Separate Room Research Articles

Safety and Feasibility of Tele-Cardiac Rehabilitation Using Remote Biological Signal Monitoring System: A Pilot Study.

Cardiac rehabilitation (CR) is categorized as a class I recommendation in the guidelines for the management of patients with cardiovascular disease (CVD). However, the penetration rate of outpatient CR is low in Japan. We designed a pilot study to evaluate the safety and feasibility of tele-CR using a remote biological signal monitoring system. A total of nine patients (median aged 70.0 (66.0 - 76.0) years (male = 6) with CVD who participated in phase II CR for 1 month under the exercise prescription using the cardiopulmonary exercise test (CPET) were analyzed. They participated in the tele-CR program with a remote biological signal monitoring system (Nipro HeartLineTM, Osaka, Japan, and Duranta, Miyagi, Japan) in the CR room and were instructed by the CR staff from a separate room in the hospital. We evaluated the occurrence and degree of remote biological signal monitoring defects as safety evaluation items, i.e., whether the patients could set the remote biological signal monitoring equipment, as a feasibility evaluation item during a 3-month period. We also performed CPET at the baseline and follow-up. Following the 3-month tele-CR program, a total of 122 remote CR programs were performed using the remote biological signal monitoring system. No patient experienced a lack of remote biological signal monitoring during exercise therapy. Significant improvement was noted in the exercise capacity, as assessed using the cardiopulmonary test (from 19.5 (16.7 - 20.2) mL/kg/min to 21.1 (17.3 - 22.8) mL/kg/min, P = 0.01, age ratio from 86% (75-96%) to 99% (78-104%), P = 0.01). One patient required support using the remote biological signal monitoring system, including information technology literacy. This study suggests the safety and feasibility of tele-CR using the remote biological signal monitoring system. However, further investigations are required to explore the suitability, effects, and cost-effectiveness of tele-CR as an alternative to center-based CR in the future.

Novice Inter-Rater Reliability on the Selective Functional Movement Assessment (SFMA) After a 4-Hour Training Session.

The Selective Functional Movement Assessment (SFMA) is a whole-body movement classification system that identifies non-optimal movement performance requiring further assessment. There needs to be more evidence specifying the training time required to obtain SFMA reliability for entry-level health care practitioners. The primary intent of this study was to determine SFMA inter-rater reliability between two third-year physical therapy students following an in-person three-hour training and one-hour follow-up training with a certified SFMA physical therapist. The secondary purpose was to compare rater scores of the composite criterion 50-point checklist and rater categorization using the top-tier movements in real-time assessments of healthy participants. Inter-rater reliability study. Two novice raters received training on assessing movement using the SFMA. Participants included non-pregnant healthy adults screened for general exercise, participants were excluded for history of orthopedic surgery within the prior six months. Three independent raters, including two novice and one SFMA-certified rater, individually assessed the top-tier movements in separate rooms in real-time. Participants were randomly assigned a start location, and raters were blinded to each other's criterion 50-point checklist and categorical scoring. Statistical analysis included a paired t-test, a repeated measures ANOVA, and a two-way, mixed absolute agreement ICC. Twenty-five participants (23.4 years ± 1.9; 72% female) completed the SFMA top-tier movements. Significant differences were identified with novice raters identifying fewer non-optimal movement patterns than the certified clinician. The intraclass correlation coefficient (ICC2,1) was moderate (0.60, p<0.001) for all three raters on the 50-point criterion checklist scoring. Third year physical therapy students were able to demonstrate moderate inter-rater reliability assessing healthy individuals using the 50-point criterion checklist. Variation between novice raters may reflect the amount of previous exposure assessing movement and suggests that some may require more time learning and practicing in order to identify non-optimal movement patterns that may require further assessment. 3b©The Author(s).

