Search results for: equivalence results

Authors: Nura Khattab, Fayad Al-Haimus, Teruko Kishibe, Netanel Krugliak, Melissa McGowan, Brodie Nolan

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Trauma-induced coagulopathy remains a significant contributor to mortality in severely injured patients. Fibrinogen is essential for early hemostasis and is recognized as the first coagulation factor to fall below critical levels, compromising the coagulation cascade. Early administration of fibrinogen concentrate may be feasible and effective to prevent coagulopathy. We conducted this scoping review to characterize the existing quantity of literature, and to explore the usage of prehospital fibrinogen concentrate products in improving clinical outcomes in trauma patients. Methods: A search strategy was developed in consultation with an information specialist. We searched MEDLINE, Embase, Cochrane, and Scopus from inception to May 6th 2024. English studies evaluating prehospital/military usage of fibrinogen concentrate in trauma patients were included. Studies were assessed by three independent reviewers for meeting inclusion and exclusion criteria. Reference lists of included articles were reviewed to identify additional studies meeting inclusion criteria. Clinical endpoints regarding fibrinogen concentrate were extracted and synthesized. Results: The literature search returned 1301 articles with seven studies meeting the inclusion criteria. Five studies (71%) were conducted in civilian settings and two studies (29%) were conducted in military settings. Of the included studies, three (43%) utilized a randomized control trial. We identified seven outcomes that compared varying concentrations of fibrinogen or fibrinogen concentrate to a placebo group. The outcomes included overall mortality, death from hemorrhage, thromboembolic events, clotting time, maximum clot firmness, clot stability at ER admission, and fibrinogen concentration at ER admission. Apart from thromboembolic events, all other reported outcomes showed statistically significant differences in group comparisons, determined using p values. The four (57%) non-clinical studies underscored the robustness, practicality, and degree of fibrinogen concentrate utilization in military environments and retrieval services. Conclusion: Preliminary research suggests that prehospital fibrinogen concentrate administration in traumatic bleeding patients is both feasible and effective, improving mortality and clotting parameters. While implementing a time-saving and proactive approach with fibrinogen holds potential for enhancing trauma care, the current evidence is limited. Further studies in this novel field are warranted.

Keywords: fibrinogen concentrate, prehospital, military, trauma, trauma-induced coagulopathy

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Authors: Yonas Shuke Kitawa

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Background: Although malaria incidence has substantially fallen sharply over the past few years, the rate of decline varies by district, time, and malaria type. Despite this turn-down, malaria remains a major public health threat in various districts of Ethiopia. Consequently, the present study is aimed at developing a predictive model that helps to identify the spatio-temporal variation in malaria risk by multiple plasmodium species. Methods: We propose a multivariate spatio-temporal Bayesian model to obtain a more coherent picture of the temporally varying spatial variation in disease risk. The spatial autocorrelation in such a data set is typically modeled by a set of random effects that assign a conditional autoregressive prior distribution. However, the autocorrelation considered in such cases depends on a binary neighborhood matrix specified through the border-sharing rule. Over here, we propose a graph-based optimization algorithm for estimating the neighborhood matrix that merely represents the spatial correlation by exploring the areal units as the vertices of a graph and the neighbor relations as the series of edges. Furthermore, we used aggregated malaria count in southern Ethiopia from August 2013 to May 2019. Results: We recognized that precipitation, temperature, and humidity are positively associated with the malaria threat in the area. On the other hand, enhanced vegetation index, nighttime light (NTL), and distance from coastal areas are negatively associated. Moreover, nonlinear relationships were observed between malaria incidence and precipitation, temperature, and NTL. Additionally, lagged effects of temperature and humidity have a significant effect on malaria risk by either species. More elevated risk of P. falciparum was observed following the rainy season, and unstable transmission of P. vivax was observed in the area. Finally, P. vivax risks are less sensitive to environmental factors than those of P. falciparum. Conclusion: The improved inference was gained by employing the proposed approach in comparison to the commonly used border-sharing rule. Additionally, different covariates are identified, including delayed effects, and elevated risks of either of the cases were observed in districts found in the central and western regions. As malaria transmission operates in a spatially continuous manner, a spatially continuous model should be employed when it is computationally feasible.

