Search results for: safe distance

Authors: Josiah O. Carter, Charlotte Hayden, Elizabeth Arthurs

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Background: During the COVID-19 pandemic, hospital management policies have changed frequently and rapidly. This has created novel challenges in keeping the workforce abreast of these changes to enable them to deliver safe and effective care. Traditional communication methods, e.g. email, do not keep pace with the rapidly changing environment in the hospital, resulting in inaccurate, irrelevant, or outdated information being communicated, resulting in inefficiencies in patient care. Methods: The creation of a WhatsApp messaging group within the medical division at the Bristol Royal Infirmary has enabled senior clinicians and the hospital management team to update the medical workforce in real-time. It has two primary functions: (1) To enable dissemination of a concise, important operational summary. This comprises information on bed status and infection control procedural changes. It is fed directly from a daily critical incident briefing (2) To facilitate a monthly scheduled question and answer (Q&A) session for junior doctors to clarify issues with clinical directors, rota, and management staff. Additional ad-hoc updates are sent out for time-critical information; otherwise, it mainly functions as a broadcast-only group to prevent important information from being lost amongst other communication. All junior doctors within the medical division were invited to join the group. At present, the group comprises 131 participants, of which 10 are administrative staff (rota coordinators, management staff & clinical directors); the remaining 121 are junior clinicians working within the medical division. An electronic survey via Microsoft forms was sent out to junior doctors via the WhatsApp group and via email to assess its utilisation and effectiveness with the aim of quality improvements. Results: Of the 121 group participants, 19 completed the questionnaire (response rate 15.7%). Of these, 16/19 (84.2%) used it regularly, and 12/19 (63.2%) rated it as the most useful source for reliable updates relating to the hospital response to the COVID-19 pandemic, whereas only 2/19 (10.5%) found the trust intranet and the trust COVID-19 operational email update most useful. Respondents rated the WhatsApp group more useful as an information source (mean score 7.7/10) than as a means of providing feedback to management staff (mean score 6.3/10). Qualitative feedback suggested information around ward closures and changes to COVID cohorting, along with updates on staffing issues, were most useful. Respondents also noted the Q&A sessions were an efficient way of relaying feedback about management decisions but that it would be preferable if these sessions could be delivered more frequently. Discussion: During the current global COVID-19 pandemic, there is an increased need for rapid dissemination of critical information within NHS trusts; this includes communication between junior doctors, managers, and senior clinicians. The versatility of WhatsApp permits a variety of functions allowing for regular updates, the dissemination of time-critical information, and enables conversing and feedback. The project has demonstrated that reserved and well-managed use of a WhatsApp group is a welcome, efficient and practical means of communication between the senior management team and the junior medical workforce.

Keywords: communication, COVID-19, hospital management, WhatsApp

Procedia PDF Downloads 87

Authors: Anand K. Vinu, Vaishnav Vimal, Sasi Gopalan

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All spacecraft components have a range of allowable temperatures that must be maintained to meet survival and operational requirements during all mission phases. Due to heat absorption, transfer, and emission on one side, the satellite surface presents an asymmetric temperature distribution and causes a change in momentum, which can manifest in spinning and non-spinning satellites in different manners. This problem can cause orbital decays in satellites which, if not corrected, will interfere with its primary objective. The thermal analysis of any satellite requires data from the power budget for each of the components used. This is because each of the components has different power requirements, and they are used at specific times in an orbit. There are three different cases that are run, one is the worst operational hot case, the other one is the worst non-operational cold case, and finally, the operational cold case. Sunlight is a major source of heating that takes place on the satellite. The way in which it affects the spacecraft depends on the distance from the Sun. Any part of a spacecraft or satellite facing the Sun will absorb heat (a net gain), and any facing away will radiate heat (a net loss). We can use the state-of-the-art foldable hybrid insulator/radiator panel. When the panels are opened, that particular side acts as a radiator for dissipating the heat. Here the insulator, in our case, the aerogel, is sandwiched with solar cells and radiator fins (solar cells outside and radiator fins inside). Each insulated side panel can be opened and closed using actuators depending on the telemetry data of the CubeSat. The opening and closing of the panels are dependent on the special code designed for this particular application, where the computer calculates where the Sun is relative to the satellites. According to the data obtained from the sensors, the computer decides which panel to open and by how many degrees. For example, if the panels open 180 degrees, the solar panels will directly face the Sun, in turn increasing the current generator of that particular panel. One example is when one of the corners of the CubeSat is facing or if more than one side is having a considerable amount of sun rays incident on it. Then the code will analyze the optimum opening angle for each panel and adjust accordingly. Another means of cooling is the passive way of cooling. It is the most suitable system for a CubeSat because of its limited power budget constraints, low mass requirements, and less complex design. Other than this fact, it also has other advantages in terms of reliability and cost. One of the passive means is to make the whole chase act as a heat sink. For this, we can make the entire chase out of heat pipes and connect the heat source to this chase with a thermal strap that transfers the heat to the chassis.

Keywords: passive cooling, CubeSat, efficiency, satellite, stationary satellite

Procedia PDF Downloads 67

Authors: Buddha Ratna Shrestha, Jimmy Faivre, Xavier Banquy

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By precisely controlling the molecular interactions between anti-wear macromolecules and bottle-brush lubricating molecules in the solution state, we obtained a fluid with excellent lubricating and wear protection capabilities. The reason for this synergistic behavior relies on the subtle interaction forces between the fluid components which allow the confined macromolecules to sustain high loads under shear without rupture. Our results provide rational guides to design such fluids for virtually any type of surfaces. The lowest friction coefficient and the maximum pressure that it can sustain is 5*10-3 and 2.5 MPa which is close to the physiological pressure. Lubricating and protecting surfaces against wear using liquid lubricants is a great technological challenge. Until now, wear protection was usually imparted by surface coatings involving complex chemical modifications of the surface while lubrication was provided by a lubricating fluid. Hence, we here research for a simple, effective and applicable solution to the above problem using surface force apparatus (SFA). SFA is a powerful technique with sub-angstrom resolution in distance and 10 nN/m resolution in interaction force while performing friction experiment. Thus, SFA is used to have the direct insight into interaction force, material and friction at interface. Also, we always know the exact contact area. From our experiments, we found that by precisely controlling the molecular interactions between anti-wear macromolecules and lubricating molecules, we obtained a fluid with excellent lubricating and wear protection capabilities. The reason for this synergistic behavior relies on the subtle interaction forces between the fluid components which allow the confined macromolecules to sustain high loads under shear without rupture. The lowest friction coefficient and the maximum pressure that it can sustain in our system is 5*10-3 and 2.5 GPA which is well above the physiological pressure. Our results provide rational guides to design such fluids for virtually any type of surfaces. Most importantly this process is simple, effective and applicable method of lubrication and protection as until now wear protection was usually imparted by surface coatings involving complex chemical modifications of the surface. Currently, the frictional data that are obtained while sliding the flat mica surfaces are compared and confirmed that a particular mixture of solution was found to surpass all other combination. So, further we would like to confirm that the lubricating and antiwear protection remains the same by performing the friction experiments in synthetic cartilages.

Keywords: bottle brush polymer, hyaluronic acid, lubrication, tribology

Procedia PDF Downloads 244

Authors: Feng Yue, Fei Dai

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With the rapid development of urbanization process in China, its environmental protection pressure is severely tested. So, analyzing and optimizing the landscape pattern is an important measure to ease the pressure on the ecological environment. This paper takes Wuhan Urban Development Zone as the research object, and studies its landscape pattern evolution and quantitative optimization strategy. First, remote sensing image data from 1990 to 2015 were interpreted by using Erdas software. Next, the landscape pattern index of landscape level, class level, and patch level was studied based on Fragstats. Then five indicators of ecological environment based on National Environmental Protection Standard of China were selected to evaluate the impact of landscape pattern evolution on the ecological environment. Besides, the cost distance analysis of ArcGIS was applied to simulate wildlife migration thus indirectly measuring the improvement of ecological environment quality. The result shows that the area of land for construction increased 491%. But the bare land, sparse grassland, forest, farmland, water decreased 82%, 47%, 36%, 25% and 11% respectively. They were mainly converted into construction land. On landscape level, the change of landscape index all showed a downward trend. Number of patches (NP), Landscape shape index (LSI), Connection index (CONNECT), Shannon's diversity index (SHDI), Aggregation index (AI) separately decreased by 2778, 25.7, 0.042, 0.6, 29.2%, all of which indicated that the NP, the degree of aggregation and the landscape connectivity declined. On class level, the construction land and forest, CPLAND, TCA, AI and LSI ascended, but the Distribution Statistics Core Area (CORE_AM) decreased. As for farmland, water, sparse grassland, bare land, CPLAND, TCA and DIVISION, the Patch Density (PD) and LSI descended, yet the patch fragmentation and CORE_AM increased. On patch level, patch area, Patch perimeter, Shape index of water, farmland and bare land continued to decline. The three indexes of forest patches increased overall, sparse grassland decreased as a whole, and construction land increased. It is obvious that the urbanization greatly influenced the landscape evolution. Ecological diversity and landscape heterogeneity of ecological patches clearly dropped. The Habitat Quality Index continuously declined by 14%. Therefore, optimization strategy based on greenway network planning is raised for discussion. This paper contributes to the study of landscape pattern evolution in planning and design and to the research on spatial layout of urbanization.

