Leveraging the BLAC Model for Situation Awareness in CIP

Because critical infrastructure (CI) is considered to be the backbone of a nation’s livelihood, the Critical Infrastructure Protection (CIP) program was established in 1998 by the American President as a directive to ensure the United States’ security and to keep it safe from any malicious attacks or unexpected disasters. However, protecting the critical infrastructure of this country has always been challenging, especially with the interdependencies among each sector, which increases its vulnerability. Any failure of one sector could cause a significant impact on the others. The Decision Support System (DSS) is a computer system that helps agencies make decisions based on existing situations. The decision making of the DSS has a strong relationship to situational awareness (SA), such that the quality of a decision relies on the degree of the situational awareness. Regarding CI, any decision for one sector affects other sectors. Therefore, decision makers should have insight about the consequences for all sectors when one sector changes. To avoid the complexity of interdependencies in the critical infrastructure of the United States, the healthcare sector was chosen to demonstrate the thesis hypothesis. Situational awareness is applied to healthcare, in general, but this thesis focuses on the situational awareness that is addressed during a multi-casualty incident (MCI). Bi-layer access control (BLAC) is an instrument that was proposed recently in a doctoral dissertation. BLAC uses a new concept named pseudoroles to verify the eligibility of access. For any request, BLAC checks, as a first step, against fixed attributes, then, in the next step, it matches against the associated policies. This two-step process increases the efficiency of the method. Although BLAC was introduced into the healthcare sector to protect patients’ privacy by regulating access to electronic health records, the pseudoroles concept can be implemented in any other sector. This thesis aims to utilize the concept of pseudoroles leveraged in situational awareness in the CIP program. Focusing on MCIs, this thesis proposes a model that will help ambulance personnel make decisions as to the most appropriate hospital for each patient’s care. The decision making depends on multiple factors that are related to the patient\u27s case and the policies of each hospital. Because of the importance of time, in such situations, and the need for the patient to be transported to a hospital as soon as possible, the model uses the BLAC mechanism of a two-step evaluation to exclude all impractical hospitals, at a first glance, based on the hospitals’ policies. Thus, by complex evaluation of the hospitals\u27 information, there is a higher probability that the most appropriate hospital will be chosen for the patients

Field accumulation risks of heavy metals in soil and vegetable crop irrigated with sewage water in western region of Saudi Arabia

Wastewater irrigated fields can cause potential contamination with heavy metals to soil and groundwater, thus pose a threat to human beings . The current study was designed to investigate the potential human health risks associated with the consumption of okra vegetable crop contaminated with toxic heavy metals. The crop was grown on a soil irrigated with treated wastewater in the western region of Saudi Arabia during 2010 and 2011. The monitored heavy metals included Cd, Cr, Cu, Pb and Zn for their bioaccumulation factors to provide baseline data regarding environmental safety and the suitability of sewage irrigation in the future. The pollution load index (PLI), enrichment factor (EF) and contamination factor (CF) of these metals were calculated. The pollution load index of the studied soils indicated their level of metal contamination. The concentrations of Ni, Pb, Cd and Cr in the edible portions were above the safe limit in 90%, 28%, 83% and 63% of the samples, respectively. The heavy metals in the edible portions were as follows: Cr > Zn > Ni > Cd > Mn > Pb > Cu > Fe. The Health Risk Index (HRI) was >1 indicating a potential health risk. The EF values designated an enhanced bio-contamination compared to other reports from Saudi Arabia and other countries around the world. The results indicated a potential pathway of human exposure to slow poisoning by heavy metals due to the indirect utilization of vegetables grown on heavy metal-contaminated soil that was irrigated by contaminated water sources. The okra tested was not safe for human use, especially for direct consumption by human beings. The irrigation source was identified as the source of the soil pollution in this study

Complicated Subacute Bacterial Endocarditis in a Patient with Ventricular Septal Defect