HBV, HCV, and HIV Seroprevalence in Hemodialysis Patients Admitted to a Tertiary Care Hospital in Mogadishu, Somalia

Hemodialysis (HD) patients are a special group of patients who are at high risk for infection and related complications. Blood-borne viruses associated with chronic diseases such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are important causes of morbidity and mortality in HD patients. Immunodeficiency of the patients, weak protective efficacy of vaccines (HBV etc.), invasive vascular procedures, long-term dialysis applications and device-related contaminated blood contact risk, need for blood transfusion, medical practices associated with the risk of nosocomial transmission are some of the factors associated with an increased risk of infection transmission in HD patients. In addition to standard precautions to prevent infection transmission, some additional practices specific to HD patients have been recommended. HBV vaccination, patient isolation (special staff and use of separated rooms, devices, and equipment) in case of indication, precautions to be taken during catheter application (selection of catheter location, catheter care, skin antisepsis, and performing the procedures under appropriate and sterile conditions), monitoring patients for infection markers (before dialysis and at recommended intervals), taking into account inadequate antibody production and the long incubation period of viral infections are some examples of preventive procedures specific to HD patients. In this study, the prevalence of HBV, HCV and HIV infections in HD patients treated in a tertiary care hospital in Somalia was investigated. A total of 744 HD patients, 419 (56.3%) males and 325 (43.7%) females, were included in the study. The mean age of the patients was 50.81±17.62 (range 7-91) and the median age was 53. 660 of the patients were tested for anti-HBs (386 positive patients; 58.5%), 718 for HBsAg (63 positive patients, 8.8%), 720 for anti-HCV (19 positive patients, 2.6%), and 599 for anti-HIV (one positive patient 0.17%). Seropositivity rates were found to increase with age in HD patients, in line with the prevalence of viral agents in the population. In 718 patients tested for HBsAg, the positivity rates in men and women were 10.8% (44/406) and 6.1% (19/312), respectively, and the seropositivity rate was significantly higher in men (p=0.026). Anti-HCV seropositivity (2.6%) was approximately twice and significantly higher in HD patients than the hospital general prevalence (1.41%) (p=0.005). Emergency responses to injuries related to ongoing conflict across the country, invasive procedures performed outside the hospital and under unsuitable conditions, lack of molecular diagnostic tests for viral infections in identifying seronegative cases, patients apply to various centers with different capabilities for dialysis procedures and irregular patient follow-up records, missing hemodialysis sessions due to economic or other reasons, high prevalence of HBV, and lack of trained and specialized personnel draw attention as problems specific to the region.

Analysis of Internal Control of Cash Receipt and Disbursement Functions at Unggul Polytechnic LP3M Medan

Cash is the company's most liquid asset and plays a significant role in funding the company's operations compared to other investments, so cash control is needed within the company. Companies with organizational management where internal controls can control errors in carrying out the profession to protect cash from misuse efforts from when cash is received until it is disbursed. LP3M Superior Polytechnic is a private tertiary institution whose primary income is the payment of student tuition fees. The research method uses the descriptive analysis method. The test results show that the cash receipts internal control system is effective, contrary to the cash disbursement internal control. At the same time, the internal control system for cash disbursements has not been effective because there are still elements of Internal Control within the company that have not been fully implemented, including placing the cashier in the same room as other employees, which should be separate and have a separate room as accounting control.

Maxillary Sinus Volume in Patients With Unilateral Cleft Lip and Palate by CBCT.

Cleft lip and palate (CLP) is one of the most common congenital craniofacial anomalies, which can change the morphology of the skull, face, and maxillary sinus due to the disruption in the fusion of palatal shelves. This study aimed to investigate the volume and dimensions of the maxillary sinus in unilateral CLP patients along with comparing the healthy and affected sides. This cross-sectional study was conducted on 27 cone-beam computed tomography stereotypes (14 male and 13 female) of patients with unilateral CLP. Maxillary sinuses were traced separately on each side and analyzed by OnDemand3D software in a separate room with low light. The height and base area of the maxillary sinuses were measured on each side. After dividing each sinus into smaller pyramids, the volume of the sinus was obtained using the partial frustum model method and analyzed by paired t test. There was no significant difference between cleft and noncleft sides in terms of mean volume and height of the sinus ( P > 0.05). The average area of the sinus base on the cleft side was 32.77mm 2 more than the noncleft side, and this difference was statistically significant ( P = 0.027). The mean upper maxillary sinus volume on the cleft side was 541.62mm 3 larger than the noncleft side, but this difference was not statistically significant ( P = 0.075). Considering the age groups, the average upper sinus volume on the cleft side in patients under 20 years old was 4.66mm 3 less than the noncleft side. In the age group of more than 20 years, the average volume of the upper sinus on the cleft side was 978.66mm 3 more than the noncleft side. The mean volume of the lower sinus on the cleft side was 505.92mm 3 lower than the noncleft side, and this difference was statistically significant ( P = 0.010). The average area of the sinus base of the cleft side was significantly higher than the noncleft side. Also, the lower sinus volume of the cleft side was significantly lower than the noncleft side. However, no significant difference was observed in upper sinus volume between the cleft and noncleft sides.