Keywords: landscape pattern, optimization strategy, ArcGIS, Erdas, landscape metrics, landscape architecture

Procedia PDF Downloads 135

Authors: Abdolrasoul Daneshjoo

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Introduction: Soccer is a game which draws more attention in different countries especially in Brazil. Kicking among different skills in soccer and soccer players is an excellent role for the success and preference of a team. The way of point gaining in this game is passing the ball over the goal lines which are gained by shoot skill in attack time and or during the penalty kicks.Regarding the above assumption, identifying the effective factors in instep kicking in different distances shoot with maximum force and high accuracy or pass and penalty kick, may assist the coaches and players in raising qualitative level of performing the skill. Purpose: The aim of the present study was to study of a few kinematical parameters in instep kicking from 3 and 5 meter distance among the male and female elite soccer players. Methods: 24 right dominant lower limb subjects (12 males and 12 females) among Tehran elite soccer players with average and the standard deviation (22.5 ± 1.5) & (22.08± 1.31) years, height of (179.5 ± 5.81) & (164.3 ± 4.09) cm, weight of (69.66 ± 4.09) & (53.16 ± 3.51) kg, %BMI (21.06 ± .731) & (19.67 ± .709), having playing history of (4 ± .73) & (3.08 ± .66) years respectively participated in this study. They had at least two years of continuous playing experience in Tehran soccer league.For sampling player's kick; Kinemetrix Motion analysis with three cameras with 500 Hz was used. Five reflective markers were placed laterally on the kicking leg over anatomical points (the iliac crest, major trochanter, lateral epicondyle of femur, lateral malleolus, and lateral aspect of distal head of the fifth metatarsus). Instep kick was filmed, with one step approach and 30 to 45 degrees angle from stationary ball. Three kicks were filmed, one kick selected for further analyses. Using Kinemetrix 3D motion analysis software, the position of the markers was analyzed. Descriptive statistics were used to describe the mean and standard deviation, while the analysis of variance, and independent t-test (P < 0.05) were used to compare the kinematic parameters between two genders. Results and Discussion: Among the evaluated parameters, the knee acceleration, the thigh angular velocity, the angle of knee proportionately showed significant relationship with consequence of kick. While company performance on 5m in 2 genders, significant differences were observed in internal – external displacement of toe, ankle, hip and the velocity of toe, ankle and the acceleration of toe and the angular velocity of pelvic, thigh and before time contact. Significant differences showed the internal – external displacement of toe, the ankle, the knee and the hip, the iliac crest and the velocity of toe, the ankle and acceleration of ankle and angular velocity of the pelvic and the knee.

Keywords: biomechanics, kinematics, soccer, instep kick, male, female

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Authors: A. Kesraoui, M. Seffen

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Applications of adsorption onto activated carbon for water treatment are well known. The process has been demonstrated to be widely effective for removing dissolved organic substances from wastewaters, but this treatment has a major drawback is the high operating cost. The main goal of our research work is to improve the retention capacity of Tunisian biomass for the depollution of industrial wastewater and retention of pollutants considered toxic. The biosorption process is based on the retention of molecules and ions onto a solid surface composed of biological materials. The evaluation of the potential use of these materials is important to propose as an alternative to the adsorption process generally expensive, used to remove organic compounds. Indeed, these materials are very abundant in nature and are low cost. Certainly, the biosorption process is effective to remove the pollutants, but it presents a slow kinetics. The improvement of the biosorption rates is a challenge to make this process competitive with respect to oxidation and adsorption onto lignocellulosic fibers. In this context, the alternating current appears as a new alternative, original and a very interesting phenomenon in the acceleration of chemical reactions. Our main goal is to increase the retention acceleration of dyes (indigo carmine, methylene blue) and phenol by using a new alternative: alternating current. The adsorption experiments have been performed in a batch reactor by adding some of the adsorbents in 150 mL of pollutants solution with the desired concentration and pH. The electrical part of the mounting comprises a current source which delivers an alternating current voltage of 2 to 15 V. It is connected to a voltmeter that allows us to read the voltage. In a 150 mL capacity cell, we plunged two zinc electrodes and the distance between two Zinc electrodes has been 4 cm. Thanks to alternating current, we have succeeded to improve the performance of activated carbon by increasing the speed of the indigo carmine adsorption process and reducing the treatment time. On the other hand, we have studied the influence of the alternating current on the biosorption rate of methylene blue onto Luffa cylindrica fibers and the hybrid material (Luffa cylindrica-ZnO). The results showed that the alternating current accelerated the biosorption rate of methylene blue onto the Luffa cylindrica and the Luffa cylindrica-ZnO hybrid material and increased the adsorbed amount of methylene blue on both adsorbents. In order to improve the removal of phenol, we performed the coupling between the alternating current and the biosorption onto two adsorbents: Luffa cylindrica and the hybrid material (Luffa cylindrica-ZnO). In fact, the alternating current has succeeded to improve the performance of adsorbents by increasing the speed of the adsorption process and the adsorption capacity and reduce the processing time.

Keywords: adsorption, alternating current, dyes, modeling

Procedia PDF Downloads 132

Authors: M. Saard, A. Kolk, K. Sepp, L. Pertens, L. Reinart, C. Kööp

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Introduction: Social competence is often impaired in children with acquired brain injury (ABI), but evidence-based rehabilitation for social skills has remained undeveloped. Modern technology-based methods create effective and safe learning environments for pediatric social skills remediation. The aim of the study was to implement our structured model of neuro rehab for socio-cognitive deficit using multitouch-multiuser tabletop (MMT) computer-based platforms and virtual reality (VR) technology. Methods: 40 children aged 8-13 years (yrs) have participated in the pilot study: 30 with ABI -epilepsy, traumatic brain injury and/or tic disorder- and 10 healthy age-matched controls. From the patients, 12 have completed the training (M = 11.10 yrs, SD = 1.543) and 20 are still in training or in the waiting-list group (M = 10.69 yrs, SD = 1.704). All children performed the first individual and paired assessments. For patients, second evaluations were performed after the intervention period. Two interactive applications were implemented into rehabilitation design: Snowflake software on MMT tabletop and NoProblem on DiamondTouch Table (DTT), which allowed paired training (2 children at once). Also, in individual training sessions, HTC Vive VR device was used with VR metaphors of difficult social situations to treat social anxiety and train social skills. Results: At baseline (B) evaluations, patients had higher deficits in executive functions on the BRIEF parents’ questionnaire (M = 117, SD = 23.594) compared to healthy controls (M = 22, SD = 18.385). The most impaired components of social competence were emotion recognition, Theory of Mind skills (ToM), cooperation, verbal/non-verbal communication, and pragmatics (Friendship Observation Scale scores only 25-50% out of 100% for patients). In Sentence Completion Task and Spence Anxiety Scale, the patients reported a lack of friends, behavioral problems, bullying in school, and social anxiety. Outcome evaluations: Snowflake on MMT improved executive and cooperation skills and DTT developed communication skills, metacognitive skills, and coping. VR, video modelling and role-plays improved social attention, emotional attitude, gestural behaviors, and decreased social anxiety. NEPSY-II showed improvement in Affect Recognition [B = 7, SD = 5.01 vs outcome (O) = 10, SD = 5.85], Verbal ToM (B = 8, SD = 3.06 vs O = 10, SD = 4.08), Contextual ToM (B = 8, SD = 3.15 vs O = 11, SD = 2.87). ToM Stories test showed an improved understanding of Intentional Lying (B = 7, SD = 2.20 vs O = 10, SD = 0.50), and Sarcasm (B=6, SD = 2.20 vs O = 7, SD = 2.50). Conclusion: Neurorehabilitation based on the Structured Model of Neurorehab for Socio-Cognitive Deficit in children with ABI were effective in social skills remediation. The model helps to understand theoretical connections between components of social competence and modern interactive computerized platforms. We encourage therapists to implement these next-generation devices into the rehabilitation process as MMT and VR interfaces are motivating for children, thus ensuring good compliance. Improving children’s social skills is important for their and their families’ quality of life and social capital.

Keywords: acquired brain injury, children, social skills deficit, technology-based neurorehabilitation

Procedia PDF Downloads 100

Authors: Gintare Judzentyte

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The present research is aimed to discuss semantics and pragmatics of spatial deictics (deictic adverbs of place and demonstrative pronouns) in the Baltic languages: in spoken Lithuanian and in spoken Latvian. The following objectives have been identified to achieve the aim: 1) to determine the usage of adverbs of place in spoken Lithuanian and Latvian and to verify their meanings in face-to-face communication; 2) to determine the usage of demonstrative pronouns in spoken Lithuanian and Latvian and to verify their meanings in face-to-face communication; 3) to compare the systems between the two spoken languages and to identify the main tendencies. As meanings of demonstratives (adverbs of place and demonstrative pronouns) are context-bound, it is necessary to verify their usage in spontaneous interaction. Besides, deictic gestures play a very important role in face-to-face communication. Therefore, an experimental method is necessary to collect the data. Video material representing spoken Lithuanian and spoken Latvian was recorded by means of the method of a qualitative interview (a semi-structured interview: an empirical research is all about asking right questions). The collected material was transcribed and evaluated taking into account several approaches: 1) physical distance (location of the referent, visual accessibility of the referent); 2) deictic gestures (the combination of language and gesture is especially characteristic of the exophoric use); 3) representation of mental spaces in physical space (a speaker sometimes wishes to mark something that is psychically close as psychologically distant and vice versa). The research of the collected data revealed that in face-to-face communication the participants choose deictic adverbs of place instead of demonstrative pronouns to locate/identify entities in situations where the demonstrative pronouns would be expected in spoken Lithuanian and in spoken Latvian. The analysis showed that visual accessibility of the referent is very important in face-to-face communication, but the main criterion while localizing objects and entities is the need for contrast: lith. čia ‘here’, šis ‘this’, latv. šeit ‘here’, šis ‘this’ usually identify distant entities and are used instead of distal demonstratives (lith. ten ‘there’, tas ‘that’, latv. tur ‘there’, tas ‘that’), because the referred objects/subjects contrast to further entities. Furthermore, the interlocutors in examples from a spontaneously situated interaction usually extend their space and can refer to a ‘distal’ object/subject with a ‘proximal’ demonstrative based on the psychological choice. As the research of the spoken Baltic languages confirmed, the choice of spatial deictics in face-to-face communication is strongly effected by a complex of criteria. Although there are some main tendencies, the exact meaning of spatial deictics in the spoken Baltic languages is revealed and is relevant only in a certain context.