Infective endocarditis (IE) is an uncommon but life-threatening infection. Despite advances in management, it still causes high morbidity and mortality. We report the case of an 8-year-old girl who presented with a prolonged fever of 2.5 months duration and a history of a small perimembranous ventricular septal defect. She was diagnosed with subacute bacterial endocarditis secondary to Streptococcus mutans. The patient developed a septic pulmonary embolism; however, with the use of appropriate antimicrobial therapy, she made an uneventful recovery. Clinicians should have a high index of suspicion for IE as the possible cause of a prolonged fever, especially in the presence of congenital heart disease (CHD). Currently, IE prophylaxis is not indicated for unrepaired acyanotic CHD. Nevertheless, with the new changes in the guidelines, more prospective studies are needed to investigate the incidence of IE in such lesions, before long-term conclusions can be drawn

Assessment of the relationship between depression and treatment compliance in chronically-ill patients in Jeddah, Saudi Arabia

Purpose: To find the relationship between depression, treatment adherence and lifestyle changes inchronically-ill patients residing in Jeddah, Saudi Arabia.Methods: A cross-sectional study was conducted. A self-administered questionnaire was used tocollect data from patients of multi-healthcare centers located in Jeddah. The questionnaire aimed tocollect the information regarding patients’ levels of medication compliance, patients’ capacity to copewith the disease and adherence to medication, along with their depression level.Results: Of the overall sample size of 439 patients, 43.1 % were suffering from hypertension, 37.8 %were diabetic and 33.7 % had hyperlipidemia. Besides, total scores of Patient Health Questionnaire-9(PHQ-9) showed that approximately 5 % patients were severely depressed, 8 % had moderately severedepression, 27 % had moderate depression, and 60 % had mild depression. Compliance scale datarevealed that 38 % patients showed low compliance, 51 % showed partial compliance, and 11 %showed high compliance. Also, a significant inverse relationship between depression and compliancescales (rs = -0.221, p = 0.004) was observed.Conclusion: The results show an inverse association between depression and medication adherencein patients with chronic disease in Jeddah. Therefore, clinicians are advised to assess the level ofdepression in chronically-ill patients in order to improve their adherence to medicine.Keywords: Chronic illness, Depression, Medication adherence, Treatment complianc

Importance and Significance of UF/MF Membrane Systems in Desalination Water Treatment

The proposed chapter addresses a comprehensive overview of the history and future outlook of ultrafiltration/microfiltration (UF/MF) membrane for desalination water pretreatment. Known theories on UF/MF membrane formation from phase inversion (Dr/wet) systems can be prolonged to define the consequences of high or low molecular weight additives. Also, direct material reengineering and surface modification for high-performance anti-fouling of UF/MF membranes are also highlighted. Before the modern final polymeric film, the characterization techniques, particularly molecular weight cut-off, pore size, pore size distribution, and microbiological activity classification, on to the UF/MF membrane surface were presented, respectively. Lab scale to commercial scale UF/MF membrane configuration and market size of UF/MF membranes for pretreatment desalination are described. The significance of UF/MF provided here as an unconventional approach for desalination water pretreatment is in contrast with the current conventionally used technologies. The recent development made in the integration of established desalination processes, such as spiral wound reverse osmosis (SWRO), multi-stage flash (MSF), multi-effect distillation (MED), electrodialysis (ED) desalination, and UF pretreatment, is addressed. Finally, the influence of UF/MF on desalination water pretreatment step on to the energy cost of desalination process system is discussed

Spectrum of AIDS Defining Opportunistic Infections in a Series of 77 Hospitalised HIV-infected Omani Patients

Objectives: Most of the morbidity and mortality in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) result from opportunistic infections (OIs). Although the spectrum of OIs in HIV infected patients from developing countries has been reported, there is a paucity of data on the natural history, pattern of disease, and survival of hospitalised patients with HIV/AIDS, particularly in Arab countries. The aim of this study was to study retrospectively the spectrum and frequency of various OIs in a cohort of hospitalised HIV-infected Omani patients. Methods: Included in the study were 77 HIV-infected Omani patients admitted to a tertiary care teaching hospital in Muscat, Oman, between January 1999 and December 2008. They were diagnosed on their first admission and hence were not on highly active antiretroviral therapy (HAART) at presentation. The frequency of various clinical and laboratory findings and individual OIs were analysed. Results: In total, 45 patients (58%) had one or more AIDS-defining OIs. Pneumocystis jiroveci pneumonia (PCP) was commonest (25%), followed by cryptococcal meningitis (22%), cytomegalovirus (CMV), retinitis (17%), disseminated tuberculosis (15%), and cerebral toxoplasmosis (12.5%). Only one patient with Mycobacterium avium-intracellulare (MAI) was identified and one patient had disseminated visceral leishmaniasis. The majority of patients (77%) had CD4+ counts <200 cells/µL. Ten patients (22%) died during hospital stays, with five deaths (50%) being caused by disseminated CMV infection. Conclusion: A wide spectrum of OIs is seen in hospitalised HIV-infected patients in Oman. P. jiroveci pneumonia and cryptococcal meningitis were the commonest OIs, while disseminated CMV was the commonest cause of death. We hope these results will advance the knowledge of specialists treating HIV in Oman and the Gulf region.

