Proper Site Selection Research Articles

Viêm tĩnh mạch tại vị trí lưu kim luồn tĩnh mạch ngoại biên và một số yếu tố liên quan tại Trung tâm Thần kinh, Bệnh viện Bạch Mai

Introduction: Peripheral venous catheter-related phlebitis is a common complication in healthcare facilities, causing pain, disrupting treatment, and potentially leading to severe complications.Objective: This study investigates the incidence and risk factors associated with peripheral intravenous catheter-related phlebitis. Method: A prospective cross-sectional descriptive study was conducted using a self-designed questionnaire and the Visual Infusion Phlebitis (VIP) Scale to assess the degree of phlebitis. The study included 347 inpatients treated in the Emergency and Intensive Care Unit, Neurology Center, at Bach Mai Hospital. Data were collected from medical records and clinical observation. Results: Among the studied patients, the incidence of phlebitis was 17.6%, and 4.3% of catheter insertion sites exhibited signs of inflammation. Grade 1 and 2 were the most common phlebitis (43.1% and 54.2%), with a small number of grade 3 cases (2.8%) and no cases of grade 4 or 5. Factors such as catheter insertion sites in the forearm, elbow, or ankle; underlying conditions like hypertension, cerebral hemorrhage, pneumonia; paralysis; continuous fluid infusion; and certain intravenous medications were identified as being associated with an increased risk of phlebitis. Conclusion: Phlebitis at the PVC site is a significant concern during treatment in ICU and Neurology centers. Proper catheter site selection and effective management of underlying conditions can help reduce the risk of phlebitis. These findings may assist in developing clinical guidelines to improve patient care quality.

Habitat Associated with Ramps/Wild Leeks (Allium tricoccum Ait.) in Pennsylvania, USA: Guidance for Forest Farming Site Selection

Ramps or wild leeks (Allium tricoccum) are a popular foraged non-timber forest product in North America consumed for their edible bulbs and leaves. The agroforestry practice of forest farming is a possible solution to conservation challenges surrounding the wild exploitation of this species, but it requires proper site selection to be successful. In this study, maximum entropy (Maxent) modeling using 163 occurrence points and field data collected at 30 wild populations were combined to determine the characteristics of the ramp habitat in Pennsylvania. Both Maxent modeling and field measurements highlighted moist, lower slope positions with base-rich bedrock types as suitable for ramps. Sites shared 50% of their floristic associates on average, with 252 species documented in total. Forest communities associated with ramps included many species indicative of base-rich mesic soil conditions, but the relative abundance of some indicator species differed by region. The confirmation of model variables by field measurements and forest community types points to the usefulness of these characteristics in identifying suitable forest farming sites. When used in tandem, these results can help to guide site selection for forest farming and other conservation strategies.

Applying analytic hierarchy process for site selection of a recreational-educational children complex in Shiraz City, Iran

The development of educational-recreational complexes for children has a significant impact on their cognitive growth and behaviour. Proper site selection is essential to ensure the success of such projects. This paper aims to identify the best location for a children’s educational-recreational complex in Shiraz, Iran. The study used a descriptive-comparative and survey method to determine effective criteria for site selection. A questionnaire was administered to experts in architecture, urban design, and planning to identify appropriate sites. The Analytic Hierarchy Process (AHP) method was then employed to select the best location. The hierarchical model included three levels: goal (educational-recreational site selection), criteria (natural potential, accessibility, land size, neighbourhood and social context, expansibility, appropriate land use (the neighbourhood between proposed and master plan land use)), and three alternative sites. The results showed that a site located near residential areas, green spaces, and natural elements is suitable for the development of an educational-recreational complex for children. The study recommends the use of the SWOT (strength, weaknesses, opportunities and threats) - AHP method for site selection in children’s complexes. The paper highlights the need for a reliability test or table/figure to support the research findings.

