Consensus on Operating Practices for the Control of Feedwater and Boiler Water Chemistry in Industrial and Institutional Boilers

The Water Technology Subcommittee of the ASME Research and Technology Committee on Water and Steam in Thermal Systems, under the leadership of Mr. Robert D. Bartholomew has revised the Consensus on Operating Practices for the Control of Feedwater Boiler Water Chemistry in Modern Industrial Boilers, first published in 1979 with prior revisions published in 1994 and 1998. The task group consisted of a cross section of manufacturers, operators, chemical treatment contractors and consultants involved in the fabrication and operation of industrial and institutional boilers. Members of this group are listed in the acknowledgments. This current document is an expansion and revision of the original, with reordered and modified texts where considered necessary. While significant revisions have been incorporated, it is recognized that there are areas of operating practice not addressed herein. Additional information is available from the references. It is the plan of the ASME Research Committee to continue to review this information, and revise and reissue this document as necessary to comply with advances in boiler design and water conditioning technology.

Outcome of laparoscopic cholecystectomy in terms of intraoperative complications in a tertiary care hospital.

Objectives: The main objective was to evaluate the outcome of laparoscopic cholecystectomy in terms of intra-operative complications and the rate and reasons of conversion to open cholecystectomy. Study Design: Descriptive Study. Setting: Hayatabad Medical Complex, Peshawar. Period: June 2018 to May 2019. Material & Methods: After taking consent of Hospital ethical & research committee, patients admitted with clinical diagnosis of cholelithiasis and chronic cholecystitis, confirmed by abdominal ultrasound, undergoing laparoscopic cholecystectomy fulfilling inclusion criteria were selected. Results: A total of 150 were included in the study. Mean age was 39.2yrs with female to male ratio of 9.75:1. Laparoscopic cholecystectomy was successfully accomplished in 98% cases. In 2% (3 patients) converted cases the most common cause of conversion observed was dense adhesions in the calots triangle. Intra-operative complications were noted in 1.4% patients, those included bile duct injury and leakage from the gallbladder bed. However other complications such as bowel injury, blood vessel injury, and post operative hemorrhage did not occur. Overall morbidity was 1.4% with no mortality. Conclusion: Laparoscopic cholecystectomy is a safe and effective procedure in our setup to the accepted standards, as evident by the national and international studies. And it can be accomplished with minimal morbidity and low rate of conversion with the increasing surgeon’s experience.

Pengaruh Status Gizi dan Tingkat Kelelahan Subjektif terhadap Produktivitas Tenaga Kerja Bagian Linting Rokok di PT. X Kabupaten Malang

The need for cigarette consumption in Indonesia judging by the number of smokers is 64.5 million. As a result, each cigarette factory will produce continuously with one of the resources for production activities coming from human labor, where they are tasked with achieving company goals. However, in practice, human labor is always directed to have a high level of productivity by paying attention to the workload and fulfilling nutritional intake in order to minimize excessive fatigue and maintain stamina. This study was conducted to determine the partial impact of nutritional status and subjective fatigue level on the productivity of the cigarette-rolling workers at PT. X Kabupaten Malang. Where the model used is quantitative analysis with an analytical observational research design, namely a cross-sectional study. The instruments used include the International Fatigue Research Committee (IFRC) questionnaire, Glass Electronic Personal Scale with Camry brand model: EB9003, and Gea brand microtoise. The significance value of the nutritional status variable was 0.857 for the normal BMI category and 0.708 for the obese BMI category which showed no influence between nutritional status and productivity, and the significance value of the subjective fatigue level variable was 0.215 for the low subjective fatigue level category which showed no the effect of subjective fatigue level with productivity. Abstrak: Kebutuhan konsumsi rokok di Indonesia dilihat dari jumlah perokok ialah sebаnyаk 64,5 jutа рerоkоk. Akibatnya setiap pabrik rokok akan memproduksi secara kontinu dengan sumber daya untuk kegiatan produksi salah satunya berasal dari tenaga kerja manusia, dimana mereka bertugas untuk mencapai tujuan perusahaan. Namun dalam pelaksanaannya, tenaga kerja senantiasa diarahkan agar memiliki tingkat produktivitas tinggi dengan cara memperhatikan beban kerja serta pemenuhan asupan gizi guna meminimalisir kelelahan berlebih serta menjaga stamina. Penelitian ini dilakukan untuk mengetahui pengaruh secara parsial antara status gizi dan tingkat kelelahan subjektif terhadap produktivitas tenaga kerja bagian linting rokok di PT. X Kabupaten Malang. Dimana model yang digunakan adalah analisis kuantitatif dengan rancangan penelitian observasional analitik yakni studi potong lintang. Instrumen yang digunakan antara lain kuesioner International Fatigue Research Committee (IFRC), Glass Electronic Personal Scale dengan merk Camry model: EB9003, serta microtoise merk Gea. Didapatkan nilai signifikansi dari variabel status gizi sebesar 0.857 untuk kategori IMT normal dan 0.708 untuk kategori IMT gemuk yang menunjukkan tidak ada pengaruh antara status gizi dengan produktivitas, serta nilai signifikansi dari variabel tingkat kelelahan subjektif sebesar 0.215 untuk kategori tingkat kelelahan subjektif rendah yang menunjukkan tidak ada pengaruh antara tingkat kelelahan subjektif dengan produktivitas.

The Use of Drawing as Learning Activity in a Human Anatomy Course: Implications for Learning Scientific Foundation of Nursing

Human anatomy is perceived by health science students and educators to be a burdensome, challenging and labour-intense course. In order to enhance understanding of human anatomy, the use of student-centred approaches is encouraged, of which drawing is included. However, it is not explicitly known how nursing students in Kavango east region experience the use of drawing. This research was conducted to explore and describe the experiences of first-year nursing students from a resource-constraint setting on the use of drawing as a learning activity in a human anatomy course. A qualitative descriptive, explorative, and contextual study was conducted in Kavango east region, Namibia. Data were collected via focus-group interviews with 28 participants who were conveniently selected. A qualitative content analysis was followed, while trustworthiness was ensured according to the four principles of Lincoln and Guba. Ethical clearance and permission were granted by the School of Nursing Research Committee. The ethical principles of autonomy, non-maleficence, beneficence, and justice were adhered to. The experienced beneficial aspects of drawing are enhancement of course understanding, boosting creativity, and integration of theory into practice. Challenging aspects were related to lacking artistical skills, time constraints, complex and complicated drawings as well as a shortage of materials and learning resources. In order to improve drawing as a learning activity in human anatomy, recommendations were made for nursing students, educators and future researchers.

Comparing the MSIS-29 and the Health Utilities Index Mark III in Multiple Sclerosis

Objective: Since the properties of health-related quality of life measures vary across samples, studies directly comparing the properties of different measures can be useful in understanding their relative strengths and limitations. We aimed to compare the psychometric properties of the Health Utilities Index Mark III (HUI3) and the Multiple Sclerosis Impact Scale-29 (MSIS-29).Methods: In Spring 2020, North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants completed the HUI3, MSIS-29, Patient Determined Disease Steps (PDDS) and SymptoMScreen. For the HUI3 and MSIS-29 we assessed floor and ceiling effects, construct validity, and internal consistency reliability. We used relative efficiency to compare the discriminating ability of the two measures with respect to disability.Results: We included 5,664 participants in the analysis, with mean (SD) age 63 (10.1) years; 4,579 (80.8%) were women. For the HUI3 the mean (SD) score was 0.44 (0.32), for the MSIS-29 physical it was 34.0 (24.2) and for the MSIS-29 psychological it was 25.9 (20.4). Neither of the measures had floor or ceiling effects, and internal consistency reliability was > 0.70 for both. The HUI3 and MSIS-29 physical were strongly correlated (r = −0.78; 95%CI:−0.79,−0.77). The correlation between the HUI3 and MSIS-29 psychological was weaker but remained moderately strong (r = −0.64; 95%CI:−0.66,−0.63). After adjusting for sociodemographic and clinical factors, relative efficiency to discriminate between disability (PDDS) groups was highest for the MSIS-29 physical scale, followed by the HUI3.Conclusion: Both measures had adequate validity and reliability. The MSIS-29 physical discriminated between disability groups better than the HUI3.

