Large Facilities Research Articles

Machine learning predicts improvement of functional outcomes in traumatic brain injury patients after inpatient rehabilitation.

Survivors of traumatic brain injury (TBI) have an unpredictable clinical course. This unpredictability makes clinical resource allocation for clinicians and anticipatory guidance for patients difficult. Historically, experienced clinicians and traditional statistical models have insufficiently considered all available clinical information to predict functional outcomes for a TBI patient. Here, we harness artificial intelligence and apply machine learning and statistical models to predict the Functional Independence Measure (FIM) scores after rehabilitation for traumatic brain injury (TBI) patients. Tree-based algorithmic analysis of 629 TBI patients admitted to a large acute rehabilitation facility showed statistically significant improvement in motor and cognitive FIM scores at discharge.

Evaluation of clinical versus non-clinical continuing education in terms of preferences and value for oral healthcare workers

ABSTRACT Background Continuing professional development (clinical) and continuing education (non-clinical) is fundamental to education and self-improvement of all categories of staff within a large healthcare facility. Aim This study sought to examine the attendance preferences and perceived value of clinical and non-clinical oral healthcare workers towards clinical continuing professional development (CPD) and non-clinical, continuing education (CE) activities. Methods A retrospective cross-sectional survey design was used capturing 8640 self-reported evaluations collected across 8 successive years and 160 CPD and CE activities in a large dental hospital. Analysis was performed using descriptive statistics including mean scores, independent t-test and cross tabulations using chi-square. Results A strongly significant association (p < 0.001) was found between attendee position type (clinical or non-clinical) and attendance preference to either clinical or non-clinical education. Dental assistants, compared to Dentist/Specialist (p < 0.001) found the programs more accurate, relevant, improved their knowledge, would use what was learned and rated the sessions higher overall. Clinical CPD was deemed more relevant (p = 0.025) and improved knowledge (p = 0.01) while non-clinical CE had higher presenter quality (p < 0.001) and overall mean scores (p = 0.015). Conclusion There was a preference towards attending clinical CPD over non-clinical CE, by not only clinical, but also non-clinical oral healthcare workers. Non-clinical CE was scored higher by both clinical and non-clinical participants and should therefore be considered for inclusion in CPD education programs with similar settings.

The Role of the Outpatient Occupational Therapist Treating Patients With Small Burns: A Retrospective Audit of Practice.

Current Australian burn care practice guidelines recommend therapies prescribed for burn injuries, irrespective of burn size. These guidelines have been informed by research related to large burns and associated treatment burden. This article describes the clinical management of small burns by occupational therapists at a large tertiary facility in Australia. A retrospective clinical chart audit was conducted for the 12-month period from January to December 2019. Participants were eligible if they had sustained a burn of 1% TBSA or less. Eligibility criteria were met for 454 patients, reflecting 77% of new outpatients in 2019. Of these, 247 or 54% of patients saw an occupational therapist. Noninvasive therapies such as scar massage, compression, silicone and taping were prescribed for 35%, 32.6%, 22.6%, and 5.9% of patients, respectively. Occupational therapist involvement was more likely postsurgical intervention (84.5%). The data presented contribute to limited research available for the management of small burns. Findings reflect use of traditional forms of therapies for small scar management; however, there appeared little use of alternative therapies, such as tapes, which may be beneficial. This study highlights the potential need for current standard practice guidelines be nuanced according burn surface area.

Muslim women's attitudes toward infant feeding in Qatar: An exploration using the Iowa infant feeding attitude scale

