Developing system-based leading indicators for proactive risk management in the chemical processing industry

Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, 2012.Cataloged from PDF version of thesis.Includes bibliographical references (p. 78-80).The chemical processing industry has faced challenges with achieving improvements in safety performance, and accidents continue to occur. When accidents occur, they usually have a confluence of multiple factors, suggesting that there are underlying complex systemic problems. Moreover, accident investigations often reveal that accidents were preventable and that many of the problems were known prior to those accidents, suggesting that there may have been early warning signs. System-based analysis addresses systemic aspects and leading indicators enable the detection of ineffective controls and degradation of the system. Together, they could enable taking needed actions before an incident or a loss event. To develop process safety indicators, the chemical processing industry currently uses guidelines that are mainly based on the concepts of the "Swiss Cheese Model" and the "Accident Pyramid." The current guidelines lack a systemic approach for developing process safety indicators; the guidelines view indicators as independent measures of the safety of a system (e.g. a failure of a barrier), which can be misleading because it would not identify ineffective controls, such as those associated with the migration of the system towards an unsafe state, or associated with interdependencies between barriers. Moreover, process safety indicators that are currently used in the chemical industry are more focused on lagging as opposed to leading indicators. This main objective of this thesis is to develop a structured system-based method that can assist a hydrocarbon/chemical processing organization in developing system-based process safety leading indicators. Building on developed safety control structures and the associated safety constraints, the proposed method can be used to develop both technical and organizational leading indicators based on the controls, feedbacks, and process models, which, ultimately, can ensure that there is an effective control structure.by Ibrahim A. Khawaji.S.M

ANTIPSYCHOTICS- CLASSIFICATION, USES, AND ADVERSE EFFECTS

Introduction: Antipsychotic agents are categorized usually as either “typical antipsychotics” or “atypical antipsychotics”. Typical antipsychotic pharmacological agents, which are also called first-generation antipsychotics or traditional antipsychotics, include chlorpromazine and haloperidol. On the other hand, atypical antipsychotic pharmacological agents, which are also called second generation antipsychotics, include risperidone, quetiapine, and olanzapine. Both typical and atypical antipsychotics work in similar mechanisms by inhibiting the activation of specific receptors in the dopamine pathway.Aim of work: In this review, we will discuss the antipsychotics- classification, uses, and adverse effects, Methodology: We did a systematic search for antipsychotics- classification, uses, and adverse effects using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles.Conclusions: The prescription of atypical antipsychotic agents, like quetiapine and olanzapine, has been significantly increasing and in many conditions, they are sometimes prescribed “off-label” – which is a worrying trend due to their possible risk of developing harmful adverse events. Therefore, atypical antipsychotic agents must only be used in their specific indications and with caution, especially among older patients and young adults. Atypical antipsychotic agents can be indicated for schizophrenia treatment and other associated conditions and in some cases to treat the behavioral and psychological manifestations related to dementia (risperidone only). Antipsychotics are not first-line treatments for patients with anxiety and are not generally recommended for the use in patients with posttraumatic stress disorder or insomnia. Key words: antipsychotics, classification, uses, and adverse effects

Common Eye Diseases in Children in Saudi Arabia (Jazan)

