Anomaly Detection of the Brake Operating Unit on Metro Vehicles Using a One-Class LSTM Autoencoder

Detecting anomalies in the Brake Operating Unit (BOU) braking system of metro trains is very important for trains’ reliability and safety. However, current periodic maintenance and inspection cannot detect anomalies at an early stage. In addition, constructing a stable and accurate anomaly detection system is a very challenging task. Hence, in this work, we propose a method for detecting anomalies of BOU on metro vehicles using a one-class long short-term memory (LSTM) autoencoder. First, we extracted brake cylinder (BC) pressure data from the BOU data since one of the anomaly cases of metro trains is that BC pressure relief time is delayed by 4 s. After that, extracted BC pressure data is split into subsequences which are fed into our proposed one-class LSTM autoencoder which consists of two LSTM blocks (encoder and decoder). The one-class LSTM autoencoder is trained using training data which only consists of normal subsequences. To detect anomalies from test data that contain abnormal subsequences, the mean absolute error (MAE) for each subsequence is calculated. When the error is larger than a predefined threshold which was set to the maximum value of MAE in the training (normal) dataset, we can declare that example an anomaly. We conducted the experiments with the BOU data of metro trains in Korea. Experimental results show that our proposed method can detect anomalies of the BOU data well.

Development of professionally important qualities of nurses of the surgery unit depending on the work experience

The aim of the study development of professionally important qualities of nurses in the operating unit, depending on the length of service. Results: the structure of the operating unit, the content and features of the activity of the operating room nurse was studied, the criteria for the professional suitability of operating room nurses were determined. Conclusion: the systematization of knowledge on the problem of ensuring the activities of a nurse in the operating unit and research materials can be used in the practice of medical institutions to develop and improve the organization of the activities of medical personnel.

STAY IN THE ULM UNIVERSITY CLINIC (GERMANY)

In March 2020 I was in the Ulm University Clinic for 2 weeks. My internship course took place on the basis of the department of general and visceral surgery. The work in the clinic is structured in such a way that not only surgeons but also doctors of the adjoining specialties, trainees and students participate in the discussion of patients’ treatment. And at the morning conferences, a resuscitator, a radiologist and an endoscopist must always be present. The operating unit has all necessary equipment in sufficient quantity. Preoperative preparation is carried out by the anesthetic team in the preoperative room. A special role is given to the patient’s thermal isolation using special blankets, protection of the patient’s eyes with a patch, and perioperative antibiotic prophylaxis. In addition to the operating surgeon and two main assistants, the operating team obligatorily includes a student. Continuous training by senior surgeons of junior ones is practiced. Basic surgical instruments are represented with everything you need. In the postoperative period all drugs are charged into infusion machines at a daily dosage, which simplifies the work of paramedical personnel and also reduces the risk of catheter infection. When entering a medical university the competition is initially very high (more than 20 people per place). All doctors work in a unified team, there is no strict division into university chairs and clinic departments. Two weeks spent in the Ulm University Clinic have shaped my understanding of medical care and medical education in Germany, acquainted me with the specificity of the surgical service and the technical features of performing surgical interventions.

Audit on induction time delays in operating room at Kibogora District Hospital: A quality improvement project

Background: Induction time delays in Operating room (OR) is an issue that affects the productivity of an operating unit especially in a setting with limited resources. It can also results in providing inappropriate services to the patients and their families. The aim of this study was to determine the causes of induction time delays and to propose solutions on how to avoid the reasons of delays. Methods: A prospective observational study was conducted. It focused on elective general surgeries and orthopedic surgeries as they were mainly being performed during the study period. The data on the type of operation, the type of anesthesia, delay or no delay of induction (DOI) of anesthesia, causes of DOI were collected. DOI was considered as the time between the previous patient out of the OR and the next one in of more than 30 minutes. Emergency surgeries and elective obstetric surgeries were excluded from the study. Results: 24.8% of surgeries were done after delays of induction of anesthesia as opposed to 75.2% surgeries for which anesthesia was induced without delay. 48.6% of delays of induction to anesthesia were due to the hospital issues followed by anesthesia provision related issues. (40.0%). The surgery related and patient related issues accounted each one 5.7%. Conclusions: There was a high rate of surgeries that had delays in induction times. The OR managers need to work more with the hospital administration and the OR team to correct causes of delays.