BackgroundMaternal attitude toward infant feeding is an important determinant of breastfeeding. The Islamic faith encourages breastfeeding, yet many Muslim women do not breastfeed as per the World Health Organization recommendations. In the Middle East, research has not addressed attitudes toward infant feeding among Muslim women. Assessing women's attitudes toward infant feeding choices is crucial to improve breastfeeding rates among Muslim women. AimThe aims of this study are to (a) examine postpartum Muslim women's attitudes toward infant feeding, (b) identify the determinants of these attitudes, and (c) determine whether attitudes can predict breastfeeding intention among Muslim women. A secondary aim is to examine the psychometric attributes of the Iowa Infant Feeding Attitude Scale among Muslim women. MethodA convenience sample of postpartum Muslim women (N = 414) were recruited between November 2019 and January 2020 in a large maternity facility in Qatar. A pre-developed questionnaire and the IIFAS were used to collect data. Both Arabic (n = 228) and English (n = 186) versions of the IIFAS were distributed postnatally to measure Muslim women's attitudes towards breastfeeding. A total attitude score was computed with higher scores indicating a more positive attitude toward breastfeeding. FindingsThe mean age of participants was 30.3 ± 5.2 years; 65.2% had a university degree and only 20.5% were employed. The mean attitude score was 61.8 ± 7.8. A significant association was found between the IIFAS attitude score and ethnicity, favouring Non-Qatari Arab women who had significantly higher attitude scores (p < .001). Women with full-time or part-time work had significantly higher scores than those not working (p = .008, p = .023). Older women had significantly lower attitude scores (adjusted slope = -0.230, p = .008). Cronbach's alpha reliability coefficient of the Arabic and English versions of the IIFAS ranged from 0.69 to 0.80. ConclusionEthnicity, employment status, and age are determinants of infant feeding attitudes among Muslim women. In Qatar, Muslim women's attitudes related to breastfeeding trend toward positive; however, attitude is not a predictor of antenatal breastfeeding intention. Further research employing a larger sample with a focus on a culturally sensitive approach is recommended. The IIFAS has a moderate reliability level and needs to be culturally adapted to be used among a Muslim population.

Profile of an “at cutting edge” pathology laboratory for pathological human deposits: from nanometer to in vivo scale analysis on large scale facilities

This contribution aims to define an analysis procedure for abnormal deposits in human tissues starting from in vivo characterization, down to the nanoscale using major instrumentation. Such an integrated approach is based on recent literature, but particularly on our research over the last twenty years on pathological calcifications. To this end, we begin by describing four successive analytical steps, on the injury site or physician’s surgery, at the hospital, at a typical physicochemical laboratory, and finally at a large scale (possibly multinational) facility. For the first step, we present various techniques which can be implemented on portable instruments. For the second step, commercial analytical setups are used. In a physicochemical laboratory, prototype or commercial setups are used and finally on large scale instruments, characterization techniques with better spatial resolution and/or higher sensitivity or techniques specific to synchrotron radiation are employed.

The hospital as a laboratory: Population studies at Tel-Hashomer hospital in Israel (1950s-1960s).

In this article we examine how a leading Israeli hospital gradually became a large biomedical research facility, resembling a huge laboratory. For Chaim Sheba (1908-1971), the founder and first director of Tel-Hashomer Hospital, the massive immigration to Israel in the 1950s was a unique opportunity for research of diverse human populations, especially Jews who had arrived to Israel from Asia and Africa. The paper focuses on the way research and medical practices were integrated and their boundaries blurred, and studies the conditions under which an entire hospital became a research field. Using the case of one of Israel's prominent medical institutes, we explore and expand upon the idea of "the hospital as a laboratory," arguing that, for Sheba, it was not only the hospital but the entire country that functioned as a great research site-a vast laboratory that "had no walls."

Sustainable Management of Thickened Tailings in Chile and Peru: A Review of Practical Experience and Socio-Environmental Acceptance

The “Thickened Tailings Disposal” (TTD) technology produces a high density mine waste that allows for the storage of this material without the need to manage large slurry tailings storage facilities (TSFs) and large dams. TTD has been applied considering site specific conditions of Chile and Peru, such as extreme climatic conditions, seismic risks, water scarcity, community demands, and environmental constraints. This review highlights the contribution of several experiences in Chile and Peru, which have chosen TTD technology for reduction of negative environmental impacts, mainly focusing on the following issues: (i) increase of tailings water recovery, (ii) reduction of TSFs footprint (impacted areas), (iii) decrease the risk of physical instability, avoiding the construction of high dams, and (iv) decrease of TSFs seepages. Finally, the article describes the advantages (benefits) and disadvantages (aspects to improve) of TTD, where nowadays a high degree of dewatering of tailings is seen as a safe option, considering the occurrence of some TSF dam failures recently worldwide, which has resulted in severe environmental pollution. A better environmental perception about TTD of authorities and communities, considering that this technology allows to satisfy the needs of stable and safe TSFs, make the TTD be more acceptable, popular and one of the best available technologies (BATs) for operations with mine tailings.