Background The rise in childhood eye diseases has become a matter of concern in Saudi Arabia, and hence a study has been conducted on the residents of Jazan. The aim of the research was to find out the root cause of such issues and provide a solution to prevent such circumstances for it may affect the vision of children. In this study, therefore, we aimed to determine the types of childhood eye diseases in Jazan and to discuss the best ways to prevent them or prevent their effect on the vision of our children. Our institutions are working toward the longevity and welfare of the residents, and healthcare is one of the important aspects in such a field. Methods This is a retrospective review of all patients less than 18 years of age who presented to the pediatric ophthalmology clinic of Prince Mohammed Bin Nasser Hospital, Jazan, between October 2014 and October 2015. The data, collected on 385 cases, included the age at first presentation, sex, clinical diagnosis, refractive error (RE) if present, and whether the child had amblyopia. If the child did not undergo complete ophthalmic examination with cycloplegic refraction, he/she was excluded. All data were collected and analyzed using the software SPSS. A P -value < 0.05 was considered statistically significant. Results We reviewed the files of 385 children, with a male/female ratio of 1.1:1.0. The group aged 0–6 years made up the largest group ( P = 0.01), and the ratio is an expression to define the credibility of the study using a chi-squared test. Strabismus (36.9%), RE (26.5%), ocular trauma (7.5%), infection of cornea and conjunctiva (7.3%), and keratoconus (6.2%) were the most common conditions. There was no significant difference in presentation by age group and sex among children with REs and squint. Trauma was seen more commonly among males and in the group aged 12–18 years. Conclusion In this retrospective study, the focus was on the common childhood eye diseases that were considerably high. Hypermetropia was the predominant RE, which is in contrast to other studies where myopia was more common. However, it is important to promote public education on the significance of early detection of strabismus, REs, and amblyopia and have periodic screening in schools. The discussion of the various issues is aimed at increasing the awareness and building a support for the cause by creating the knowledge base to treat things on time and acknowledging the severity of the issues

Vitamin D deficiency and glycaemic control among patients with Type 2 diabetes mellitus in Jazan City, Saudi Arabia

Background: The prevalence of vitamin D deficiency (VDD) is predicted to be high in patients with type 2 diabetes mellitus (T2DM), but the exact figure is not known in Jazan, Saudi Arabia. Emerging data suggests that VDD plays a role in glycaemic control. The aim of this study was to measure the prevalence of VDD among T2DM patients and to investigate its association with patients’ characteristics and glycaemic control in Jazan. Methods: This is an analytical cross-sectional study which recruited 309 patients with T2DM randomly from the Jazan diabetes registry. Logistic regression analysis was conducted to determine the VDD predictors and to examine the association of VDD in predicting glycaemic control adjusting for other covariates. Results: The VDD prevalence was found to be 60.8% in patients with T2DM. Age, gender, diabetic retinopathy (DR), dyslipidaemia, glycaemic control and obesity were significantly associated with VDD, and all except obesity were independent predictors of VDD. There was a significant negative correlation between 25-hydroxyvitamin D and glycosylated haemoglobin (HbA1c). VDD was a significant independent predictor of poor glycaemic control after adjustment for hypertension, DR, diabetic neuropathy (DN), type of diabetes medication, diabetes duration, and education level. Conclusion: In this Saudi Arabian population, VDD is highly prevalent in people with T2DM and is associated with poor glycaemic control. Health education targeting patients with T2DM and national strategies regarding vitamin D fortification are needed to prevent VDD in Saudi Arabia. Earlier VDD diagnosis by healthcare providers may help to improve the outcome for patients with T2DM. Establishing the causal association between VDD and glycaemic control and clarifying the biological role of vitamin D in T2DM are important aims for future studies

Severity and prevalence of allergic rhinitis among school children, Jazan Region Saudi Arabia

Background: Allergic diseases such as allergic rhinitis (AR) represent a global health problem, affecting 10–25% of the world population. There is clear evidence to support the concept that allergic diseases are influenced by genetic predisposition and environmental exposure. Objectives: To assess the severity and prevalence of AR among school children in Jazan Region, Saudi Arabia. Methods: This is a cross-sectional study using a modified International Study of Asthma and Allergies in Children (ISAAC) questionnaire. Results: The nasal blocking is considered to be one of the most common symptoms of AR. Regarding the frequency of AR-related symptoms which indicate severity in the last 12 months according to the gender, our statistical analysis results found that the severity regarding nasal symptoms varied from nasal block to disturbed sleep due to nasal block where 97 (6.9%) had nasal block, 109 (7.8%) had nasal block interfering with daily activities, 12.1% had nasal block resulting in breathing difficulties, and 67 (4.7%) had disturbed sleep due to nasal block/problem. About 258 (18.4%) of all population urgently visited the emergency department due to nasal problems. Sixty-four (4.5%) were admitted due to nasal problems and 92 (6.6%) missed school days due to nasal block. The prevalence in elementary and intermediate school was 209 (14.9) and 170 (12.2), respectively with P value of 0.013, according to gender of study population showed no statistical significance according to all parameters. The prevalence was higher among Saudi population, regarding education level the prevalence was higher among intermediate school children. Conclusion: In conclusion, it was clear that the prevalence of AR among Saudi school children is 27.1%. Living in urban areas, intermediate school education level, lowlander population are significant risk factors for the prevalence and severity of AR