Level of stress and anxiety regarding Covid-19 among nursing students

INTRODUCTION: COVID-19 pandemic has caused disasters and disorders all over the world. India is also going through a challenging situation as the number of infected/positive cases is increasing day by day. Due to the crisis of COVID-19 education system has come to a halt as schools and colleges are closed to slow down and prevent the spread of infection. Nursing institution also closed down and online mode of teaching was done. Hands on training is required to relate theory in to practice which was thwarted due to the pandemic COVID-19. Nursing students were panic and apprehensive about the situation even though they were asked to stay in the hostel. OBJECTIVE: To assess the level of stress and anxiety among the nursing students and to associate the level of stress and anxiety with selected demographic variables. METHODS: The study design was descriptive cross-sectional. The study was conducted in College of Nursing CIHSR among the 3rd Year GNM, 3rd Year and 4th Year B. Sc. Nursing Students. Total enumerative sampling method was used and sample size was 95. Standardized instrument on Perceived stress scale for assessing stress and Corona anxiety scale for assessing anxiety regarding COVID – 19 were used for the study. The study was approved by nursing research committee and informed consent was taken. Data was analysed using descriptive and inferential statistics. RESULTS: The study found that 80(84.2%) had moderate stress out of 95 respondents, 8 (8.4%) had high perceived stress, and 7(7.4%) had low level of stress. In the Coronavirus anxiety scale majority of the respondents, 91(95.8%) have little to no dysfunctional anxiety out of 95 respondents, 2 (2.1%) had possible dysfunctional anxiety and 2 (2.1%) had probable dysfunctional anxiety. There were no significant association between level of stress, anxiety and demographic variables. CONCLUSION: Study reveals that majority of the students had moderate level of stress and little to no dysfunctional anxiety regarding COVID - 19. Thus leaflet regarding cause, spread, prevention and management of COVID-19 given to each student to reduce their stress and anxiety.

The Use and Potential Interactions of Herbal Medicines among Diabetic Patients in Saudi Arabia: A Cross-sectional Study

Objectives: The use of herbal medicines as non-conventional treatment is popular, especially in developing countries where people suffering from chronic diseases as diabetes mellitus are more likely to use herbal medicines along with conventional medicines. However, their simultaneous use may concur serious drug interactions and may therefore result in a serious outcome. The present study was designed to identify the most commonly used herbal medicines and conventional anti-diabetic medications among Saudi population. Methods: A cross-sectional survey was developed and piloted.Data were retrieved and manually entered in Excel 2016. Frequencies and percentages were utilized to perform descriptive analysis. The study was approved by the Scientific and Research Committee of the main hospital taking part in the study. Results: A total of 347 responses were recorded (69.4% response rate). 54% of participants were male, 53% were between the age of 41 and 64 years, and 35.5% had no formal education. Black tea, Peppermint, ginger, green tea, olive oil, and black seed were among the frequently mentioned herbal medicines. Black tea was used by the majority of patients (80%) while peppermint and ginger were used by more than half of patients, i.e., (56.5%) and (52.7%) respectively. Least common herb used by patients was Artemisia species (2.8%). A majority of patients (53.4%) used traditional medicine at least once daily, and 83% used traditional medicine without their physician's prescription. Conclusion: Concomitant use of herbal and conventional anti-diabetic medication was a common practice among patients in Saudi Arabia, therefore, pharmacists-led educational programs should target both prescribers and general public about the possible interactions/risks of herbal medicines.

