To date, many high-profile accidents involving the loss of large numbers of containers overboard have occurred during ocean voyages. It is estimated that an average of 1629 containers are lost at sea ...each year, and the statistics also highlight that the number of lost shipping containers has increased by two-thirds in the last five years. It is important to consider that falling containers are not only a threat to the safety of shipping but also a potential health and environmental hazard. In this direction, there are ongoing initiatives to improve container handling and reduce the risk of container loss. This paper focuses on container loss at sea, which is a serious risk in terms of marine pollution and financial loss, and seeks to evaluate this problem by identifying its causes. A Fuzzy Bayesian Network (FBN) model is therefore created to provide an approach for determining the factors and weights to be considered by seafarers during container transportation when assessing the causes of a container falling overboard. As a result of the research process, a model for assessing the risk of container falls is developed and the probabilistic relationships between the causes of container falls overboard are revealed. According to the analysis of the model, improper stuffing (15%), misdeclaration of container weight (12.6%), and container structural resistance (11.1%), are the three most risky root causes of container falls. In addition, the most obvious finding to emerge from this study is that the causes of container losses overboard are strictly related to both the process of the lashing and securing of the cargo and to the stability of the ship. Taken together, the results indicate that to prevent container falls at sea, it is crucial to avoid poor stability and ensure proper cargo securing. Consequently, FBN model developed for the study is expected to help improve the safety of container transport and reduce the risk of container loss by providing a comprehensive probabilistic risk analysis of container operations and predicting the risk of container loss if undesirable factors arise.
Acute liver failure (ALF) is a life-threatening condition characterized by rapid liver function deterioration, necessitating a multidisciplinary approach for optimal perioperative care. This ...comprehensive review focuses on the critical role of the anaesthesiologist throughout the preoperative, intraoperative, and postoperative phases, addressing the unique challenges posed by ALF. The article begins with an exploration of ALF, underlining the urgency of timely referral to specialized hepatology centres. Liver transplantation emerges as a life-saving intervention, and the complex decision-making process is discussed, emphasizing the need for a multidisciplinary team to assess transplantation candidacy based on established prognostic criteria. In the preoperative phase, the review stresses the importance of early engagement with tertiary liver centres for timely referrals and identifies patients suitable for transplantation. Safe transport protocols are detailed, highlighting the meticulous planning required for the secure transfer of ALF patients between healthcare facilities. The intraoperative management section delves into the anaesthesiologist’s key concerns, including neurological status, sepsis, acute kidney injury, body mass index, and preoperative fasting. Hemodynamic stability, fluid management, and coagulation balance during surgery are emphasized, with insights into anaesthesia techniques, vascular access, monitoring, and hemodynamic management tailored to the challenges posed by ALF patients. The postoperative care is thoroughly examined covering neurological, hemodynamic, metabolic, renal, and nutritional aspects. Management of ALF involves multidisciplinary team, including nephrology for continuous renal replacement therapy, transfusion medicine for plasma exchange, critical care for overall patient care, nutritionists for ensuring adequate nutrition, and hepatologists as the primary guides. In conclusion, the review recognizes the anaesthesiologist as a linchpin in the perioperative care of ALF patients. The integration of safe transport protocols and multidisciplinary approach is deemed crucial for navigating complexities of ALF, contributing to improved patient outcomes. This article serves as an invaluable resource for gastroenterologist and intensivists, enhancing their understanding of the anaesthesiologist’s indispensable role in the holistic care of ALF patients in an ever-evolving healthcare landscape.
•Infectious non-enveloped viruses were completely inactivated by UNEXP disks.•Norovirus RNA was detected in all stool samples from UNEXP disks after 2 weeks.•Seventy-five percent of samples could be ...genotyped by sequencing.