Keywords: disease mapping, MSTCAR, graph-based optimization algorithm, P. falciparum, P. vivax, waiting matrix

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Authors: Aisha Siddiqa

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The knowledge of pragmatic practices in a particular language is considered key to effective communication. Unlike one’s native language where this knowledge is acquired spontaneously, more conscious attention is required to learn second language pragmatics. Traditional foreign language (FL) classrooms generally focus on the acquisition of vocabulary and lexico-grammatical structures, neglecting pragmatic functions that are essential for effective communication in the multilingual networks of the modern world. In terms of effective communication, of particular importance is knowledge of what is perceived as polite or impolite in a certain language, an aspect of pragmatics which is not perceived as obligatory but is nonetheless indispensable for successful intercultural communication and integration. While learning a second language, the acquisition of politeness assumes more prominence as the politeness norms and practices vary according to language and culture. Therefore, along with focusing on the ‘use’ of politeness strategies, it is crucial to examine the ‘acquisition’ and the ‘acquisitional development’ of politeness strategies by second language learners, particularly, by lower proficiency leaners as the norms of politeness are usually focused in lower levels. Hence, there is an obvious need for a study that not only investigates the acquisition of pragmatics by young FL learners using innovative multiple methods; but also identifies the potential causes of the gaps in their development. The present research employs a cross sectional design to explore the acquisition of politeness by young English as a foreign language learners (EFL) in France; at three levels of secondary school learning. The methodology involves two phases. In the first phase a cartoon oral production task (COPT) is used to elicit samples of requests from young EFL learners in French schools. These data are then supplemented by a) role plays, b) an analysis of textbooks, and c) video recordings of classroom activities. This mixed method approach allows us to explore the repertoire of politeness strategies the learners possess and delve deeper into the opportunities available to learners in classrooms to learn politeness strategies in requests. The paper will provide the results of the analysis of COPT data for 250 learners at three different stages of English as foreign language development. Data analysis is based on categorization of requests developed in CCSARP project. The preliminary analysis of the COPT data shows that there is substantial evidence of pragmalinguistic development across all levels but the developmental process seems to gain momentum in the second half of the secondary school period as compared to the early period at school. However, there is very little evidence of sociopragmatic development. The study aims to document the current classroom practices in France by looking at the development of young EFL learner’s politeness strategies across three levels of secondary schools.

Keywords: acquisition, English, France, interlanguage pragmatics, politeness

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Authors: Aisha Maroof

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Introduction: Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers and health systems. Severe 2019 novel coronavirus infectious disease (COVID-19) with pneumonia is associated with high rates of admission to the intensive care unit (ICU) and they are at high risk to obtain the hospital acquire bloodstream infection (HAIs) such as central line associated bloodstream infection (CLABSI), catheter associated urinary tract infections (CAUTI) and laboratory confirm bloodstream infection (LCBSI). The chances of infection transmission increase when healthcare worker’s (HCWs) practice is inappropriate. Risk related to hand hygiene (HH) and personal protective equipment (PPE) as regards multidrug-resistant organism transmission: use of multiple gloving instead of HH and incorrect use of PPE can lead to a significant increase of device-related infections. As it reaches low- and middle-income countries, its effects could be even more, because it will be difficult for them to react aggressively to the pandemic. HAIs are one of the biggest medical concerns, resulting in increased mortality rates. Objective: To assess the effect of intervention on compliance of hand hygiene and PPE among HCWs reduce the rate of HAI in COVID-19 patients. Method: An interventional study was done between July to December, 2020. CLABSI, CAUTI and LCBSI data were collected from the medical record and direct observation. There were total of 50 Nurses, 18 doctors and all patients with laboratory-confirmed severe COVID-19 admitted to the hospital were included in this research study. Respiratory tract specimens were obtained after the first 48 h of ICU admission. Practices were observed after and before intervention. Education was provided based on WHO guidelines. Results: During the six months of study July to December, the rate of CLABSI, CAUTI and LCBSI pre and post intervention was reported. CLABSI rate decreasedd from 22.7 to 0, CAUTI rate was decreased from 1.6 to 0, LCBSI declined from 3.3 to 0 after implementation of intervention. Conclusion: HAIs are an important cause of morbidity and mortality. Most of the device related infections occurs due to lack of correct use of PPE and hand hygiene compliance. Hand hygiene and PPE is the most important measure to protect patients, through education it can be improved the correct use of PPE and hand hygiene compliance and can reduce the bacterial infection in COVID-19 patients.