Keywords: Baltic languages, face-to-face communication, pragmatics, semantics, spatial deictics

Procedia PDF Downloads 262

Authors: Vixen Joshua Tan, Siyuan He

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Scanners have been implemented within single point laser rangefinders, to determine the ranges within an environment by sweeping the laser spot across the surface of interest. The research motivation is to exploit a smaller and cheaper alternative scanning component for the emitting portion within current designs of laser rangefinders. This research implements an FPCB (Flexible Programmable Circuit Board) Electromagnetic 1-Dimensional scanning micro-mirror as a scanning component for laser rangefinding by means of triangulation. The prototype uses a laser module, micro-mirror, and receiver. The laser module is infrared (850 nm) with a power output of 4.5 mW. The receiver consists of a 50 mm convex lens and a 45mm 1-dimensional PSD (Position Sensitive Detector) placed at the focal length of the lens at 50 mm. The scanning component is an elliptical Micro-Mirror attached onto an FPCB Structure. The FPCB structure has two miniature magnets placed symmetrically underneath it on either side, which are then electromagnetically actuated by small solenoids, causing the FPCB to mechanically rotate about its torsion beams. The laser module projects a laser spot onto the micro-mirror surface, hence producing a scanning motion of the laser spot during the rotational actuation of the FPCB. The receiver is placed at a fixed distance from the micro-mirror scanner and is oriented to capture the scanning motion of the laser spot during operation. The elliptical aperture dimensions of the micro-mirror are 8mm by 5.5 mm. The micro-mirror is supported by an FPCB with two torsion beams with dimensions of 4mm by 0.5mm. The overall length of the FPCB is 23 mm. The voltage supplied to the solenoids is sinusoidal with an amplitude of 3.5 volts and 4.5 volts to achieve optical scanning angles of +/- 10 and +/- 17 degrees respectively. The operating scanning frequency during experiments was 5 Hz. For an optical angle of +/- 10 degrees, the prototype is capable of detecting objects within the ranges from 0.3-1.2 meters with an error of less than 15%. As for an optical angle of +/- 17 degrees the measuring range was from 0.3-0.7 meters with an error of 16% or less. Discrepancy between the experimental and actual data is possibly caused by misalignment of the components during experiments. Furthermore, the power of the laser spot collected by the receiver gradually decreased as the object was placed further from the sensor. A higher powered laser will be tested to potentially measure further distances more accurately. Moreover, a wide-angled lens will be used in future experiments when higher scanning angles are used. Modulation within the current and future higher powered lasers will be implemented to enable the operation of the laser rangefinder prototype without the use of safety goggles.

Keywords: FPCB electromagnetic 1-D scanning micro-mirror, laser rangefinder, position sensitive detector, PSD, triangulation

Procedia PDF Downloads 115

Authors: Dahna Alkahtani, Faryal Suraya, Fadah Alanazi

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Background: Buccal mucosal graft for urethral augmentation has surpassed other grafting options, and is now considered the standard of choice for substitution Urethroplasty. The graft has gained its popularity due to its excellent short and long-term results, easy harvesting as well as its ability in withstanding wet environments. However, although Buccal mucosal grafts are an excellent option, it is not free of complications, potential intraoral complications are bleeding, pain, swelling, injury to the nerve resulting in numbness, lip deviation or retraction. Objectives: The current study aims to evaluate the intraoral complications of buccal mucosa grafts harvested from one cheek, and used in Augmentation Urethroplasty. Methodology: The study was conducted retrospectively using the medical records of patients who underwent open augmentation urethroplasty with a buccal mucosa graft at King Khalid University Hospital, Saudi Arabia. Data collection of demographics included the type of graft used, presence or absence of strictures and its etiological factors. Pre-operative and post-operative evaluations were carried out on the subjects including the medical history, physical examination, uroflowmetry, retrograde urethrography, voiding cystourethrography and urine cultures were also noted. Further, the quality of life and complications of the procedure including the presence or occurrence of bleeding within 3-days post-procedure, the severity of pain, oral swelling after grafting, length of return to normal daily diet, painful surgical site, intake of painkillers, presence or absence of speech disturbance, numbness in the cheeks and lips were documented. Results: Thirty-two male subjects with ages ranging from 15 years to 72 years were included in the current study. Following the procedure, a hundred percent of the subjects returned to their normal daily diet by the sixth postoperative day. Further, the majority of the patients reported experiencing mild pain accounting for 61.3%, and 90.3% of the subjects reported using painkillers to control the pain. Surgical wound Pain was reportedly more common at the perineal site as 48.4% of the subjects experienced it; on the other hand, 41.9% of the patients experienced pain in the oral mucosa. The presence of speech disorders, as assessed through medical history, was found to be present in 3.2% of patients. The presence of numbness in the cheeks and lips was found in 3.2% of patients. Other complications such as parotid duct injury, delayed wound healing, non-healing wound and suture granuloma were rare as 90.3% of the subjects denied experiencing any of them, there were nonetheless reports of parotid duct injury by 6.5% of the patients, and non-healing wound by the 3.2% of patients. Conclusion: Buccal Mucosa Graft in Augmentation Urethroplasty is an ideal source of allograft, although not entirely painless; it is considerably safe with minimal intra-oral complication and undetectable strain on the patients’ quality of life.

Keywords: augmentation, buccal, graft, oral

Procedia PDF Downloads 153

Authors: Vijayabhaskar Reddy Kandula, Peter Provost Taillac, Balasubramanya M. A., Ram Krishnan Nair, Gokul Toshnival, Vibhu Dhawan, Vijaya Karanam, Buffy Cramer

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Introduction: The lack of Emergency Care Services (ECS) is a cause of extensive and serious public health problems in low- and middle-income countries (LMIC), Many LMIC countries have ambulance services that allow timely transfer of ill patients but due to poor care during the ‘Golden Hour’ many deaths occur which are otherwise preventable. Lack of adequate training as evidenced by a study in India is a major reason for poor care during the ‘Golden Hour’. Adapting developed country models which includes staffing specialty-trained doctors in emergency care, is neither feasible nor guarantees cost-effective ECS. Methods: Based on our assessment and felt needs by first-line doctors providing emergency care in 2014, Rajiv Gandhi Health Sciences University’s JeevaRaksha Trust in partnership with the University of Utah, USA, designed, piloted and successfully implemented a 4-day Comprehensive-Emergency Care and Life Support course (C-ECLS) for allopathic doctors. 1730 doctors completed the 4-day course between June 2014 and December- 2020. Subsequently, we conducted a survey to investigate the utilization rates and usefulness of the training. 1662 were contacted but only 309 completed the survey. The respondents had the following designations: Senior faculty (33%), junior faculty (25), Resident (16%), Private-Practitioners (8%), Medical-Officer (16%) and not-working (11%). 51% were generalists (51%) and the rest were specialists (>30 specialties). Results: 97% (271/280) felt they are better doctors because of C-ECLS. 79% (244/309) reported that training helped to save life- specialists more likely than generalists (91% v/s 68%. P<0.05). 64% agreed that they were confident of managing COVID-19 symptomatic patients better because of C-ECLS. 27% (77) were neutral; 9% (24) disagreed. 66% agreed that training helps to be confident in managing COVID-19 critically ill patients. 26% (72) were neutral; 8% (23) disagreed. Frequency of use of C-ECLS skills: Hemorrhage-control (70%), Airway (67%), circulation skills (62%), Safe-transport and communication (60%), managing critically ill patients (58%), cardiac arrest (51%), Trauma (49%), poisoning/animal bites/stings (44%), neonatal-resuscitation (39%), breathing (36%), post-partum-hemorrhage and eclampsia (35%). Among those who used the skills, the majority (ranging from (88%-94%) reported that they were able to apply the skill more effectively because of ECLS training. Conclusion: JeevaRaksha’s C-ECLS is the world’s first comprehensive training. It improves the confidence of front-line doctors and enables them to provide quality care during the ‘Golden Hour’ of emergency. It also prepares doctors to manage unknown emergencies (e.g., COVID-19). C-ECLS was piloted in Morocco, and Uzbekistan and implemented countrywide in Bhutan. C-ECLS is relevant to most settings and offers a replicable model across LMIC.