Significance of critical infrastructure development in post-disaster resettlement in Sri Lanka

Post-Disaster Resettlement (PDR) is one of the most important, time and cost-consuming disaster management activity following a catastrophic event. Restoration of human lifestyle while safeguarding the victims by providing permanent houses and integrating them with critical infrastructures are essential in the PDR context. The better accessibility to critical infrastructures enhances the living conditions of disaster-affected community and influences the success of PDR projects. However, the success of PDR projects in Sri Lanka, is not at a sufficient level due to lack of concentration provided on the critical infrastructure needs of the resettled community. Thus, the study is focused on emphasizing the significance of critical infrastructure to enhance the success of PDR projects in Sri Lanka. The need of developing critical infrastructure was broadly investigated through the literature review. Subsequently, survey and case study research strategies were adopted to proceed with the research following the qualitative research approach. Empirical evidence was gathered in two phases. Preliminary expert interviews under Phase I and key-informant interviews under Phase II (case studies) were used as the data collection methods. Interviews in both phases were conducted in a semi-structured format. The data analysis was carried out through manual content analysis. The outcomes of the study revealed that provision of both physical and social critical infrastructure have an equal importance for the physical function and mental well-being of the disaster-affected community, respectively. However, to achieve the success in PDR projects, critical infrastructure development must be carried out considering the factors such as proper site selection criteria, previous livelihood of the people and their requirements, resilient features, and threshold levels.

Geo-information Technology-Based Suitability Site Selection for Temperate Fruits of Apple, Peach, and Plum in Tigray Region, Northern Ethiopia

Introduction: Growing temperate fruits in its appropriate region is important for growers and is used as a means of improving agricultural production, helps to improve livelihood of the community and source of income. The land needs to careful and appropriate use that is vital to achieve optimum production and productivity, and to guarantee environmental sustainability for the future generation. This requires an effective and up to date land information for effective utilization, management, and for decision making purpose. All agricultural crops, needs their ecological requirements for modelling the spatiotemporal distribution of land suitability potential and for performing agricultural activities effectively and accurately. There is a problem related to proper site selection for growing temperate fruits in the Tigray region and to solve this problem GIS-based suitability site selection for growing temperate fruit trees is important for getting better production and to help in improving the livelihood of the community.
 Methods: To identify the ecological requirements, for growing temperate fruits considers the physical, meteorological, and landscape environmental factors. To come up with the best suitability regions, physical, meteorological, and landscape spatial layers of the study area were collected from different primary and secondary data sources and stored in a personal geodatabase with the same resolution, cell size, and projection system. After collecting the important parameters, reclassification of these factors and using their influences, overlay analysis was performed to get the potential suitability sites for apple, plum, and peach fruits, and the model result was validated using ground control points.
 The Results: According to the overlay-based suitability modeling approach, suitability sites of these low chilling temperate fruits were identified and mapped. Apple has a potential of 21% as suitable land and 79% as an unsuitable area of the total area of 54,573km2, peach has a potential of 17% as suitable land and 83% as unsuitable land and plum has a potential of 27% as suitable land and 73% as unsuitable land in Tigray region. Around 50 ground control points (GCP) was collected from the ground, and 80% of the ground data were fitted with the suitability sites found from the overlay analysis modeling.
 Conclusion: This information was used as a baseline information for different agricultural experts, stakeholders, research organizations, NGO’s and policy makers for growing of low-chilling temperate fruits and getting a good production in the region.

Optimizing the dam site selection problem considering sustainability indicators and uncertainty: An integrated decision-making approach

Changes of climate, population growth, extended droughts, water scarcity, and sustainability considerations are amongst the concerns that stress more than before the significance of water resources management (WRM). One of the approaches that may assist decision-makers (DMs) in handling water resources is the proper site selection for dam construction. The dam site selection decision is a huge long-term investment and due to multiple decision-making factors, stakeholders or DMs, non-deterministic information in the decision-making process, and ripple effect on many other elements of the economy, meticulous analysis is needed. In this study, dam site selection problem (DSSP) is modeled in the form of binary programming under certainty, uncertainty, and hybrid circumstances. Hence, nadir compromise programming (NCP) model is executed in order to tackle the problem with crisp data. Further, a novel model based on NCP and stochastic programming is suggested to treat the uncertainty. The integration of the proposed models is able to address the problem with crisp and random data. The evaluation criteria are categorized based on sustainability (social, economic, and environmental) and technical indicators for dam site selection. To obtain the criteria weight, an interval group decision-making trial and evaluation laboratory (IGDEMATEL) approach is also applied where experts are able to state their opinions on linguistic terms and interval numbers. A real case study in Iran is then investigated in order to appraise the applicability of the developed methodology. A simulation method is further proposed to assess the obtained results and validate the suggested model's performance. Finally, the IGDEMATEL results are employed to survey the relationships between cause-and-effect criteria. The results obtained from the proposed and simulation models are similar in 83% of the cases, and the remaining difference of 17% is because of the uncertainty governing the problem, as well as the lack of sufficient data for precise decision-making.

ORGANIZATIONAL AND ECONOMIC MEASURES AND PROPOSALS FOR IMPLEMENTING RECIRCULATION SYSTEMS IN THE AQUACULTURE INDUSTRY IN UKRAINE

Topicality. Recirculating systems in aquaculture play a vital role in ensuring the sustainability and environmental friendliness of the industry. The European Union actively supports their use, focusing on reducing the negative impact on the environment and achieving strategic goals. Ukrainian legislation also recognizes the importance of using recirculating systems in aquaculture, but institutional support for these systems is insufficient compared to the European Union. Efforts should be made to promote the adoption of recirculating systems and harmonize legislation with European standards to achieve sustainable development in Ukrainian aquaculture.Aim and tasks. The aim of this article is to analyze the challenges and perspectives of developing recirculating systems in aquaculture. The tasks include examining the economic benefits and cost reduction associated with the implementation of recirculating systems, emphasizing the importance of effective communication between governmental and industrial structures, highlighting the need for statistical reporting and monitoring mechanisms, discussing the role of automation and digitalization in monitoring and control, emphasizing the importance of business insurance in aquaculture, and addressing the impact of the Internet on production models and marketing.Materials and Methods. The article is based on the analysis of scientific literature, official documents of the European Union and Ukrainian legislation. To achieve the goal of the article, argumentation, comparative analysis, statement of facts and logical calculations are used.Research results. The research findings demonstrate that the implementation of recirculating systems in aquaculture brings positive economic results, such as increased profits and reduced disease-related expenses. Effective communication between governmental and industrial structures, licensing, and reporting on aquaculture activities are crucial for industry development. Statistical reporting and monitoring mechanisms are necessary to ensure accountability for information provision. Automation and digitalization can be used for monitoring and control in recirculating systems, but qualified personnel and proper site selection are essential to reduce water demand and preserve resources. Business insurance in aquaculture is an important aspect that requires development in Ukraine. The growth of the Internet demands changes in production models and a focus on product standardization and marketing.Conclusion. To overcome the challenges faced by the aquaculture industry, knowledge transfer, innovation promotion, and governmental support are crucial. The integration of information technologies and the concept of "smart" production in intelligent aquaculture farms can improve the quality and efficiency of aquaculture production. Innovative feed sources should be implemented to address the issues in aquaculture. The combination of recirculating systems with the cultivation of algae, vegetables, and plants is an important step towards creating efficient and environmentally friendly food production systems. The application of information technologies and the concept of "smart" production in aquaculture can be a promising approach to overcoming industry challenges and ensuring its future success.