Adaptations to HIV services delivery amidst the COVID-19 pandemic restrictions in Kampala, Uganda: A qualitative study.

The enforcement of the coronavirus disease (COVID-19) pandemic restrictions disrupted health services delivery and currently, there is a limited understanding regarding measures employed by health facilities to ensure delivery of human immunodeficiency virus (HIV) services amidst the interruptions. We, therefore, designed a qualitative study to explore the measures for continuity of HIV services during the COVID-19 pandemic restrictions in Kampala, Uganda. This study was conducted at six large primary health care facilities in the Kampala Metropolitan area. Qualitative data were collected from anti-retroviral therapy (ART) focal persons and lay health workers namely linkage facilitators and peer mothers through key informant interviews (KIIs). Overall, 14 KIIs were performed, 10 with lay health workers and 4 with ART focal persons. Data were audio-recorded, transcribed verbatim, and analyzed using the content approach, and the results were presented as themes along with participant quotations. Five themes emerged to describe measures for continuity of HIV services. The measures included: 1) leveraging the use of mobile phone technology to support ART adherence counseling, psychosocial care, and reminders concerning clinic appointments and referrals; 2) adoption of novel differentiated service delivery models for ART like the use of motorcycle taxis and introduction of an individualized ART delivery model for patients with non-disclosed HIV status; 3) scale-up of existing differentiated service delivery models for ART, namely multi-month dispensing of antiretroviral drugs (ARVs), fast-track ARV refill, home-based ARV refill, peer ART delivery, use of community pharmacy model, and community client-led ART delivery model; and, 4) reorientation of health facility functioning to the COVID-19 pandemic restrictions characterized by the use of nearby health facilities for ARV refill and viral load monitoring, transportation of healthcare providers and flexible work schedules and reliance on shift work. We found several measures were adopted to deliver HIV care, treatment, and support services during the COVID-19 pandemic restrictions in Kampala, Uganda. We recommend the scale-up of the new measures for service continuity in the post-COVID-19 period.

Improving Data-Driven Infrastructure Degradation Forecast Skill with Stepwise Asset Condition Prediction Models

Organizations with large facility and infrastructure portfolios have used asset management databases for over ten years to collect and standardize asset condition data. Decision makers use these data to predict asset degradation and expected service life, enabling prioritized maintenance, repair, and renovation actions that reduce asset life-cycle costs and achieve organizational objectives. However, these asset condition forecasts are calculated using standardized, self-correcting distribution models that rely on poorly-fit, continuous functions. This research presents four stepwise asset condition forecast models that utilize historical asset inspection data to improve prediction accuracy: (1) Slope, (2) Weighted Slope, (3) Condition-Intelligent Weighted Slope, and (4) Nearest Neighbor. Model performance was evaluated against BUILDER SMS, the industry-standard asset management database, using data for five roof types on 8549 facilities across 61 U.S. military bases within the United States. The stepwise Weighted Slope model more accurately predicted asset degradation 92% of the time, as compared to the industry standard’s continuous self-correcting prediction model. These results suggest that using historical condition data, alongside or in-place of manufacturer expected service life, may increase the accuracy of degradation and failure prediction models. Additionally, as data quantity increases over time, the models presented are expected to improve prediction skills. The resulting improvements in forecasting enable decision makers to manage facility assets more proactively and achieve better returns on facility investments.

Does professionalism change with different sociodemographic variables? A survey of Arab medical residents