Keywords: hospital acquire infection, healthcare workers, hand hygiene, personal protective equipment

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Authors: Diamant Irene, Shklarnik Batya

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In on to its widespread effects on health and economic issues, Covid-19 shook the work and employment world. Among the prominent changes during the pandemic is the work-from-home trend, complete or partial, as part of social distancing. In fact, these changes accelerated an existing tendency of work flexibility already underway before the pandemic. Technology and means of advanced communications led to a re-assessment of “place of work” as a physical space in which work takes place. Today workers can remotely carry out meetings, manage projects, work in groups, and different research studies point to the fact that this type of work has no adverse effect on productivity. However, from the worker’s perspective, despite numerous advantages associated with work from home, such as convenience, flexibility, and autonomy, various drawbacks have been identified such as loneliness, reduction of commitment, home-work boundary erosion, all risk factors relating to the quality of life and burnout. Thus, a real need has arisen in exploring differences in work-from-home experiences and understanding the relationship between psychological characteristics and the prevalence of burnout. This understanding may be of significant value to organizations considering a future hybrid work model combining in-office and remote working. Based on Hobfoll’s Theory of Conservation of Resources, we hypothesized that burnout would mainly be found among workers whose physical remoteness from the workplace threatens or hinders their ability to retain significant individual resources. In the present study, we compared fully remote and partially remote workers (hybrid work), and we examined psychological characteristics and their connection to the formation of burnout. Based on the conceptualization of Place Attachment as the cognitive-emotional bond of an individual to a meaningful place and the need to maintain closeness to it, we assumed that individuals characterized with Place Attachment to the workplace would suffer more from burnout when working from home. We also assumed that extrovert individuals, characterized by the need of social interaction at the workplace and individuals with segmentationpreference – a need for separation between different life domains, would suffer more from burnout, especially among fully remote workers relative to partially remote workers. 194 workers, of which 111 worked from home in full and 83 worked partially from home, aged 19-53, from different sectors, were tested using an online questionnaire through social media. The results of the study supported our assumptions. The repercussions of these findings are discussed, relating to future occupational experience, with an emphasis on suitable occupational adjustment according to the psychological characteristics and needs of workers.

Keywords: working from home, burnout, place attachment, extraversion, segmentation preference, Covid-19

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Authors: Diom Loreen Ndum, Omarine Njimanted

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With increasing automation in clinical laboratories, the requirements for quality control materials have greatly increased in order to monitor daily performance. The constant use of commercial control material is not economically feasible for many developing countries because of non-availability or the high-cost of the materials. Therefore, preparation and use of in-house quality control serum will be a very cost-effective measure with respect to laboratory needs.The objective of this study was to determine the efficacy of in-house prepared pooled sera with respect to commercially acquired control sample for routine internal quality control at the Nkwen District Hospital Laboratory. This was an analytical study, serum was taken from leftover serum samples of 5 healthy adult blood donors at the blood bank of Nkwen District Hospital, which had been screened negative for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and Hepatitis B antigens (HBsAg), and were pooled together in a sterile container. From the pooled sera, sixty aliquots of 150µL each were prepared. Forty aliquots of 150µL each of commercially acquired samples were prepared after reconstitution and stored in a deep freezer at − 20°C until it was required for analysis. This study started from the 9th June to 12th August 2022. Every day, alongside with commercial control sample, one aliquot of pooled sera was removed from the deep freezer and allowed to thaw before analyzed for the following parameters: blood urea, serum creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), potassium and sodium. After getting the first 20 values for each parameter of pooled sera, the mean, standard deviation and coefficient of variation were calculated, and a Levey-Jennings (L-J) chart established. The mean and standard deviation for commercially acquired control sample was provided by the manufacturer. The following results were observed; pooled sera had lesser standard deviation for creatinine, urea and AST than commercially acquired control samples. There was statistically significant difference (p<0.05) between the mean values of creatinine, urea and AST for in-house quality control when compared with commercial control. The coefficient of variation for the parameters for both commercial control and in-house control samples were less than 30%, which is an acceptable difference. The L-J charts revealed shifts and trends (warning signs), so troubleshooting and corrective measures were taken. In conclusion, in-house quality control sample prepared from pooled serum can be a good control sample for routine internal quality control.