Alcohol Withdrawal with Delirium Tremens.

Emergency medicine (EM) residents (1st year and 2nd year levels), 4th year medical students and advanced practice providers. Alcohol use has played a major role in causing significant morbidity and mortality for patients. In 2016, it was the 7th leading risk factor for deaths and disability-adjusted life years globally.1 Among heavy alcohol users admitted for hospital management, the incidence of alcohol withdrawal syndrome is estimated to be 1.9 to 6.7%.1 Alcohol withdrawal (AW) in the ED has been associated with increased use of critical care resources, and frequent ED visits for alcohol-related presentations have been associated with mortality rates that are about 1-4% when withdrawal progresses to delirium tremens (DTs).1 Patients with alcohol withdrawal can present in many different ways to the ED including anxiety, tachycardia, delirium tremens (DTs), seizures and severe autonomic dysfunction leading to severe sickness and death.2 Therefore, it is extremely important for an EM physician to recognize the signs of AW in patients and to manage the critically ill patients. In addition, Clinical Institute Withdrawal Assessment (CIWA) of alcohol was developed to assess severity of alcohol withdrawal in 1989.3 EM physicians should utilize CIWA to help determine the severity of AW. By the end of the session, learner will be able to 1) discuss the causes of altered mental status, 2) utilize CIWA scoring system to quantify AW severity, 3) formulate appropriate treatment plan for AW by treating with benzodiazepine and escalating treatment appropriately, 4) treat electrolyte abnormalities by giving appropriate medications for hypokalemia and hypomagnesemia, and 5) discuss clinical progression and timing to AW. This session was conducted using high-fidelity simulation, which was immediately followed by an in-depth debriefing session. The session was run during first year EM resident intern orientation, and it was run during two consecutive years. There was a total of 32 EM residents who participated. There was a total of 16 residents who actively managed the patient while the other 16 were observers. Each session had four learners and was run twice in two separate rooms. There was one simulation instructor running the session and one simulation technician who acted as a nurse. After the simulation and debriefing session was complete, an online survey was sent via surveymonkey.com to all the participants. The survey collected responses to the following questions: (1) the case was believable, (2) the case had right the amount of complexity (based on their Gestalt), (3) the case helped in improving medical knowledge and patient care, (4) the simulation environment gave me a real-life experience and, (5) the debriefing session after simulation helped improve my knowledge. The responses were collected using a Likert scale of 1 to 5 with 1 being "Strongly disagree" and 5 being "Strongly agree." There was a total of 15 respondents from both years. One hundred percent of them either agreed or strongly agreed that the case was beneficial in learning, in improving medical knowledge and in patient care. All of them found the post-session debrief to be very helpful. Two of them felt neutral about the case being realistic. The median response for questions 1, 3 and 5 is 5. The median response for questions 2 and 4 was 4. The range of responses for questions 1, 2, 3 and 5 was 4-5 while the range for question 4 was 3-5. This high-fidelity simulation was a cost-effective and realistic way of educating learners on how to manage AW with DTs. Learners are forced to start with a broad differential for the patient who presents with AMS. As they recognize the cause of mental status, the patient quickly decompensates into developing severe agitation and autonomic dysfunction requiring learners to manage the patient and establish an airway. Learners found the case to be beneficial in learning the management of AW. Alcohol withdrawal, delirium tremens, agitation, altered mental status.

Rheumatology congresses post COVID-19: we cannot regress.

Rheumatology congresses post COVID-19: we cannot regress.