Keywords: comprehensive emergency care and life support, training, capacity building, low- and middle-income countries, developing countries

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Authors: A. Drapeaux, S. Aviles, E. Garfoot

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Stem cell injections are a promising alternative treatment for hip osteoarthritis. Current literature has focused on short-term outcomes for both knee and hip osteoarthritis; however, there is a significant gap for longitudinal benefits for hip OA and limited firm conclusions due to small sample sizes. The purpose of this prospective study was to determine longitudinal changes in pain, function, and radiographs following bone marrow concentrate injection (BMAC) into the osteoarthritic hip joint. Methods: A prospective, cross-sectional study was conducted over the course of 12 months at an orthopedic practice. The study recruited 15 osteoarthritic pre-surgical hips with mild to moderate osteoarthritic severity who were scheduled to undergo hip arthroscopy. Data was collected at both pre-operative and post-operative time frames. Data collected included: hip radiographs, i-HOT-33 questionnaire data, BMAC autologous volume, and demographics. Questionnaire data was captured using Qualtrics XM software, and participants were sent an anonymous link at the following time frames: pre-operative, 2 weeks, 6 weeks, 12 weeks, 6 months, 12 months, and 24 months. Radiographic changes and BMAC volume were collected and reviewed by an orthopedic surgeon and sent to the primary investigator. Data was exported and analyzed in IBM-SPSS. Results: A total of 15 hips from 15 participants (mean age: 49, gender: 50% males, 50% females, BMI: 29.7) were used in the final analysis. Summative i-HOT 33 mean scores significantly changed between pre-operative status and 2-6 weeks post-operative status (p <.001) and pre-operative status and 3-6 months post-operative status (p <.001). There were no significant changes between other post-operative phases or between pre-operative status and 12 months post-operative. Significant improvements were found between summative i-HOT 33 mean (p<.001), daily pain (p<.001), daily sitting (p=.02), daily distance walked (p =.003), and daily limp (p=0.03) and post-operative status (2-6 weeks). No significant differences between demographic variables (gender, age, tobacco use, or diabetes) and i-HOT 33 summative mean scores. Discussion/Implications: The purpose of this study was to determine longitudinal changes in pain and function following a hip joint bone marrow concentrate injection. Results indicate that participants experience a significant improvement in pain and function between pre-operative and 2-6 weeks and 3-6 months post-injection. Participants also self-reported a significant change in average daily pain with sitting and walking between pre-operation and 2-6 weeks post-operative. This study includes a larger sample size of hip osteoarthritis cases; however, future research is warranted to include random controlled trials with a larger sample size.

Keywords: adult stem cell, orthopedics, osteoarthritis (hip), patient outcome assessment

Procedia PDF Downloads 35

Authors: Cao Bin, Yuan Yi, Wang Qiang, Amor Abdelkader, Ali Reza Kamali, Diogo Montalvão

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The study of the electrodynamic behavior of non-ferrous particles in time-varying magnetic fields is a promising area of research with wide applications, including recycling of non-ferrous metals, mechanical transmission, and space debris. The key technology for recovering non-ferrous metals is eddy current separation (ECS), which utilizes the eddy current force and torque to separate non-ferrous metals. ECS has several advantages, such as low energy consumption, large processing capacity, and no secondary pollution, making it suitable for processing various mixtures like electronic scrap, auto shredder residue, aluminum scrap, and incineration bottom ash. Improving the separation efficiency of mixtures with different particle sizes in ECS can create significant social and economic benefits. Our previous study investigated the influence of particle size on separation efficiency by combining numerical simulations and separation experiments. Pearson correlation analysis found a strong correlation between the eddy current force in simulations and the repulsion distance in experiments, which confirmed the effectiveness of our simulation model. The interaction effects between particle size and material type, rotational speed, and magnetic pole arrangement were examined. It offer valuable insights for the design and optimization of eddy current separators. The underlying mechanism behind the effect of particle size on separation efficiency was discovered by analyzing eddy current and field gradient. The results showed that the magnitude and distribution heterogeneity of eddy current and magnetic field gradient increased with particle size in eddy current separation. Based on this, we further found that increasing the curvature of magnetic field lines within particles could also increase the eddy current force, providing a optimized method to improving the separation efficiency of fine particles. By combining the results of the studies, a more systematic and comprehensive set of optimization guidelines can be proposed for mixtures with different particle size ranges. The separation efficiency of fine particles could be improved by increasing the rotational speed, curvature of magnetic field lines, and electrical conductivity/density of materials, as well as utilizing the eddy current torque. When designing an ECS, the particle size range of the target mixture should be investigated in advance, and the suitable parameters for separating the mixture can be fixed accordingly. In summary, these results can guide the design and optimization of ECS, and also expand the application areas for ECS.

Keywords: eddy current separation, particle size, numerical simulation, metal recovery

Procedia PDF Downloads 52

Authors: Naava Dihi, Jon Anson

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Love, so it appears, is not socially blind. We show that partner selection is socially constrained, and the freedom to choose is limited by at least two major factors or capitals: on the one hand, material resources and education, locating the partners on a scale of personal achievement and economic independence. On the other, the partners' ascriptive belonging to particular ethnic, or origin, groups, differentiated by the groups' social prestige, as well as by their culture, history and even physical characteristics. However, the relative importance of achievement and ascriptive factors, as well as the overlap between them, varies from society to society, depending on the society's structure and the factors shaping it. Israeli social structure has been shaped by the waves of new immigrants who arrived over the years. The timing of their arrival, their patterns of physical settlement and their occupational inclusion or exclusion have together created a mosaic of social groups whose principal common feature has been the country of origin from which they arrived. The analysis of marriage patterns helps illuminate the social meanings of the groups and their borders. To the extent that ethnic group membership has meaning for individuals and influences their life choices, the ascriptive factor will gain in importance relative to the achievement factor in their choice of marriage partner. In this research, we examine Jewish Israeli marriage patterns by looking at the marriage choices of 5,041 women aged 15 to 49 who were single at the census in 1983, and who were married at the time of the 1995 census, 12 years later. The database for this study was a file linking respondents from the 1983 and the 1995 censuses. In both cases, 5 percent of household were randomly chosen, so that our sample includes about 4 percent of women in Israel in 1983. We present three basic analyses: (1) Who was still single in 1983, using personal and household data from the 1983 census (binomial model), (2) Who married between 1983 and a1995, using personal and household data from the 1983 census (binomial model), (3) What were the personal characteristics of the womens’ partners in 1995, using data from the 1995 census (loglinear model). We show (i) that material and cultural capital both operate to delay marriage and to increase the probability of remaining single; and (ii) while there is a clear association between ethnic group membership and education, endogamy and homogamy both operate as separate forces which constraint (but do not determine) the choice of marriage partner, and thus both serve to reproduce the current pattern of relationships, as well as identifying patterns of proximity and distance between the different groups.

Keywords: Israel, nuptiality, ascription, achievement

Procedia PDF Downloads 92

Authors: Julia Wimmers Klick

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Interprofessional Education (IPE) is widely recognized as a valuable approach in healthcare education, despite the challenges it presents. This study explores IP surface anatomy lab sessions, with a focus on fostering trust and collaboration among healthcare students. The research is conducted within the context of rural healthcare settings in British Columbia (BC), where a medical school and a physical therapy (PT) program operate under the Faculty of Medicine at the University of British Columbia (UBC). While IPE sessions addressing soft skills have been implemented, the integration of hard skills, such as Anatomy, remains limited. To address this gap, a pilot feasibility study was conducted with a positive outcome, a follow-up study involved these IPE sessions aimed at exploring the influence of bonding and trust between medical and PT students. Data were collected through focus groups comprising participating students and faculty members, and a structured SWOC (Strengths, Weaknesses, Opportunities, and Challenges) analysis was conducted. The IPE sessions, 3 in total, consisted of a 2.5-hour lab on surface anatomy, where PT students took on the teaching role, and medical students were newly exposed to surface anatomy. The focus of the study was on the relationship-building process and trust development between the two student groups, rather than assessing the acquisition of surface anatomy skills. Results indicated that the surface anatomy lab served as a suitable tool for the application and learning of soft skills. Faculty members observed positive outcomes, including productive interaction between students, reversed hierarchy with PT students teaching medical students, practicing active listening skills, and using a mutual language of anatomy. Notably, there was no grade assessment or external pressure to perform. The students also reported an overall positive experience; however, the specific impact on the development of soft skill competencies could not be definitively determined. Participants expressed a sense of feeling respected, welcomed, and included, all of which contributed to feeling safe. Within the small group environment, students experienced becoming a part of a community of healthcare providers that bonded over a shared interest in health professions education. They enjoyed sharing diverse experiences related to learning across their varied contexts, without fear of judgment and reprisal that were often intimidating in single professional contexts. During a joint Christmas party for both cohorts, faculty members observed students mingling, laughing, and forming bonds. This emphasized the importance of early bonding and trust development among healthcare colleagues, particularly in rural settings. In conclusion, the findings emphasize the potential of IPE sessions to enhance trust and collaboration among healthcare students, with implications for their future professional lives in rural settings. Early bonding and trust development are crucial in rural settings, where healthcare professionals often rely on each other. Future research should continue to explore the impact of content-concentrated IPE on the development of soft skill competencies.