Assessment of installation suitability of a vertical closed loop ground source heat pump system in regional scale

Installation suitability of a vertical closed loop GSHP system in the Echigo Plain of Japan was assessed considering the regional scale groundwater flow and heat transport analysis. For evaluating and understand the variation of development potential of the system, the necessary length of ground heat exchanger (GHE) was analyzed at different points, where groundwater, geology and subsurface temperature distribution varies. The computation was done for the model case of the Japanese single-family dwelling with reference to standard for energy saving in Japan. The necessary length of GHE ranged from 67 m to 101 m within the plain and found comparatively longer at the central coastal area around the Niigata City. These results showing the variation of the necessary length of GHE in the plain scale is significant and essential for the proper design and site selection of the system in the Echigo Plain, and can also be beneficial for the development of GSHP system in Japan. Influence of the existing groundwater pumping system was also evaluated to determine if the pumping system can enhance heat exchange performance for space-heating. The effect of groundwater pumping was not so significant to improve heat exchange rates due to the natural existence of groundwater flow.

Development of neutrosophic cubic hesitant fuzzy exponential aggregation operators with application in environmental protection problems

The population growth and urbanization has caused an exponential increase in waste material. The proper disposal of waste is a challenging problem nowadays. The proper disposal site selection with typical sets and operators may not yield fruitful results. To handle such problems, the exponential aggregation operators based on neutrosophic cubic hesitant fuzzy sets are proposed. For appropriate decisions in a decision-making problem, it is important to have a handy environment and aggregation operators. Many multi attribute decision making methods often ignore the uncertainty and hence yields the results which are not reliable. The neutrosophic cubic hesitant fuzzy set can efficiently handle the complex information in a decision-making problem, as it combines the advantages of neutrosophic cubic set and hesitant fuzzy set. In this paper first we establish exponential operational laws in neutrosophic cubic hesitant fuzzy sets, in which the exponents are neutrosophic cubic hesitant fuzzy numbers and bases are positive real numbers. In order to use neutrosophic cubic hesitant fuzzy sets in decision making, we are developing exponential aggregation operators and investigate their properties in the current study. In many multi expert decision-making methods there are different decision matrices but same weighting vector for attributes. The results of a multi expert decision-making problem becomes more reliable if every decision expert has its own decision matrix along with his own weighting vector for attributes. In this study, we are developing multi expert decision-making method that uses different weights for an attribute corresponding to different experts. At the end we present two applications of exponential aggregation operators in environmental protection multi attribute decision making problems.

Suitability Mapping of Solar Energy Potential of Selected Areas in Camarines Sur using ArcGIS

Abstract— Solar energy, the most common and scalable renewable energy, has a huge potential to supply the increasing electricity demand. Hence, proper site selection for deploying solar PV systems is required. This paper presents the development of a solar suitability map to identify potential sites for solar PV systems in the selected areas in the Rinconada District of the province of Camarines Sur, Philippines. ArcGIS analyzed the annual average solar radiation, weather datasets, and geographical conditions and performed suitability mapping combined with the Analytic Hierarchy Process (AHP) to identify the weights of the nine criteria of suitable site selection. Based on these factors, twenty-seven (27) barangays were found suitable, where the central and eastern parts of Barangay Malawag in Nabua and a massive part of Barangay Causip in Bula are the most suitable locations for large-scale solar PV installation.

An AHP-GIS based site suitability analysis for integrating large-scale hybrid CSP+PV plants in Morocco: An approach to address the intermittency of solar energy

Greater integration of solar energy into the worldwide energy mix is increasingly ineluctable and implies a proper site selection. Photovoltaic (PV) is economically more considerable due to its falling price, but storage issues arise with large-scale integration and might be tackled with Concentrated Solar Power (CSP) considering its thermal energy storage (TES) system. CSP + PV hybridization may constitute an optimal option for better energy dispatchability, higher capacity factors with a reduced Levelized Cost of Electricity (LCOE). Herein, the overarching goal is to help locating and classifying appropriate sites suited for hybrid solar plants by dint of the Analytic Hierarchy Process (AHP) method associated with Geographic Information System (GIS) tools. Given that CSP operates with either dry or wet cooling systems, the current assessment regarded both configurations to generate two potential maps within Morocco. Outcomes reveal that 11.2% and 32.2% represent the field share of excellent sites to host CSP + PV plants with wet and dry cooling correspondingly. Additionally, roughly 26.53% of the total area was left out representing the restriction mask. A sensitivity analysis was subsequently conducted to examine the most and least sensitive criteria. Thereafter, a techno-economic feasibility study in a hotspot was carried out for validation purposes: yield performances and LCOE of the hybrid CSP + PV plant - with 100 MWe capacity - were evaluated. Actually, the plant using wet cooling system can produce 312 GWeh/year with an LCOE of 0.0800 $/kWh. Whereas, with a dry cooling option, the annual production is of 333 GWeh/year and the LCOE is of 0.0816 $/kWh. This paper brings a novelty: the introduction of the “Water risk index (WRI)” amongst the decision factors from a visionary viewpoint. Being the first of its kind, the present research work may provide support for scientists and policy makers to evaluate their region's suitability for CSP + PV plants.

Sediment Characteristics—A Key Factor for Fish Farm Site Selection: Examples from Croatia

The rapid development and intensive production of aquaculture have brought to light various environmental problems. In particular, fish farming adversely affects the benthic environments through the accumulation of organic matter (OM), which leads to the degradation of aquatic sediments and associated biotic communities. To prevent environmental degradation, proper site selection for fish farming is a prerequisite for sustainable aquaculture practices. An important physical factor in selecting a site for fish farming is sediment structure. Coarser sediments are preferred, while their mineral composition is rarely discussed. To investigate relationships between sediment characteristics and the content of OM, sediments were collected from three different sites with different aquaculture practices under different climatic and environmental conditions and analyzed during the one-year monitoring period. Grain size distribution, mineral composition, carbonate content, and organic matter content were determined for three fish farm sites (Ilova, River, Krka River, and Pelješac) and their reference sites. Preliminary results from all studied sites showed that sediment texture in combination with natural mineral composition is one of the key factors for the accumulation of OM in the sediment. In particular, the mineral composition of the fine-grained sediment should be known when conducting an environmental impact assessment of fish farms.

A geospatial approach for site suitability and accessibility for healthcare services in Bankura district, West Bengal, India

Healthcare site selection assumes an imperative part in healthcare development and management. From part of the public authority, proper medical site selection will help the distribution of clinical assets, coordinating with the arrangement of medical care with the social and economic demands, organizing the metropolitan and rural healthcare administration advancement, and facilitating social logical inconsistencies. Site suitability analysis is a variety of analysis utilized in GIS to work out the simplest place or site for one thing. The main objective of the current study was to select a site for new healthcare services with geospatial technologies to intermix spatial and non-spatial data to create a weighted result. The current study had been done into three phases, where many processes are intermixed into a single phase. In the first phase of analysis, distance, density, and proximity were mapped to seek out poor and lower accessible areas of healthcare from existing healthcare. To selecting new healthcare sites, four-factor criteria (Buffer around road and rail, land use land cover and buffer around settlement,) and some constrain criteria considered in the second phase of analysis. Finally, the shortest network path analysis has been done in the third phase to determine the shortest and best route from selected healthcare sites towards district medical college. The current study presents some suitable sites in the poor and inaccessible areas of the district. This study will be very helpful for the decision support system of healthcare management in the future.

Suitable Sites Identification for Solid Waste Disposal Using Geographic Information System and Analytical Hierarchy Process Method in Debark Town, Northwestern Ethiopia

Proper site selection for solid waste disposal is a significant issue in the management of solid waste. The present study has been carried out in Debark town, Amhara region, Northwestern Ethiopia, with an analytical hierarchy process (AHP) method and geographic information system (GIS) tools to locate the suitable solid waste disposal sites. In the present study, the following eleven thematic layers such as groundwater level, lithology, land use/land cover, precipitation, soil types, elevation, and slope, distance from the (drainages, springs, lineaments, and roads), and their sub-criteria have been used for the selection of suitable solid waste disposal sites. The above-mentioned thematic factors and their sub-criteria standardized weights and consistency ratios have been calculated and checked using the AHP method. The outcome of this study shows (2 km2 area) 2.50%, (3 km2 area) 3%, and (77 km2 area) 94.5% of the area is highly, moderately, and unsuitable, respectively, for the siting the solid waste disposal site in the present study area. The current study results show the effectiveness of GIS tools and the AHP method in solid waste disposal site selection analysis.

Sustainable site selection using system dynamics; case study LEED-certified project

ABSTRACT This study establishes a dynamic modelling for site-related credits. Guidelines of the ‘Leadership in Energy and Environmental Design’ (LEED) system are used for the context and project levels under Location and Transportation (LT) and Sustainable Sites (SS) categories, respectively. The research steps are; determining site-dependent credits based on LEED project checklist and credit-weighting calculator, calculating the dependency coefficient of credits and categories, developing representative causal-effect feedback loops and a stock-and-flow model using VENSIM-PLE and testing two alternative project site locations. Studying these intrinsic relations reveals that proper site selection may earn the project 63% of total available points which qualifies it to LEED Gold certification level. The results show the dominant effect of site selection on the context and site-related credits. It also shows the latent effect on other sustainable categories; the highest impact is seen for energy-related credits (EA), followed by indoor environmental quality (IEQ), materials and resources (MR) and finally for water efficiency (WE). Comparing site-dependent credits for LEED Version 3.0 and 4.0 shows that they are less in WE and EA for the latter and more for the MR and IEQ categories. This shows that the improper selection of a project site may eventually lead to downsizing building performance. Furthermore, the proposed model establishes a dynamic predictive tracing and evaluation mechanism for the rate and pattern of point-scoring scenarios to achieve sustainability targets and level of certification. It also proposes a new datum to assess the sustainability of site locations; both in a comparative and absolute manner.

Environmental Impact Assessment Using Mathematical Matrixes Case: Qaen Steel, South Khorasan, Iran

Qaen Steel Complex in South Khorasan, is located near the city Nimbolook. The aim of this study is assessment of project effects on environment by mathematical matrices. Significantly impact the results are classified in 4 groups: L: Low - M: Medium - H: High - VH: Very High. The results show that the low-and medium-classes were affected on the environment and high and very high classes have a little effect on the environment so any project works are not in very high class. On the other hand, the results show that for the most part, by the interaction of factors relating to the middle class and the poor, the most interactions for basic factors were for medium and low class. The most interaction effects for complimentary factors were for the low class. To reduce and control the negative effects of those projects were proposed. Using conventional environment improvement, erosion control, proper site selection and facility services to the environment, green space development, soil stabilization, alignment properly access roads, fields, forest and pasture restoration of organizing activities, site selection and proper villas Integration Projects with the least damage to the environment and create green space, restaurants and vegetation at specified times.

A geospatial technique‐based site suitability analysis for construction of water reservoirs in Arsha and Balarampur Blocks, Purulia

AbstractWater security is a term associated with the availability of fresh water for all. However, this finite resource has certain other related factors, as water resource can act as a driver for development or underdevelopment. From ancient history to now, human civilization has been dependent on water resources, not only for drinking but for the maintenance of natural systems, for hunting and foraging, through to the growth of agriculture and industrialization. Moreover, the relationship between water resource and regional development becomes more prominent in those areas where this finite resource is scarce. In most dryland areas, water resource management becomes an integral part of regional policy for overall development. This study aims to understand the intensity of water resource scarcity and management through proper site selection in the southwestern part of West Bengal, particularly in Purulia district. The district is underdeveloped, as well as water stressed due to climatic, geological, and socioeconomic factors. Water scarcity in the district impacts agricultural productivity through wasteland generation, which also drives regional poverty and migration. This study also seeks to explain how sustainable development goals, such as climate change (SDGs 13), life on land (SDGs 15), and poverty (SDGs 1), are related to water security. With the help of a semi‐structured questionnaire, secondary data (census, 2011), and geographical information systems, we endorse the view that assessment and management of water through proper site selection can help drive integrated rural water security.