Stabilizing paper matrix methods for retaining nucleic acid from inactivated clinical specimens offer a solution for molecular diagnostics when specimens may be stored or shipped at ambient temperature. We developed cellulose disks (UNEXP) saturated with a total nucleic acid extraction buffer (UNEX) modified from a previously developed lysis buffer for multiple enteric pathogens. Infectivity of hepatitis A virus, adenovirus and poliovirus was destroyed after 2–3 h incubation at room temperature on the UNEXP disks. Norovirus RNA could be detected in UNEXP-eluted nucleic acids by reverse transcription-quantitative PCR (RT-qPCR) from 54 stool samples after 2 weeks storage at room temperature on disks; a subset of seven samples were positive after 3 months storage. Genotyping was successful in 76% of 54 samples tested including six of seven samples stored on the UNEXP disks for up to one month. Comparison of UNEXP with the FTA elute card in a subset of 10 samples demonstrated similar detection and genotyping rates after two weeks of storage at room temperature.
UNEXP disks could be useful for epidemiologic investigations of disease outbreaks in resource-limited areas by simplifying specimen transport to regional diagnostic laboratories or shipment to international centers without the need to ship samples on dry ice.
Background
Transfer of critically ill patients within the hospital is commonly associated with adverse incidents, but, despite this, no standardised training exists on how to carry out this task. ...Very little information is published in the literature on the learning needs of staff undertaking these transfers, and this limits our ability to provide a focused and appropriate educational intervention.
Aims
This study aimed to explore the organisational, environmental and individual issues that increase risk to patients during intrahospital transport (IHT) and to explore the potential educational solutions to these issues as articulated by these practitioners.
Methods
This qualitative descriptive study was conducted in an Irish tertiary hospital critical care unit. Semi-structured interviews were conducted on critical care practitioners until data saturation was achieved. After manual transcription of the data, they were then analysed to identify themes.
Results
Two themes emerged: challenges related to intrahospital transport and plans to improve intrahospital transport.
Conclusions
Organisational, communication and individual issues need to be considered when addressing problems associated with IHT. A multifaceted approach is needed, with a focus on organisational solutions in the form of checklists as well as educational interventions such as interprofessional education initiatives. Further studies on implementation of educational initiatives will add to the findings we report here.
Availability of safe, reliable and affordable public transport facilitates access to work opportunities. This relationship between transport and economic independence is not gender neutral. Delhi’s ...Metro Rail Network marked a milestone in this regard as it provided a gender-sensitive means of mass transit with specific facilities for women passengers. However, the onset of Covid-19 pandemic, followed by restrictions on mobility and change in working habits, brought the urban public transport network to a standstill. Given this background, the paper explores the impact of Metro Rail Network on the commuting pattern and preferences of working women in Delhi-NCR region as well as the travel-related challenges faced by women that were magnified during the pandemic.
The dimensions and weight of machines, structures, and components that need to be transported safely by road are growing constantly. One of the safest and most widely used transport systems on the ...road today due to their versatility and configuration are modular trailers. These trailers have hydraulic pendulum axles that are that are attached in pairs to the rigid platform above. In turn, these modular trailers are subject to limitations on the load that each axle carries, the tipping angle, and the oil pressure of the suspension system in order to guarantee safe transport by road. Optimizing the configuration of these modular trailers accurately and safely is a complex task. Factors to be considered include the load’s characteristics, the trailer’s mechanical properties, and road route conditions including the road’s slope and camber, precipitation and direction, and force of the wind. This paper presents a theoretical model that can be used for the optimal configuration of hydraulic cylinder suspension of special transport by road using modular trailers. It considers the previously mentioned factors and guarantees the safe stability of road transport. The proposed model was validated experimentally by placing a nacelle wind turbine at different points within a modular trailer. The weight of the wind turbine was 42,500 kg and its dimensions were 5133 × 2650 × 2975 mm. Once the proposed model was validated, an optimization algorithm was employed to find the optimal center of gravity for load, number of trailers, number of axles, oil pressures, and hydraulic configuration. The optimization algorithm was based on the iterative and automatic testing of the proposed model for different positions on the trailer and different hydraulic configurations. The optimization algorithm was tested with a cylindrical tank that weighed 108,500 kg and had dimensions of 19,500 × 3200 × 2500 mm. The results showed that the proposed model and optimization algorithm could safely optimize the configuration of the hydraulic suspension of modular trailers in special road transport, increase the accuracy and reliability of the calculation of the load configuration, save time, simplify the calculation process, and be easily implemented.