Keywords: interprofessional education, rural healthcare settings, trust, surface anatomy

Procedia PDF Downloads 45

Authors: Sadao Araki, Daisuke Gondo, Satoshi Imasaka, Hideki Yamamoto

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The separation of organic compounds from aqueous solutions is a key technology for recycling valuable organic compounds and for the treatment of wastewater. The wastewater from chemical plants often contains organic compounds such as ethyl acetate (EA), methylethyl ketone (MEK) and isopropyl alcohol (IPA). In this study, we prepared hydrophobic silica membranes by a sol-gel method. We used phenyltrimethoxysilane (PhTMS), ethyltrimethoxysilan (ETMS), Propyltrimethoxysilane (PrTMS), N-butyltrimethoxysilane (BTMS), N-Hexyltrimethoxysilane (HTMS) as silica sources to introduce each functional groups on the membrane surface. Cetyltrimethyl ammonium bromide (CTAB) was used as a molecular template to create suitable pore that enable the permeation of organic compounds. These membranes with five different functional groups were characterized by SEM, FT-IR, and permporometry. Thicknesses and pore diameters of silica layer for all membrane were about 1.0 μm and about 1 nm, respectively. In other words, functional groups had an insignificant effect on the membrane thicknesses and the formation of the pore by CTAB. We confirmed the effect of functional groups on the flux and separation factor for ethyl acetate (EA), methyl ethyl ketone, acetone and 1-butanol (1-BtOH) /water mixtures. All membranes showed a high flux for ethyl acetate compared with other compounds. In particular, the hydrophobic silica membrane prepared by using BTMS showed 0.75 kg m-2 h-1 of flux for EA. For all membranes, the fluxes of organic compounds showed the large values in the order corresponding to EA > MEK > acetone > 1-BtOH. On the other hand, carbon chain length of functional groups among ETMS, PrTMS, BTMS, PrTMS and HTMS did not have a major effect on the organic flux. Although we confirmed the relationship between organic fluxes and organic molecular diameters or fugacity of organic compounds, these factors had a low correlation with organic fluxes. It is considered that these factors affect the diffusivity. Generally, permeation through membranes is based on the diffusivity and solubility. Therefore, it is deemed that organic fluxes through these hydrophobic membranes are strongly influenced by solubility. We tried to estimate the organic fluxes by Hansen solubility parameter (HSP). HSP, which is based on the cohesion energy per molar volume and is composed of dispersion forces (δd), intermolecular dipole interactions (δp), and hydrogen-bonding interactions (δh), has recently attracted attention as a means for evaluating the resolution and aggregation behavior. Evaluation of solubility for two substances can be represented by using the Ra [(MPa)1/2] value, meaning the distance of HSPs for both of substances. A smaller Ra value means a higher solubility for each substance. On the other hand, it can be estimated that the substances with large Ra value show low solubility. We established the correlation equation, which was based on Ra, of organic flux at low concentrations of organic compounds and at 295-325 K.

Keywords: hydrophobic, membrane, Hansen solubility parameter, functional group

Procedia PDF Downloads 346

Authors: C. D. Ellis, H. Xia, X. Chen

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Experimental and computational studies investigating heat transfer in separated flows have been of increasing importance over the last 60 years, as efforts are being made to understand and improve the efficiency of components such as combustors, turbines, heat exchangers, nuclear reactors and cooling channels. Understanding of not only the time-mean heat transfer properties but also the unsteady properties is vital for design of these components. As computational power increases, more sophisticated methods of modelling these flows become available for use. The hybrid LES-RANS approach has been applied to a blunt leading edge flat plate, utilising a structured grid at a moderate Reynolds number of 20300 based on the plate thickness. In the region close to the wall, the RANS method is implemented for two turbulence models; the one equation Spalart-Allmaras model and Menter’s two equation SST k-ω model. The LES region occupies the flow away from the wall and is formulated without any explicit subgrid scale LES modelling. Hybridisation is achieved between the two methods by the blending of the nearest wall distance. Validation of the flow was obtained by assessing the mean velocity profiles in comparison to similar studies. Identifying the vortex structures of the flow was obtained by utilising the λ2 criterion to identify vortex cores. The qualitative structure of the flow compared with experiments of similar Reynolds number. This identified the 2D roll up of the shear layer, breaking down via the Kelvin-Helmholtz instability. Through this instability the flow progressed into hairpin like structures, elongating as they advanced downstream. Proper Orthogonal Decomposition (POD) analysis has been performed on the full flow field and upon the surface temperature of the plate. As expected, the breakdown of POD modes for the full field revealed a relatively slow decay compared to the surface temperature field. Both POD fields identified the most energetic fluctuations occurred in the separated and recirculation region of the flow. Latter modes of the surface temperature identified these levels of fluctuations to dominate the time-mean region of maximum heat transfer and flow reattachment. In addition to the current research, work will be conducted in tracking the movement of the vortex cores and the location and magnitude of temperature hot spots upon the plate. This information will support the POD and statistical analysis performed to further identify qualitative relationships between the vortex dynamics and the response of the surface heat transfer.

Keywords: heat transfer, hybrid LES-RANS, separated and reattached flow, vortex dynamics

Procedia PDF Downloads 204

Authors: Lauren G. Coggins

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Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) are among the most common healthcare-associated infections (HAI), contributing to prolonged lengths of stay, greater costs of patient care, and increased patient mortality. Evidence-based preventative care bundles exist to establish consistent, safe patient-care practices throughout an entire organization, helping to ensure the collective application of care strategies that aim to improve patient outcomes and minimize complications. The cardiac intensive care unit at a nationally ranked teaching and research hospital in the United States exceeded its annual CAUTI and CLABSI targets in the fiscal year 2019, prompting examination into the unit’s infection prevention efforts that included preventative care bundles for both HAIs. Adherence to the CAUTI and CLABSI preventative care bundles was evaluated through frequent audits conducted over three months, using standards and resources from The Joint Commission, a globally recognized leader in quality improvement in healthcare and patient care safety. The bundle elements with the lowest scores were identified as the most commonly missed elements. Three elements from both bundles, six elements in total, served as key content areas for the educational interventions targeted to bedside nurses. The CAUTI elements included appropriate urinary catheter order, appropriate continuation criteria, and urinary catheter care. The CLABSI elements included primary tubing compliance, needleless connector compliance, and dressing change compliance. An integrated, multi-platform education campaign featured content on each CAUTI and CLABSI preventative care bundle in its entirety, with additional reinforcement focused on the lowest scoring elements. One-on-one educational materials included an informational pamphlet, badge buddy, a presentation to reinforce nursing care standards, and real-time application through case studies and electronic health record demonstrations. A digital hub was developed on the hospital’s Intranet for quick access to unit resources, and a bulletin board helped track the number of days since the last CAUTI and CLABSI incident. Audits continued to be conducted throughout the education campaign, and staff were given real-time feedback to address any gaps in adherence. Nearly every nurse in the cardiac intensive care unit received all educational materials, and adherence to all six key bundle elements increased after the implementation of educational interventions. Recommendations from this implementation include providing consistent, comprehensive education across multiple teaching tools and regular audits to track adherence. The multi-platform education campaign brought focus to the evidence-based CAUTI and CLABSI bundles, which in turn will help to reduce CAUTI and CLABSI rates in clinical practice.

Keywords: education, healthcare-associated infections, infection, nursing, prevention

Procedia PDF Downloads 88

Authors: Ali Abdul Kadhim, Fue Lien

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Solid particle distribution on an impingement surface has been simulated utilizing a graphical processing unit (GPU). In-house computational fluid dynamics (CFD) code has been developed to investigate a 3D turbulent impinging jet using the lattice Boltzmann method (LBM) in conjunction with large eddy simulation (LES) and the multiple relaxation time (MRT) models. This paper proposed an improvement in the LBM-cellular automata (LBM-CA) probabilistic method. In the current model, the fluid flow utilizes the D3Q19 lattice, while the particle model employs the D3Q27 lattice. The particle numbers are defined at the same regular LBM nodes, and transport of particles from one node to its neighboring nodes are determined in accordance with the particle bulk density and velocity by considering all the external forces. The previous models distribute particles at each time step without considering the local velocity and the number of particles at each node. The present model overcomes the deficiencies of the previous LBM-CA models and, therefore, can better capture the dynamic interaction between particles and the surrounding turbulent flow field. Despite the increasing popularity of LBM-MRT-CA model in simulating complex multiphase fluid flows, this approach is still expensive in term of memory size and computational time required to perform 3D simulations. To improve the throughput of each simulation, a single GeForce GTX TITAN X GPU is used in the present work. The CUDA parallel programming platform and the CuRAND library are utilized to form an efficient LBM-CA algorithm. The methodology was first validated against a benchmark test case involving particle deposition on a square cylinder confined in a duct. The flow was unsteady and laminar at Re=200 (Re is the Reynolds number), and simulations were conducted for different Stokes numbers. The present LBM solutions agree well with other results available in the open literature. The GPU code was then used to simulate the particle transport and deposition in a turbulent impinging jet at Re=10,000. The simulations were conducted for L/D=2,4 and 6, where L is the nozzle-to-surface distance and D is the jet diameter. The effect of changing the Stokes number on the particle deposition profile was studied at different L/D ratios. For comparative studies, another in-house serial CPU code was also developed, coupling LBM with the classical Lagrangian particle dispersion model. Agreement between results obtained with LBM-CA and LBM-Lagrangian models and the experimental data is generally good. The present GPU approach achieves a speedup ratio of about 350 against the serial code running on a single CPU.