Background Medical professionalism reflects the commitment of physicians to their patients, society, themselves, and the profession. The study examined residents’ attitudes towards professionalism and how these attitudes vary among the different demographic groups, namely gender, specialty, and year of residency. Methods A proportionate random sampling strategy was used to select the study sample. Medical residents from six specialties at a large tertiary care teaching facility were invited to participate in an online survey. The survey used the modified Learners Attitude of Medical Professionalism Scale (LAMPS), which consists of five domains: respect, excellence, altruism, duty/accountability, and integrity. Chi-square, Student t-test, one-way ANOVA, factorial ANOVA, and post hoc analysis were used to examine the attitudinal differences towards professionalism among the different demographic factors. Results The overall response rate was 82.7%. Overall, the residents’ self-reported attitudes towards professionalism was positive. The highest score was for the “respect” domain (4.61), and the lowest was for “altruism” (3.67). No significant association was found between the mean scores and the three studied variables, namely, gender, specialty (surgical/nonsurgical), and level (senior/junior). Conclusions No significant differences were observed in the overall attitude towards professionalism among the residents regarding their year of residency, gender, and specialty. The low altruism score and absence of improvement of the total score regarding the residents’ increasing experience in the profession are concerns that need remedial action. Therefore, we suggest that future research look for possible explanations by using multi-institutional surveys that explore not only the residents’ attitudes, but also the trainers’ attitudes and practice, work situations, the hidden curriculum, and culture. Key messages Attitudes towards professionalism among different demographic groups of residents do not show similar variations as has been reported in the literature, albeit in different sociocultural contexts. The low altruism score and absence of improvement of the total score as the residents gained more experience in the profession are concerns that need remedial action. A longitudinal study involving more than one institution for both residents and their faculty members to compare faculty scores with those of residents, while controlling for specialty and gender, may help elucidate the factors affecting attitudes towards professionalism and suggest possible means of addressing unfavourable attitudes.

Elevated soil and blood lead levels with increasing residential proximity to a mine tailings facility in Soweto, South Africa

Mining has long been associated with the release of a range of toxic metals including lead, elevated levels of which have been found in land surrounding mine dumps as far afield as Spain, India, Macedonia and Nigeria. Mining has been a key pillar of economic development in South Africa for around a century and a half, and has left a legacy of major environmental contamination, with the poorest experiencing the highest burden of exposure. The current study was undertaken to ascertain the concentrations of lead in soil and in the blood of adults and children residing at increasing distances from a cluster of large tailings facilities (MTFs) in greater Johannesburg, South Africa. Through a cross-sectional survey data on household characteristics were collected through a questionnaire survey, and supplemented with samples of soil from household gardens, together with blood samples from child-adult pairs from all households included in the study. Soil lead concentrations decreased significantly (median = 35.7 mg/kg closest to the mine tailings facility (MTF) and 8.6 mg/kg at the furthest point in the study site) with increasing distance from the MTF. Blood lead levels were highest in both adults (median = 3.0 μg/dL) and children (median = 4.0 μg/dL) who lived closest (≤500 m) to the MTF, and lowest (1.4 μg/dL in adults and 2.5 μg/dL in children) in those who lived furthest away (4–5 km). The study findings point to a need for greater emphasis on the precautionary principle in environmental health and for health impact assessments to inform decisions on planning, especially with regard to the location of human settlements relative to major, polluting development initiatives.

Primary and Secondary Care Related Quality Indicators for Dementia Care Among Australian Aged Care Users: National Trends, Risk Factors, and Variation.

Studies related to clinical quality indicators (CQIs) in dementia have focused on hospitalizations, medication management, and safety. Less attention has been paid to indicators related to primary and secondary care. To evaluate the incidence of primary and secondary care CQIs for Australians with dementia using government-subsidized aged care. The examined CQIs were: comprehensive medication reviews, 75+ health assessments, comprehensive geriatric assessments, chronic disease management plans, general practitioner (GP) mental health treatment plans, and psychiatrist attendances. Retrospective cohort study (2011-2016) of 255,458 individuals. National trend analyses estimated incidence rates and 95% confidence intervals (CI) using Poisson or negative binomial regression. Associations were assessed using backward stepwise multivariate Poisson or negative binomial regression model, as appropriate. Funnel plots examined geographic and permanent residential aged care (PRAC) facility variation. CQI incidence increased in all CQIs but medication reviews. For the overall cohort, 75+ health assessments increased from 1.07/1000 person-days to 1.16/1000 person-days (adjusted incidence rate ratio (aIRR) = 1.03, 95% CI 1.02-1.03).Comprehensive geriatric assessments increased from 0.24 to 0.37/1000 person-days (aIRR = 1.12, 95% CI 1.10-1.14). GP mental health treatment plans increased from 0.04 to 0.07/1000 person-days (aIRR = 1.13, 95% CI 1.12-1.15). Psychiatric attendances increased from 0.09 to 0.11/1000 person-days (aIRR = 1.05, 95% CI 1.03-1.07). Being female, older, having fewer comorbidities, and living outside a major city were associated with lower likelihood of using the services. Large geographical and PRAC facility variation was observed (0-92%). Better use of primary and secondary care services to address needs of individuals with dementia is urgently needed.

