Search results for: early mobilisation in intensive care (ICU)

Authors: Syed Faizan Hassan Shah

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Introduction: Burn injuries are among the most devastating of all injuries. Burns is the fourth most common type of trauma worldwide. Ap?proximately 90 percent of burns occur in low to middle-income countries. Nearly half a million Americans each year, with approximately 40,000 hospitalizations and 3,400 deaths annually, suffer burns. The survival rate for admitted burn patients has improved consistently over the past four decades, largely attributed to national decreases in burn size, improvements in burn critical care, and advancements in burn wound care. Objectives: The present study was conducted to compare the efficacy of Honey dressing versus Silver Sulfadiazine dressing for complete wound healing in the 2nd-degree thermal burn. Study Design: A Randomized controlled trial was carried out in the Department of General Surgery/burn unit of Ayub Teaching Hospital Abbottabad from July to December 2018. The study population included thermal burn patients presenting with ASA-I, ASA-II, and body surface area less than 50% of the age group above 12 to 60 years of either gender. All the patients were randomly divided into two equal groups of patients by blocked randomization using permuted block g 6. In group ‘A,’ patients underwent dressing by honey method, and patients in group ‘B’ had silver sulfadiazine dressing. The dressing was changed every 48 hours by a senior sur?geon, and the condition of the wound was observed. Time duration till complete wound healing was noted in the Proforma. Results: A total of 100 patients were selected and divided into two groups of 50 patients in each two groups. The mean age of the patients was 27.66±13.388 ran?ging from 12 to 60 years of age, and the mean duration of complete healing of wound in days was 20.20±6.251, ranging from 2 to 30 days. Mean comparison of age with both groups, age of the patients was 21.24±3.761 (n=50) in group ‘A,’ i.e., honey dressing, and 19.16±7.911 (n=50) was in group ‘B,’ i.e., silver sulfadiazine dressing. Efficacy in the honey dressing group was found effective in 48(75.0%) and ineffect? ive in 2(5.6%) out of 50 patients. Efficacy in silver sulfadiazine dressing group 16(25.0%) was three found effective and in 34(94.4%) was inef?fective out of 50 patients. There was a statistically significant difference between both groups. (P=0.000) . Conclusion: honey dressing is more effective as compared to silver sulfadiazine dressing in terms of complete wound healing in second-degree thermal burn patients; our study also concluded the same.

Keywords: efficacy, honey dressing, silver sulfadiazine dressing, wound healing

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Authors: Jaimala Ghambir, Tilak Thakur, Puneet Chawla

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As per the statistical data, the Doubly-fed Induction Generator (DFIG) based wind turbine with variable speed and variable pitch control is the most common wind turbine in the growing wind market. This machine is usually used on the grid connected wind energy conversion system to satisfy grid code requirements such as grid stability, fault ride through (FRT), power quality improvement, grid synchronization and power control etc. Though the requirements are not fulfilled directly by the machine, the control strategy is used in both the stator as well as rotor side along with power electronic converters to fulfil the requirements stated above. To satisfy the grid code requirements of wind turbine, usually grid side converter is playing a major role. So in order to improve the operation capacity of wind turbine under critical situation, the intensive study of both machine side converter control and grid side converter control is necessary In this paper DFIG is modeled using power components as variables and the performance of the DFIG system is analysed under grid voltage fluctuations. The voltage fluctuations are made by lowering and raising the voltage values in the utility grid intentionally for the purpose of simulation keeping in view of different grid disturbances.

Keywords: DFIG, dynamic modeling, DPC, sag, swell, voltage fluctuations, FRT

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Authors: Ann Rousseau, Steven Eggermont

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The current study sought to explain pre-adolescents’ differential susceptibility to the internalization of mediated appearance ideals, using a three-wave panel survey of preadolescent girls and boys (N = 973, Mage = 11.14). Based on the premises of objectification theory and sexual script theory, we proposed a double role for pubertal timing and cross-sex interactions in preadolescents’ media internalization. More specifically, we expected pubertal timing and cross-sex interactions to (a) trigger higher levels of media internalization, directly and indirectly via body surveillance, and (b) positively moderate the relationship between objectifying media exposure and girls’ and boys’ media internalization. A first cross-lagged model tested whether the pubertal timing and cross-sex interactions could trigger preadolescents media internalization and body surveillance. Structural equation analysis indicated that pubertal timing (Wave1) positively predicted body surveillance and media internalization (both Wave3). Cross-sex involvement (Wave1) was positively linked to media internalization (Wave2), but body surveillance (Wave2) was not associated with cross-sex interactions. Results also showed a reciprocal interaction between media internalization (Wave 2 and 3) and body surveillance (Wave2 and 3). Multiple group analysis showed that the observed relationships did not vary by gender. A second moderated moderation model examined whether (a) the relationship between objectifying media exposure (television and magazines, both Wave1) and media internalization (Wave3) depended on pubertal timing (Wave1), and (b) the two-way interaction between objectifying media exposure (Wave1) and pubertal timing (Wave1) varied depending on cross-sex interactions (Wave1). Results revealed that cross-sex interactions functioned as a buffer against media internalization. For preadolescents who had fewer cross-sex interactions, early puberty (relative to peers) positively moderated the relationship between magazine exposure and the internalization of mediated appearance ideals. No significant relationships were found for television. Again, no gender difference could be observed. The present study suggests a double role for pubertal timing and cross-sex interactions in preadolescents media internalization, and indicate that early developers with few cross-sex experiences are particularly vulnerable for media internalization. Additionally, the current findings suggest that there is relative gender equity in magazines’ ability to cultivate media internalization among preadolescents.