Keywords: CUDA, GPU parallel programming, LES, lattice Boltzmann method, MRT, multi-phase flow, probabilistic model

Procedia PDF Downloads 179

Authors: Alisa Salimova, Jiane Zuo, Christopher Homer

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The objective of this study is to analyse the North Canal riparian zone land use with the help of remote sensing analysis in ArcGis using 30 cloudless Landsat8 open-source satellite images from May to August of 2013 and 2017. Land cover, urban construction, heat island effect, vegetation cover, and water system change were chosen as the main parameters and further analysed to evaluate its impact on the North Canal water quality. The methodology involved the following steps: firstly, 30 cloudless satellite images were collected from the Landsat TM image open-source database. The visual interpretation method was used to determine different land types in a catchment area. After primary and secondary classification, 28 land cover types in total were classified. Visual interpretation method was used with the help ArcGIS for the grassland monitoring, US Landsat TM remote sensing image processing with a resolution of 30 meters was used to analyse the vegetation cover. The water system was analysed using the visual interpretation method on the GIS software platform to decode the target area, water use and coverage. Monthly measurements of water temperature, pH, BOD, COD, ammonia nitrogen, total nitrogen and total phosphorus in 2013 and 2017 were taken from three locations of the North Canal in Tongzhou district. These parameters were used for water quality index calculation and compared to land-use changes. The results of this research were promising. The vegetation coverage of North Canal riparian zone in 2017 was higher than the vegetation coverage in 2013. The surface brightness temperature value was positively correlated with the vegetation coverage density and the distance from the surface of the water bodies. This indicates that the vegetation coverage and water system have a great effect on temperature regulation and urban heat island effect. Surface temperature in 2017 was higher than in 2013, indicating a global warming effect. The water volume in the river area has been partially reduced, indicating the potential water scarcity risk in North Canal watershed. Between 2013 and 2017, urban residential, industrial and mining storage land areas significantly increased compared to other land use types; however, water quality has significantly improved in 2017 compared to 2013. This observation indicates that the Tongzhou Water Restoration Plan showed positive results and water management of Tongzhou district had been improved.

Keywords: North Canal, land use, riparian vegetation, river ecology, remote sensing

Procedia PDF Downloads 84

Authors: Jason Blair, Adeboye Adebayo, Mohamed Saad, Jeannette M. Byrne, Fabien A. Basset

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Running economy is a key physiological parameter of an individual’s running efficacy and a valid tool for predicting performance outcomes. Of the many factors known to influence running economy (RE), footwear certainly plays a role owing to its characteristics that vary substantially from model to model. Although minimalist footwear is believed to enhance RE and thereby endurance performance, conclusive research reports are scarce. Indeed, debates remain as to which footwear characteristics most alter RE. The purposes of this study were, therefore, two-fold: (a) to determine whether wearing minimalist shoes results in better RE compared to shod and to identify relationships with kinematic and muscle activation patterns; (b) to determine whether changes in RE with minimalist shoes are still evident following a fatiguing bout of exercise. Well-trained male distance runners (n=10; 29.0 ± 7.5 yrs; 71.0 ± 4.8 kg; 176.3 ± 6.5 cm) partook first in a maximal O₂ uptake determination test (VO₂ₘₐₓ = 61.6 ± 7.3 ml min⁻¹ kg⁻¹) 7 days prior to the experimental sessions. Second, in a fully randomized fashion, an RE test consisting of three 8-min treadmill runs in shod and minimalist footwear were performed prior to and following exercise induced fatigue (EIF). The minimalist and shod conditions were tested with a minimum of 7-day wash-out period between conditions. The RE bouts, interspaced by 2-min rest periods, were run at 2.79, 3.33, and 3.89 m s⁻¹ with a 1% grade. EIF consisted of 7 times 1000 m at 94-97% VO₂ₘₐₓ interspaced with 3-min recovery. Cardiorespiratory, electromyography (EMG), kinematics, rate of perceived exertion (RPE) and blood lactate were measured throughout the experimental sessions. A significant main speed effect on RE (p=0.001) and stride frequency (SF) (p=0.001) was observed. The pairwise comparisons showed that running at 2.79 m s⁻¹ was less economic compared to 3.33, and 3.89 m s⁻¹ (3.56 ± 0.38, 3.41 ± 0.45, 3.40 ± 0.45 ml O₂ kg⁻¹ km⁻¹; respectively) and that SF increased as a function of speed (79 ± 5, 82 ± 5, 84 ± 5 strides min⁻¹). Further, EMG analyses revealed that root mean square EMG significantly increased as a function of speed for all muscles (Biceps femoris, Gluteus maximus, Gastrocnemius, Tibialis anterior, Vastus lateralis). During EIF, the statistical analysis revealed a significant main effect of time on lactate production (from 2.7 ± 5.7 to 11.2 ± 6.2 mmol L⁻¹), RPE scores (from 7.6 ± 4.0 to 18.4 ± 2.7) and peak HR (from 171 ± 30 to 181 ± 20 bpm), expect for the recovery period. Surprisingly, a significant main footwear effect was observed on running speed during intervals (p=0.041). Participants ran faster with minimalist shoes compared to shod (3:24 ± 0:44 min [95%CI: 3:14-3:34] vs. 3:30 ± 0:47 min [95%CI: 3:19-3:41]). Although EIF altered lactate production and RPE scores, no other effect was noticeable on RE, EMG, and SF pre- and post-EIF, except for the expected speed effect. The significant footwear effect on running speed during EIF was unforeseen but could be due to shoe mass and/or heel-toe-drop differences. We also cannot discard the effect of speed on foot-strike pattern and therefore, running performance.

Keywords: exercise-induced fatigue, interval training, minimalist footwear, running economy

Procedia PDF Downloads 215

Authors: Olivier Mills, Bernard McDonell, Laura A. S. MacDonald

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The increasing availability and quality of internet access throughout the developing world provides an opportunity to utilize online spaces to disseminate water, sanitation and hygiene (WASH) knowledge to practitioners. Since 2001, CAWST has provided in-person education, training and consulting services to thousands of WASH practitioners all over the world, supporting them to start, troubleshoot, improve and expand their WASH projects. As CAWST continues to grow, the organization faces challenges in meeting demand from clients and in providing consistent, timely technical support. In 2012, CAWST began utilizing online spaces to expand its reach by developing a series of resources websites and webinars. CAWST has developed a WASH Education and Training resources website, a Biosand Filter (BSF) Knowledge Base, a Household Water Treatment and Safe Storage Knowledge Base, a mobile app for offline users, a live chat support tool, a WASH e-library, and a series of webinar-style online training sessions to complement its in-person capacity development services. In order to determine the preliminary outcomes of providing these online services, CAWST has monitored and analyzed registration to the online spaces, downloads of the educational materials, and webinar attendance; as well as conducted user surveys. The purpose of this analysis was to find out who was using the online spaces, where users came from, and how the resources were being used. CAWST’s WASH Resources website has served over 5,800 registered users from 3,000 organizations in 183 countries. Additionally, the BSF Knowledge Base has served over 1000 registered users from 68 countries, and over 540 people from 73 countries have attended CAWST’s online training sessions. This indicates that the online spaces are effectively reaching a large numbers of users, from a range of countries. A 2016 survey of the Biosand Filter Knowledge Base showed that approximately 61% of users are practitioners, and 39% are either researchers or students. Of the respondents, 46% reported using the BSF Knowledge Base to initiate a BSF project and 43% reported using the information to train BSF technicians. Finally, 61% indicated they would like even greater support from CAWST’s Technical Advisors going forward. The analysis has provided an encouraging indication that CAWST’s online spaces are contributing to its objective of engaging and supporting WASH practitioners to start, improve and expand their initiatives. CAWST has learned several lessons during the development of these online spaces, in particular related to the resources needed to create and maintain the spaces, and respond to the demand created. CAWST plans to continue expanding its online spaces, improving user experience of the sites, and involving new contributors and content types. Through the use of online spaces, CAWST has been able to increase its global reach and impact without significantly increasing its human resources by connecting WASH practitioners with the information they most need, in a practical and accessible manner. This paper presents on CAWST’s use of online spaces through the CAWST-developed platforms discussed above and the analysis of the use of these platforms.

Keywords: education and training, knowledge sharing, online resources, water and sanitation

Procedia PDF Downloads 244

Authors: James Gallagher, Phillip Benachour

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As location aware mobile technologies become ever more omnipresent, the prospect of exploiting their context awareness to enforce learning approaches thrives. Utilizing the growing acceptance of ubiquitous computing, and the steady progress both in accuracy and battery usage of pervasive devices, we present a case study of remote location viewing, how the application can be utilized to support mobile learning in situ using an existing scenario. Through the case study we introduce a new innovative application: Mobipeek based around a request/response protocol for the viewing of a remote location and explore how this can apply both as part of a teacher lead activity and informal learning situations. The system developed allows a user to select a point on a map, and send a request. Users can attach messages alongside time and distance constraints. Users within the bounds of the request can respond with an image, and accompanying message, providing context to the response. This application can be used alongside a structured learning activity such as the use of mobile phone cameras outdoors as part of an interactive lesson. An example of a learning activity would be to collect photos in the wild about plants, vegetation, and foliage as part of a geography or environmental science lesson. Another example could be to take photos of architectural buildings and monuments as part of an architecture course. These images can be uploaded then displayed back in the classroom for students to share their experiences and compare their findings with their peers. This can help to fosters students’ active participation while helping students to understand lessons in a more interesting and effective way. Mobipeek could augment the student learning experience by providing further interaction with other peers in a remote location. The activity can be part of a wider study between schools in different areas of the country enabling the sharing and interaction between more participants. Remote location viewing can be used to access images in a specific location. The choice of location will depend on the activity and lesson. For example architectural buildings of a specific period can be shared between two or more cities. The augmentation of the learning experience can be manifested in the different contextual and cultural influences as well as the sharing of images from different locations. In addition to the implementation of Mobipeek, we strive to analyse this application, and a subset of other possible and further solutions targeted towards making learning more engaging. Consideration is given to the benefits of such a system, privacy concerns, and feasibility of widespread usage. We also propose elements of “gamification”, in an attempt to further the engagement derived from such a tool and encourage usage. We conclude by identifying limitations, both from a technical, and a mobile learning perspective.