Zolpidem: a masked hero. A reply to ZORRO study

The use of zolpidem has been driven by the still-widespread false belief among doctors that, since zolpidem is chemically not a benzodiazepine, it cannot lead to addiction and tolerance. We would like to contribute to better highlight certain characteristics of zolpidem and its potential as a substance of abuse due to the fact that our operating unit, which is entirely dedicated to medication abuse, has described among the most numerous cases of addiction to high doses of benzodiazepines and related hypnotics. - Zolpidem was in fourth place among the 29 molecules present on the Italian market; - We believe it’s now time to drop the term “Z-drugs”: zolpidem, zopiclone e zaneplon all have different chemical structures, they bind to different receptors and have completely different abuse potentials3. In our case history, both zopiclon and zaneplon were virtually absent, albeit being commonly used in Italy; - Istvan & colleagues highlight the fact that addiciton and abuse are prevalent in samples suffering from mental illness. In our case history this hasn’t been confirmed: about half of our patients had no history of psychiatric illnesses, nor a history of addiction to illicit substances or alcohol; - Lastly, regarding zolpidem’s hazardousness, we would like to report the fact that the drug was significantly preferred by addicts with a positive ADHD test result. In conclusion, the 2000s saw solid confirmation of the effectiveness of partial agonists in the treatment of some common addictions, such as buprenorphine, varenicline, cytisine. This didn’t happen for BZs

Choosing a method to perform an esophageal-intestinal anastomosis after complete removal of the stomach

The paper reviews various methods of performing esophageal-intestinal anastomoses with complete removal of the stomach (gastrectomy). The main methods of manual and stapler stitching of the esophagus with the jejunum are described. Special attention is paid to detailing of techniques for the most commonly performed esophageal-intestinal anastomoses, with a comparative assessment of the reliability of manual and stapler anastomoses. Given the large number of proposed methods to perform esophageal-intestinal anastomoses, it can be stated that no universal anastomosis yet exists. In laparotomy, a stapler suture is most commonly used to perform an esophageal-intestinal anastomosis with circular crosslinking devices, while the manual version implies one of the invagination techniques, or muff-like anastomosis (the Tsatsanidi K.N., Bondar G.V., Davydov M.I. procedure). With laparoscopic access, the anastomosis is performed with linear endoscopic crosslinking devices. The choice of a technique to perform an esophageal-intestinal joint remains with the operating surgeon and depends on his/hers experience, skills, individual intraoperative situation, and equipment of the operating unit.

Definition of a novel vaccination pathway in PLWHA: experience of a Southern University Hospital

Background At the end of 2018 across the globe there are ∼37.9 million people with HIV/AIDS also thanks to the use of HAART which led to an increase in life expectancy. The Italy Immunization Plan 2017-19 recommend vaccines to these patients but a protocol still isn't present. Moreover, despite the availability of effective vaccines, coverage remained very low for many reasons including problems with privacy. The objectives of this study were a) the appliance of a shared clinical pathway between the “Immunization Center of Hospital Hygiene Operating Unit” and the “HIV/AIDS Disease Prevention, Diagnosis and Treatment Center of Infectious Diseases Operating Unit” b) the increase in vaccination coverage and the evaluation of side effects. Methods A prospective study was conducted from Oct 2019 to Feb 2020 at the G. Martino University Hospital of Messina. In particular, of the 138 patients followed by the Infectious Diseases OU, after evaluation of their immune status, 62% were enrolled in this study. Following the acquisition of informed consent, we collected socio-anagraphical data and we started the free administration of vaccines by providing an hoc calendar in the Immunization Center. Statistical analysis was performed with R software. Results The sample was represented by 86 patients (74% males and 26% females, 21% foreigners and 79% Italian, mean age=40±13.6 SD). We didn't observe drop out and no differences were observed for local/systemic AEs generally reported. We obtained an increase of vaccination coverage with a total of 74 doses administered for flu (+164%) and 240 for other vaccines (+172%). In particular, we immunized a total of 74% of patients for HPV (2% in 2018), 42% for HAV (28% in 2018), 37% for HBV (28% in 2018), 58% for pneumococcal (21% in 2018), 54% for meningococcal ACWY and B (0% in 2018). Conclusions The undertook clinical pathway showed the relevance of specific management of these patients and the need to increase the vaccination offer. Key messages The immunization in people living with HIV is priority to reduce the risk of infectious disease. It’s important to implement a shared clinical pathway to increase vaccination rates of these patients. The application of the protocol had an high impact in patients' adhesion to vaccination also thanks to the chance of accessing to the service in a comfortable setting and suitable to protect privacy.

