordinated efforts from the simulation team, ACU fellows and registrars, charge nurses and Practice Development Nurse. We estimate to have reached more than 50 colleagues, with typically 4-8 attendees per session. We have rotated through 15 different scenarios and counting, covering key topics including various medical emergencies, violence and aggression, and ‘soft signs’ of deterioration. The programme has been well received, and feedback has specifically commented on the benefit of simulation in a multidisciplinary and in-situ setting. We demonstrate it is possible to maintain an effective regular simulation programme in the department to support patient safety initiatives and team working. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Experimental study fluidized bed reactor using number hole 8 to see distribution gas fluid pressure

Innovations related to fluidization systems using fluidized bed reactor are still needed to be developed in order to improve the fluidization process services for particle in order to produce the right fluid pressure in certain fluidized bed spaces that are currently operating. In this research, the pressurized fluid in question is air sourced from a compressor which has been arranged in such a way. The aim of the research is to obtain information regarding the characteristics of bubble resulting from the air pressure process pressing fluidized system particle. The research method was carried out by experimenting with testing fluidized bed reactor as test model in the form 8 hole, providing air pressure from compressor then observing the characteristics visually. The results of this visually documented research have been carried out and obtained. By using the number of hole 8 with height silica sand inserted to height of 25 cm, which is measured from the beginning of the hole plate before pressure is applied. After being given high pressure the bed increased to 27.6 cm, the highest bubble diameter was obtained at the input air pressure of 8 bar, which was 3.9 cm, with bed silica sand produced 26.1 cm, where the babble condition began to appear after the 9th second. Other characteristics also obtained reactor temperature of 25.45 °C where this condition is the smallest when compared to other pressure input results, this is because the small input pressure causes the temperature to be low, while the large pressure input temperature becomes higher due to many factor, including friction between silica sand, silica sand collisions, and faster movement of particle material.