Bytový dům pro zemědělce: k procesu adaptace městských standardů bydlení v prostředí vesnických sídel

Housing construction in Czechoslovakia began to grow in the 1940s, which was reflected in the increased number of flats and improved housing standards. This growth was made possible mainly due to the construction of blocks of flats. Although in the countryside, in contrast to the cities, people predominantly lived in their own family houses, the construction of apartment blocks also contributed to the increase in capacity there. However, the experience from the 1940s and 1950s shows negative impacts of adopting the projects for blocks of flats which were designed for the city and the urban way of life and did not suit rural residents, who had different working patterns and needs. In the 1960s, an intensive dialogue between local participants, architects, and the authorities took place, leading to the adaptation of the apartment block concept to the needs of agricultural workers. The adaption concerned both the external appearance, which had to respect the village environment, and the internal layout. The adapted projects included separate rooms for residents to wash themselves after their return from fields and gardens, and storage compartments for foods and livestock feed. Attention was also paid to the surroundings, where buildings related to residents’ farming activities were designed (small animal breeding, working in the gardens and small fields). The willingness to conduct the dialogue and to adapt the projects for rural blocks of flats disappeared in the 1970s as a result of the normalization and gradual improvement in agricultural workers’ living standards.

Evaluation of sentinel lymph node localization in malignant melanoma by preoperative semiconductor gamma camera and planar lymphoscintigraphy.

Performing lymphoscintigraphy in a separate room, frees up the conventional gamma camera, coupled with the desire to directly localize sentinel lymph nodes (SLN) in the operating theatre has led to the development of high-resolution semiconductor-detector based handheld gamma-cameras, CrystalCam. This work consists of phantom and clinical studies. For the first part, a Jaszczak phantom with hollow spheres of various volumes were filled with the 99m Tc and the camera's sensitivity was measured at various distances to assess the possibilities and limitations of the device. The clinical study evaluates the effectiveness of CrystalCam in localizing SLN in 40 consecutive malignant melanoma patients compared to both conventional planar lymphoscintigraphy and hybrid SPECT/CT. SLNs detected by planar lymphoscintigraphy were marked on the patients' skin using a UV-marker. CrystalCam images were acquired in another room by another examiner and the SLNs were marked with a felt pen. The detected nodes by both camera systems were evaluated using UV-lamp and normal light to visualize the UV- and felt pen marks respectively. The concordance rate of the SLNs and higher-echelon nodes localized by both planar scintigraphy and CrystalCam imaging with respect to the total SLNs and higher-echelon nodes detected by SPECT/CT imaging are compared and statistically analyzed. The results of the phantom study show a good correlation between activity and count-rates for all distancesSPECT/CT, CrystalCamm, and planar lymphoscintigraphy detected 69, 58, and 61 SLNs respectively. The concordance rate of 95.65% by the CrystalCam and planar scintigraphy implies both cameras are statistically coequal in preoperative SLN detection of malignant melanoma. For the higher-echelon nodes, SPECT/CT, planar and CrystalCam imaging systems identified 82, 48, and 13 respectively; thus, CrystalCam was statistically inferior to planar imaging. The handheld CrystalCam is a reliable instrument for localizing SLNs in surgical centers without an on-site nuclear medicine department.

Attitudes towards the mixing of COVID-19 vaccinated and unvaccinated patients in multi-bed hospital rooms.

To explore patient and staff views about the mixing of COVID-19 vaccinated and unvaccinated patients in multi-bed hospital rooms. We conducted a mixed methods study with paper surveys and structured interviews. Self-administered surveys were undertaken with inpatients on the general medicine, general surgery, orthopaedic and respiratory wards in Dunedin Public Hospital. Face-to-face interviews were conducted with ward staff including consultants, registrars, charge nurses, registered nurses and nurse managers. The study was undertaken in February 2022, at the start of the first New Zealand wave of the Omicron variant. Of 118 eligible patients, 63 agreed to participate. Sixty (95%) of these patients were vaccinated for COVID-19. Most patients (59%) thought that vaccinated and unvaccinated people should be accommodated in separate hospital rooms. Vaccinated patients felt more comfortable sharing a multi-bed room with others of the same COVID-19 vaccination status as themselves than with unvaccinated patients. Participants who thought that they were at higher risk of severe illness from COVID-19 were more likely to support separation of patients based on vaccination status. Fifteen ward staff were interviewed: most would prefer the hospital to separate patients by vaccination status but were aware this would present practical and ethical problems and thought that current arrangements were adequate. While most vaccinated patients and staff wanted patients to be separated according to their COVID-19 vaccination status, the current precautionary measures for COVID-19 were viewed by most staff members as adequate.