Cadmium, Lead and Mercury Concentrations in the Hooded Rock Oyster Saccostrea Cucullata (Born, 1778) From the Oman Coast of the Arabian Sea

The concentrations of cadmium (Cd), lead (Pb) and mercury (Hg) were estimated in the soft tissue of the hooded rock oyster Saccostrea cucullata from four sites in Dhofar on Oman coast, that were collected monthly from June 2009 to July 2010. The mean concentrations in µg/g dry weight of Pb, Hg and Cd were: 0.013±0.004, 0.015±0.001 and 3.41±0.15 (±SD), respectively. The concentrations of Hg and Pb were close to background levels, indicating no anthropogenic contamination, while concentrations of Cd exceeded the permissible level by approximately 3.4 times. Comparison between concentrations of heavy metals in different sites by ANOVA and Turkey post hoc tests, indicated significant differences between some sites for Cd, while differences for Hg and Pb were not significant. Meanwhile, no significant seasonal differences were reported in concentrations of the studied heavy metals. Generally,  metal concentrations in the soft tissues of the examined oyster in Dhofar were found to be lesser than in other regions of the Indian Ocean and in previous surveys in Oman. Keywords: Saccostrea cucullata, heavy metals, concentration, Oman

Treatment of Taman Beringin landfill leachate using the column technique

Landfill leachate is currently a major environmental concern because it contains high concentrations of organic and inorganic contaminants. Leachate treatment using natural materials, such as aquifer sand, peat, and the commercial material BIRM (Burgess Iron Removal Media), was performed through column experiments. Aquifer sand was taken from Kg Teluk, Kelantan, peat was taken from Peatland Paradise, and BIRM was bought from a supplier. The heavy metals (Fe3+, Cr, Ni, and Cu) from natural leachate were selected for this experiment. The concentrations of Fe, Cr, Ni, and Cu before the experiment were 11, 1.27, 4.535, and 3.293 mg L–1, respectively. The physical and chemical parameters of leachate and surface water at the Taman Beringin Landfill have been studied to understand the impact of pollution in the area. The results show that leachate samples at the bottom of the landfills have the highest pollution. Both the physical and chemical parameters of leachate exceed the limits of Interim National Water Quality Standards for Malaysia. Experimental test results were also analyzed in terms of breakthrough curves and percentage of heavy metal removal. The results show that the BIRM sample has a higher adsorption capacity for heavy metals, including Fe, compared with aquifer sand and peat

Study of modern nano enhanced techniques for removal of dyes and metals

Industrial effluent often contains the significant amount of hexavalent chromium and synthetic dyes. The discharge of wastewater without proper treatment into water streams consequently enters the soil and disturbs the aquatic and terrestrial life. A range of wastewater treatment technologies have been proposed which can efficiently reduce both Cr(VI) and azo dyes simultaneously to less toxic form such as biodegradation, biosorption, adsorption, bioaccumulation, and nanotechnology. Rate of simultaneous reduction of Cr(VI) and azo dyes can be enhanced by combining different treatment techniques. Utilization of synergistic treatment is receiving much attention due to its enhanced efficiency to remove Cr(VI) and azo dye simultaneously. This review evaluates the removal methods for simultaneous removal of Cr(VI) and azo dyes by nanomicrobiology, surface engineered nanoparticles, and nanophotocatalyst. Sorption mechanism of biochar for heavy metals and organic contaminants is also discussed. Potential microbial strains capable of simultaneous removal of Cr(VI) and azo dyes have been summarized in some details as well