THE ROLE OF DISINFECTOLOGICAL INVESTIGATIONS IN THE MANAGEMENT OF THE COMPLEX OF PREVENTIVE ACTIVITIES

Introduction. Among infectious agents associated with provision of medical care, resistant ones to disinfectants from various chemical groups are more often met. In this regard, disinfection measures carried out in a medical facility are not always effective enough. Material and methods. 9 strains of microorganisms were selected for research (Klebsiella pneumoniae -2 pcs., Enterococcus faecalis, Staphylococcus warneri, Serratia rubidaea, Staphylococcus sciuri, Enterobacter cloacae, Acinetobacter baumannii, Enterococcus faecium - per 1 pcs.), isolated from the objects of hospital environment in operating unit, intensive care and trauma units, as well as 5 samples of disinfectants from different chemical groups (on the basis of quaternary ammonium salt, tertiary amine and polyhexamethyleneguanidine; on the basis of sodium percarbonate with activator; on the basis of hydrogen peroxide and didecyldimethylammonium chloride; in the form of tablets on the basis of sodium salt sodium dichloroisocyanurate acid), used in the specified divisions of medical facities. The studies were performed in accordance with the methodology set out in methodology instructions MU 3.5.1.3439-17 “Assessment of sensitivity to disinfectants of microorganisms circulating in medical organizations.” Results. When conducting chemical-analytical studies of samples of disinfectants 4 samples out of 5 were found to have inconsistencies in one or another quality indices. The analysis of instructions on application of disinfectants 4 means from 5 were showed to have unreasonably underestimated modes of application. According to the results of the evaluation of the sensitivity of microorganisms to disinfectants, the majority of isolated microorganisms was found to have resistance to the studied disinfectants Conclusion. Based on the results of the study of sensitivity of microorganisms to disinfectants, a new tactic for improving disinfection measures is proposed for medical facilities: rotation of disinfectants and an enhanced system of microbiological monitoring of the sensitivity of microorganisms to disinfectants

The role of disinfectological investigations in the management of the complex of preventive activities

Introduction. Among infectious agents associated with provision of medical care, resistant ones to disinfectants from various chemical groups are more often met. In this regard, disinfection measures carried out in a medical facility are not always effective enough. Material and methods. 9 strains of microorganisms were selected for research (Klebsiella pneumoniae -2 pcs., Enterococcus faecalis, Staphylococcus warneri, Serratia rubidaea, Staphylococcus sciuri, Enterobacter cloacae, Acinetobacter baumannii, Enterococcus faecium - per 1 pcs.), isolated from the objects of hospital environment in operating unit, intensive care and trauma units, as well as 5 samples of disinfectants from different chemical groups (on the basis of quaternary ammonium salt, tertiary amine and polyhexamethyleneguanidine; on the basis of sodium percarbonate with activator; on the basis of hydrogen peroxide and didecyldimethylammonium chloride; in the form of tablets on the basis of sodium salt sodium dichloroisocyanurate acid), used in the specified divisions of medical facities. The studies were performed in accordance with the methodology set out in methodology instructions MU 3.5.1.3439-17 “Assessment of sensitivity to disinfectants of microorganisms circulating in medical organizations.” Results. When conducting chemical-analytical studies of samples of disinfectants 4 samples out of 5 were found to have inconsistencies in one or another quality indices. The analysis of instructions on application of disinfectants 4 means from 5 were showed to have unreasonably underestimated modes of application. According to the results of the evaluation of the sensitivity of microorganisms to disinfectants, the majority of isolated microorganisms was found to have resistance to the studied disinfectants Conclusion. Based on the results of the study of sensitivity of microorganisms to disinfectants, a new tactic for improving disinfection measures is proposed for medical facilities: rotation of disinfectants and an enhanced system of microbiological monitoring of the sensitivity of microorganisms to disinfectants

Dry disposal technology in transportation and processing of reusable medical devices

The processing of multiple-use medical devices (MD) between patient use is an integral part of anti-epidemic measures in a medical organization (MO) and directly affects the safety of medical services. Based on the requirements of the Sanitary Rules and Regulations 2.1.3.2630–10 it is possible to use washing and disinfecting machines for disinfection purposes. At the same time, there remains the problem of organizing the operation of the operating unit and the central medical department of the medical organization for transportation and work with MD contaminated with blood and other biological fluids.