Assessing the Impact of a Utility Scale Solar Photovoltaic Facility on a Down Gradient Mojave Desert Ecosystem

A field study was conducted in the Mojave Desert (USA) to assess the influence of a large photo voltaic facility on heat and water transport into an adjacent creosote (Larrea tridentata) bursage (Ambrosia dumosa) plant community. Air temperature, plant physiological status, soil water in storage and precipitation were monitored over a two to four year period. A service road built 27 years before the construction of the PV facility decoupled the wash system at the site leading to a significant decline in soil moisture, canopy level NDVI values and mid-day leaf xylem water potentials (p &lt; 0.001) down gradient from the PV facility. Measurements along a 900 m gradient suggested that plants closer to where the wash was decoupled were placed under significantly greater stress during the higher environmental demand summer months. Air temperatures measured at three 10 m meteorological towers revealed warmer night time temperatures at the two towers located in close association with the solar facility (Inside Facility—IF and Adjacent to facility—AF), compared to the Down Gradient Control tower (DGC). As the warmer air was displaced down gradient, the temperature front advanced into the creosote—bursage plant community with values 5 to 8 °C warmer along an east west front just north of tower AF. Based on our research in Eldorado Valley, NV, USA, a down gradient zone of about 300 m was impacted to the greatest extent (water and heat), suggesting that the spacing between solar facilities will be a critical factor in terms of preserving high quality habitat for the desert tortoise and other species of concern. Greater research is needed to identify habitat zones acceptable for animal populations (especially the desert tortoise) within areas of high solar energy development and this should be done prior to any fragmentation of the ecosystem.

POLICING FORENSIC EVIDENCE

POLICING FORENSIC EVIDENCE

Structure optimization of the protection inductor for the high energy density pulse pump power supply

High energy density pulse pump power supply is an important part of a large laser fusion facility. When a short-circuit fault occurs, massive energy injection will cause the capacitor and switch to damage or even explode. Therefore, it is of great significance to set a series protection inductor. In this paper, the structure of the widely used solenoid inductor is optimized. The geometric mean distance principle is introduced, and Neumann’s formula is extended to calculate the inductance of the solenoid. The electromagnetic force on each turn is solved by the virtual displacement method. The analytical expression of the electromagnetic stress in the current-carrying solenoid is deduced by combining the force balance equation, constitutive equation and geometric constraint equation. The electromagnetic-structure coupling simulation verifies the accuracy of the expression. Based on the Taguchi method, the structure parameters of the solenoid are optimized. The results show that the solenoid’s wire radius and layer count are the two most important influencing factors. As the wire radius increases and the layer count increases, the maximum carrying energy per unit volume increases. The influence of insulation encapsulation on the stress distribution in the inductor is studied based on electromagnetic-structure coupling simulation. It can be known that insulation encapsulation can effectively reduce stress and restrain deformation. On this basis, a novel type of double-layer solenoid inductor is designed and processed. Several pulse discharge tests verify its large current-carrying capacity and high reliability. The above results are useful for structure design and application of the protection inductor.

Understanding Salmon Migration Dynamics in a Data‐Limited Environment

AbstractEffective management of natural resources and migratory fish populations depends on understanding the relationship between life cycle parameters, management decisions, and environmental conditions. However, the difficulty of data collection can result in small or nonrepresentative data sets, thus limiting the accuracy and utility of modeling results. This is especially true for studies of migratory species in changing environments. In such situations, reevaluating previous results in light of new data is an essential exercise. We used three additional years of acoustic telemetry data to assess and update previous statistical models of survival of juvenile fall‐run Chinook Salmon Oncorhynchus tshawytscha smolts emigrating through the southern portion of the Sacramento–San Joaquin River Delta (hereafter, “Delta”) in California. Some previously identified relationships were maintained with the additional data, including the significance of water flow measures in areas outside the main‐stem migration route and the role of water temperature and river discharge into the system for upstream reaches. The net downstream‐directed discharge in the interior Delta was associated with fish movement to a large water pumping facility, but its perceived importance in the original analysis depended on a single dominant study year. Survival in dry years was predicted to be higher in the upstream region of the main‐stem San Joaquin River when a temporary rock barrier limited entry of fish and river flow to the first distributary encountered in the Delta. In normal and wet years, through‐Delta survival was predicted to be higher for fish that departed the main‐stem river at that distributary. However, considerable uncertainty remains in the modeling results. Additional monitoring will be necessary to further reduce uncertainty and ensure that the modeling results reflect the system as it responds to climate change.

