Evaluating capacity at three government referral hospital emergency units in the kingdom of Eswatini using the WHO Hospital Emergency Unit Assessment Tool

BACKGROUND

The Kingdom of Eswatini, a lower-middle income nation of 1.45 million in southern Africa, has recently identified emergency care as a key strategy to respond to the national disease burden. We aimed to evaluate the current capacity of hospital emergency care areas using the WHO Hospital Emergency Unit Assessment Tool (HEAT) at government referral hospitals in Eswatini.

METHODS

We conducted a cross-sectional study of three government referral hospital emergency care areas using HEAT in May 2018. This standardised tool assists healthcare facilities to assess the emergency care delivery capacity in facilities and support in identifying gaps and targeting interventions to strengthen care delivery within emergency care areas. Senior-level emergency care area employees, including senior medical officers and nurse matrons, were interviewed using the HEAT.

RESULTS

All sites provided some level of emergency care 24 h a day, 7 days a week, though most had multiple entry points for emergency care. Only one facility had a dedicated area for receiving emergencies and a dedicated resuscitation area; two had triage areas. Facilities had limited capacity to perform signal functions (life-saving procedures that require both skills and resources). Commonly reported barriers included training deficits and lack of access to supplies, medications, and equipment. Sites also lacked formal clinical management and process protocols (such as triage and clinical protocols).

CONCLUSIONS

The HEAT highlighted strengths and weaknesses of emergency care delivery within hospitals in Eswatini and identified specific causes of these system and service gaps. In order to improve emergency care outcomes, multiple interventions are needed, including training opportunities, improvement in supply chains, and implementation of clinical and process protocols for emergency care areas. We hope that these findings will allow hospital administrators and planners to develop effective change management plans.

Assessment of an action against environmental noise: Acoustic durability of a pavement surface with crumb rubber

Environmental noise is a worldwide problem that has an adverse effect in the quality of life of urban population. Some work has shown that there is a correlation between environmental noise and health issues as sleep disturbance or annoyance. This study presents the time evolution of a test track fabricated with an asphalt mixture with 20% of crumb rubber by weight of bitumen, added by the wet process. A complete surface characterization has been performed by determining tire/pavement sound levels, road texture profiles, in-situ dynamic stiffness and sound absorption of compacted and extracted sample cores. Two measurement campaigns were performed: just after mixture laying and after 3 years in service. This study confirms that the use of crumb rubber as a modifier of bituminous binders (CRMB) can improve the pavement characteristics: gap-graded mixtures with crumb rubber can be used in the action plans as urban rehabilitation measure to fight noise pollution. However, this noise reduction seems to decrease with age at a rate of approximately 0.15 dB(A) per year.

Piston-cylinder based micro liquid–liquid extraction with GC–qMS for trace analysis of targeted chlorinated organic compounds in water

A fast and reliable approach for the measurement of sub parts-per-billion levels of targeted chlorinated compounds like tetrachloroethane, hexachloroethane, hexachlorobutadiene, pentachlorobenzene, and hexachlorobenzene in various water matrices such as waste water is described. The method employed a novel piston-cylinder-based micro liquid–liquid extraction technique using hexane as an extraction solvent. The device, known commercially as the MIXXOR, substantially accelerates extraction time by a factor of more than 100 times and reduces solvent consumption by a factor of 25 times when compared with the solvent extraction technique using wrist-action mechanical agitation. A recently introduced 6% cyanopropylphenyl –94% dimethylpolysiloxane capillary column offering a high degree of inertness was used for the separation of the analytes. A quadrupole mass spectrometer equipped with a triple-axis detector was also employed to enhance the instrument detection limit. With this technique, a complete separation for the analytes in water can be conducted in less than 10 min using a three-port SilFlow planar microfluidic device for back-flushing. Repeatability of retention times for all compounds were found to be less than 0.04% (n = 10). The compounds cited can be analyzed from 1 ng/mL to 10 μg/mL, with a detection limit and correlation coefficient of at least 0.5 ng/mL and 0.999, respectively. A relative precision of less than 1.2% relative standard deviation (RSD) (n = 20) at the 50 ng/mL level, with analyte recovery of greater than 99% (n = 3) from 10 ng/mL to 10 μg/mL, was obtained.

Assessment of asphalt concrete acoustic performance in urban streets

Geo-referenced close proximity rolling noise and sound absorption measurements are used for acoustical characterization of asphalt concrete surfaces in an urban environment. A close proximity noise map of streets with low speed limits is presented for a reference speed of 50 km/h. Different pavements and pavement conditions, common in urban streets, are analyzed: dense and semidense asphalt concrete, with Spanish denomination D-8 and S-12, respectively, and on the other hand, dense pavement at the end of its service life (D-8(*)). From the acoustics point of view, the most favorable surface, by more than 4 dB(A) compared with the S-12 mix, is the smoothest surface, i.e., the D-8 mix, even though it presents a minor absorption coefficient in normal incidence. Noise levels from dense surfaces (D-8) increase significantly over time, principally due to the appearance of surface defects such as cracks and ruts. Longitudinal variability of the close proximity tire/pavement noise emission and surface homogeneity are also analyzed.

Comprehensive Two-Dimensional Gas Chromatography for Fast Screening of Wash Oils

Fast screening of wash oils is demonstrated using comprehensive two-dimensional gas chromatography (GCxGC). Wash oils are used in ethylene production plants to minimize compressor fouling. The composition of a wash oil determines its effectiveness in solubilizing heavy hydrocarbons. In particular, the relative amount of 1- and 2-ring aromatics is important. The presence of oxygenates is undesirable because of adverse effects to the process. It is shown that GCxGC is well suited for this application. Species in wash oils are separated and grouped into three bands: a nonpolar aliphatics band, 1- and 2-ring aromatics band, and polyaromatics band. For a given polar secondary column, the spacing between bands in the second dimension can be adjusted in a broad range by selecting a primary column and an oven-temperature-programming rate. Integration of GCxGC peaks is evaluated using a standard GC integration program and a new GCxGC integration program. Consistent results are obtained using both programs for well-separated GCxGC peaks with relative differences for individual peak ranging from 0.04% to 1.6%. Peak responses are integrated by the GCxGC software, and the relative amounts of aromatics content and aliphatics content are estimated by peak response percent with relative standard deviations ranging from 0.15% to 2.8% (n = 3).