#3410 COVID-19 PANDEMIC: STRUCTURAL AND FINANCIAL CHALLENGES AND QUALITY OF TREATMENT IN HEMODIALYSIS CLINICS

Abstract Background and Aims In December 2019, Chinese Centers for Disease Control and Prevention was the first to report an outbreak of febrile respiratory disease where a new coronavirus identified, called SARS-CoV-2 that triggered a complex multisystemic disease, Covid-19. It spread rapidly, reaching countries in all five continents. The World Health Organization declared Covid-19 a pandemic in March 2020. The following years were a challenge for humanity and health systems around the world. Studies show that Chronic Kidney Disease (CKD) with glomerular filtration rate &amp;lt;30 ml/min/1.73 m2 is an important risk factor for critical disease. Patients undergoing in-center hemodialysis (HD) are at higher risk for COVID-19, as they stay indoors without renewed air, which is important to control transmission, the same occurring with the professionals involved in the treatment. In our units, in order to mitigate the contamination, in addition to all measures required by health authorities, all SARS-Cov-2 positive patients performed their treatment in a separate room and with an in-center different flow from negative patients. The aim of this study was to verify whether the significant structural disarrangement that occurred in this period could interfere with the goals of the quality indicators established by the Patient Safety Program (PSP). Method We conducted a retrospective cross-sectional study to evaluate the evolution of both operating costs and PSP quality markers during 2019 to 2022. We studied 457 patients undergoing in-center HD, with no distinction by gender, race, age or underlying disease. In the measurement of costs, only materials/medications specifically to HD, as well as the expenses in the remuneration of the constant changes of the care team, the absence due to contracting the disease or the established health standards. The following were analyzed: Conversion of viral hepatitis, with a target of 0%; SpKt/V ≥1.2, target 70%; Healthcare-Related Infections for Arterio-Venous Fistula (HRI-AVF) target &amp;lt;1%. Hospitalization/deaths ratio as an index of the impact of the disease on our population was also calculated. All indexes were measured monthly and annualized using mean (costs), median and standard deviation, as a measure of central trend. Statistical analysis was used ANOVA and Kruskal-Wallis Test. Results In 2019, the cost of items corresponded 22.2% SD±1.6 of the value of the dialysis session; 30.4% SD±2.8 in 2020; 32.3% SD±3.0 in 2021 and finally 31.1% SD±3.0 in 2022. Obtaining statistical significance only from 2019 for other periods, p&amp;lt;0.05. We did not observe viral hepatitis conversion at all times, reaching the goal. In the SpKt/V indicator, we observed 78% SD±4 in 2019, 73% SD±4 in 2020, 72% SD±6 in 2021 and 79% SD±6 in 2022, with no statistical significance observed between years. HRI-AVF rate was 1% in 2019, 3%, 2% and 2% in 2020, 2021 and 2022, respectively. No static significance found. The hospitalization/deaths ratio was 13% in 2019, 45% in 2020, 41% and 31% in 2021 and 2022, respectively. Conclusion The pressure in health units, a large increase in hospital costs due to the scarcity of materials/medicines and equipment for patient care, and especially the absence of sick professionals and/or increased workload, led to structural and financial disorganization in all health units including HD centres. This destructuring could somehow interfere with the quality of treatment. However, we did not show this relationship, because we found increased costs, and achievement of the goals of Viral Conversion Rates, SpKt/V&amp;gt;1.2 and AVF-related IRAS. The number of hospitalizations was large, as in the whole world, with high lethality. We are in line with the official Brazilian Government: a fall in the prevalence of CKD per 100,000 inhabitants and a fall in deaths due to CKD, leading cause of death from Covid-19, as shown in the graphs below. The implementation of the PSP with a work of solidification of its standards and its objectives, go through continuous work with each patient, and incessant training of all professionals involved. With this, they become a strong barrier of protection to adverse events of the size to those caused by the Covid-19 pandemic.