Keywords: internal quality control, levey-jennings chart, pooled sera, shifts, trends, westgard rules

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Authors: Chunhua Liao, Jinfei Wang, Bo Shan, Yang Song, Yongjun He, Taifeng Dong

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Winter wheat is one of the main crops in Canada. Forecasting of within-field variability of yield in winter wheat at the early stages is essential for precision farming. However, the crop yield modelling based on high spatial resolution satellite data is generally affected by the lack of continuous satellite observations, resulting in reducing the generalization ability of the models and increasing the difficulty of crop yield forecasting at the early stages. In this study, the correlations between Sentinel-2 data (vegetation indices and reflectance) and yield data collected by combine harvester were investigated and a generalized multivariate linear regression (MLR) model was built and tested with data acquired in different years. It was found that the four-band reflectance (blue, green, red, near-infrared) performed better than their vegetation indices (NDVI, EVI, WDRVI and OSAVI) in wheat yield prediction. The optimum phenological stage for wheat yield prediction with highest accuracy was at the growing stages from the end of the flowering to the beginning of the filling stage. The best MLR model was therefore built to predict wheat yield before harvest using Sentinel-2 data acquired at the end of the flowering stage. Further, to improve the ability of the yield prediction at the early stages, three simple unsupervised domain adaptation (DA) methods were adopted to transform the reflectance data at the early stages to the optimum phenological stage. The winter wheat yield prediction using multiple vegetation indices showed higher accuracy than using single vegetation index. The optimum stage for winter wheat yield forecasting varied with different fields when using vegetation indices, while it was consistent when using multispectral reflectance and the optimum stage for winter wheat yield prediction was at the end of flowering stage. The average testing RMSE of the MLR model at the end of the flowering stage was 604.48 kg/ha. Near the booting stage, the average testing RMSE of yield prediction using the best MLR was reduced to 799.18 kg/ha when applying the mean matching domain adaptation approach to transform the data to the target domain (at the end of the flowering) compared to that using the original data based on the models developed at the booting stage directly (“MLR at the early stage”) (RMSE =1140.64 kg/ha). This study demonstrated that the simple mean matching (MM) performed better than other DA methods and it was found that “DA then MLR at the optimum stage” performed better than “MLR directly at the early stages” for winter wheat yield forecasting at the early stages. The results indicated that the DA had a great potential in near real-time crop yield forecasting at the early stages. This study indicated that the simple domain adaptation methods had a great potential in crop yield prediction at the early stages using remote sensing data.

Keywords: wheat yield prediction, domain adaptation, Sentinel-2, within-field scale

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Authors: Rabia Genc, Aysun Eksioglu, Emine Serap Sarican, Sibel Icke

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Today the habit of cigarette smoking is among one of the most important public health concerns because of the health problems it leads to. The most important and hazardous group to use tobacco and tobacco products is adolescents and teenagers. And one of the most effective ways to prevent them from starting to smoke is education. This research is a kind of educational intervention study which was carried out in order to evaluate the effect of peer education on the teenagers' knowledge about smoking. The research was carried out between October 15, 2013 and September 9, 2015 at Ege University Ataturk Vocational Health School. The population of the research comprised of the students that have been studying at Ege University Atatürk Vocational Health School, Midwifery Department (N=390). The peer educator group that would give training on smoking consisted of 10 people, and the peer groups that would be trained were divided into two groups via simple randomization as experimental group (n=185) and control group (n=185). Questionnaire, information evaluation form, and informed consent forms were used as date collection tools. The analysis of the data which were collected in the study was carried out on Statistical Package for Social Science (SPSS 15.0). It was found out that 62.5 % of the students who were in peer educator group had smoked in some period of their lives; however, none of them continued to smoke. When they were asked about their reasons to start smoking, 25% said they just wanted to try it, and 25% of them answered that it was because of their friend groups. When the pre-peer education and post-peer education point averages of peer educator group were evaluated, the results showed that there was a significant difference between the point averages (p < 0.05). When the cigarette use of experimental group and the control group were evaluated, it was clear that 18.2% of the experimental group and 24.2%of the control group still smokes. 9.1% of the experimental group and 14.8% of control group stated that they started smoking because of their friend groups. Among the students who smoke 15.9% of the ones who belongs to the experimental group and 21.9% of the ones who belong to the control group stated they are thinking of quitting smoking. It was clear that there is a significant difference between the pre-education and post-education point averages of experimental group statistically (p ≤ 0.05); however, in terms of control group, there were no significant differences between the pre-test post-test averages statistically. Between the pre-test post-test averages of experimental and control groups there were not any statistically significant differences (p > 0.05). It was found out in the study that the peer education programme is not effective on the smoking habit of Vocational Health School students. When the future studies are being planned in order to evaluate the peer education activity, it can be taken into consideration that the peer education takes a long term and the students in the educator group will be more enthusiastic and a kind of leader in their environment.

Keywords: midwifery, peer, peer education, smoking

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Authors: Folajinmi Oluwasina, Towolawi Adetayo, Kate Ssamula, Penninah Iutung, Daniel Reijer

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Objective: Routine HIV screening has been promoted as an essential component of efforts to reduce incidence, morbidity, and mortality. The objectives of this study were to identify the optimal annual volume needed to realize the public health goals of HIV screening in the AIDS Healthcare Foundation supported hospitals and establish an implementation process to realize that optimal annual volume. Methods: Starting in 2011 a program was established to routinize HIV screening within communities and government hospitals. In 2016 Five-years of HIV screening data were reviewed to identify the optimal annual proportions of age-eligible patients screened to realize the public health goals of reducing new diagnoses and ending late-stage diagnosis (tracked as concurrent HIV/AIDS diagnosis). Analysis demonstrated that rates of new diagnoses level off when 42% of age-eligible patients were screened, providing a baseline for routine screening efforts; and concurrent HIV/AIDS diagnoses reached statistical zero at screening rates of 70%. Annual facility based targets were re-structured to meet these new target volumes. Restructuring efforts focused on right-sizing HIV screening programs to align and transition programs to integrated HIV screening within standard medical care and treatment. Results: Over one million patients were screened for HIV during the five years; 16, 033 new HIV diagnoses and access to care and treatment made successfully for 82 % (13,206), and concurrent diagnosis rates went from 32.26% to 25.27%. While screening rates increased by 104.7% over the 5-years, volume analysis demonstrated that rates need to further increase by 62.52% to reach desired 20% baseline and more than double to reach optimal annual screening volume. In 2011 facility targets for HIV screening were increased to reflect volume analysis, and in that third year, 12 of the 19 facilities reached or exceeded new baseline targets. Conclusions and Recommendation: Quantifying targets against routine HIV screening goals identified optimal annual screening volume and allowed facilities to scale their program size and allocate resources accordingly. The program transitioned from utilizing non-evidence based annual volume increases to establishing annual targets based on optimal volume analysis. This has allowed efforts to be evaluated on the ability to realize quantified goals related to the public health value of HIV screening. Optimal volume analysis helps to determine the size of an HIV screening program. It is a public health tool, not a tool to determine if an individual patient should receive screening.

Keywords: HIV screening, optimal volume, HIV diagnosis, routine

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Authors: Isidro Perez, Maryam Nazari

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Numerous earthquakes, which have taken place across the world, led to catastrophic damage and collapse of structures (e.g., 1971 San Fernando; 1995 Kobe-Japan; and 2010 Chile earthquakes). Engineers are constantly studying methods to moderate the effect this phenomenon has on structures to further reduce damage, costs, and ultimately to provide life safety to occupants. However, there are regions where structures, cities, or water reservoirs are built near fault lines. When an earthquake occurs near the fault lines, they can be categorized as near-field earthquakes. In contrary, a far-field earthquake occurs when the region is further away from the seismic source. A near-field earthquake generally has a higher initial peak resulting in a larger seismic response, when compared to a far-field earthquake ground motion. These larger responses may result in serious consequences in terms of structural damage which can result in a high risk for the public’s safety. Unfortunately, the response of structures subjected to near-field records are not properly reflected in the current building design specifications. For example, in ASCE 7-10, the design response spectrum is mostly based on the far-field design-level earthquakes. This may result in the catastrophic damage of structures that are not properly designed for near-field earthquakes. This research investigates the knowledge that the effect of near-field earthquakes has on the response of structures. To fully examine this topic, a structure was designed following the current seismic building design specifications, e.g. ASCE 7-10 and ACI 318-14, being analytically modeled, utilizing the SAP2000 software. Next, utilizing the FEMA P695 report, several near-field and far-field earthquakes were selected, and the near-field earthquake records were scaled to represent the design-level ground motions. Upon doing this, the prototype structural model, created using SAP2000, was subjected to the scaled ground motions. A Linear Time History Analysis and Pushover analysis were conducted on SAP2000 for evaluation of the structural seismic responses. On average, the structure experienced an 8% and 1% increase in story drift and absolute acceleration, respectively, when subjected to the near-field earthquake ground motions. The pushover analysis was ran to find and aid in properly defining the hinge formation in the structure when conducting the nonlinear time history analysis. A near-field ground motion is characterized by a high-energy pulse, making it unique to other earthquake ground motions. Therefore, pulse extraction methods were used in this research to estimate the maximum response of structures subjected to near-field motions. The results will be utilized in the generation of a design spectrum for the estimation of design forces for buildings subjected to NF ground motions.