Validation of the Arabic Version of Diabetes Eating Problem Survey&ndash;Revised (DEPS-R) among Adolescents with Type 1 Diabetes

Disordered eating behaviors (DEBs) in type 1 diabetes (T1D) have been studied globally in different age groups. However, there is no validated diabetes-specific questionnaire in the Arabic language for the screening of DEBs. This study aimed to translate the Diabetes Eating Problem Survey&ndash;Revised scale (DEPS-R) into the Arabic language and study its psychometric properties in adolescents with T1D. We adopted the forward&ndash;backward procedure to translate the DEPS-R questionnaire into Arabic. The validation study enrolled 258 Saudi adolescents with T1D aged 12&ndash;18 years who completed the Arabic DEPS-R questionnaire and the EAT-26. The Arabic DEPS-R showed good construct validity and reliability (Cronbach&rsquo;s alpha = 0.86). The factor analysis revealed a three-factor structure of DEPS-R which explains 54.4 % of the variance. In total, 30.6% of the participants are at high risk for DEBs (DEPS-R score &ge; 20). The psychometric properties of the Arabic DEPS-R are satisfactory, consistent with the original scale and translations in other languages. These results support the validity of the Arabic DEPS-R for assessment of DEBs in the T1D Arabic population

Disordered Eating Behaviors and Insulin Restriction in Saudi Adolescents and Young Adults with Type 1 Diabetes

Background and Objectives: The prevalence of disordered eating behaviors (DEBs) in type 1 diabetes (T1D) has been studied globally; however, data from Saudi Arabia and Arab-speaking countries are scarce. This study aimed to measure the prevalence of DEBs and associated clinical characteristics in adolescents and young adults with T1D, and the impact of DEBs on glycemic parameters. Materials and Methods: A total of 265 adolescents and young adults with T1D (aged 12–25 years) were recruited randomly from the registry at the Jazan Endocrinology and Diabetes Center, Saudi Arabia. Participants completed the Diabetes Eating Problem Survey–Revised (DEPS-R) questionnaire. Other measures included hemoglobin A1c (HbA1c) in addition to sociodemographic, anthropometric, and clinical data. Results: The prevalence of DEBs among T1D was 27.2%. Females (32.5%) had a higher proportion of DEBs than males (18.6%) (p = 0.01). About 27% of the participants reported insulin restriction. A history of hospital admission in the previous 6 months due to DKA and frequent hypoglycemia was more frequently reported in T1D participants with DEBs compared to those without (p = 0.03). Participants with DEBs had higher HbA1c and higher BMI compared to those without DEBs. Conclusions: Adolescents and young adults with T1D with disordered eating and insulin restriction have higher glycated hemoglobin, and are at higher risk of DKA. Routine screening for DEBs should be an essential element in diabetes care, especially among highly vulnerable groups

AN OVERVIEW NEONATAL HYPOGLYCEMIA MANAGEMENT APPROACHES

Background: Hypoglycemia remains to stand for a usual metabolic problem dealing with the neonatal populace. Both healthy and ill-appearing neonates could be impacted by hypoglycemia throughout the very first days of life. Severe neonatal hypoglycemia (HG) leads to neurologic damage, mental retardation, epilepsy, personality disorders, impaired cardiac performance and muscle weakness. Objective: The goal of this review is to highlight the background of the inborn errors of metabolism that present with neonatal hypoglycemia to understand more and discuss management of neonatal hypoglycemia. Methodology: We conducted a search using electronic databases; MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL), up to November, 2018. Conclusion: Neonatal HG is important factor in the general neonatal death. HG could additionally create serious invalidity. Treatment of the hypoglycemic infant may begin while investigations continu