DESIGN, ENGINEERING, AND ASSESSMENT OF MOBILE MINEFIELDS

Naval mine warfare typically supports a sea denial strategy through the denial and/or delay of the enemy’s use of the water space or by controlling sea traffic in a designated area. Sea mines have been effective for decades. However, with technological progress, mine countermeasure (MCM) efforts have reduced the risks of a minefield by detecting and/or neutralizing mines to establish and maintain a Q-route for safe passage. The concept of a mobile minefield is proposed to increase the difficulty of the enemy’s MCM and improve the survivability of the minefield by adding mobility. This research explores both the physical design concepts and the operational effectiveness of mobile mines based on simulations and models. The simulation results show that, compared to static mines, mobile mines improved the number of enemy ships destroyed by at least 200% and increased the time it took the enemy to transition through the minefield by 50%. The results suggest that the mobile minefield would be operationally useful for the Department of the Navy and this technology is worth pursing and exploring.Distribution Statement A. Approved for public release: Distribution is unlimited.Captain, Singapore ArmyCaptain, Singapore ArmyMajor, Singapore ArmyLieutenant, Taiwan NavyMajor, United States ArmyCivilian, Department of the NavyLieutenant, United States NavyCivilian, Singapore Technologies Engineering, SingaporeMajor, Singapore ArmyMajor, Singapore ArmyMajor, Singapore ArmyCommander, United States NavyCivilian, Defense Science and Technology Agency (DSTA), SingaporeMajor, Singapore ArmyMajor, Republic of Singapore Air ForceTenente-Coronel, Brazilian Air ForceLieutenant, United States NavyCivilian, Department of the ArmyMajor, Singapore ArmyMajor, Israel Defense ForcesCivilian, Defense Science Organisation, SingaporeCaptain, Singapore Arm

Mentoring in palliative medicine in the time of covid-19: a systematic scoping review : Mentoring programs during COVID-19.

IntroductionThe redeployment of mentors and restrictions on in-person face-to-face mentoring meetings during the COVID-19 pandemic has compromised mentoring efforts in Palliative Medicine (PM). Seeking to address these gaps, we evaluate the notion of a combined novice, peer-, near-peer and e-mentoring (CNEP) and interprofessional team-based mentoring (IPT) program.MethodsA Systematic Evidence Based Approach (SEBA) guided systematic scoping review was carried out to study accounts of CNEP and IPT from articles published between 1st January 2000 and 28th February 2021. To enhance trustworthiness, concurrent thematic and content analysis of articles identified from structured database search using terms relating to interprofessional, virtual and peer or near-peer mentoring in medical education were employed to bring together the key elements within included articles.ResultsFifteen thousand one hundred twenty one abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Four themes and categories were identified and combined using the SEBA's Jigsaw and Funnelling Process to reveal 4 domains - characteristics, mentoring stages, assessment methods, and host organizations. These domains suggest that CNEP's structured virtual and near-peer mentoring process complement IPT's accessible and non-hierarchical approach under the oversight of the host organizations to create a robust mentoring program.ConclusionThis systematic scoping review forwards an evidence-based framework to guide a CNEP-IPT program. At the same time, more research into the training and assessment methods of mentors, near peers and mentees, the dynamics of mentoring interactions and the longitudinal support of the mentoring relationships and programs should be carried out

Knowledge, attitude and practice on food higiene among the homemakers in Bukit Aup, Sibu, Sarawak from 8th July 2013 to 20th September 2013