Keywords: cross-sex interactions, media effects, objectification theory, pubertal timing

Procedia PDF Downloads 330

Authors: M. Petunia Tsweleng

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Statement of the Problem: Research and aid organisations report that children and adolescents orphaned due to HIV and AIDS are particularly vulnerable as they are often exposed to negative effects of both HIV and AIDS and orphanhood. Without much-needed parental love, care, and support, these children and adolescents are at risk of poor developmental outcomes. A cursory look at the available literature on AIDS-orphaned adolescents, and the quality of caregiving relationships with caregivers, shows that this is a relatively under-researched terrain. This article is a review of the literature on caregiving relationships of adolescents orphaned due to AIDS and their current primary caregivers. It aims to inform community programmes and policymakers by providing insight into the qualities of these relationships. Methodology: A comprehensive search of both peer-reviewed and non-peer-reviewed literature was conducted through EBSCOhost, SpringLINK, PsycINFO, SAGE, PubMed, Elsevier ScienceDirect, JSTOR, Wiley Online Library databases, and Google Scholar. The combination of keywords used for the search were: (caregiving relationships); (orphans OR AIDS orphaned children OR AIDS orphaned adolescents); (primary caregivers); and (quality caregiving); (orphans); (HIV and AIDS). The search took place between 24 January and 28 February 2022. Both qualitative and quantitative research studies published between 2010 and 2020 were reviewed. However, only qualitative studies were selected in the end -as they presented more profound findings concerning orphan-caregiver relationships. The following three stages of meta-synthesis analysis were used to analyse data: refutational syntheses, reciprocal syntheses, and line of argument. Results: The search resulted in a total of 2090 titles, of which 750 were duplicates and therefore subtracted. The researcher reviewed all the titles and abstracts of the remaining 1340 articles. 329 articles were identified as relevant, and full texts were reviewed. Following the review of the full texts, 313 studies were excluded for relevance and 4 for methodology. Twelve articles representing 11 studies fulfilled the inclusion criteria and were selected. These studies, representing different countries across the globe, reported similar forms of hardships experienced by caregivers economically, psychosocially, and healthwise. However, the studies also show that the majority of caregivers found contentment in caring for orphans, particularly grandmother carers, and were thus enabled to provide love, care, and support despite hardships. This resulted in positive caregiving relationships -as orphans fared well emotionally and psychosocially. Some relationships, however, were found negative due to unhealed emotional wounds suffered by both caregivers and orphans and others due to the caregiver’s lack of interest in providing care. These findings were based on self-report data from both orphans and caregivers. Conclusion: Findings suggest that intervention efforts need to be intensified to: alleviate poverty in households that are affected by HIV and AIDS pandemic, strengthen the community psychosocial support programmes for orphans and their caregivers; and integrate clinical services with community programmes for the healing of emotional and psychological wounds. Contributions: Findings inform community programmes and policymakers by providing insight into the qualities of the mentioned relationships as well as identifying factors commonly associated with high-quality caregiving and poor-quality caregiving.

Keywords: systematic review, caregiving relationships, orphans and primary caregivers, AIDS

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Authors: Yu-Ju Hsieh, Lin-Hung Lin, Wen-Hui Chang

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This study was designed as an interventional research and intended to validate whether the introduction of drinking vinegar every day can reduce and even prevent urinary tract infection in Taiwan home stayed disabilities who using indwelling catheter. The data was collected from the subjects who have received home care case at northern Taiwan, according to the questionnaire and a medical records retroactive methodology, the subjects were informed and consent to drink 15ml of table vinegar in a daily diet, and through routine urine testing and culture study. Home care nurses would assist collecting urine at the point of before and after a meal from total 35 studied subjects per month, and total collected 4 times for testing. The results showed that when the average age of study subjects was 65.46 years and catheter indwelling time was 15 years, drinking table vinegar could inhibit the activity of E. coli O157: H7 and reduce its breeding. Before drinking table vinegar daily, the subjects’ urine pH value was 7.0-8.0, and the average was 7.5, and the urine PH value dropped to 6.5 after drinking table vinegar for a month. There were two purple urine cases whose urine were changed from purple to normal color after two weeks of drinking, and the protein and bacteria values of urine gradually improved. Urine smell unpleasant before attending to this study, and the symptom improved significantly only after 1 week, and the urine smell returned to normal ammonia and became clean after 1 month later. None of these subjects received treatment in a hospital due to urinary tract infection, and there were no signs of bleeding in all cases during this study. The subjects of this study are chronic patients with a long-term bedridden catheterization; drinking cranberry juice is an economic burden for them, and also highly prohibited for diabetes patients. By adapting to use cheaper table vinegar to acidified urine and improve its smell and ease Purple Urine Syndrome, to furthermore, proven urinary tract infection, it can also to reduce the financial burden on families, the cost of social resources and the rate of re-admission.

Keywords: table vinegar, urinary tract infection, disability patients, long-term indwelling catheter

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Authors: Katalin Szöllősi, László Szabó

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Introduction and purpose: Even though female sexual dysfunctions are common among women in the postpartum period, the profile of these disturbances has not been well investigated in Hungary yet. The aim of the study was to evaluate the postpartum female sexual functions in Hungary. This research sought to investigate the possible predictor factors which can influence postpartum female sexual functions. Method and sample: This was a cross-sectional study, including patients from two maternity clinics in Budapest. 113 women were recruited into our study 3 months after their childbirth. 53 had vaginal birth, 60 had a caesarian section. Data were collected from medical reports in addition by using self-developed questions and validated questionnaires in order to measure important predictors which may be responsible for postpartum sexual dysfunctions such as mode of delivery, parity, urinary incontinence and body image. Sexual functions were evaluated by the Hungarian version of the Female Sexual Function Index (FSFI). The Hungarian version of Body Image Questionnaire-Short Form14 (BSQ-SF14) was applied for assessing body image. Results: 82,3% of the participants began to have sexual intercourse within three months postpartum. 53,98% of the participants reported sexual dysfunctions (cut-off FSFI score 26,55). According to our results mode of delivery, parity, hemorrhoids, time of intercourse, resumption was not associated with female sexual dysfunctions. We found correlation at a tendential level between urinary incontinence and sexual dysfunctions (p=0,003, R=0,26). We found a negative correlation at a tendential level between the total score of BSQ-SF14 and FSFI (p=0,03, R=-0,269). Only 32,74% of women reported discussing sexual life with health care professionals. However, 67,25% of them would have had the need to be asked about their postpartum health issues. Conclusions and recommendations: The prevalence of female sexual dysfunctions were relatively high after childbirth. We found that incontinence and body image was associated with sexual dysfunctions; other risk factors remained unknown. Despite regular contact with health care professionals, women rarely get any information about postpartum sexual health issues. The high prevalence of dysfunctions indicates the need for further investigation to address other risk factors and proper counselling of women after childbirth.

Keywords: body image, postpartum, sexual dysfunction, urinary incontinence

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Authors: Rahimah Saimin

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Previous research has shown that young children can learn from educational television programmes, videos or other technological media. However, the blending of any of these with traditional printed-based text appears to be omitted. Repeated viewing is an important factor in children's ability to comprehend the content or plot. The present study combined videos with traditional printed-based text and required repeated viewing and is original and distinctive. The first study was a pilot study to explore whether the intervention is implementable in ordinary classrooms. The second study explored whether the curricular embedding is important or whether the video with curricular embedding is effective. The third study explored the effect of “dosage”, i.e. whether a longer/ more intense intervention has a proportionately greater effect on outcomes. Both measured outcomes (comprehension, word sounds, and early word recognition) and unmeasured outcomes (engagement to reading traditional printed-based texts or/and multimodal texts) were obtained from this study. Observation indicated degree of engagement in reading. The theoretical framework was multimodality theory combined with Piaget’s and Vygotsky’s learning theories. An experimental design was used with 4-5-year-old children in nursery schools and primary schools. Six links to video clips exploring non-fiction science content were provided to teachers. The first session is whole-class and subsequent sessions small-group. The teacher then engaged the children in dialogue using supplementary materials. About half of each class was selected randomly for pre-post assessments. Two assessments were used the British Picture Vocabulary Scale (BPVSIII) and the York Assessment of Reading for Comprehension (YARC): Early Reading. Different programme fidelity means were deployed- observations, teacher self-reports attendance logs and post-delivery interviews. Data collection is in progress and results will be available shortly. If this multiphase study show effectiveness in one or other application, then teachers will have other tools which they can use to enhance vocabulary, letter knowledge and word reading. This would be a valuable addition to their repertoire.

Keywords: language skills, literacy skills, multimodality, video

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Authors: N. N. Pandey, Raghvendra Singh, Biju S. Kamlam, Bipin K. Vishwakarma, Preetam Kala

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The rainbow trout (Oncorhynchus mykiss) is an exotic salmonid fish, well known for its fast growth, tremendous ability to thrive in diverse conditions, delicious flesh and hard fighting nature in Europe and other countries. Rainbow trout farming has a great potential for its contribution to the mainstream economy of Himalayan states in India and other temperate countries. These characteristics establish them as one of the most widely introduced and cultured fish across the globe, and its farming is also prominent in the cold water regions of India. Nevertheless, genetic fatigue, slow growth, early maturity, and low productivity are limiting the expansion of trout production. Moreover, farms adjacent to natural streams or other water sources are subject to escape of domesticated rainbow trout into the wild, which is a serious environmental concern as the escaped fish is subject to contaminate and disrupt the receiving ecosystem. A decline in production traits due to early maturity prolongs the culture duration and affects the profit margin of rainbow trout farms in India. A viable strategy that could overcome these farming constraints in large scale operation is the production of triploid fish that are sterile and more heterozygous. For better triploidy induction rate (TR), heat shock at 28°C for 10 minutes and pressure shock 9500 psi pressure for 5 minutes is applied to green eggs with 90-100% of triploidy success and 72-80% survival upto swim-up fry stage. There is 20% better growth in aquaculture with triploids rainbow trout over diploids. As compared to wild diploid fish, larger sized and fitter triploid rainbow trout in natural waters attract to trout anglers, and support the development of recreational fisheries by state fisheries departments without the risk of contaminating existing gene pools and disrupting local fish diversity. Overall, enhancement of productivity in rainbow trout farms and trout production in coldwater regions, development of lucrative trout angling and better ecological management is feasible with triploid rainbow trout.

Keywords: rainbow trout, triploids fish, heat shock, pressure shock, trout angling

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Authors: Sandeep Nath

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There are good stresses and bad stresses. To tell the difference, recognize early signs of stress, and label stress conditions correctly, we need to understand stress triggers and the mechanism of stress as it arises. By understanding this in our teenage years, we can be prepared to prevent harmful stress from escalating and ruining health, physical, mental, and emotional. We can also prepare others/peers to be stress-free. The understanding of this is available in a form closest to our natural being, in ancient oriental wisdom, and is brought together as actionable habits in the movement called RENEWALism. The constructs of RENEWALism Habits are detailed in this paper, and case studies are presented of teenagers who have been equipped with both capability and capacity to handle their situations and environments independently.

Keywords: habits, renewalism, stress, teenagers

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Authors: Bonnie R. Brammall, Rhonda M. Garad, Helena J. Teede, Cheryce L. Harrison

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Introduction: Reproductive aged women are at high-risk for accelerated weight gain and obesity development, with pregnancy recognised as a critical contributory life phase. Healthy lifestyle interventions during the preconception and antenatal period improve maternal and infant health outcomes. Yet, interventions from preconception through to postpartum and translation and implementation into real-world healthcare settings remain limited. OptimalMe is a randomised, hybrid implementation effectiveness study of evidence-based healthy lifestyle intervention. Here, we report engagement, acceptability of the intervention during preconception, and self-reported behaviour change outcomes as a result of the preconception phase of the intervention. Methods: Reproductive aged women who upgraded their private health insurance to include pregnancy and birth cover, signalling a pregnancy intention, were invited to participate. Women received access to an online portal with preconception health and lifestyle modules, goal-setting and behaviour change tools, monthly SMS messages, and two coaching sessions (randomised to video or phone) prior to pregnancy. Results: Overall n=527 expressed interest in participating. Of these, n=33 did not meet inclusion criteria, n=8 were not contactable for eligibility screening, and n=177 failed to engage after the screening, leaving n=309 who were enrolled in OptimalMe and randomised to intervention delivery method. Engagement with coaching sessions dropped by 25% for session two, with no difference between intervention groups. Women had a mean (SD) age of 31.7 (4.3) years and, at baseline, a self-reported mean BMI of 25.7 (6.1) kg/m², with 55.8% (n=172) of a healthy BMI. Behaviour was sub-optimal with infrequent self-weighing (38.1%), alcohol consumption prevalent (57.1%), sub-optimal pre-pregnancy supplementation (61.5%), and incomplete medical screening. Post-intervention 73.2% of women reported engagement with a GP for preconception care and improved lifestyle behaviour (85.5%), since starting OptimalMe. Direct pre-and-post comparison of individual participant data showed that of 322 points of potential change (up-to-date cervical screening, elimination of high-risk behaviours [alcohol, drugs, smoking], uptake of preconception supplements and improved weighing habits) 158 (49.1%) points of change were achieved. Health coaching sessions were found to improve accountability and confidence, yet further personalisation and support were desired. Engagement with video and phone sessions was comparable, having similar impacts on behaviour change, and both methods were well accepted and increased women's accountability. Conclusion: A low-intensity digital health and lifestyle program with embedded health coaching can improve the uptake of preconception care and lead to self-reported behaviour change. This is the first program of its kind to reach an otherwise healthy population of women planning a pregnancy. Women who were otherwise healthy showed divergence from preconception health and lifestyle objectives and benefited from the intervention. OptimalMe shows promising results for population-based behaviour change interventions that can improve preconception lifestyle habits and increase engagement with clinical health care for pregnancy preparation.

Keywords: preconception, pregnancy, preventative health, weight gain prevention, self-management, behaviour change, digital health, telehealth, intervention, women's health

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Authors: James M. Wakiru, Liliane Pintelon, Peter Muchiri, Peter Chemweno

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The fast-changing business and operational environment are forcing organizations to adopt asset performance management strategies, not only to reduce costs but also maintain operational and production policies while addressing demand. To attain optimal asset performance management, a framework that ensures a continuous and systematic approach to analyzing an organization’s current maturity level and expected improvement regarding asset maintenance processes, strategies, technologies, capabilities, and systems is essential. Moreover, this framework while addressing maintenance-intensive organizations should consider the diverse business, operational and technical context (often dynamic) an organization is in and realistically prescribe or relate to the appropriate tools and systems the organization can potentially employ in the respective level, to improve and attain their maturity goals. This paper proposes an asset maintenance maturity model to assess the current capabilities, strength and weaknesses of maintenance processes an organization is using and analyze gaps for improvement via structuring set levels of achievement. At the epicentre of the proposed framework is the utilization of maintenance objective selected by an organization for various maintenance optimization programs. The framework adapts the Capability Maturity Model of assessing the maintenance process maturity levels in the organization.

Keywords: asset maintenance, maturity models, maintenance objectives, optimization

Procedia PDF Downloads 233

Authors: S. MacDonald, A. Manuel, R. Law, N. Bandruak, A. Dubrowski, V. Curran, J. Smith-Young, K. Simmons, A. Warren

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High fidelity human patient simulation has been used for many years by health sciences education programs to foster critical thinking, engage learners, improve confidence, improve communication, and enhance psychomotor skills. Unfortunately, there is a paucity of research on the use of high fidelity human patient simulation to foster teamwork among nursing, medicine and pharmacy undergraduate students. This study compared the impact of high fidelity and low fidelity simulation education on teamwork among nursing, medicine and pharmacy students. For the purpose of this study, two innovative teaching scenarios were developed based on the care of an adult patient experiencing acute anaphylaxis: one high fidelity using a human patient simulator and one low fidelity using case based discussions. A within subjects, pretest-posttest, repeated measures design was used with two-treatment levels and random assignment of individual subjects to teams of two or more professions. A convenience sample of twenty-four (n=24) undergraduate students participated, including: nursing (n=11), medicine (n=9), and pharmacy (n=4). The Interprofessional Teamwork Questionnaire was used to assess for changes in students’ perception of their functionality within the team, importance of interprofessional collaboration, comprehension of roles, and confidence in communication and collaboration. Student satisfaction was also assessed. Students reported significant improvements in their understanding of the importance of interprofessional teamwork and of the roles of nursing and medicine on the team after participation in both the high fidelity and the low fidelity simulation. However, only participants in the high fidelity simulation reported a significant improvement in their ability to function effectively as a member of the team. All students reported that both simulations were a meaningful learning experience and all students would recommend both experiences to other students. These findings suggest there is merit in both high fidelity and low fidelity simulation as a teaching and learning approach to foster teamwork among undergraduate nursing, medicine and pharmacy students. However, participation in high fidelity simulation may provide a more realistic opportunity to practice and function as an effective member of the interprofessional health care team.

Keywords: acute anaphylaxis, high fidelity human patient simulation, low fidelity simulation, interprofessional education

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Authors: Vu Dinh Tuan, Truc Xuyen Nguyen Phan, Nguyen Thi Truc Nhi

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Cultivating on hillslopes in Northwest Vietnam induced soil erosion that reduce overall soil fertility, capacity of water bodies and drainage ditches or channels, and enhance the risk of flooding, even obstruct traffics and create 'mud flooding or landslide’. This study aimed at assessing the magnitude of erosion under maize monocropping and perennial teak plantation on a rainstorm basic over two years 2010-2011 using double sediment fences installed at convergent point of catchments (slope inclination of 27-74%). Mean annual soil erosion under maize cultivation was 4.39 kg.m⁻², being far greater than that under teak plantation 1.65 kg.m⁻². Intensive tillage in maize monocropping and clearance of land before sowing was most probably the causes induced such effect as no tillage was performed in teak plantation during monitored period. Larger sediment generated across two land use types in year 2010 (4.11 kg.m⁻²) compared to year 2011 (1.87 kg.m⁻²) was attributed to higher amount and intensity of precipitation in the first year (1448 mm) as compared to the latter year (1299 mm). Reducing tillage and establishing good cover for maize monocropping on steep slopes, therefore, are necessary to reduce soil erosion and control sediment delivery to downstream.

Keywords: maize monocropping, teak plantation, tillage, sediment fence, sediment delivery, soil erosion

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Authors: Mustafa Yıldız, Ali Ulvi Uzer, Murat Olgun

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In this study, geotechnical and mineralogical properties of gypsum containing clay basis which form the ground of Second Organized Industrial Zone in Konya province have been researched through comprehensive field and laboratory experiments. Although sufficient geotechnical research has not been performed yet, an intensive structuring in the region continues at present. The study area consists of mid-lake sediments formed by gypsum containing soft silt-clay basis which evolves to a large area. To determine the soil profile and geotechnical specifications; 18 drilling holes were opened and disturbed / undisturbed soil samples have been taken through shelby tubes within 1.5m intervals. Tests have been performed on these samples to designate the index and strength properties of soil. Besides, at all drilling holes Standart Penetration Tests have been done within 1.5m intervals. For the purpose of determining the mineralogical characteristics of the soil; all rock and X-RD analysis have been carried out on 6 samples which were taken from various depths through the soil profile. Strength and compressibility characteristics of the soil were defined with correlations using laboratory and field test results. Unconfined compressive strength, undrained cohesion, compression index varies between 16 kN/m2 and 405.4 kN/m2, 6.5 kN/m2 and 72 kN/m2, 0.066 and 0.864, respectively.

Keywords: Konya second organized industrial region, strength, compressibility, soft clay

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Authors: K. Shaji Mon, P. R. John Sreenidhi

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In deep-submicrometer CMOS processes, time-domain resolution of a digital signal is becoming higher than voltage resolution of analog signals. This claim is nowadays pushing toward a new circuit design paradigm in which the traditional analog signal processing is expected to be progressively substituted by the processing of times in the digital domain. Within this novel paradigm, digitally controlled delay lines (DCDL) should play the role of digital-to-analog converters in traditional, analog-intensive, circuits. Digital delay locked loops are highly prevalent in integrated systems.The proposed paper addresses the glitches present in delay circuits along with area,power dissipation and signal integrity.The digitally controlled delay lines(DCDL) under study have been designed in a 90 nm CMOS technology 6 layer metal Copper Strained SiGe Low K Dielectric. Simulation and synthesis results show that the novel circuits exhibit no glitches for dual output coarse DCDL with less power dissipation and consumes less area compared to the glitch free NAND based DCDL.

Keywords: glitch free, NAND-based DCDL, CMOS, deep-submicrometer

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Authors: Dinesh Gundavaram

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This paper presents an investigation on bridge damage detection based on the dynamic responses estimated from a passing vehicle. A numerical simulation of steel truss bridge for railway was used in this investigation. The bridge response at different locations is measured using CSI-Bridge software. Several damage scenarios are considered including different locations and severities. The possibilities of dynamic properties of global modes in the identification of structural changes in truss bridges were discussed based on the results of measurement.

Keywords: bridge, damage, dynamic responses, detection

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Authors: Kivilcim Ersoy, Cansu Yazganarikan

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In recent years, composite materials are more frequently utilized not only in aviation but also in automotive industry due to its high strength to weight ratio, fatigue and corrosion resistances as well as better performances in specific environments. The market demand also favors lightweight design for wheeled and tracked armored vehicles due to the increased demand for land and amphibious mobility features. This study represents the current application areas and trends in automotive, bus and armored land vehicles industries. In addition, potential utilization areas of fiber composite and hybrid material concepts are being addressed. This work starts with a survey of current applications and patent trends of composite materials in automotive and land vehicle industries. An intensive investigation is conducted to determine the potential of these materials for application in land vehicle industry, where small series production dominates and challenging requirements are concerned. In the end, potential utilization areas for combat land vehicle systems are offered. By implementing these light weight solutions with alternative materials and design concepts, it is possible to achieve drastic weight reduction, which will enable both land and amphibious mobility without unyielding stiffness and survivability capabilities.

Keywords: land vehicle, composite, light-weight design, armored vehicle

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Authors: Omar Youssef, Aija Knuuttila, Paivi Piirilä, Virinder Sarhadi, Sakari Knuutila

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Exhaled breath condensate (EBC) is a unique sample that allows studying different genetic changes in lung carcinoma through a non-invasive way. With the aid of next generation sequencing (NGS) technology, analysis of genetic mutations has been more efficient with increased sensitivity for detection of genetic variants. In order to investigate the possibility of applying this method for cancer diagnostics, mutations in EBC DNA from lung cancer patients and healthy individuals were studied by using NGS. The key aim is to assess the feasibility of using this approach to detect clinically important mutations in EBC. EBC was collected from 20 healthy individuals and 9 lung cancer patients (four lung adenocarcinomas, four 8 squamous cell carcinoma, and one case of mesothelioma). Mutations in hotpot regions of 22 genes were studied by using Ampliseq Colon and Lung cancer panel and sequenced on Ion PGM. Results demonstrated that all nine patients showed a total of 19 cosmic mutations in APC, BRAF, EGFR, ERBB4, FBXW7, FGFR1, KRAS, MAP2K1, NRAS, PIK3CA, PTEN, RET, SMAD4, and TP53. In controls, 15 individuals showed 35 cosmic mutations in BRAF, CTNNB1, DDR2, EGFR, ERBB2, FBXW7, FGFR3, KRAS, MET, NOTCH1, NRAS, PIK3CA, PTEN, SMAD4, and TP53. Additionally, 45 novel mutations not reported previously were also seen in patients’ samples, and 106 novel mutations were seen in controls’ specimens. KRAS exon 2 mutations G12D was identified in one control specimen with mutant allele fraction of 6.8%, while KRAS G13D mutation seen in one patient sample showed mutant allele fraction of 17%. These findings illustrate that hotspot mutations are present in DNA from EBC of both cancer patients and healthy controls. As some of the cosmic mutations were seen in controls too, no firm conclusion can be drawn on the clinical importance of cosmic mutations in patients. Mutations reported in controls could represent early neoplastic changes or normal homeostatic process of apoptosis occurring in lung tissue to get rid of mutant cells. At the same time, mutations detected in patients might represent a non-invasive easily accessible way for early cancer detection. Follow up of individuals with important cancer mutations is necessary to clarify the significance of these mutations in both healthy individuals and cancer patients.

Keywords: exhaled breath condensate, lung cancer, mutations, next generation sequencing

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Authors: Monika Nuffer, Wesley Nuffer

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The problem of obesity is one that continues to be faced in the United States health care system and across the developing world. Prescription medications are available, but are often very expensive with minimal insurance coverage. The over-the-counter diet aid industry is a robust one, selling billions of dollars in products every year. It is important for clinicians to understand the myriad of different nutritional supplements marketed for obesity, and to weigh the evidence behind these products. This manuscript outlines the most commonly used nutritional supplements currently marketed for weight loss, reviewing the evidence with a focus on the efficacy and safety of these products.

Keywords: obesity, weight loss, herbal products, nutritional supplements

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Authors: Kiran P. Kumar, H. M. Nayana, R. Rakshitha, S. Sushmitha

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Aircraft noise is a highly concerned problem in the field of the aviation industry. It is necessary to reduce the noise in order to be environment-friendly. Air-frame noise is caused because of the quick separation of the boundary layer over an aircraft body. So, we have to delay the boundary layer separation of an air-frame and engine nacelle. By following a certain procedure boundary layer separation can be reduced by converting laminar into turbulent and hence early separation can be prevented that leads to the noise reduction. This method has a tendency to reduce the noise of the aircraft hence it can prove efficient and environment-friendly than the present Aircraft.

Keywords: airframe, boundary layer, noise, reduction

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Authors: Wei-Kuang Liu, Ya-Hsu Chiang

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In the coming of an aging society, the issues of living quality, health care, and social security for the elderly have been gradually taken seriously. In order to maintain favorable living condition, urban societies are also facing the challenge of disasters caused by extreme climate change. However, in the practice of disaster prevention, elderly people are always weak due to their physiological conditions. That is to say, in the planning of resilient urbanism, the aging society is relatively in need of more care. Thus, this research aims to map areas where have high-density elderly population and fragile environmental condition in Taiwan, and to understand the actual situation of disaster prevention management in these areas, so as to provide suggestions for the development of intellectual resilient urban management. The research takes the cities of Taoyuan and Taichung as examples for explorations. According to GIS mapping of areas with high aging index, high-density population and high flooding potential, the communities of Sihai and Fuyuan in Taoyuan and the communities of Taichang and Nanshih in Taichung are highlighted. In these communities, it can be found that there are more elderly population and less labor population with high-density living condition. In addition, they are located in the areas where they have experienced severe flooding in the recent past. Based on a series of interviews with community organizations, there is only one community out of the four using flood information mobile app and Line messages for the management of disaster prevention, and the others still rely on the traditional approaches that manage the works of disaster prevention by their community security patrol teams and community volunteers. The interview outcome shows that most elderly people are not interested in learning the use of intellectual devices. Therefore, this research suggests to keep doing the GIS mapping of areas with high aging index, high-density population and high flooding potential for grasping the high-risk communities and to help develop smart monitor and forecast systems for disaster prevention practice in these areas. Based on case-study explorations, the research also advises that it is important to develop easy-to-use bottom-up and two-way immediate communication mechanism for the management of aging society’s disaster prevention.

Keywords: aging society, disaster prevention, GIS, resilient, Taiwan

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Authors: Sameer A. Pathan, Biswadev Mitra, Salman Mirza, Umais Momin, Zahoor Ahmed, Lubna G. Andraous, Dharmesh Shukla, Mohammed Y. Shariff, Magid M. Makki, Tinsy T. George, Saad S. Khan, Stephen H. Thomas, Peter A. Cameron

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Study objective: Emergency physician’s (EP) ability to identify hydronephrosis on point-of-care ultrasound (POCUS) has been assessed in the past using CT scan as the reference standard. We aimed to assess EP interpretation of POCUS to identify and grade the hydronephrosis in a direct comparison with the consensus-interpretation of POCUS by radiologists, and also to compare the EP and radiologist performance using CT scan as the criterion standard. Methods: Using data from a POCUS databank, a prospective interpretation study was conducted at an urban academic emergency department. All POCUS exams were performed on patients presenting with renal colic to the ED. Institutional approval was obtained for conducting this study. All the analyses were performed using Stata MP 14.0 (Stata Corp, College Station, Texas). Results: A total of 651 patients were included, with paired sets of renal POCUS video clips and the CT scan performed at the same ED visit. Hydronephrosis was reported in 69.6% of POCUS exams by radiologists and 72.7% of CT scans (p=0.22). The κ for consensus interpretation of POCUS between the radiologists to detect hydronephrosis was 0.77 (0.72 to 0.82) and weighted κ for grading the hydronephrosis was 0.82 (0.72 to 0.90), interpreted as good to very good. Using CT scan findings as the criterion standard, Eps had an overall sensitivity of 81.1% (95% CI: 79.6% to 82.5%), specificity of 59.4% (95% CI: 56.4% to 62.5%), PPV of 84.3% (95% CI: 82.9% to 85.7%), and NPV of 53.8% (95% CI: 50.8% to 56.7%); compared to radiologist sensitivity of 85.0% (95% CI: 82.5% to 87.2%), specificity of 79.7% (95% CI: 75.1% to 83.7%), PPV of 91.8% (95% CI: 89.8% to 93.5%), and NPV of 66.5% (95% CI: 61.8% to 71.0%). Testing for a report of moderate or high degree of hydronephrosis, specificity of EP was 94.6% (95% CI: 93.7% to 95.4%) and to 99.2% (95% CI: 98.9% to 99.5%) for identifying severe hydronephrosis alone. Conclusion: EP POCUS interpretations were comparable to the radiologists for identifying moderate to severe hydronephrosis using CT scan results as the criterion standard. Among patients with moderate or high pre-test probability of ureteric calculi, as calculated by the STONE-score, the presence of moderate to severe (+LR 6.3 and –LR 0.69) or severe hydronephrosis (+LR 54.4 and –LR 0.57) was highly diagnostic of the stone disease. Low dose CT is indicated in such patients for evaluation of stone size and location.

Keywords: renal colic, point-of-care, ultrasound, bedside, emergency physician

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Authors: Kingsley Oturu, Winifred Ijomah, Wale Coker, Chibueze Achi

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With the impact of BREXIT and the need for cross-border collaboration, this international research investigated the use of a conceptual model for remanufacturing medical equipment (with a focus on anesthetic machines and baby incubators). Early findings of the research suggest that contextual factors need to be taken into consideration, as well as an emphasis on cleaning (e.g., sterilization) during the process of remanufacturing medical equipment. For example, copper tubings may be more important in the remanufacturing of anesthetic equipment in tropical climates than in cold climates.

Keywords: medical equipment remanufacture, sustainability, circular business models, remanufacture process model

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Authors: Abdullah Karaman, Kursad Sayin

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In this research, which information technologies are used in small hotel businesses, and the information technologies-performance perception of the managers are pointed out. During the research, the questionnaire was prepared and the small scale hotel managers were interviewed face to face and they filled out the questionnaire and the answers acquired were evaluated. As the result of the research, it was obtained that the managers do not care much about the information technologies usage in practice even though they accepted that the information technologies are important in terms of performance.

Keywords: information technologies, managers, performance, small hotels

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Authors: Ahmed Amin Mousa, Tamer M. Ismail, M. Abd El Salam

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This work presents a robot called Conceptual Robotic Cube, CR-Cube. The robot can be used as an educational tool for children from the age of three. It has a cube shape attached with a camera colours sensor. In addition, it contains four wheels to move smoothly. The researchers prepared a questionnaire to measure the efficiency of the robot. The design and the questionnaire was presented to 11 experts who agreed that the robot is appropriate for learning numbering and colours for preschool children.

Keywords: CR-Cube, robotic cube, conceptual robot, conceptual cube, colour concept, early childhood education

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Authors: Seyed Sadegh Naseralavi, Sadegh Balaghi, Ehsan Khojastehfar

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Time history dynamic analysis of structures is considered as an exact method while being computationally intensive. Filtration of earthquake strong ground motions applying wavelet transform is an approach towards reduction of computational efforts, particularly in optimization of structures against seismic effects. Wavelet transforms are categorized into continuum and discrete transforms. Since earthquake strong ground motion is a discrete function, the discrete wavelet transform is applied in the present paper. Wavelet transform reduces analysis time by filtration of non-effective frequencies of strong ground motion. Filtration process may be repeated several times while the approximation induces more errors. In this paper, strong ground motion of earthquake has been filtered once applying each wavelet. Strong ground motion of Northridge earthquake is filtered applying various wavelets and dynamic analysis of sampled shear and moment frames is implemented. The error, regarding application of each wavelet, is computed based on comparison of dynamic response of sampled structures with exact responses. Exact responses are computed by dynamic analysis of structures applying non-filtered strong ground motion.

Keywords: wavelet transform, computational error, computational duration, strong ground motion data

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Authors: Suresh Salla

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In this paper, author explores for most sustainable last mile transport mode addressing present problems of traffic congestion, jams, pollution and travel stress. Development of energy-efficient sustainable integrated transport system(s) is/are must to make our cities more livable. Emphasis on autonomous, connected, electric, sharing system for effective utilization of systems (vehicles and public infrastructure) is on the rise. Many surface mobility innovations like PBS, Ride hailing, ride sharing, etc. are, although workable but if we analyze holistically, add to the already congested roads, difficult to ride in hostile weather, causes pollution and poses commuter stress. Sustainability of transportation is evaluated with respect to public adoption, average speed, energy consumption, and pollution. Why public prefer certain mode over others? How commute time plays a role in mode selection or shift? What are the factors play-ing role in energy consumption and pollution? Based on the study, it is clear that public prefer a transport mode which is exhaustive (i.e., less need for interchange – network is widespread) and intensive (i.e., less waiting time - vehicles are available at frequent intervals) and convenient with latest technologies. Average speed is dependent on stops, number of intersections, signals, clear route availability, etc. It is clear from Physics that higher the kerb weight of a vehicle; higher is the operational energy consumption. Higher kerb weight also demands heavier infrastructure. Pollution is dependent on source of energy, efficiency of vehicle, average speed. Mode can be made exhaustive when the unit infrastructure cost is less and can be offered intensively when the vehicle cost is less. Reliable and seamless integrated mobility till last ¼ mile (Five Minute Walk-FMW) is a must to encourage sustainable public transportation. Study shows that average speed and reliability of dedicated modes (like Metro, PRT, BRT, etc.) is high compared to road vehicles. Electric vehicles and more so battery-less or 3rd rail vehicles reduce pollution. One potential mode can be Cycleloop PRT, where commuter rides e-cycle in a dedicated path – elevated, at grade or underground. e-Bike with kerb weight per rider at 15 kg being 1/50th of car or 1/10th of other PRT systems makes it sustainable mode. Cycleloop tube will be light, sleek and scalable and can be modular erected, either on modified street lamp-posts or can be hanged/suspended between the two stations. Embarking and dis-embarking points or offline stations can be at an interval which suits FMW to mass public transit. In terms of convenience, guided e-Bike can be made self-balancing thus encouraging driverless on-demand vehicles. e-Bike equipped with smart electronics and drive controls can intelligently respond to field sensors and autonomously move reacting to Central Controller. Smart switching allows travel from origin to destination without interchange of cycles. DC Powered Batteryless e-cycle with voluntary manual pedaling makes it sustainable and provides health benefits. Tandem e-bike, smart switching and Platoon operations algorithm options provide superior through-put of the Cycleloop. Thus Cycleloop PRT will be exhaustive, intensive, convenient, reliable, speedy, sustainable, safe, pollution-free and healthy alternative mode for last mile connectivity in cities.

Keywords: cycleloop PRT, five-minute walk, lean modular infrastructure, self-balanced intelligent e-cycle

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Authors: Pauline Calleja, Brooke Alexander

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In 2010 the College of Emergency Nursing Australasia (CENA) undertook sole administration of the Trauma Nursing Program (TNP) across Australia. The original TNP was developed from recommendations by the Review of Trauma and Emergency Services-Victoria. While participant and faculty feedback about the program was positive, issues were identified that were common for industry training programs in Australia. These issues included didactic approaches, with many lectures and little interaction/activity for participants. Participants were not necessarily encouraged to undertake deep learning due to the teaching and learning principles underpinning the course, and thus participants described having to learn by rote, and only gain a surface understanding of principles that were not always applied to their working context. In Australia, a trauma or emergency nurse may work in variable contexts that impact on practice, especially where resources influence scope and capacity of hospitals to provide trauma care. In 2011, a program review was undertaken resulting in major changes to the curriculum, teaching, learning and assessment approaches. The aim was to improve learning including a greater emphasis on pre-program preparation for participants, the learning environment and clinically applicable contextualized outcomes participants experienced. Previously if participants wished to undertake assessment, they were given a take home examination. The assessment had poor uptake and return, and provided no rigor since assessment was not invigilated. A new assessment structure was enacted with an invigilated examination during course hours. These changes were implemented in early 2012 with great improvement in both faculty and participant satisfaction. This presentation reports on a comparison of participant evaluations collected from courses post implementation in 2012 and in 2015 to evaluate if positive changes were sustained. Methods: Descriptive statistics were applied in analyzing evaluations. Since all questions had more than 20% of cells with a count of <5, Fisher’s Exact Test was used to identify significance (p = <0.05) between groups. Results: A total of fourteen group evaluations were included in this analysis, seven CENA TNP groups from 2012 and seven from 2015 (randomly chosen). A total of 173 participant evaluations were collated (n = 81 from 2012 and 92 from 2015). All course evaluations were anonymous, and nine of the original 14 questions were applicable for this evaluation. All questions were rated by participants on a five-point Likert scale. While all items showed improvement from 2012 to 2015, significant improvement was noted in two items. These were in regard to the content being delivered in a way that met participant learning needs and satisfaction with the length and pace of the program. Evaluation of written comments supports these results. Discussion: The aim of redeveloping the CENA TNP was to improve learning and satisfaction for participants. These results demonstrate that initial improvements in 2012 were able to be maintained and in two essential areas significantly improved. Changes that increased participant engagement, support and contextualization of course materials were essential for CENA TNP evolution.

Keywords: emergency nursing education, industry training programs, teaching and learning, trauma education

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Authors: Farzad Masoud Kabir, Jamshid Bagheri, Khosro Barkhordari

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This historical cohort study included 17,751 patients patients who underwent isolated CABG at our center between 2007 and 2016. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. Our findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs.

Keywords: body mass index, surgical outcomes, midterm, cardiac surgery patients

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Authors: Guijie Sang, Geo Davis, Momchil Terziev

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Geological CO2 storage has been regarded as a promising strategy to mitigate the emission of greenhouse gas generated from traditional power stations and energy-intensive industry. Caprocks with very low permeability and ultra-fine pores create viscous and capillary barriers to guarantee CO2 sealing efficiency. However, caprock fractures, either naturally existing or artificially induced due to injection, could provide preferential paths for CO₂ escaping. Seeking an efficient technique to seal and strengthen caprock fractures is crucial. We apply microbial-induced-calcite-precipitation (MICP) technique for sealing and strengthening caprock fractures in the laboratory scale. The MICP bio-grouting technique has several advantages over conventional cement grouting methods, including its low viscosity, micron-size microbes (accessible to fine apertures), and low carbon footprint, among others. Different injection strategies are tested to achieve relatively homogenous calcite precipitation along the fractures, which is monitored dynamically based on laser ultrasonic technique. The MICP process in caprock fractures, which integrates the coupled flow and bio-chemical precipitation, is also modeled and validated through the experiment. The study could provide an effective bio-mediated grouting strategy for caprock sealing and thus ensuring a long-term safe geological CO2 storage.

Keywords: caprock sealing, geological CO2 storage, grouting strategy, microbial induced calcite precipitation

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