Keywords: context aware, location aware, mobile learning, remote viewing

Procedia PDF Downloads 267

Authors: M. Kozłowski, M. Kadela

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Foamed concrete is known for its low self-weight and excellent thermal and acoustic properties. For many years, it has been used worldwide for insulation to foundations and roof tiles, as backfill to retaining walls, sound insulation, etc. However, in the last years it has become a promising material also for structural purposes e.g. for stabilization of weak soils. Due to favorable properties of foamed concrete, many interests and studies were involved to analyze its strength, mechanical, thermal and acoustic properties. However, these studies do not cover the investigation of fracture energy which is the core factor governing the damage and fracture mechanisms. Only limited number of publications can be found in literature. The paper presents the results of experimental investigation and numerical campaign of foamed concrete based on three-point bending test of beams with initial notch. First part of the paper presents the results of a series of static loading tests performed to investigate the fracture properties of foamed concrete of varying density. Beam specimens with dimensions of 100×100×840 mm with a central notch were tested in three-point bending. Subsequently, remaining halves of the specimens with dimensions of 100×100×420 mm were tested again as un-notched beams in the same set-up with reduced distance between supports. The tests were performed in a hydraulic displacement controlled testing machine with a load capacity of 5 kN. Apart from measuring the loading and mid-span displacement, a crack mouth opening displacement (CMOD) was monitored. Based on the load – displacement curves of notched beams the values of fracture energy and tensile stress at failure were calculated. The flexural tensile strength was obtained on un-notched beams with dimensions of 100×100×420 mm. Moreover, cube specimens 150×150×150 mm were tested in compression to determine the compressive strength. Second part of the paper deals with numerical investigation of the fracture behavior of beams with initial notch presented in the first part of the paper. Extended Finite Element Method (XFEM) was used to simulate and analyze the damage and fracture process. The influence of meshing and variation of mechanical properties on results was investigated. Numerical models simulate correctly the behavior of beams observed during three-point bending. The numerical results show that XFEM can be used to simulate different fracture toughness of foamed concrete and fracture types. Using the XFEM and computer simulation technology allow for reliable approximation of load–bearing capacity and damage mechanisms of beams made of foamed concrete, which provides some foundations for realistic structural applications.

Keywords: foamed concrete, fracture energy, three-point bending, XFEM

Procedia PDF Downloads 273

Authors: Lara Bettinelli, Bernhard Glatz, Josef Fink

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Planning engineers and researchers use various calculation models with different levels of complexity, calculation efficiency and accuracy in dynamic calculations of railway bridges under high-speed traffic. When choosing a vehicle model to depict the dynamic loading on the bridge structure caused by passing high-speed trains, different goals are pursued: On the one hand, the selected vehicle models should allow the calculation of a bridge’s vibrations as realistic as possible. On the other hand, the computational efficiency and manageability of the models should be preferably high to enable a wide range of applications. The commonly adopted and straightforward vehicle model is the moving load model (MLM), which simplifies the train to a sequence of static axle loads moving at a constant speed over the structure. However, the MLM can significantly overestimate the structure vibrations, especially when resonance events occur. More complex vehicle models, which depict the train as a system of oscillating and coupled masses, can reproduce the interaction dynamics between the vehicle and the bridge superstructure to some extent and enable the calculation of more realistic bridge accelerations. At the same time, such multi-body models require significantly greater processing capacities and precise knowledge of various vehicle properties. The European standards allow for applying the so-called additional damping method when simple load models, such as the MLM, are used in dynamic calculations. An additional damping factor depending on the bridge span, which should take into account the vibration-reducing benefits of the vehicle-bridge interaction, is assigned to the supporting structure in the calculations. However, numerous studies show that when the current standard specifications are applied, the calculation results for the bridge accelerations are in many cases still too high compared to the measured bridge accelerations, while in other cases, they are not on the safe side. A proposal to calculate the additional damping based on extensive dynamic calculations for a parametric field of simply supported bridges with a ballasted track was developed to address this issue. In this contribution, several different approaches to determine the additional damping of the supporting structure considering the vehicle-bridge interaction when using the MLM are compared with one another. Besides the standard specifications, this includes the approach mentioned above and two additional recently published alternative formulations derived from analytical approaches. For a bridge catalogue of 65 existing bridges in Austria in steel, concrete or composite construction, calculations are carried out with the MLM for two different high-speed trains and the different approaches for additional damping. The results are compared with the calculation results obtained by applying a more sophisticated multi-body model of the trains used. The evaluation and comparison of the results allow assessing the benefits of different calculation concepts for the additional damping regarding their accuracy and possible applications. The evaluation shows that by applying one of the recently published redesigned additional damping methods, the calculation results can reflect the influence of the vehicle-bridge interaction on the design-relevant structural accelerations considerably more reliable than by using normative specifications.

Keywords: Additional Damping Method, Bridge Dynamics, High-Speed Railway Traffic, Vehicle-Bridge-Interaction

Procedia PDF Downloads 143

Authors: Salima R. Rajwani, Tazeen Ali, Rubina Barolia, Yasmin Parpio, Nasreen Alwani, Salima B. Virani

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Introduction: Nurses and physicians have a critical role in initiating lifesaving interventions during cardiac arrest. It is important that timely delivery of high quality Cardio Pulmonary Resuscitation (CPR) with advanced resuscitation skills and management of cardiac arrhythmias is a key dimension of code during cardiac arrest. It will decrease the chances of patient survival if the healthcare professionals are unable to initiate CPR timely. Moreover, traditional training will not prepare physicians and nurses at a competent level and their knowledge level declines over a period of time. In this regard, simulation training has been proven to be effective in promoting resuscitation skills. Simulation teaching learning strategy improves knowledge level, and skills performance during resuscitation through experiential learning without compromising patient safety in real clinical situations. The purpose of the study is to evaluate the effectiveness of simulation training in Advanced Cardiac Life Support Courses by using the selfefficacy tool. Methods: The study design is a quantitative research design and non-randomized quasi-experimental study design. The study examined the effectiveness of simulation through self-efficacy in two instructional methods; one is Medium Fidelity Simulation (MFS) and second is Traditional Training Method (TTM). The sample size was 220. Data was compiled by using the SPSS tool. The standardized simulation based training increases self-efficacy, knowledge, and skills and improves the management of patients in actual resuscitation. Results: 153 students participated in study; CG: n = 77 and EG: n = 77. The comparison was done between arms in pre and post-test. (F value was 1.69, p value is <0.195 and df was 1). There was no significant difference between arms in the pre and post-test. The interaction between arms was observed and there was no significant difference in interaction between arms in the pre and post-test. (F value was 0.298, p value is <0.586 and df is 1. However, the results showed self-efficacy scores were significantly higher within experimental group in post-test in advanced cardiac life support resuscitation courses as compared to Traditional Training Method (TTM) and had overall (p <0.0001) and F value was 143.316 (mean score was 45.01 and SD was 9.29) verses pre-test result showed (mean score was 31.15 and SD was 12.76) as compared to TTM in post-test (mean score was 29.68 and SD was 14.12) verses pre-test result showed (mean score was 42.33 and SD was 11.39). Conclusion: The standardized simulation-based training was conducted in the safe learning environment in Advanced Cardiac Life Suport Courses and physicians and nurses benefited from self-confidence, early identification of life-threatening scenarios, early initiation of CPR, and provides high-quality CPR, timely administration of medication and defibrillation, appropriate airway management, rhythm analysis and interpretation, and Return of Spontaneous Circulation (ROSC), team dynamics, debriefing, and teaching and learning strategies that will improve the patient survival in actual resuscitation.

Keywords: advanced cardiac life support, cardio pulmonary resuscitation, return of spontaneous circulation, simulation

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Authors: Nadeen Felemban, Hamsa Banjer, Rabaah Jaafari

Abstract:

One of the most common hazards in the pharmaceutical industry is the chemical hazard, which can cause harm or develop occupational health diseases/illnesses due to chronic exposures to hazardous substances. Therefore, a chemical agent management system is required, including hazard identification, risk assessment, controls for specific hazards and inspections, to keep your workplace healthy and safe. However, routine management monitoring is also required to verify the effectiveness of the control measures. Moreover, Betamethasone Valerate and Clobetasol Propionate are some of the APIs (Active Pharmaceutical Ingredients) with highly hazardous classification-Occupational Hazard Category (OHC 4), which requires a full containment (ECA-D) during handling to avoid chemical exposure. According to Safety Data Sheet, those chemicals are reproductive toxicants (reprotoxicant H360D), which may affect female workers’ health and cause fatal damage to an unborn child, or impair fertility. In this study, qualitative (chemical Risk assessment-qCRA) was conducted to assess the chemical exposure during handling of Betamethasone Valerate and Clobetasol Propionate in pharmaceutical laboratories. The outcomes of qCRA identified that there is a risk of potential chemical exposure (risk rating 8 Amber risk). Therefore, immediate actions were taken to ensure interim controls (according to the Hierarchy of controls) are in place and in use to minimize the risk of chemical exposure. No open handlings should be done out of the Steroid Glove Box Isolator (SGB) with the required Personal Protective Equipment (PPEs). The PPEs include coverall, nitrile hand gloves, safety shoes and powered air-purifying respirators (PAPR). Furthermore, a quantitative assessment (personal air sampling) was conducted to verify the effectiveness of the engineering controls (SGB Isolator) and to confirm if there is chemical exposure, as indicated earlier by qCRA. Three personal air samples were collected using an air sampling pump and filter (IOM2 filters, 25mm glass fiber media). The collected samples were analyzed by HPLC in the BV lab, and the measured concentrations were reported in (ug/m3) with reference to Occupation Exposure Limits, 8hr OELs (8hr TWA) for each analytic. The analytical results are needed in 8hr TWA (8hr Time-weighted Average) to be analyzed using Bayesian statistics (IHDataAnalyst). The results of the Bayesian Likelihood Graph indicate (category 0), which means Exposures are de "minimus," trivial, or non-existent Employees have little to no exposure. Also, these results indicate that the 3 samplings are representative samplings with very low variations (SD=0.0014). In conclusion, the engineering controls were effective in protecting the operators from such exposure. However, routine chemical monitoring is required every 3 years unless there is a change in the processor type of chemicals. Also, frequent management monitoring (daily, weekly, and monthly) is required to ensure the control measures are in place and in use. Furthermore, a Similar Exposure Group (SEG) was identified in this activity and included in the annual health surveillance for health monitoring.