Background: Foodborne diseases are a potential threat to the public health. Despite all the Food Act and Regulation, the problem of foodbome diseases is still not uncommon in Malaysia. Objective: The purpose of this study is to determine the level of knowledge, attitude, and practice (KAP) with regards to food hygiene among homemakers of Bukit Aup in Sibu, Sarawak. Methods: This was a cross-sectional study done among 101 homemakers in Bukit Aup, Sibu, Sarawak. A Non-probability sampling method was adopted to select at least one homemaker from each household in the village. An interviewer-guided style of data collection was used. The data was analysed for descriptive data of mean and median, frequencies and standard deviation using SPSS. Results: Among the respondents, the level of good KAP are 53.5%, 39.6% and 58.4% respectively. A significant positive correlation is noted between attitude score and practice score (r=0.203, p<0.05) using Pearson correlation analysis. Out of a total number of 457 villagers, 33 of them (7.2%) had gastrointestinal health complaints in the past six months. There were 36 episodes (7.9%) of abdominal cramp or pain, followed by 18 episodes (3.9%) of diarrhoea and three episodes (0.7%) of vomiting. Conclusion: Generally, it was observed that the respondents had a satisfactory level of knowledge and practices of food hygiene. However some of the respondents had some lapses in their responses to queries on food hygiene attitude

Forensics investigation of hardened concrete

Construction of massive structures such as columns, dam, pier or beam which involves large volume of concrete is known as mass concrete. Hydration of cement being a very exothermic process will lead to a rise in temperature at the core usually reaching above 70°C and as a result, deterioration of concrete will occur. When concrete is subjected to high early temperature, many chemical and physical changes of hardened concrete can occur. It is widely acknowledged that the concrete is likely to crack when subjected to high early temperature with the constant exposure to moisture due to delayed ettringite formation (DEF). DEF which sometimes referred to as internal sulphate attack is responsible for the cracking in massive concrete structures. DEF caused internal swelling reaction of the concrete that occurs in the presence of water without any external ingression of sulphate. This report will evaluate the presence of defects in hardened concrete associated with high heat of hydration at early age through a series investigation. In the investigation presented in this report, samples were extracted from a localized area on an actual foundation slab with a volume of 8200m^3 by means of coring. Temperature sensor has recorded a high early temperature of 90°C at the localized area. Field emission scanning electron microscopy (FESEM) was used to analyse how the microstructure of the samples changes due to high early age temperature and also to detect the possible presence of ettringite in the samples. Since DEF mainly comprises of sulphur, aluminium and calcium, Energy-dispersive X-ray (EDX) was use to identify the element composition of the samples which will provide a more accurate identification of DEF. Compression strength test was also carried out to relate how high early age temperature affects the compressive strength of hardened concrete. In the efforts to support and verify the findings from the core samples, 4 cylindrical concrete samples with dimensions of 300ϕ x 150mm were cast based on the exact mix proportion used for the foundation slab in. To simulate the high core temperature during the early age in mass concrete, special measures were taken. In addition, by adjusting the fly ash content, different trial mix proportions were used in efforts to achieve the optimum temperature in minimizing the chance for the occurrence of DEF. There are many factors which affects the early age temperature which will subsequently lead to cracking and other deterioration of concrete. Experimental investigation has revealed that even if the concrete is subjected to a short period of high early temperature, there is a possibility of long term reduction in strength, increase in permeability and delayed ettringite formation. Therefore, it is a basic requirement to specify limiting temperature for any major concrete concretion. Apart from controlling the maximum temperature rise in concrete during early age, having a good composition of cement, fly ash and GGBS is effective in preventing most of the problems associated with high early age temperature.Bachelor of Engineering (Civil

Author Correction: Saliva is more sensitive than nasopharyngeal or nasal swabs for diagnosis of asymptomatic and mild COVID-19 infection (Scientific Reports, (2021), 11, 1, (3134), 10.1038/s41598-021-82787-z)

10.1038/s41598-021-89880-3Scientific Reports1111253

Saliva is more sensitive than nasopharyngeal or nasal swabs for diagnosis of asymptomatic and mild COVID-19 infection

10.1038/s41598-021-82787-zScientific Reports111313

Post graduate remediation programs in medicine: a scoping review.

BackgroundRecognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the 'deliberate practice of improving performance through practising beyond one's comfort level under guidance'. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs.MethodsKrishna's Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA's Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions.ResultsThe research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs.ConclusionBuilding upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy's Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation's role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine