Search results for: primary ideal
2011 A National Survey of Clinical Psychology Graduate Student Attitudes toward Psychotherapy Treatment Manuals: A Replication Study
Authors: B. Bergström, A. Ladd, A. Jones, L. Rosso, P. Michael
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Attitudes toward treatment manuals serve as a meaningful predictor of general attitudes toward evidence-based practice. Despite demonstrating high effectiveness in treating many mental disorders, manualized treatments have been underutilized by practitioners. Thus, one can assess the state of the field regarding the adoption of evidence-based practices by surveying practitioner attitudes towards manualized treatments. This study is an adapted replication that assesses psychology graduate student attitudes towards manualized treatments, as a general marker for attitudes towards evidence-based practice. Training programs provide future clinicians with the foundation for critical skills in clinical practice. Research demonstrates that post-graduate continuing education has little to no effect on clinical practice; thus, graduate programs serve as the primary, and often final platform for all future practice. However, there are little empirical data identifying the attitudes and training of graduate students in utilizing manualized treatments. The empirical analysis of this study indicates an increase in positive attitudes among graduate student attitudes towards manualized treatments (within the United States), when compared to past surveys of professional psychologists. Findings from this study may inform graduate programs of barriers for students in developing positive attitudes toward manualized treatments and evidence-based practice. This study also serves as a preliminary predictor of the state-of-the field, in regards to professional psychologists attitudes towards evidence-based practice, if attitudes remain stable. This study indicates that the attitudes toward utilizing evidence-based practices, such as treatment manuals, has become more positive since year 2000.Keywords: exposure therapy, evidence based practice, manualized treatments, student attitudes
Procedia PDF Downloads 1632010 Cerebral Venous Thrombosis at High Altitude: A Rare Presentation by Sub-Arachnoid Hemorrhage
Authors: Eman G. Alayad, Mazen G. Aleyad, Mohammed Alshahrani, Ibrahim Alnaami
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Introduction: Cerebral venous thrombosis (CVT) is a rare type of cerebrovascular disease that can occur at any age. Patients with CVT commonly present with headache, focal neurological deficit, decreased level of consciousness and seizures. Many etiologic risk factors have been reported for CVT, high altitude and oral contraceptive pill some of them. Case Presentation: A 37-year-old woman living in Abha city in the southeastern area of Saudi Arabia. (about 10,000 feet-3000 m) over the sea. complaining acute onset of severe diffuse headache and generalized tonic clonic convulsions. Followed by loss of consciousness. She was on contraceptive pills for the last 3 years. No significant Medical or surgical history. Brain CT revealed subarachnoid hemorrhage, with MRI findings showing thrombosis in transvers sinus. There was no vascular malformations such as aneurysm, arteriovenous malformation (AVM), or dural arteriovenous fistula. A CVT with subarachnoid hemorrhage was our final diagnosis based on clinical presentation and radiographic findings. Discussion: Patients with CVT had evidence of cortical SAH by 10 of 233, others found 3% of SAH was caused by CVT, indicating that the presence of cortical SAH without involvement of the basal cisterns may provide an early sign of underlying CVT. However, what is more interesting in this case, is the relationship of high altitude with CVT and SAH, which previously undescribed. Conclusion: High-altitude climbing per se was described as a risk factor for the development of CVT, though its occurrence was probably rare. Whether it is primary in etiology due to high altitude induced hypercoagulable state of unknown origin or due to cerebrovascular disturbances there is a need for further investigation especially at this unusual presentation of subarachnoid hemorrhage.Keywords: cerebral venous thrombosis, high-altitude, subarachnoid hemorrhage, stroke
Procedia PDF Downloads 2572009 Preparation of Ternary Metal Oxide Aerogel Catalysts for Carbon Dioxide and Propylene Oxide Cycloaddition Reaction
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CO2 is the primary greenhouse gas which causes global warming in recent years. As the carbon capture and storage (CCS) getting maturing, the reuse of carbon dioxide which made from CCS is the important issue. In this way, the most common method is the synthesis of cyclic carbonate chemicals from the cycloaddition reaction of carbon dioxide and epoxide. The catalyst plays an important role in the CO2/epoxide cycloaddition reactions. The Lewis acid and base sites are both needed on the catalyst surface for the help of epoxide ring opening, leading to the synthesis of cyclic carbonate. Furthermore, the larger specific surface area and more active site of the catalyst are also needed to enhance the efficiency of the CO2/epoxide cycloaddition reactions. Aerogel is a mesoporous nanomaterial (pore size between 2~50 nm) with high specific surface area and porosity (at least 90%) and low density. In this study, the ternary metal oxide aerogels, Mg-doped Al2O3 aerogels, with higher specific surface area and Lewis acid and base sites on the aerogel surface are successfully prepared by using a facile sol-gel reaction. The as-prepared Mg-doped Al2O3 aerogels are also served as heterogenous catalyst for the CO2/propylene- oxide cycloaddition reaction. Compared to the pristine Al2O3 aerogels, the Mg-doped Al2O3 aerogels possessed both Lewis acid and base sites on the surface are able to enhance the efficiency of the CO2/propylene oxide cycloaddition reactions. As a result, the as-prepared Mg-doped Al2O3 aerogels are a promising and novel catalyst for the CO2/epoxide cycloaddition reactions.Keywords: ternary, metal oxide aerogel, CO2 reuse, cycloaddition, propylene oxide
Procedia PDF Downloads 2612008 Development of Noninvasive Method to Analyze Dynamic Changes of Matrix Stiffness and Elasticity Characteristics
Authors: Elena Petersen, Inna Kornienko, Svetlana Guryeva, Sergey Dobdin, Anatoly Skripal, Andrey Usanov, Dmitry Usanov
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One of the most important unsolved problems in modern medicine is the increase of chronic diseases that lead to organ dysfunction or even complete loss of function. Current methods of treatment do not result in decreased mortality and disability statistics. Currently, the best treatment for many patients is still transplantation of organs and/or tissues. Therefore, finding a way of correct artificial matrix biofabrication in case of limited number of natural organs for transplantation is a critical task. One important problem that needs to be solved is development of a nondestructive and noninvasive method to analyze dynamic changes of mechanical characteristics of a matrix with minimal side effects on the growing cells. This research was focused on investigating the properties of matrix as a marker of graft condition. In this study, the collagen gel with human primary dermal fibroblasts in suspension (60, 120, 240*103 cells/mL) and collagen gel with cell spheroids were used as model objects. The stiffness and elasticity characteristics were evaluated by a semiconductor laser autodyne. The time and cell concentration dependency of the stiffness and elasticity were investigated. It was shown that these properties changed in a non-linear manner with respect to cell concentration. The maximum matrix stiffness was observed in the collagen gel with the cell concentration of 120*103 cells/mL. This study proved the opportunity to use the mechanical properties of matrix as a marker of graft condition, which can be measured by noninvasive semiconductor laser autodyne technique.Keywords: graft, matrix, noninvasive method, regenerative medicine, semiconductor laser autodyne
Procedia PDF Downloads 3462007 Window Analysis and Malmquist Index for Assessing Efficiency and Productivity Growth in a Pharmaceutical Industry
Authors: Abbas Al-Refaie, Ruba Najdawi, Nour Bata, Mohammad D. AL-Tahat
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The pharmaceutical industry is an important component of health care systems throughout the world. Measurement of a production unit-performance is crucial in determining whether it has achieved its objectives or not. This paper applies data envelopment (DEA) window analysis to assess the efficiencies of two packaging lines; Allfill (new) and DP6, in the Penicillin plant in a Jordanian Medical Company in 2010. The CCR and BCC models are used to estimate the technical efficiency, pure technical efficiency, and scale efficiency. Further, the Malmquist productivity index is computed to measure then employed to assess productivity growth relative to a reference technology. Two primary issues are addressed in computation of Malmquist indices of productivity growth. The first issue is the measurement of productivity change over the period, while the second is to decompose changes in productivity into what are generally referred to as a ‘catching-up’ effect (efficiency change) and a ‘frontier shift’ effect (technological change). Results showed that DP6 line outperforms the Allfill in technical and pure technical efficiency. However, the Allfill line outperforms DP6 line in scale efficiency. The obtained efficiency values can guide production managers in taking effective decisions related to operation, management, and plant size. Moreover, both machines exhibit a clear fluctuations in technological change, which is the main reason for the positive total factor productivity change. That is, installing a new Allfill production line can be of great benefit to increasing productivity. In conclusions, the DEA window analysis combined with the Malmquist index are supportive measures in assessing efficiency and productivity in pharmaceutical industry.Keywords: window analysis, malmquist index, efficiency, productivity
Procedia PDF Downloads 6102006 China's BRI and Germany's Baghdad Railroad – a Realist Analysis of Hegemonic Conflict and the Circumvention of Maritime Power
Authors: Kamen Kirov
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In the late 19th and early 20th centuries, Britain dominated global trade and finance in large part due to its maritime superiority. Germany, a land power, sought to undermine Britain’s position as the primary hegemon but ultimately could not challenge Britain’s maritime position or capabilities. This drove Germany to seek alternative strategies to weaken Britain’s position. Notably, it pushed Germany to create a reliable overland link through the Balkans to the Middle East via railroad. This article will seek to draw parallels between the German-British hegemonic conflict of the early 20th century and the Chinese-American hegemonic conflict taking place today using both secondary historical sources and current scholarly discussions of the changing international sphere. In doing so, it will provide useful insights into how China might attempt to outflank American power. The article will demonstrate that in many ways, the strategic positions and approaches of the early-20th century Germany and modern China are similar. Both countries were faced with a vastly superior foe with respect to maritime and economic power, and in both cases, their response was to undermine their rival hegemon by creating new overland infrastructure. Furthermore, in both cases, a major goal of creating new overland links was to gain further access to and control over Middle Eastern energy markets. It seems that in the modern day, China is conducting such a policy on a much grander scale than Germany did in the early 20th century—which may result in negative consequences for the US strategic position.Keywords: belt and road Initiative, hegemonic conflict, maritime power, realism
Procedia PDF Downloads 1822005 M. J. Rodríguez, F. M. Sánchez, B. Velardo, P. Calvo, M. J. Serradilla, J. Delgado, J. M. López
Authors: Q. Rzina, M. Lahrouni, S. Rida, N. Saadaoui, Y. Almossaid, K. Oufdou, K. Fares
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Many organic solid wastes are produced in the world. Poultry manure (PM), municipal organic wastes (MOW) and sugar beet lime sludge (LS) are produced in large quantities in Morocco. The co-composting of these organic wastes was investigated. The recycling and the valorization of such wastes is environmentally and economically beneficial especially for PM which is known source of bacterial pathogens. The aerobic biodegradation process was carried out by using three windrows of variable compositions: C1 prepared without LS (only MOW were composted with PM), C2 prepared from MOW plus PM and10% LS; and the last one C3 from MOW plus PM and 20% LS. The main process physico-chemical parameters (temperature, pH, humidity and C/N) and microbiological populations (mesophilic and thermophilic flora, total coliform, fecal coliform, Streptococci, Staphylococcus aureus and mesophilic fungi) were monitored over three months to ascertain the compost maturity and to ensure the compost hygienic aspect. The final products were characterized by their relatively high organic matter content, and low C/N ratio of 10.6-10.9. The organic matter degradation was reached approximately 59% for C2 and C3. In addition, the monitoring of the microbial population showed that the produced composts are mature and hygienic. The agronomic valorization of the final composts was tested on radish plant with tree level of composts and poultry manure without composting. The primary results of field trial showed a growth of radish plant biomass and root development without any phytotoxicity detected which reflects the quality of the composts produced. As for poultry manure it allowed to have a better results than other composts because of its readily available nitrogen.Keywords: compost, municipal organic wastes, poultry manure, radish crop, sugar beet lime sludge
Procedia PDF Downloads 3142004 Functions and Challenges of New County-Based Regional Plan in Taiwan
Authors: Yu-Hsin Tsai
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A new, mandated county regional plan system has been initiated since 2010 nationwide in Taiwan, with its role situated in-between the policy-led cross-county regional plan and the blueprint-led city plan. This new regional plan contain both urban and rural areas in one single plan, which provides a more complete planning territory, i.e., city region within the county’s jurisdiction, and to be executed and managed effectively by the county government. However, the full picture of its functions and characteristics seems still not totally clear, compared with other levels of plans; either are planning goals and issues that can be most appropriately dealt with at this spatial scale. In addition, the extent to which the inclusion of sustainability ideal and measures to cope with climate change are unclear. Based on the above issues, this study aims to clarify the roles of county regional plan, to analyze the extent to which the measures cope with sustainability, climate change, and forecasted declining population, and the success factors and issues faced in the planning process. The methodology applied includes literature review, plan quality evaluation, and interview with officials of the central and local governments and urban planners involved for all the 23 counties in Taiwan. The preliminary research results show, first, growth management related policies have been widely implemented and expected to have effective impact, including incorporating resources capacity to determine maximum population for the city region as a whole, developing overall vision of urban growth boundary for all the whole city region, prioritizing infill development, and use of architectural land within urbanized area over rural area to cope with urban growth. Secondly, planning-oriented zoning is adopted in urban areas, while demand-oriented planning permission is applied in the rural areas with designated plans. Then, public participation has been evolved to the next level to oversee all of government’s planning and review processes due to the decreasing trust in the government, and development of public forum on the internet etc. Next, fertile agricultural land is preserved to maintain food self-supplied goal for national security concern. More adoption-based methods than mitigation-based methods have been applied to cope with global climate change. Finally, better land use and transportation planning in terms of avoiding developing rail transit stations and corridor in rural area is promoted. Even though many promising, prompt measures have been adopted, however, challenges exist to surround: first, overall urban density, likely affecting success of UGB, or use of rural agricultural land, has not been incorporated, possibly due to implementation difficulties. Second, land-use related measures to mitigating climate change seem less clear and hence less employed. Smart decline has not drawn enough attention to cope with predicted population decrease in the next decade. Then, some reluctance from county’s government to implement county regional plan can be observed vaguely possibly since limits have be set on further development on agricultural land and sensitive areas. Finally, resolving issue on existing illegal factories on agricultural land remains the most challenging dilemma.Keywords: city region plan, sustainability, global climate change, growth management
Procedia PDF Downloads 3522003 Passive Attenuation of Nitrogen Species at Northern Mine Sites
Authors: Patrick Mueller, Alan Martin, Justin Stockwell, Robert Goldblatt
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Elevated concentrations of inorganic nitrogen (N) compounds (nitrate, nitrite, and ammonia) are a ubiquitous feature to mine-influenced drainages due to the leaching of blasting residues and use of cyanide in the milling of gold ores. For many mines, the management of N is a focus for environmental protection, therefore understanding the factors controlling the speciation and behavior of N is central to effective decision making. In this paper, the passive attenuation of ammonia and nitrite is described for three northern water bodies (two lakes and a tailings pond) influenced by mining activities. In two of the water bodies, inorganic N compounds originate from explosives residues in mine water and waste rock. The third water body is a decommissioned tailings impoundment, with N compounds largely originating from the breakdown of cyanide compounds used in the processing of gold ores. Empirical observations from water quality monitoring indicate nitrification (the oxidation of ammonia to nitrate) occurs in all three waterbodies, where enrichment of nitrate occurs commensurately with ammonia depletion. The N species conversions in these systems occurred more rapidly than chemical oxidation kinetics permit, indicating that microbial mediated conversion was occurring, despite the cool water temperatures. While nitrification of ammonia and nitrite to nitrate was the primary process, in all three waterbodies nitrite was consistently present at approximately 0.5 to 2.0 % of total N, even following ammonia depletion. The persistence of trace amounts of nitrite under these conditions suggests the co-occurrence denitrification processes in the water column and/or underlying substrates. The implications for N management in mine waters are discussed.Keywords: explosives, mining, nitrification, water
Procedia PDF Downloads 3192002 A Qualitative Investigation of Shia Muslims' Mourning Practices as a Coping Strategy
Authors: Anusha Sajjad, Sibtain Kazmi, Sadaf Sajjad, Ali Mohsin
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Shia Muslims, a distinct minority within the broader Muslim community, have a unique mourning practice set that remains underexplored in research. These practices hold cultural and religious significance and are essential to Shia spirituality. This study seeks to delve into the emotional and psychological dimensions of Shia Muslims' mourning rituals, specifically investigating how these practices serve as coping strategies during times of grief and adversity. The motivation for this research stems from a gap in understanding the psycho-spiritual aspects of Shia mourning, with a focus on the potential therapeutic value of these practices for individuals experiencing daily life stressors. This qualitative investigation employs an online survey conducted in September 2023 as the primary research method. Data was collected from a sample of 49 Shia Muslims who have actively participated in mourning rituals. Pearson's correlation test was applied to assess the relationship between participants’ reported feelings of mentally feeling ‘Lighter or Heavier' and their 'Coping' responses. Pearson's correlation analysis revealed a positive but relatively weak correlation between 'Mentally Feeling Lighter' and 'Coping' (r = 0.303) with a statistically significant p-value of 0.034. The findings suggest that there is a statistically significant positive correlation between feeling "Mentally Lighter" and coping, as reported by participants in Shia mourning rituals, although the strength of this correlation is relatively weak. This implies that individuals who feel "Mentally Lighter" are more likely to report coping effectively, but other factors likely contribute to the overall coping strategies employed by participants in this context. Further research with a larger sample size would be needed to strengthen this correlation further.Keywords: shia, mourning, religion, coping
Procedia PDF Downloads 882001 The Role of Leadership in Enhancing Health Information Systems to Improve Patient Outcomes in China
Authors: Nisar Ahmad, Xuyi, Ali Akbar
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As healthcare systems worldwide strive for improvement, the integration of advanced health information systems (HIS) has emerged as a pivotal strategy. This study aims to investigate the critical role of leadership in the implementation and enhancement of HIS in Chinese hospitals and how such leadership can drive improvements in patient outcomes and overall healthcare satisfaction. We propose a comprehensive study to be conducted across various hospitals in China, targeting healthcare professionals as the primary population. The research will leverage established theories of transformational leadership and technology acceptance to underpin the analysis. In our approach, data will be meticulously gathered through surveys and interviews, focusing on the experiences and perceptions of healthcare professionals regarding HIS implementation and its impact on patient care. The study will utilize SPSS and SmartPLS software for robust data analysis, ensuring precise and comprehensive insights into the correlation between leadership effectiveness and HIS success. We hypothesize that strong, visionary leadership is essential for the successful adoption and optimization of HIS, leading to enhanced patient outcomes and increased satisfaction with healthcare services. By applying advanced statistical methods, we aim to identify key leadership traits and practices that significantly contribute to these improvements. Our research will provide actionable insights for policymakers and healthcare administrators in China, offering evidence-based recommendations to foster leadership that champions HIS and drives continuous improvement in healthcare delivery. This study will contribute to the global discourse on health information systems, emphasizing the future role of leadership in transforming healthcare environments and outcomes.Keywords: health information systems, leadership, patient outcomes, healthcare satisfaction
Procedia PDF Downloads 372000 Gender and Work-Family Conflict Gaps in Hong Kong: The Impact of Family-Friendly Policies
Authors: Lina Vyas
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Gender gap, unfortunately, is still prevalent in the workplace around the world. In most countries, women are less likely than men to participate in the workplace. They earn considerably less than men for doing the same work and are generally expected to prioritize family obligations over work responsibilities. Women often face more conflicts while balancing the increasingly normalized roles of both worker and mother. True gender equality in the workplace is still a long way off. In Hong Kong, no less is this true. Despite the fact that female students are outnumbered by males at universities, only 55% of women are active participants in the labour market, and for those in the workforce, the gender pay gap is 22%. This structural inequality also exacerbates the issues of confronting biases at work for choosing to be employed as a mother, as well as reinforces the societal expectation of women to be the primary caregiver at home. These pressures are likely to add up for women and contribute to increased levels of work-life conflict, which may be a further barrier for the inclusion of women into the workplace. Family-friendly policies have long been thought to be an alleviator of work-life conflict through helping employees balance the demands in both work and family. Particularly, for women, this could be a facilitator of their integration into the workplace. However, little research has looked at how family-friendly policies may also have a gender differential in effect, as opposed to traditional notions of having universal efficacy. This study investigates both how and how much the gender dimension impacts work-family conflict. In addition to disentangling the reasons for gender gaps existing in work-life conflict for women, this study highlights what can be done at an organizational level to alleviate these conflicts. Most importantly, the policies recommendations derived from this study serve as an avenue for more active participation for women in the workplace and can be considered as a pathway for promoting greater gender egalitarianism and fairness in a traditionally gender-segregated society.Keywords: family-friendly policies, Hong Kong, work-family conflict, workplace
Procedia PDF Downloads 1781999 Effect of Omega-3 Supplementation on Stunted Egyptian Children at Risk of Environmental Enteric Dysfunction: An Interventional Study
Authors: Ghada M. El-Kassas, Maged A. El Wakeel, Salwa R. El-Zayat
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Background: Environmental enteric dysfunction (EED) is asymptomatic villous atrophy of the small bowel that is prevalent in the developing world and is associated with altered intestinal function and integrity. Evidence has suggested that supplementary omega-3 might ameliorate this damage by reducing gastrointestinal inflammation and may also benefit cognitive development. Objective: We tested whether omega-3 supplementation improves intestinal integrity, growth, and cognitive function in stunted children predicted to have EED. Methodology: 100 Egyptian stunted children aged 1-5 years and 100 age and gender-matched normal children as controls. At the primary phase of the study, we assessed anthropometric measures and fecal markers such as myeloperoxidase (MPO), neopterin (NEO), and alpha-1-anti-trypsin (AAT) (as predictors of EED). Cognitive development was assessed (Bayley or Wechsler scores). Oral n-3 (omega-3) LC-PUFA at a dosage of 500 mg/d was supplemented to all cases and followed up for 6 months after which the 2ry phase of the study included the previous clinical, laboratory and cognitive assessment. Results: Fecal inflammatory markers were significantly higher in cases compared to controls. (MPO), (NEO) and (AAT) showed a significant decline in cases at the end of the 2ry phase (P < 0.001 for all). Omega-3 supplementation resulted also in a significant increase in mid-upper arm circumference (MUAC) (P < 0.01), weight for age z-score, and skinfold thicknesses (P< 0.05 for both). Cases showed significant improvement of cognitive function at phase 2 of the study. Conclusions: Omega-3 supplementation successfully improved intestinal inflammatory state related to EED. Also, some improvement of anthropometric and cognitive parameters showed obvious improvement with omega-3 supplementation.Keywords: cognitive functions, EED, omega-3, stunting
Procedia PDF Downloads 1501998 Post Operative Analgesia after Orthotopic Liver Transplantation; A Clinical Randomized Trial
Authors: Soudeh Tabashi, Mohammadreza Moshari, Parisa Sezari
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Introduction: Postoperative analgesia in Orthotopic Liver Transplantation (OLT) surgery is challenging for anesthesiologists. Although OLT is one of the most extensive abdominal operations, it seems that patients don’t suffer from severe post operative pain. On the other hands drug metabolism is unpredictable due to unknown graft function. The aim of this study was to compare intraoperative infusion of remifentanil versus fentanyl in postoperative opioid demand in patients with OLT and evaluating the complications in two groups. Method: In this double-blind clinical trial 34 patients who had OLT were included. They divided randomly in two groups of Remifentanil (R) and Fentanyl (F). Patients in group R and F received infusion of Remifentanil 0.3-1 µg/Kg/min and Fentanyl 0.3-1 µg/Kg/min during maintenance of anesthesia. Post operative pain were measured in 6, 12, 18, 24 hours and second and third days after surgery with Numeric Rate Scale (NRS). Patients had received intravenous acetaminophen as rescue therapy with NRS of 3 or more. In addition to demographic information, post operative opioid consumption were recorded as the primary outcome. Intraoperative blood transfusion, intraoperative inotropic drugs consumption, weaning time and intensive care unit stay were also evaluated. Results: Total dose of acetaminophen consumption in first 3 days after surgery did not have significant difference between two groups (Pvalue=0.716). intraoperative inotrope consumption, blood transfusion and post operative weaning time and ICU stay were also similar in both groups. Conclusion: This study demonstrates that intraoperative infusion of remifentanil in OLT have the same effect on post operative pain management as fentanyl. Despite the complications of operation were not increased by remifentanil.Keywords: liver transplantation, postoperative pain, remifentanil, fentanyl
Procedia PDF Downloads 681997 Correlation between Peripheral Arterial Disease and Coronary Artery Disease in Bangladeshi Population: A Five Years Retrospective Study
Authors: Syed Dawood M. Taimur
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Background: Peripheral arterial disease (PAD) is under diagnosed in primary care practices, yet the extent of unrecognized PAD in patients with coronary artery disease (CAD) is unknown. Objective: To assess the prevalence of previously unrecognized PAD in patients undergoing coronary angiogram and to determine the relationship between the presence of PAD and severity of CAD. Material & Methods: This five years retrospective study was conducted at an invasive lab of the department of Cardiology, Ibrahim Cardiac Hospital & Research Institute from January 2010 to December 2014. Total 77 patients were included in this study. Study variables were age, sex, risk factors like hypertension, diabetes mellitus, dyslipidaemia, smoking habit and positive family history for ischemic heart disease, coronary artery and peripheral artery profile. Results: Mean age was 56.83±13.64 years, Male mean age was 53.98±15.08 years and female mean age was 54.5±1.73years. Hypertension was detected in 55.8%, diabetes in 87%, dyslipidaemia in 81.8%, smoking habits in 79.2% and 58.4% had a positive family history. After catheterization 88.3% had peripheral arterial disease and 71.4% had coronary artery disease. Out of 77 patients, 52 had both coronary and peripheral arterial disease which was statistically significant (p < .014). Coronary angiogram revealed 28.6% (22) patients had triple vessel disease, 23.3% (18) had single vessel disease, 19.5% (15) had double vessel disease and 28.6% (22) were normal coronary arteries. The peripheral angiogram revealed 54.5% had superficial femoral artery disease, 26% had anterior tibial artery disease, 27.3% had posterior tibial artery disease, 20.8% had common iliac artery disease, 15.6% had common femoral artery disease and 2.6% had renal artery disease. Conclusion: There is a strong and definite correlation between coronary and peripheral arterial disease. We found that cardiovascular risk factors were in fact risk factors for both PAD and CAD.Keywords: coronary artery disease (CAD), peripheral artery disease(PVD), risk, factors, correlation, cathetarization
Procedia PDF Downloads 4271996 Design of the Compliant Mechanism of a Biomechanical Assistive Device for the Knee
Authors: Kevin Giraldo, Juan A. Gallego, Uriel Zapata, Fanny L. Casado
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Compliant mechanisms are designed to deform in a controlled manner in response to external forces, utilizing the flexibility of their components to store potential elastic energy during deformation, gradually releasing it upon returning to its original form. This article explores the design of a knee orthosis intended to assist users during stand-up motion. The orthosis makes use of a compliant mechanism to balance the user’s weight, thereby minimizing the strain on leg muscles during standup motion. The primary function of the compliant mechanism is to store and exchange potential energy, so when coupled with the gravitational potential of the user, the total potential energy variation is minimized. The design process for the semi-rigid knee orthosis involved material selection and the development of a numerical model for the compliant mechanism seen as a spring. Geometric properties are obtained through the numerical modeling of the spring once the desired stiffness and safety factor values have been attained. Subsequently, a 3D finite element analysis was conducted. The study demonstrates a strong correlation between the maximum stress in the mathematical model (250.22 MPa) and the simulation (239.8 MPa), with a 4.16% error. Both analyses safety factors: 1.02 for the mathematical approach and 1.1 for the simulation, with a consistent 7.84% margin of error. The spring’s stiffness, calculated at 90.82 Nm/rad analytically and 85.71 Nm/rad in the simulation, exhibits a 5.62% difference. These results suggest significant potential for the proposed device in assisting patients with knee orthopedic restrictions, contributing to ongoing efforts in advancing the understanding and treatment of knee osteoarthritis.Keywords: biomechanics, complaint mechanisms, gonarthrosis, orthoses
Procedia PDF Downloads 391995 Study Employed a Computer Model and Satellite Remote Sensing to Evaluate the Temporal and Spatial Distribution of Snow in the Western Hindu Kush Region of Afghanistan
Authors: Noori Shafiqullah
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Millions of people reside downstream of river basins that heavily rely on snowmelt originating from the Hindu Kush (HK) region. Snowmelt plays a critical role as a primary water source in these areas. This study aimed to evaluate snowfall and snowmelt characteristics in the HK region across altitudes ranging from 2019m to 4533m. To achieve this, the study employed a combination of remote sensing techniques and the Snow Model (SM) to analyze the spatial and temporal distribution of Snow Water Equivalent (SWE). By integrating the simulated Snow-cover Area (SCA) with data from the Moderate Resolution Imaging Spectroradiometer (MODIS), the study optimized the Precipitation Gradient (PG), snowfall assessment, and the degree-day factor (DDF) for snowmelt distribution. Ground observed data from various elevations were used to calculate a temperature lapse rate of -7.0 (°C km-1). Consequently, the DDF value was determined as 3 (mm °C-1 d-1) for altitudes below 3000m and 3 to 4 (mm °C-1 d-1) for higher altitudes above 3000m. Moreover, the distribution of precipitation varies with elevation, with the PG being 0.001 (m-1) at lower elevations below 4000m and 0 (m-1) at higher elevations above 4000m. This study successfully utilized the SM to assess SCA and SWE by incorporating the two optimized parameters. The analysis of simulated SCA and MODIS data yielded coefficient determinations of R2, resulting in values of 0.95 and 0.97 for the years 2014-2015, 2015-2016, and 2016-2017, respectively. These results demonstrate that the SM is a valuable tool for managing water resources in mountainous watersheds such as the HK, where data scarcity poses a challenge."Keywords: improved MODIS, experiment, snow water equivalent, snowmelt
Procedia PDF Downloads 711994 Towards the Concept of Global Health Nursing
Authors: Nuruddeen Abubakar Adamu
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Background: Global health nursing describes health-related work across borders and focuses more on the differences between the nurses’ role between countries and identified why nursing care in particular country differs from another. It also helps in analyzing the health issues and concerns that transcend national borders class, race, ethnicity and culture. The primary objective of this study is to introduce the concept of global health nursing. And the article also argues for the need for global health nursing. Methods This review assesses available evidence, both published and unpublished, on issues relating to the global health nursing and the nurse's role in global health. The review is qualitative based. Results: Globalization, modern technologies, travel, migration and changes in diseases trend globally has made the nursing role to become more diverse and less traditional. These issues change the nurse’s role in the healthcare industry to become enormous and very challenging. This article considers response to issues of emerging global health nursing concept, challenges, purposes, global health nursing activities in both developed and developing countries and the nurse's role globally in maternal-newborn health; preparedness for advocacy in global health within a framework of social justice, equity; and health system strengthening globally. Conclusion: Global health nursing goes beyond the intervention to care for a patient with a particular health problem but, however health is interconnected to political, economic and social context and therefore this explains the need of a multi-professional and multi-sectoral approach to achieve the goal of global health and the need for global health nursing. Global health equity can be promoted and if the profile of nursing and nurses will be raised and enable nurses to be aware of global health issues so as to enable them to work to their full maximum potential, to attain greater health outcome and wellness.Keywords: global health nursing, double burden of diseases, globalization, health equity
Procedia PDF Downloads 1771993 Factors Affecting the Caregiving Experience of Children with Parental Mental Illnesses: A Systematic Review
Authors: N. Anjana
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Worldwide, the prevalence of mental illnesses is increasing. The issues of persons with mental illness and their caregivers have been well documented in the literature. However, data regarding the factors affecting the caregiving experience of children with parental mental illnesses is sparse. This systematic review aimed to examine the existing literature of the factors affecting the caregiving experience of children of parents with mental illnesses. A comprehensive search of databases such as PubMed, EBSCO, JSTOR, ProQuest Central, Taylor and Francis Online, and Google Scholar were performed to identify peer-reviewed papers examining the factors associated with caregiving experiences of children with parental mental illnesses such as schizophrenia and major depression, for the 10-year period ending November 2019. Two researchers screened studies for eligibility. One researcher extracted data from eligible studies while a second performed verification of results for accuracy and completeness. Quality appraisal was conducted by both reviewers. Data describing major factors associated with caregiving experiences of children with parental mental illnesses were synthesized and reported in narrative form. Five studies were considered eligible and included in this review. Findings are organized under major themes such as the impact of parental mental illness on children’s daily life, how children provide care to their mentally ill parents as primary carers, social and relationship factors associated with their caregiving, positive and negative experiences in caregiving and how children cope with their experiences with parental mental illnesses. Literature relating to the caregiving experiences of children with parental mental illnesses is sparse. More research is required to better understand the children’s caregiving experiences related to parental mental illnesses so as to better inform management for enhancing their mental health, wellbeing, and caregiving practice.Keywords: caregiving experience, children, parental mental illnesses, wellbeing
Procedia PDF Downloads 1411992 Seepage Analysis through Earth Dam Embankment: Case Study of Batu Dam
Authors: Larifah Mohd Sidik, Anuar Kasa
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In recent years, the demands for raw water are increasing along with the growth of the economy and population. Hence, the need for the construction and operation of dams is one of the solutions for the management of water resources problems. The stability of the embankment should be taken into consideration to evaluate the safety of retaining water. The safety of the dam is mostly based on numerous measurable components, for instance, seepage flowrate, pore water pressure and deformation of the embankment. Seepage and slope stability is the primary and most important reason to ascertain the overall safety behavior of the dams. This research study was conducted to evaluate static condition seepage and slope stability performances of Batu dam which is located in Kuala Lumpur capital city. The numerical solution Geostudio-2012 software was employed to analyse the seepage using finite element method, SEEP/W and slope stability using limit equilibrium method, SLOPE/W for three different cases of reservoir level operations; normal and flooded condition. Results of seepage analysis using SEEP/W were utilized as parental input for the analysis of SLOPE/W. Sensitivity analysis on hydraulic conductivity of material was done and calibrated to minimize the relative error of simulation SEEP/W, where the comparison observed field data and predicted value were also carried out. In seepage analysis, such as leakage flow rate, pore water distribution and location of a phreatic line are determined using the SEEP/W. The result of seepage analysis shows the clay core effectively lowered the phreatic surface and no piping failure is shown in the result. Hence, the total seepage flux was acceptable and within the permissible limit.Keywords: earth dam, dam safety, seepage, slope stability, pore water pressure
Procedia PDF Downloads 2231991 Silver Nanoparticle Application in Food Packaging and Impacts on Food Safety and Consumer’s Health
Authors: Worku Dejene Bekele, András Marczika Csilla Sörös
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Silver nanoparticles are silver metal with a size of 1-100nm. The most common source of silver nanoparticles is inorganic salts. Nanoparticles can be ingested through our foods and constitute nanoparticles and silver ions, whether as an additive or by migrants and, in some cases, as a pollutant. Silver nanoparticles are the most widely applicable engineered nanomaterials, especially for antimicrobial function. Ag nanoparticles give different advantages in the case of food safety, quality, and overall acceptability; however, they affect the health of humans and animals, putting them at risk of health problems and environmental pollution. Silver nanoparticles have been used widely in food packaging technologies, especially in water treatments, meat and meat products, fruit, and many other food products. This is for bio-preservation from food products. The primary goal of this review is to determine the safety and health impact of Ag nanoparticles application in food packaging and analysis of the human organs more affected by this preservative technology, to assess the implications of a nanoparticle on food safety, to determine the effects of nanoparticles on consumers health and to determine the impact of nanotechnology on product acceptability. But currently, much research has demonstrated that there is cause to believe that silver nanoparticles may have toxicological effects on biological organs and systems. The silver nanoparticles affect DNA expression, gastrointestinal barriers, lungs, and other breathing organs illness. Silver particles and molecules are very toxic. During its application in food packaging, food industries used the thinnest particle. This particle can potentially affect the gastrointestinal tracts-it suffers from mucus production, DNA, lungs, and other breezing organs. This review is targeted to demonstrate the knowledge gap that industrials use in the application of silver nanoparticles in food packaging and preservation and its health effects on the consumer.Keywords: food preservatives, health impact, nanoparticle, silver nanoparticle
Procedia PDF Downloads 711990 Lying Decreases Relying: Deceiver's Distrust in Online Restaurant Reviews
Authors: Jenna Barriault, Reeshma Haji
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Online consumer behaviourand reliance on online reviews may be more pervasive than ever, andthis necessitates a better scientific understanding of the widespread phenomenon of online deception. The present research focuses on the understudied topic of deceiver’s distrust, where those who engage in deception later have less trust in others in the context of online restaurant reviews. The purpose was to examine deception and valence in online restaurant reviews and the effects they had on deceiver’s distrust. Undergraduate university students (N = 76) completed an online study where valence was uniquely manipulated by telling participants that either positive (or negative reviews) were influential and asking them to write a correspondingly valenced review. Deception was manipulated in the same task. Participants in the deception condition were asked to write an online restaurant review that was counter to their actual experience of the restaurant (negative review of a restaurant they liked, positive review of the restaurant they did not like). In the no deception condition, participants were asked to write a review that they actually liked or didn’t like (based on the valence condition to which they were randomly assigned). Participants’ trust was then assessed through various measures, includingfuture reliance on online reviews. There was a main effect of deception on reliance on online reviews. Consistent with deceiver’s distrust, those who deceived reported that they would rely less on online reviews. This study demonstrates that even when participants are induced to write a deceptive review, it can result in deceiver’s distrust, thereby lowering their trust in online reviews. If trust or reliance can be altered through deception in online reviews, people may start questioning the objectivity or true representation of a company based on such reviews. A primary implication is that people may reduce theirreliance upon online reviews if they know they are easily subject to manipulation. The findings of this study also contribute to the limited research regarding deceiver’s distrust in an online context, and further research is clarifying the specific conditions in which it is most likely to occur.Keywords: deceiver’s distrust, deception, online reviews, trust, valence
Procedia PDF Downloads 1241989 The Healing 'Touch' of Music: A Neuro-Acoustics Approach to Understand Its Therapeutic Effect
Authors: Jagmeet S. Kanwal, Julia F. Langley
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Music can heal the body, but a mechanistic understanding of this phenomenon is lacking. This study explores the effects of music presentation on neurologic and physiologic responses leading to metabolic changes in the human body. The mind and body co-exist in a corporeal entity and within this framework, sickness ensues when the mind-body balance goes awry. It is further hypothesized that music has the capacity to directly reset this balance. Two lines of inquiry taken together can provide a mechanistic understanding of this phenomenon 1) Empirical evidence for a sound-sensitive pressure sensor system in the body, and 2) The notion of a “healing center” within the brain that is activated by specific patterns of sounds. From an acoustics perspective, music is spatially distributed as pressure waves ranging from a few cm to several meters in wavelength. These waves interact and propagate in three-dimensions in unique ways, depending on the wavelength. Furthermore, music creates dynamically changing wave-fronts. Frequencies between 200 Hz and 1 kHz generate wavelengths that range from 5'6" to 1 foot. These dimensions are in the range of the body size of most people making it plausible that these pressure waves can geometrically interact with the body surface and create distinct patterns of pressure stimulation across the skin surface. For humans, short wavelength, high frequency (> 200 Hz) sounds are best received via cochlear receptors. For low frequency (< 200 Hz), long wavelength sound vibrations, however, the whole body may act as an ideal receiver. A vast array of highly sensitive pressure receptors (Pacinian corpuscles) is present just beneath the skin surface, as well as in the tendons, bones, several organs in the abdomen, and the sexual organs. Per the available empirical evidence, these receptors contribute to music perception by allowing the whole body to function as a sound receiver, and knowledge of how they function is essential to fully understanding the therapeutic effect of music. Neuroscientific studies have established that music stimulates the limbic system that can trigger states of anxiety, arousal, fear, and other emotions. These emotional states of brain activity play a crucial role in filtering top-down feedback from thoughts and bottom-up sensory inputs to the autonomic system, which automatically regulates bodily functions. Music likely exerts its pleasurable and healing effects by enhancing functional and effective connectivity and feedback mechanisms between brain regions that mediate reward, autonomic, and cognitive processing. Stimulation of pressure receptors under the skin by low-frequency music-induced sensations can activate multiple centers in the brain, including the amygdala, the cingulate cortex, and nucleus accumbens. Melodies in music in the low (< 600 Hz) frequency range may augment auditory inputs after convergence of the pressure-sensitive inputs from the vagus nerve onto emotive processing regions within the limbic system. The integration of music-generated auditory and somato-visceral inputs may lead to a synergistic input to the brain that promotes healing. Thus, music can literally heal humans through “touch” as it energizes the brain’s autonomic system for restoring homeostasis.Keywords: acoustics, brain, music healing, pressure receptors
Procedia PDF Downloads 1671988 Fuzzy Climate Control System for Hydroponic Green Forage Production
Authors: Germán Díaz Flórez, Carlos Alberto Olvera Olvera, Domingo José Gómez Meléndez, Francisco Eneldo López Monteagudo
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In recent decades, population growth has exerted great pressure on natural resources. Two of the most scarce and difficult to obtain resources, arable land, and water, are closely interrelated, to the satisfaction of the demand for food production. In Mexico, the agricultural sector uses more than 70% of water consumption. Therefore, maximize the efficiency of current production systems is inescapable. It is essential to utilize techniques and tools that will enable us to the significant savings of water, labor and fertilizer. In this study, we present a production module of hydroponic green forage (HGF), which is a viable alternative in the production of livestock feed in the semi-arid and arid zones. The equipment in addition to having a forage production module, has a climate and irrigation control system that operated with photovoltaics. The climate control, irrigation and power management is based on fuzzy control techniques. The fuzzy control provides an accurate method in the design of controllers for nonlinear dynamic physical phenomena such as temperature and humidity, besides other as lighting level, aeration and irrigation control using heuristic information. In this working, firstly refers to the production of the hydroponic green forage, suitable weather conditions and fertigation subsequently presents the design of the production module and the design of the controller. A simulation of the behavior of the production module and the end results of actual operation of the equipment are presented, demonstrating its easy design, flexibility, robustness and low cost that represents this equipment in the primary sector.Keywords: fuzzy, climate control system, hydroponic green forage, forage production module
Procedia PDF Downloads 3981987 Development of Regional Cooperation to Sustainable Implementation of Customary Refugee Solutions in International Arena
Authors: Md. Reduanul Haque
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In recent time, more and more refugees are emerging in the international arena than the times ever that has come into the notice of world scholars. The prevailing customary solutions such as voluntary repatriation, local integration, and resettlement of refugee problem have been reflected unsustainable one for the lack of regional cooperation. In the international arena, the protraction of refugee problems is seen, and refugees are suffering due to the outrageous process of customary refugee solutions. If the regional cooperation can be developed, then the suffering of the refugees can be mitigated by the contribution of neighboring country and international and regional organizations. Data collected from the various secondary sources have been used throughout the research. It has been discussing in the refugee academia for a long time to develop regional cooperation mechanisms to ensure the sustainability of this solution and to make the environment of the country of origin for suitable voluntary repatriation as well as a durable solution. It is mainly qualitative research based on primary and secondary data will be studied on library-based project. Data collected by such methodology on this study indicates to make a bridge between the gaps of the cooperation mechanism and to make a more regional approach to share the burden and to strengthen the customary refugee solution. Hence, the importance of questing for a regional mechanism is to ensure the responsible countries to be more responsible towards refugees, their human rights, and durable solution under the mandate of the UNHCR. To implement effectively all the customary durable solutions, country to country or regional organization to organization based regional cooperation can be developed where the countries and regional organizations will work together to draw a sustainable solution to this problem in international context.Keywords: refugee, regional cooperation, sustainable implementation, customary solutions, international arena
Procedia PDF Downloads 1441986 Potential Usefulness of Video Lectures as a Tool to Improve Synchronous and Asynchronous the Online Education
Authors: Omer Shujat Bhatti, Afshan Huma
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Online educational system were considered a great opportunity for distance learning. In recent days of COVID19 pandemic, it enable the continuation of educational activities at all levels of education, from primary school to the top level universities. One of the key considered element in supporting the online educational system is video lectures. The current research explored the usefulness of the video lectures delivered to technical students of masters level with a focus on MSc Sustainable Environmental design students who have diverse backgrounds in the formal educational system. Hence they were unable to cope right away with the online system and faced communication and understanding issues in the lecture session due to internet and allied connectivity issues. Researcher used self prepared video lectures for respective subjects and provided them to the students using Youtube channel and subject based Whatsapp groups. Later, students were asked about the usefulness of the lectures towards a better understanding of the subject and an overall enhanced learning experience. More than 80% of the students appreciated the effort and requested it to be part of the overall system. Data collection was done using an online questionnaire which was prior briefed to the students with the purpose of research. It was concluded that video lectures should be considered an integral part of the lecture sessions and must be provided prior to the lecture session, ensuring a better quality of delivery. It was also recommended that the existing system must be upgraded to support the availability of these video lectures through the portal. Teachers training must be provided to help develop quality video content ensuring that is able to cover the content and courses taught.Keywords: video lectures, online distance education, synchronous instruction, asynchronous communication
Procedia PDF Downloads 1171985 Challenges in Providing Protection to the Conflict-Affected Refugee Children in Pakistan: A Critical Analysis of the 1951 Refugee Convention
Authors: Faiz Bakhsh, Tahira Yasmeen
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The Afghan refugee children in Pakistan are considered as the most vulnerable persons in danger of being abused and treated badly as compared to the minimum criteria of the protection of refugee children under 1951 refugee convention. This paper explores the impact of the 1951 refugee convention on the protection of refugee children, affected by the armed conflict in Afghanistan, residing in refugee camps in Pakistan. Despite, protection available under Refugee Convention, there exist millions of refugees in the world, including a huge portion of women and children, that remain unprotected, and their protection remains a challenging task for the world community. This study investigates the status and number of refugees in Pakistan, especially children; protection and assistance of refugees under Refugee Convention; protection of the rights of refugee children in Pakistan; and implementation of the rules of Refugee Convention relating refugee children in Pakistan and measures for the protection of refugee children in Pakistan. This socio-legal study utilizes a qualitative research approach and applies mixed methods of data collection. The primary data is collected through the interpretation of the legal framework available for the protection of refugees as well as domestic laws of Pakistan. The secondary data is collected through previous studies available on the same topic. The result of this study indicates that lack of proper implementation of the rules, of the Refugee Convention, relating protection of refugee children cause sufferings to refugee children including the provision of basic health, nutrition, family life, education and protection from child abuse. Pakistan needs a comprehensive domestic legal framework for the protection of refugees, especially refugee children. Moreover, the government of Pakistan with the help of the United Nations High Commissioner for Refugees (UNHCR) must prioritize the protection of Afghan refugee children as per standard criteria provided by the refugee convention 1951.Keywords: refugee children, refugee convention, armed conflict, Pakistan
Procedia PDF Downloads 1601984 A Basic Modeling Approach for the 3D Protein Structure of Insulin
Authors: Daniel Zarzo Montes, Manuel Zarzo Castelló
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Proteins play a fundamental role in biology, but their structure is complex, and it is a challenge for teachers to conceptually explain the differences between their primary, secondary, tertiary, and quaternary structures. On the other hand, there are currently many computer programs to visualize the 3D structure of proteins, but they require advanced training and knowledge. Moreover, it becomes difficult to visualize the sequence of amino acids in these models, and how the protein conformation is reached. Given this drawback, a simple and instructive procedure is proposed in order to teach the protein structure to undergraduate and graduate students. For this purpose, insulin has been chosen because it is a protein that consists of 51 amino acids, a relatively small number. The methodology has consisted of the use of plastic atom models, which are frequently used in organic chemistry and biochemistry to explain the chirality of biomolecules. For didactic purposes, when the aim is to teach the biochemical foundations of proteins, a manipulative system seems convenient, starting from the chemical structure of amino acids. It has the advantage that the bonds between amino acids can be conveniently rotated, following the pattern marked by the 3D models. First, the 51 amino acids were modeled, and then they were linked according to the sequence of this protein. Next, the three disulfide bonds that characterize the stability of insulin have been established, and then the alpha-helix structure has been formed. In order to reach the tertiary 3D conformation of this protein, different interactive models available on the Internet have been visualized. In conclusion, the proposed methodology seems very suitable for biology and biochemistry students because they can learn the fundamentals of protein modeling by means of a manipulative procedure as a basis for understanding the functionality of proteins. This methodology would be conveniently useful for a biology or biochemistry laboratory practice, either at the pre-graduate or university level.Keywords: protein structure, 3D model, insulin, biomolecule
Procedia PDF Downloads 591983 An Analysis of the Causes of SMEs Failure in Developing Countries: The Case of South Africa
Authors: Paul Saah, Charles Mbohwa, Nelson Sizwe Madonsela
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In the context of developing countries, this study explores a crucial component of economic development by examining the reasons behind the failure of small and medium-sized enterprises (SMEs). SMEs are acknowledged as essential drivers of economic expansion, job creation, and poverty alleviation in emerging countries. This research uses South Africa as a case study to evaluate the reasons why SMEs fail in developing nations. This study explores a quantitative research methodology to investigate the complex causes of SME failures using statistical tools and reliability tests. To ensure the viability of data collection, a sample size of 400 small business owners was chosen using a non-probability selection technique. A closed-ended questionnaire was the primary technique used to obtain detailed information from the participants. Data was analysed and interpreted using computer software packages such as the Statistical Package for the Social Sciences (SPSS). According to the findings, the main reasons why SMEs fail in developing nations are a lack of strategic business planning, a lack of funding, poor management, a lack of innovation, a lack of business research and a low level of education and training. The results of this study show that SMEs can be sustainable and successful as long as they comprehend and use the suggested small business success determining variables into their daily operations. This implies that the more SMEs in developing countries implement the proposed determinant factors of small business success in their business operations the more the businesses are likely to succeed and vice versa.Keywords: failure, developing countries, SMEs, economic development, South Africa
Procedia PDF Downloads 791982 The Value of Routine Terminal Ileal Biopsies for the Investigation of Diarrhea
Authors: Swati Bhasin, Ali Ahmed, Valence Xavier, Ben Liu
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Aims: Diarrhea is a problem that is a frequent clinic referral to the gastroenterology and surgical team from the General practitioner. To establish a diagnosis, these patients undergo colonoscopy. The current practice at our district general hospital is to perform random left and right colonic biopsies. National guidelines issued by the British Society of Gastroenterology advise all patients presenting with chronic diarrhea should have an Ileoscopy as an indicator for colonoscopy completion. Our primary aim was to check if Terminal ileum (TI) biopsy is required to establish a diagnosis of inflammatory bowel disease (IBD). Methods: Data was collected retrospectively from November 2018 to November 2019. The target population were patients who underwent colonoscopies for diarrhea. Demographic data, endoscopic and histology findings of TI were assessed and analyzed. Results: 140 patients with a mean age of 57 years (19-84) underwent a colonoscopy (M: F; 1:2.3). 92 patients had random colonic biopsies taken and based on the histological results of these, 15 patients (16%) were diagnosed with IBD. The TI was successfully intubated in 40 patients, of which 32 patients had colonic biopsies taken as well. 8 patients did not have a colonic biopsy taken. Macroscopic abnormality in the TI was detected in 5 patients, all of whom were biopsied. Based on histological results of the biopsy, 3 patients (12%) were diagnosed with IBD. These 3 patients (100%) also had colonic biopsies taken simultaneously and showed inflammation. None of the patients had a diagnosis of IBD confirmed on TI intubation alone (where colonic biopsies were not done). None of the patients has a diagnosis of IBD confirmed on TI intubation alone (where colonic biopsies were negative). Conclusion: TI intubation is a highly-skilled, time-consuming procedure with a higher risk of perforation, which as per our study, has little additional diagnostic value in finding IBD for symptoms of diarrhea if colonic biopsies are taken. We propose that diarrhea is a colonic symptom; therefore, colonic biopsies are positive for inflammation if the diarrhea is secondary to IBD. We conclude that all of the IBDs can be diagnosed simply with colonic biopsies.Keywords: biopsy, colon, IBD, terminal ileum
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