Stray bullet injuries in a tertiary care center

Background. A stray bullet injury is defined as an accidental firearm injury occurring outdoors by an anonymous attacker. Stray bullet injuries are rare, but not uncommon in certain parts of the world. In Pakistan, 165 patients with stray bullet injuries were recorded between 2006 and 2010. Objectives. In Lebanon, gunshots may occur during politicians’ speeches, funerals and after exam results are published. No studies to date have looked at the details and consequences of these gunshot injuries. Methods. A retrospective chart review of patients presenting to an emergency department (ED) in Beirut, Lebanon, from 2010 to 2015, with clear stray bullet injuries was conducted. Variables included: demographics, injured body part, admission to hospital, number of days in hospital, length of stay in the ED, mortality, past medical history, emergency severity index, and consequences of injury including surgery. Results. Out of 154 bullet injuries, 12 stray bullet injuries were recorded. Injuries of the lower extremity were most common, followed by the head, shoulder/thorax, abdomen/pelvis and upper extremity. Surgery was needed in 7 patients (58.3%). The median length of stay was 3.08 hours in the ED and 4.78 days in hospital. There were no recorded deaths. Consequences of each stray bullet injury are presented. Conclusion. Stray bullet injuries are commonly reported on in news and media outlets. This is the first study in Lebanon and the region to document cases of stray bullet injuries presenting to the ED. Better laws and educational policies need to be implemented to help discourage this practice

PERENCANAAN JARINGAN IRIGASI AIR TANAH DI DESA BERAT WETAN KECAMATAN GEDEG KABUPATEN MOJOKERTO

Desa Beratwetan ialah salah satu desa yang letaknya di Kecamatan Gedeg Kabupaten Mojokerto. Dengan kondisi wilayah yang mempunyai banyaknya lahan persawahan. Di wilayah tersebut mempunyai 2 musim yaitu penghujan dan kemarau ketika musim penghujan sawah dapat terairi leh air yang mewadahi dan ketika musim kemarau lahan persawahan sangat sulit untuk mendapatkan air tersebut maka dari itu membuat terbatasnya ketersediaan air permukaan dan berdasarkan survey yang dilakukan menyatakan sulitnya mendapatkan air ketika musim kemarau sehingga petani hanya mengandalkan air bor tanah dengan manual, maka diupayakan dengan memanfaatkan air tanah dengan cara membuat sumur pompa. Tujuan dari studi ini adalah untuk mengetahui kebutuhan air irigasi untuk area yang akan dilayani sumur pompa ketika musim kemarau , untuk merencanakan jaringan irigasi air tanah dengan system perpipaan dan menuatkan rumah banguanan bagi pompa tersebut. Metode yang digunakan dalam perencaan ini menggunakan system gravitasi dimana air dari tanah ditampung pada reservoir yang kemudian dialirkan secara gravitasi ke setiap box outlet yang kemudian dialirkan ke petak-petak sawah. Besarnya air yang di perlukan untuk memenuhi kebutuhan air irigasi untuk areal yang akan dilayani oleh sumur pompa. Dalam hal ini penulis sangat mengharapkan untuk penelitian tugas akhir yang akan di teliti mendapatkan hasil sebuah perencanaan jaringan irigasi air tanah pada lahan persawahan di Desa Beratwetan Kecamatan Gedeg Kabupaten Mojokerto. Dan juga bisa sangat bermanfaat bagi para petani untuk lahan sawah di waktu musim kemarau tib

Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department

Introduction: Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%-38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions.Methods: We conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period.Results: Overall, E-prescriptions included fewer prescription errors as compared to HW- prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p <0.0001), missing frequency (3.5% to 2.2%, p=0.04), missing strength errors (32.4% to 10.2%, p <0.0001) and legibility (0.7% to 0.2%, p=0.005). E-prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02).Conclusion: A basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive

Assessing the psychological impact of Beirut Port blast: A cross-sectional study

Beirut Port blast's magnitude is considered the third after Hiroshima and Nagasaki atomic bombings. This blast occurred in the densely populated section of Beirut, leaving more than six thousand injured patients. The psychological disturbances were assessed in the blast survivors who presented to the Emergency Department (ED) at the American University of Beirut Medical Center (AUBMC). This was a cross-sectional study at the ED of AUBMC. Identified patients were contacted and consented to participate in the study. Post-Traumatic Stress Disorder (PTSD) was selected as an outcome. Depression, PTSD, and concussion were assessed using patient health questionnaire (PHQ)-9, PTSD checklist for DSM-5 (PCL5), and brain injury symptoms (BISx) tools, respectively. The association of patients and injury characteristics with the study outcome was assessed using logistic regression. 145 participants completed the study procedures. The participants' average age was 39.8 ± 15.4 years, and 60% were males. Almost half of the participants showed depression on PHQ, and 2-thirds had PTSD. The participant's age was negatively associated with PTSD, whereas being a female, having depression, and having a concussion were positively associated with PTSD. The results of this study were in line with the previous literature report except for the association between younger age and PTSD, which warrants further investigations to delineate the reasons

Healthcare Management In Promoting Role Of Paramedics And Nurses In Critical Care; Review

Healthcare unit managers play a crucial role in promoting the importance of paramedics and nurses in critical care. They are responsible for ensuring the health and well-being of nurses and paramedics, as well as maintaining high-quality care. However, there is a lack of research focused on the actions and organizational strategies employed by healthcare unit managers to support nurses, as well as the specific working environments that facilitate such support. This paper utilizes a mixed methods approach, combining qualitative interviews and quantitative surveys with healthcare unit managers and nurses. The findings highlight the crucial role of healthcare unit managers\u27 accessibility to their nursing staff in promoting nurses. Additionally, the study emphasizes the importance of responsive support from the care unit managers\u27 superiors, administration, and managerial colleagues in creating favorable working conditions. The care unit manager\u27s own support was highly supported by the superior manager, and this support was positively connected with nurses

A model describing diffusion in prostate cancer

PURPOSE: Quantitative diffusion MRI has frequently been studied as a means of grading prostate cancer. Interpretation of results is complicated by the nature of prostate tissue, which consists of four distinct compartments: vascular, ductal lumen, epithelium, and stroma. Current diffusion measurements are an ill-defined weighted average of these compartments. In this study, prostate diffusion is analyzed in terms of a model that takes explicit account of tissue compartmentalization, exchange effects, and the non-Gaussian behavior of tissue diffusion.  METHOD: The model assumes that exchange between the cellular (ie, stromal plus epithelial) and the vascular and ductal compartments is slow. Ductal and cellular diffusion characteristics are estimated by Monte Carlo simulation and a two-compartment exchange model, respectively. Vascular pseudodiffusion is represented by an additional signal at b = 0. Most model parameters are obtained either from published data or by comparing model predictions with the published results from 41 studies. Model prediction error is estimated using 10-fold cross-validation.  RESULTS: Agreement between model predictions and published results is good. The model satisfactorily explains the variability of ADC estimates found in the literature.  CONCLUSION: A reliable model that predicts the diffusion behavior of benign and cancerous prostate tissue of different Gleason scores has been developed. Magn Reson Med, 2016. © 2016 Wiley Periodicals, Inc

Does true Gleason pattern 3 merit its cancer descriptor?

Nearly five decades following its conception, the Gleason grading system remains a cornerstone in the prognostication and management of patients with prostate cancer. In the past few years, a debate has been growing whether Gleason score 3 + 3 = 6 prostate cancer is a clinically significant disease. Clinical, molecular and genetic research is addressing the question whether well characterized Gleason score 3 + 3 = 6 disease has the ability to affect the morbidity and quality of life of an individual in whom it is diagnosed. The consequences of treatment of Gleason score 3 + 3 = 6 disease are considerable; few men get through their treatments without sustaining some harm. Further modification of the classification of prostate cancer and dropping the label cancer for Gleason score 3 + 3 = 6 disease might be warranted