Performance Analysis of Ultra-Dense Networks With Regularly Deployed Base Stations

The concept of Ultra Dense Networks (UDNs) is often seen as a key enabler of the next generation mobile networks. The massive number of BSs in UDNs represents a challenge in deployment, and there is a need to understand the performance behaviour and benefit of a network when BS locations are carefully selected. This can be of particular importance to the network operators who deploy their networks in large indoor open spaces such as exhibition halls, airports or train stations where locations of BSs often follow a regular pattern. In this paper we study performance of UDNs in downlink for regular network produced by careful BS site selection and compare to the irregular network with random BS placement. We first develop an analytical model to describe the performance of regular networks showing many similar performance behaviour to that of the irregular network widely studied in the literature. We also show the potential performance gain resulting from proper site selection. Our analysis further shows an interesting finding that even for over-densified regular networks, a non-negligible system performance could be achieved.

Hospital Site Selection in Iskandar Malaysia using GIS-Multi Criteria Analysis

Hospital is one of the most important and beneficial public services in the world, therefore, these facilities should be located in a rational manner. Increasing the population of countries particularly developing countries and remote areas leads to the demand for new public health facilities and hospitals. No matter who provides the healthcare facilities, the most important issue is where to locate a new hospital to provide, both facility location and attractiveness. Hospital proper site selection has a vital role in hospital construction and management. From the aspect of the government and healthcare organization, appropriate hospital site selection will help optimize the allocation of medical resources, matching the provision of health care with the social and economic demands. From the aspect of the investors and operators of the hospital, optimum hospital site selection will definitely be cost-saving on capital strategy. On the other hand, establishing a hospital in urban districts has its own positive and negative consequences. The positive impacts of establishing a hospital in an area are that it increases property value in the neighboring periphery as well as improving healthrelated accessibility for the residents of that urban district. The negative impacts of establishing a hospital in an area are negative side-effects such as environmental contamination and inducing new waves of traffic flow. Then, the adjacent community is impacted by forms of increased traffic flow, increased emergency vehicle usage in residential areas. Therefore, in hospital site selection should be tried to reduce the negative impacts. Then, main aim of this paper is to select a site for the building of a new hospital in Iskandar Malaysia using GIS-based Multi-Criteria Analysis (MCA) with consideration of various factor criteria, and constraint criteria in order to balance the medical resource there.

An Approach to Retiform Purpura for the Inpatient Dermatologist

Retiform purpura is a potentially ominous cutaneous sign that develops secondary to vascular compromise by either vasculitis or a vasculopathic disorder. The wide array of associated complications mandate a thorough investigation in a timely fashion. This review provides an overview of the frequent causes of retiform purpura in hospitalized adult patients and proposes a diagnostic approach for the inpatient dermatologist. Early recognition of the primary cutaneous morphology in retiform purpura is especially important as this can help generate a focused differential and workup plan. A high-yield skin biopsy result warrants a proper site selection and an adequate depth. Further workup and treatment depend on the underlying pathogenic process. For patients with underlying systemic vasculitis, rituximab is emerging as an effective treatment. Rivaroxaban was found to have excess risk (increased thromboembolic and bleeding events) and no benefit when compared to warfarin in a trial of high-risk anti-phospholipid syndrome patients. The differential diagnosis of retiform purpura is broad and a systematic approach is required to identify and treat the underlying cause.