Using Interventions to Increase Test Access: An Alternative to Accommodations?

Students with disabilities are often given accommodations in testing situations (e.g., extended testing time). However, for many students with high-incidence disabilities, interventions can reduce the need for these accommodations or serve as a helpful supplement to accommodations. Applied behavior analysis provides a framework for understanding how accommodations alter testing settings, as well as for developing related interventions. We review research on evidence-based interventions that can reduce the need for five common testing accommodations: extended testing time, separate room administration, test breaks, read-aloud, and dictated response. We conclude with suggestions for changes to school-based practice as well as remaining research needs.

Emergency service perspective of families with children who have neurodevelopmental diseases

Introduction: It is known that children with neurodevelopmental diseases have frequent traumas like falling and apply to emergency department which significantly affects patient and family. Our aim is to examine the families' view and the problems encountered in emergency services by examining their answers to questionnaire.&#x0D; Method: This study was designed retrospectively. Patients registered in Department of Autism, Mental Special Needs and Rare Diseases as families with children who have neurodevelopmental diseases included in the study. 324 families’ survey with 12 open-ended questions evaluated in terms of distribution and frequencies with descriptive statistical methods.&#x0D; Results: By analyzing the data obtained the findings of the research were gathered under 12 main themes and 80 sub-themes. 313 (89.9%) were diagnosed with Down Syndrome, 9 (2.5%) with Angelman Syndrome, 7 (2.02%) with intellectual disability, and 5 (1.4%) with Autism. 34.2% of the children were 0-3 years old, 28.7% were 3-6 years old, 20.9% were 6-10 years old. Emergency services were used in "all cases where urgent intervention is required" (70%), and in cases where “an outpatient appointment couldn’t made" (10.8%)&#x0D; Conclusion: It would be beneficial to examine children with neurodevelopmental diseases in an understanding and patient manner, using a plain and understandable language, in a quiet environment in emergency room. To solve these patient’s problems, awareness training of healthcare professionals, having separate examination and observation room, ensuring accessibility and arranging the room with necessary medical supplies and equipment should be made.

Prevalence, potential determinants, and treatment-seeking behavior of acute respiratory infection among children under age five in India: Findings from the National Family Health Survey, 2019-21

BackgroundAcute respiratory infections (ARI) are a major cause of mortality and morbidity among under-five children worldwide, particularly in developing countries. Current evidence using nationally representative data on determinants and care-seeking behavior for ARI is limited in the Indian context. Hence, the present study complements the existing literature by examining the prevalence, determinants, and health-care-seeking behavior regarding ARI among Indian children under age five.Study designCross-sectional study.MethodsThe data for the present study were drawn from the fifth round of the National Family Health Survey (NFHS-5) conducted in 28 states and 8 union territories of India in 2019-21. A total of 222,233 children age less than five years were selected to estimate the prevalence and determinants of ARI, and 6198 children having ARI were selected to explore the treatment-seeking behavior. Bivariate analysis and multivariable binary logistic regression analysis were employed.ResultsAmong children under five years, 2.8% suffered from ARI in the two weeks preceding the survey, and 56.1% sought treatment for ARI. Younger age, a recent episode of diarrhea, maternal asthmatic history, and tobacco smoke exposure in the household increase the risk of having ARI. Further, having a separate room as a kitchen in the household reduces the likelihood of having ARI by 14% (AOR: 0.86; CI: 0.79–0.93). Female children (AOR: 0.88; CI: 0.77-1.00) and children belonging to households having difficulty in accessing transport to health facility (AOR: 0.83; CI: 0.69–0.99) are less likely to seek treatment.ConclusionThe study identified several socio-demographic, maternal, and household characteristics associated with ARI and treatment seeking for ARI. The study also recommends making health centers more accessible to the people in terms of proximity and cost.