PENGARUH PENGEMBANGAN, KOMPENSASI DAN PEMELIHARAAN TERHADAP KINERJA KARYAWAN DI PAM TIRTA MANGKALUKU KOTA PALOPO

ABSTRAK Syahrur Mufarrij, 2022.”Pengaruh Pengembangan, Kompensasi dan Pemeliharaan Terhadap Kinerja Karyawan di PAM Tirta Mangkaluku Kota Palopo”. Skripsi Program Studi Manajemen Bisnis Syariah Fakultas Ekonomi dan Bisnis Islam Institut Agama Islam Negeri Palopo. Dibimbing oleh Nurdin Batjo. Rumusan masalah dalam penelitian ini adalah, Apakah pengembangan berpengaruh terhadap kinerja karyawan pada PAM Tirta Mangkaluku Kota Palopo?; Apakah kompensasi berpengaruh terhadap kinerja karyawan pada PAM Tirta Mangkaluku Kota Palopo?; Apakah pemeliharaan berpengaruh terhadap kinerja karyawan pada PAM Tirta Mangkaluku Kota Palopo?; Apakah pengembangan kompensasi dan pemeliharaan secara bersama-sama berpengaruh terhdap kinerja karyawan pada PAM Tirta Mangkaluku Kota Palopo? Jenis penelitian ini adalah penelitian Kuantitatif. penelitian ini bertujuan untuk mengetahui pengaruh pengaruh pengembangan, kompensasi, dan pemeliharaan terhadap kinerja karyawan secara parsial dan simultan pada PAM Tirta Mangkaluku Kota Palopo. Teknik pengumpulan data dalam penelitian ini menggunakan angket/kuesioner yang disebar, dimana populasinya ialah karyawan pada PAM Tirta Mangkaluku Kota Palopo. Teknik pengambilan sampel menggunakan nonprobabiliy sampling yaitu accidental sampling. Accidental sampling adalah teknik penentuan sampel berdasarkan kebetulan. Jumlah sampel dalam penelitian ini ditentukan dengan rumus slovin sebanyak 76 responden. Teknik analisis yang digunakan adalah analisis regresi berganda dengan bantuan software SPSS versi 26. Hasil penelitian menunjukkan bahwa (1) Pengembangan berpengaruh positif dan signifikan terhadap kinerja karyawan dengan 0,000<0,05 dan nilai t hitung 5,444 > t table 1,99346; (2) Kompensasi berpengaruh positif signifikan terhadap kinerja karyawan dengan nilai signifikan sebesar 0,000<0,05 dan t hitung 3,184 > t table 1,99346; (3) Pemeliharaan berpengaruh positif dan signifikan terhadap kinerja karyawan dengan nilai signifikan sebesar 0,000<0,05 dan t hitung 6,834 > t table 1,99346; dan (4) Pengembangan, kompensasi dan pemeliharaan secara simultan berpengaruh positif dan signifikan terhadap kinerja karyawan dengan signifikan 0,000 2,73. Nilai Koefisien Determinasi (R2) sebesar 0,632 (63,2%). Kata Kunci: Kinerja Karyawan, Kompensasi, Pemeliharaan, Pengembanga

Development and comparative lifecycle assessment of various LDPE and HDPE production processes based on CO2 capture and utilization

Low-density polyethylene (LDPE) and high-density polyethylene (HDPE) are some of the most commonly used materials worldwide. These polymers are typically produced through the polymerization of ethylene which is conventionally produced through the energy-intensive steam cracking of naphtha or ethane. However, the conventional production process for LDPE and HDPE results in significant greenhouse gas emissions (1.92 and 1.86 kg CO2/kg of polymer, respectively). Hence, this work focuses on the design of alternative pathways based on CO2 capture and utilization (CCU) for polymer production. The proposed pathways for CCU-polymers are based on the conversion of CO2 to methanol, followed by the methanol-to-olefins (MTO) process to produce mainly ethylene, and consequently LDPE and HDPE from ethylene. The process design and simulation of the entire pathway are conducted in AspenPlus, while the life cycle assessment (LCA) is done through OpenLCA. The LCA results showed that the CCU-MTO pathway is an environmentally attractive option, particularly in regions where renewable (low-carbon) electricity is more prominent, such as Quebec and Ontario, where negative CO2 emissions are achieved. This makes polymer production via the proposed method suitable for the permanent mitigation of CO2