Summary Maternal and infant mortality has been a major concern in India with the Government taking serious efforts to achieve the Millennium Development Goals by 2015. Ganapathy Venkata Krishna Reddy ...Emergency Management and Research Institute (GVK EMRI) is one such effort and is the country's first emergency service provider working under the public–private partnership model to provide emergency response services and quality pre-hospital care to any sick person, pregnant mothers, and sick neonates. Since the introduction of the emergency medical services, institutional deliveries have increased in all states and union territories where the ambulances have been deployed and the majority of mothers have been provided the required emergency care at the appropriate time. This in turn has helped in considerably reducing the maternal mortality. GVK EMRI has partnered with the government of Tamil Nadu and deployed specialized neonatal ambulances to ensure safe transport of newborns. The safe transport of sick, vulnerable neonates and the improvement in survival of transported neonates over the years advocate scaling up of this program to other states, which would greatly contribute towards reducing infant and neonatal mortality.
Objective
Intra-hospital transport (IHT) of critically ill patients is associated with morbidity and mortality. Mass transfer of patients, as happens with unit relocation, is poorly described. We ...outline the process and adverse events associated with the relocation of a critical care unit.
Design
Extensive planning of the relocation targeted patient and equipment transfer, reduction in clinical pressure prior to the event and patient care during the relocation phase.
Setting
The setting was a 30-bed, tertiary referral, combined medical and surgical critical care unit, located in a 570-bed hospital that serves as the national referral centre for cardiothoracic surgery and spinal injuries.
Participants
All stakeholders relevant to the critical care unit relocation were involved, including nursing and medical staff, porters, information technology services, laboratory staff, project development managers, pharmacy staff and building contractors.
Main outcome measures
Mortality at discharge from critical care unit and discharge from hospital were the main outcome measures. A wide range of adverse events were prospectively recorded, as were transfer times.
Results
Twenty-one patients underwent IHT, with a median transfer time of 10 min. Two transfers were complicated by equipment failure and three patients experienced an episode of hypotension requiring intervention. There were no cases of central venous or arterial catheter or endotracheal tube dislodgement, and hospital mortality at 30 days was 14%.
Conclusion
Although IHT is associated with morbidity and mortality, careful logistical planning allows for efficient transfer with low complication rates.
Safe-transport is important to well-being in later life but balancing safety and independence for older drivers can be challenging. While self-regulation is a promising tool to promote road safety, ...more research is required to optimise programs.
Qualitative research was used to inform the choice and adaptation of a safe-transport education program for older drivers. Three focus groups were conducted with older drivers living in northwest Sydney to explore four key areas related to driving in later life including aged-based licensing, stopping or limiting driving, barriers to driving cessation and alternative modes of transportation. Data were analysed using content analysis.
Four categories emerged from the data; bad press for older drivers, COMPETENCE not age, call for fairness in licensing regulations, and hanging up the keys: It's complicated! Two key issues being (1) older drivers wanted to drive for as long as possible but (2) were not prepared for driving cessation; guided the choice and adaption of the Knowledge Enhances Your Safety (KEYS) program. This program was adapted for the Australian context and focus group findings raised the need for practical solutions, including transport alternatives, to be added. Targeted messages were developed from the data using the Precaution Adoption Process Model (PAPM), allowing the education to be tailored to the individual's stage of behaviour change.
Adapting our program based on insights gained from community consultation should ensure the program is sensitive to the needs, skills and preferences of older drivers.
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