USING CASE BASED LEARNING TO FOSTER CRITICAL LEARNING IN MEDICAL BIOCHEMISTRY

The interventional study was conducted in the Department of Biochemistry, Nishtar Medical Hospital, from January 2021 to January 2022 to analyze the impact of case-based learning on first-year biochemistry students' critical thinking skills and creative abilities. The study was conducted on 1st year MBBS students who had undergone CBL. A total of 60 students were included in the study. Study participants were randomly divided into a study group (n=30) and a control group (n=30). Pre-test questionnaires were administered to both groups; the control group was then seated in a separate room, and the study group was randomly subdivided into subgroups I, II, and III. Sub-groups were asked to design study cases on given topics and discuss the designed case with each other. The control group was asked to study the same topics individually. All participants then underwent a post-test. Responses were recorded. Results showed that the pre-test score (out of 20) in the study group ranged from 8.5-16.5 and in the control group from 9-17, which means that there was no significant difference between both groups before intervention (P&gt;0.05). Post-test scores in the control group ranged from 8-17 and in the study group from 12-19, and this difference between the scores was statistically significant. Results showed that case-based learning increases students' critical thinking skills and enables them to consider alternatives, imagine possibilities, and seek solutions.

VOX2BIM+ - A Fast and Robust Approach for Automated Indoor Point Cloud Segmentation and Building Model Generation

Building Information Modeling (BIM) plays a key role in digital design and construction and promises also great potential for facility management. In practice, however, for existing buildings there are often either no digital models or existing planning data is not up-to-date enough for use as as-is models in operation. While reality-capturing methods like laser scanning have become more affordable and fast in recent years, the digital reconstruction of existing buildings from 3D point cloud data is still characterized by much manual work, thus giving partially or fully automated reconstruction methods a key role. This article presents a combination of methods that subdivide point clouds into separate building storeys and rooms, while additionally generating a BIM representation of the building’s wall geometries for use in CAFM applications. The implemented storeys-wise segmentation relies on planar cuts, with candidate planes estimated from a voxelized point cloud representation before refining them using the underlying point data. Similarly, the presented room segmentation uses morphological operators on the voxelized point cloud to extract room boundaries. Unlike the aforementioned spatial segmentation methods, the presented parametric reconstruction step estimates volumetric walls. Reconstructed objects and spatial relations are modelled BIM-ready as IFC in one final step. The presented methods use voxel grids to provide relatively high speed and refine their results by using the original point cloud data for increased accuracy. Robustness has proven to be rather high, with occlusions, noise and point density variations being well-tolerated, meaning that each method can be applied to data acquired with a variety of capturing methods. All approaches work on unordered point clouds, with no additional data being required. In combination, these methods comprise a complete workflow with each singular component suitable for use in numerous scenarios.

Evaluation of different methods of environmental enrichment to control anxiety in dogs undergoing hemilaminectomy after acute intervertebral disc extrusion: a randomized double-blinded study.

The goal of this randomized, double-blinded, placebo-controlled study was to evaluate the effect of environmental enrichment (EE) on post-operative pain and anxiety in dogs following hemilaminectomy for acute intervertebral disc extrusion (IVDE). Twenty healthy client-owned dogs undergoing a hemilaminectomy for IVDE with the same immediate post-operative analgesia protocol were randomly assigned to either the EE or standard environment (SE) group post-operatively. Recovery was achieved in an intensive care room (SE) or a separate quiet room (EE) equipped with white noise and classical music. EE dogs were also exposed to dog-appeasing pheromones, essential oil scents, and positive human interactions and were provided meals through food toys. A blinded evaluator assessed all dogs using the modified Glasgow Composite Pain Scale (mGCPS) on presentation and at several time points post-operatively. A rescue injection of the opioid methadone was given to the dogs with an mGCPS score of ≥5/20. Dogs received the antidepressant trazodone when anxious behaviors (5 mg/kg) were observed. The mGCPS scores, the latencies to receive the first methadone and trazodone doses and to eat the first meal, the number of methadone and trazodone doses, and the number of meals ingested in the first 24 and 48 h post-surgery were compared using Wilcoxon tests, and Benjamini-Hochberg correction for false discovery rate was applied. Although median mGCPS scores did not differ between the groups, compared to SE dogs (n = 10), EE dogs (n = 6) received trazodone earlier (p = 0.019), were administered fewer methadone injections at 24 h (p = 0.043), and ate more at 48 h post-surgery (p = 0.007). Therefore, EE and anti-anxiety medications could be beneficial in improving the wellbeing of dogs post-operatively.