Keywords: occupational health and safety, risk assessment, chemical exposure, hierarchy of control, reproductive

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Authors: Kevin Potoczny, Katsuichiro Goda

Abstract:

The St. Lawrence lowlands extend from Ottawa to Quebec City and are known for large deposits of sensitive Leda clay. Leda clay deposits are responsible for many large landslides, such as the 1993 Lemieux and 2010 St. Jude (4 fatalities) landslides. Due to the large extent and sensitivity of Leda clay, regional hazard analysis for landslides is an important tool in risk management. A 2018 regional study by Farzam et al. on the susceptibility of Leda clay slopes to landslide hazard uses 1 arc second topographical data. A qualitative method known as Hazus is used to estimate susceptibility by checking for various criteria in a location and determine a susceptibility rating on a scale of 0 (no susceptibility) to 10 (very high susceptibility). These criteria are slope angle, geological group, soil wetness, and distance from waterbodies. Given the flat nature of St. Lawrence lowlands, the current assessment fails to capture local slopes, such as the St. Jude site. Additionally, the data did not allow one to analyze failure planes accurately. This study majorly improves the analysis performed by Farzam et al. in two aspects. First, regional assessment with high resolution data allows for identification of local locations that may have been previously identified as low susceptibility. This then provides the opportunity to conduct a more refined analysis on the failure plane of the slope. Slopes derived from 1 arc second data are relatively gentle (0-10 degrees) across the region; however, the 1- and 2-meter resolution 2022 HRDEM provided by NRCAN shows that short, steep slopes are present. At a regional level, 1 arc second data can underestimate the susceptibility of short, steep slopes, which can be dangerous as Leda clay landslides behave retrogressively and travel upwards into flatter terrain. At the location of the St. Jude landslide, slope differences are significant. 1 arc second data shows a maximum slope of 12.80 degrees and a mean slope of 4.72 degrees, while the HRDEM data shows a maximum slope of 56.67 degrees and a mean slope of 10.72 degrees. This equates to a difference of three susceptibility levels when the soil is dry and one susceptibility level when wet. The use of GIS software is used to create a regional susceptibility map across the St. Lawrence lowlands at 1- and 2-meter resolutions. Failure planes are necessary to differentiate between small and large landslides, which have so far been ignored in regional analysis. Leda clay failures can only retrogress as far as their failure planes, so the regional analysis must be able to transition smoothly into a more robust local analysis. It is expected that slopes within the region, once previously assessed at low susceptibility scores, contain local areas of high susceptibility. The goal is to create opportunities for local failure plane analysis to be undertaken, which has not been possible before. Due to the low resolution of previous regional analyses, any slope near a waterbody could be considered hazardous. However, high-resolution regional analysis would allow for more precise determination of hazard sites.

Keywords: hazus, high-resolution DEM, leda clay, regional analysis, susceptibility

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Authors: Fabienne Samyn, Pauline Tranchard, Sophie Duquesne, Emilie Goncalves, Bruno Estebe, Serge Boubigot

Abstract:

Stringent fire safety regulations are enforced in the aeronautical industry due to the consequences that potential fire event on an aircraft might imply. This is so much true that the fire issue is considered right from the design of the aircraft structure. Due to the incorporation of an increasing amount of polymer matrix composites in replacement of more conventional materials like metals, the nature of the fire risks is changing. The choice of materials used is consequently of prime importance as well as the evaluation of its resistance to fire. The fire testing is mostly done using the so-called certification tests according to standards such as the ISO2685:1998(E). The latter describes a protocol to evaluate the fire resistance of structures located in fire zone (ability to withstand fire for 5min). The test consists in exposing an at least 300x300mm² sample to an 1100°C propane flame with a calibrated heat flux of 116kW/m². This type of test is time-consuming, expensive and gives access to limited information in terms of fire behavior of the materials (pass or fail test). Consequently, it can barely be used for material development purposes. In this context, the laboratory UMET in collaboration with industrial partners has developed a horizontal and a vertical small-scale instrumented fire benches for the characterization of the fire behavior of composites. The benches using smaller samples (no more than 150x150mm²) enables to cut downs costs and hence to increase sampling throughput. However, the main added value of our benches is the instrumentation used to collect useful information to understand the behavior of the materials. Indeed, measurements of the sample backside temperature are performed using IR camera in both configurations. In addition, for the vertical set up, a complete characterization of the degradation process, can be achieved via mass loss measurements and quantification of the gasses released during the tests. These benches have been used to characterize and study the fire behavior of aeronautical carbon/epoxy composites. The horizontal set up has been used in particular to study the performances and durability of protective intumescent coating on 2mm thick 2D laminates. The efficiency of this approach has been validated, and the optimized coating thickness has been determined as well as the performances after aging. Reductions of the performances after aging were attributed to the migration of some of the coating additives. The vertical set up has enabled to investigate the degradation process of composites under fire. An isotropic and a unidirectional 4mm thick laminates have been characterized using the bench and post-fire analyses. The mass loss measurements and the gas phase analyses of both composites do not present significant differences unlike the temperature profiles in the thickness of the samples. The differences have been attributed to differences of thermal conductivity as well as delamination that is much more pronounced for the isotropic composite (observed on the IR-images). This has been confirmed by X-ray microtomography. The developed benches have proven to be valuable tools to develop fire safe composites.

Keywords: aeronautical carbon/epoxy composite, durability, intumescent coating, small-scale ‘ISO 2685 like’ fire resistance test, X-ray microtomography

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Authors: Bar Y. Ainuz, Harry M. Salinas, Aleeza Ali, Eli B. Levitt, Austin J. Pourmoussa, Antoun Bouz, Miguel A. Medina

Abstract:

Introduction: Breast conservation therapy remains the mainstay surgical treatment for early breast cancer. Oncoplastic techniques, in conjunction with lumpectomy and adjuvant radiotherapy, have been demonstrated to achieve good aesthetic results without adversely affecting cancer outcomes in the treatment of patients with macromastia or significant ptosis. In our patient population, many women present for breast conservation with pre-existing cosmetic implants or with breast volumes too small for soft tissue, only oncoplastic techniques. Our study evaluated a consecutive series of patients presenting for breast conservation undergoing concomitant oncoplastic-augmentation-mastopexy (OAM) with a contralateral augmentation-mastopexy for symmetry. Methods: OAM surgical technique involves simultaneous lumpectomy with exchange or placement of implants, oncoplastic mastopexy, and concomitant contralateral augmentation mastopexy for symmetry. Patients undergoing lumpectomy for breast conservation as outpatients were identified via retrospective chart review at a high volume private academic affiliated community-based cancer center. Patients with ptosis and either pre-existing breast implants or insufficient breast volume undergoing oncoplastic implant placement (or exchange) and mastopexy were included in the study. Operative details, aesthetic outcomes, and complications were assessed. Results: Over a continuous three-year period, with a two-surgeon cohort, 30 consecutive patients (56 breasts, 4 unilateral procedures) were identified. Patients had an average age of 52.5 years and an average BMI of 27.5, with 40% smokers or former smokers. The average operative time was 2.5 hours, the average implant size removed was 352 cc, and the average implant size placed was 300 cc. All new implants were smooth silicone, with the majority (92%) placed in a retropectoral fashion. 40% of patients received chemotherapy, and 80% of patients received whole breast adjuvant photon radiotherapy with a total radiation dose of either 42.56 or 52.56 Gy. The average and median length of follow-up were both 8.2 months. Of the 24 patients that received radiotherapy, 21% had asymmetry due to capsular contracture. A total of 7 patients (29.2%) underwent revisions for either positive margins (12.5%), capsular contracture (8.3%), implant loss (4.2%), or cosmetic concerns (4.2%). One patient developed a pulmonary embolism in the acute postoperative period and was treated with anticoagulant therapy. Conclusion: Oncoplastic augmentation mastopexy is a safe technique with good aesthetic outcomes and acceptable complication rates for ptotic patients with breast cancer and a paucity of breast volume or pre-existing implants who wish to pursue breast-conserving therapy. The revision rates compare favorably with single-stage cosmetic augmentation procedures as well as other oncoplastic techniques described in the literature. The short-term capsular contracture rates seem lower than the rates in patients undergoing radiation after mastectomy and implant-based reconstruction. Long term capsular contractures and revision rates are too early to know in this cohort.

Keywords: breast conserving therapy, oncoplastic augmentation mastopexy, capsular contracture, breast reconstruction

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