Probing hadronic interactions with measurements from the Pierre Auger Observatory

The Pierre Auger Observatory is the largest facility in the world to study ultra-high-energy cosmic rays. It has a hybrid detection technique that combines the observation of the longitudinal development of extensive air showers and the measurement of their particles at the ground. This capability has opened the possibility to probe hadronic interactions taking place at energies well beyond those accessible by human-made accelerators. In this report, we present a selection of the latest results on hadronic interactions with measurements from the Pierre Auger Observatory. These data span over three decades in energy, showing the tension between data from the muon component of air showers and predictions based on the most updated hadronic interaction models.

Failure of sterilization in a dental outpatient facility: Investigation, risk assessment, and management.

In 2017, an incident of failed sterilization of dental instruments occurred at a large dental outpatient facility in Singapore. We aim to describe findings of the investigation of the sterilization breach incident, factors related to risk of viral transmission to the potentially affected patients, and the contact tracing process, patient management, and blood test results at a 6-month follow-up.A full assessment of the incident was immediately carried out. The factors related to risk of viral transmission due to affected instruments were analyzed using 3 keys points: breached step(s) and scale of the incident, prevalence of underlying bloodborne diseases and immunity in the Singapore population, health status of potential source patients, and type of dental procedure performed, and health status of affected patients and type of dental procedure received.Up to 72 affected instrument sets were used in 714 potentially affected patients who underwent noninvasive dental procedures. The investigation revealed that there was a lapse in the final step of steam sterilization, resulting in the use of incompletely sterilized items. The assessment determined that there was an extremely low risk of bloodborne virus transmission of diseases to the patients. At the 6-month follow-up, there were no infected/colonized cases found related to the incident.Lapses in the sterilization process for medical and dental instruments can happen, but a risk assessment approach is useful to manage similar incidents. Quick response and proper documentation of the sterilization process can prevent similar incidents.

Development of Sustainable Inhibitors for Corrosion Control

Metal degradation due to corrosion is a major challenge in most industries, and its control and prevention has to maintain a balance between efficiency and cost-effectiveness. The rising concern over environmental damage has greatly influenced this domain, as corrosion prevention should comply with the waste regulations of different regions. In this respect, a fundamental question is which modern synthetic materials are more viable from the point of view of their effectiveness. Therefore, this paper is aims to provide an advanced and holistic review of corrosion prevention and control methods. Corrosion prevention techniques have become extensive; however, the literature indicates that polymer coatings, nano-composite coatings, and encapsulation techniques consistently provide the most efficient and feasible outcomes. Therefore, this review article examined the phenomenon of corrosion inhibition mainly from the perspective of these three techniques. Moreover, this research utilized secondary qualitative methods to obtain data and information on comparative techniques. It is found that due to the rapid development of novel materials, corrosion inhibition techniques need to be developed on scales that are more general, so that they could be applied to varying environments. The self-healing coatings are generally based on epoxy-resins incorporated with synthetic compounds such as inhibitor ions, amino-acids, or carboxylic acids. These coatings have become more widespread, especially due to bans on several traditional prevention materials such as compounds of chromium (VI). However, self-healing coatings are comparatively more costly than other techniques because of their method of synthesis and long-term durability. Therefore, although self-healing nanomaterial-based coatings are viable options for limited usage, their utilization in large and complex facilities is limited due to the costs involved. Amino acids and other biological macro-molecules provide another option to attain environmental sustainability and long durability, especially due to their origins being most of naturally occurring compounds such as lignin, cellulose, and proteins.

The Cruel Optimism of Anthropocene Technologies: Suspicion and Fascination of Technology in Okja, What Happened to Monday, and Geostorm

The Cruel Optimism of Anthropocene Technologies: Suspicion and Fascination of Technology in <i>Okja</i>, <i>What Happened to Monday</i>, and <i>Geostorm</i>