Assessment of thermal environment and thermal comfort in a typical composite ice shell building

Composite ice shell buildings are a special type of architecture found in severe cold regions and have played an important role in ice and snow tourism in recent years owing to their ability to offer tourists a romantic and novel experience. We conducted a field study to examine the thermal environment of a typical composite ice shell building in Harbin, China. In the unheated hall and separate small room, the indoor air had an average temperature and relative humidity of −20.64 °C and 76.94%, and −17.71 °C and 79.57%, respectively. Surface heat flux measurement of the north-facing building envelope revealed that the thermal properties of composite and plain ice differed significantly, suggesting that composite ice may have a lower thermal conductivity. The natural ventilation rate of 48,041 m3/h corresponded to an air change rate of 6.86 h−1, making the thermal environment highly susceptible to outdoor meteorological conditions. In addition, we conducted a questionnaire survey to study the thermal sensation and thermal comfort of the tourists. The results showed that the mean thermal sensation for the foot and head were approximately “cold " and “slightly cool”, respectively. The overall and mean thermal sensation for the hand were both between “cool” and “cold”, and the mean thermal comfort was approximately “slightly uncomfortable”. An adaptive thermal sensation prediction model suitable for composite ice shell buildings was developed through the study. These findings can assist in the design and construction of thermal environments that are better suited for short-term stays and specialty tourism.

Adoption of emergency department crowding interventions among US hospitals between 2007 and 2020

BackgroundTo deal with emergency department (ED) crowding, the American College of Emergency Physicians (ACEP) established a task force to develop a list of low-cost, high-impact solutions. In this study, we report on the trend in the adoption rate of ACEP-recommended ED crowding interventions by US hospitals. MethodsWe analyzed the National Hospital Ambulatory Medical Care Survey data from 2007 to 2020 (N = 3874 hospitals). The primary outcome was whether a hospital adopted each of the ACEP-recommended interventions, which were grouped into three overlapping categories: technology-based, flow modifications, and physical-based (e.g., changing ED layout). ResultsOn average, the most frequently adopted intervention was bedside registration (85.1%) and the least frequently adopted intervention was kiosk check-in (8.3%). The adoption of ED crowding interventions increased significantly between 2007 and 2020, except for expanding ED treatment space which declined by 45.0% from 30.3% in 2007 to 15.7% in 2020. The largest adoption rate increase occurred in having a separate operating room for ED cases with a 188.5% increase in adoption rate followed by radio-frequency identification (RFID) tracking (151.2%), and kiosk check-in (144.2%). ConclusionsThe adoption rate of ED crowding interventions by hospitals has risen, however most effective ED crowding interventions are still underutilized. The trends for each intervention did not always increase linearly, with certain periods showing greater fluctuations in adoption rate. Hospitals tend to implement technology-based interventions, compared to physical-based interventions and flow modification interventions.

Development of neutron detection systems at the NDPS of RAON

The Nuclear Data Production System (NDPS) at RAON has been built to produce nuclear data generated by the reactions induced by neutrons of tens of MeV. For the neutron Time-Of-Flight (TOF) measurement, neutron monitoring detectors based on a gas-filled Parallel Plate Avalanche Counter (PPAC) and a MICRO-MEsh-GASeous (MICROMEGAS) detector have been developed by the Rare Isotope Science Project (RISP) and Sungkyunkwan University (SKKU). These detectors have a neutron converter with a thin 232Th layer, which produces fission products due to fast neutrons. The PPAC achieved a 1 ns FWHM time resolution in a test with an 241Am α source and also showed good performance when tested with fast neutrons generated by a 45 MeV proton beam through the 9Be(p, n)9B reaction. Additionally, EJ-301, liquid scintillation detectors are assembled for the measurement of neutron flux with pulse shape discrimination capability. Slow charge signals as well as fast timing signals from the detectors will be processed for particle identification by a data acquisition (DAQ) system, located at a separate control room through 30 m long cables. Development of the detection system and the test results will be reported together with the on-site assembly status.