Research Committee Update: The curmudgeon's column: High-tech low tech

When I posted to LinkedIn some time back to generate publicity for my Geophysical Society of Houston technical lunch talk on beam tomography, one of the interesting comments from a colleague at a large service company was that beam technology is “a technology with many benefits that unfortunately is commonly regarded as old school/low tech.” I loved receiving the comment because it gives me an opportunity to talk about one of my favorite business concepts that I always look to apply: high-tech low tech. “High tech” is a term for new technology that incorporates advanced features. “Low tech” is old-school technology. I'll start with an example: the story of the Nest thermostat.

Implementation, efficacy and cost effectiveness of the unified protocol in a blended format for the transdiagnostic treatment of emotional disorders: a study protocol for a multicentre, randomised, superiority controlled trial in the Spanish National Health System

IntroductionEmotional disorders (EDs) have become the most prevalent psychological disorders in the general population, which has boosted the economic burden associated with their management. Approximately half of the individuals do not receive adequate treatment. Consequently, finding solutions to deliver cost-effective treatments for EDs has become a key goal of today’s clinical psychology. Blended treatments, a combination of face-to-face and online interventions, have emerged as a potential solution to the previous. The Unified Protocol for the Transdiagnostic Treatment of EDs (UP) might serve this purpose, as it can be applied to a variety of disorders simultaneously and its manualised format makes it suitable for blended interventions.Methods and analysisThe study is a multicentre, randomised, superiority, clinical trial. Participants will be 310 individuals with a diagnosis of an ED. They will be randomised to a treatment as usual (individual cognitive behavioural therapy) or a UP condition in a blended format (face-to-face individual UP +online, app-based UP). Primary outcomes will be ED diagnostic criteria and depression and anxiety symptoms. Cost efficiency of the intervention, app usability, as well as opinion and confidence in the treatment will also be evaluated. Assessment points will include baseline and 3 months, 6 months and 12 months after UP treatment.Ethics and disseminationThe study has received approvals by the Ethics Research Committee of Navarra, Castellón, Euskadi, Castilla y León, Extremadura, Lleida and Aragón. The study is currently under an approval process by the Ethics Research Committees of all the remaining collaborating centres. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings.Trial registration numberNCT04304911.

Analisis Beban Kerja dan Perhitungan Waktu Baku dengan Metode Stopwatch Time Study pada Operator SPBU XYZ

Penelitian ini mengidentifikasi beban kerja mental operator SPBU XYZ dengan menggunakan kuesioner National Aeronautic and Space Administration–Task Load Index (NASA-TLX) dan perhitungan tingkat kelelahan kerja untuk menganalisis tingginya beban kerja mental pada operator SPBU. Perhitungan tingkat kelelahan kerja menggunakan metode Subjective Self Rating Test (SSRT) dari kuesioner Industrial Fatigue Research Committee (IFRC). Upaya yang dilakukan untuk menurunkan tingkat beban kerja mental operator, dilakukan dengan menghitung waktu standar dengan menggunakan metode Stopwatch Time Study. Hasil perhitungan beban kerja mental operator SPBU menunjukkan beban kerja mental yang didapatkan operator berlebih dengan total rata-rata sebesar 77,35. Dimana indikator beban kerja mental yang memiliki skor tertinggi yaitu effort, temporal demand, dan physical demand. Dan hasil perhitungan tingkat kelelahan kerja operator 37,75 dengan klasifikasi kelelahan sedang. Setelah dilakukan perhitungan waktu standar, terjadi penyesuaian waktu kerja. Dimana waktu siklus rata-rata kerja sebelumnya 8,24 menit menjadi 12,29 menit. Penyesuaian waktu kerja merupakan persentase penurunan 3 indikator tertinggi beban kerja mental operator. Setalah dilakukan perhitungan untuk menurunkan beban kerja mental, skor akhir yang didapatkan adalah 52,30 dengan klasifikasi beban kerja mental optimal load dan kenaikan persentase utilitas stasiun pengisian bahan bakar sebesar 32%.