Keywords: near-field, pulse, pushover, time-history

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Authors: Aziza Al-Sawafi

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Introduction: The evidence of family interventions in schizophrenia is robust primarily in high-income settings. However, they have been adapted to other settings and cultures to improve effectiveness and acceptability. In Oman, there is limited integration of psychosocial interventions in the treatment of schizophrenia. Therefore, the adaptation of family intervention to the Omani culture may facilitate its uptake. Most service users in Oman live with their families outside the healthcare system, and nothing is known about their experience, needs, or resources. Furthermore, understanding caregivers' and mental health professionals' preferences, perceptions, and experience is a fundamental element in the process of intervention development. Therefore, this study aims to develop a culturally sensitive, feasible, and acceptable family intervention for relatives living with schizophrenia in Oman. Method: The Medical Research Council's framework for the evaluation of complex health care interventions provided the conceptual structure for the study. The development phase was carried out, which involved three stages: 1) systematically reviewing the available literature regarding culturally adapted family interventions in the Arab world 2) In-depth interviews with caregivers to explore their experience and perceived needs and preferences regarding intervention 3) A focus group study involving health professionals to explore the acceptability and feasibility of delivering the family intervention in the Omani context. Data synthesis determined the design of the proposed intervention according to the findings obtained from the previous stages. Results: Stage one: The systematic review found limited evidence of culturally-adapted family interventions in the Arab region. However, the cultural adaptation process was comprehensive, and the implementation was reported to be feasible and acceptable. Stage two: The experience of family caregivers illuminated four main themes: burden, stigma, violence, and family needs. Burdens of care included objective and subjective burdens, positive feelings, and coping mechanisms. Caregivers gave their opinion about the content and preference of the intervention from their personal experiences. Stage three: mental health professionals discussed the delivery system of the intervention from a clinical standpoint concerning issues and barriers to implementation. They recommended modifications to the components of the intervention to ensure its acceptability and feasibility in the local setting. Data synthesis was carried out, and the intervention was designed. Conclusion: This study provides evidence of the potential applicability and acceptability of a culturally sensitive family intervention for families of individuals with schizophrenia in Oman. However, more work needs to be done to test the feasibility of the study and overcome the practical challenges.

Keywords: cultural-adaptation, family intervention, Oman, schizophrenia

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Authors: Amardass Dhami, Clare Samuelson

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Background: Sickle cell disease (SCD) is a complex, multisystem condition that significantly impacts patients' quality of life, characterized by acute illness episodes, progressive organ damage, and reduced life expectancy. In the UK, over 13,000 individuals are affected, with South Yorkshire having the fifth highest prevalence, including approximately 800 patients. Retinal complications in SCD can manifest as either proliferative or non-proliferative disease, with proliferative changes being more prevalent. These retinal issues can cause significant morbidity, including visual loss and increased care requirements, underscoring the need for regular monitoring. An integrated approach was applied to ensure timely interventions, ultimately enhancing patient outcomes and reduce ‘did not attend’ rates. Aim: To assess the factors which may influence attendance to Haematology and Ophthalmology Clinics with attention towards levels of deprivation towards non-attendance. Method : A retrospective study on 84 eligible patients, from the regional tertiary Centre for Sickle Cell Care (Sheffield Teaching Hospital) from 2017 to 2023. The study focused on the incidence of sickle cell eye disease, specifically examining the outcomes of patients who attended the combined haematology and ophthalmology clinics. Patients who did not attend either clinic were excluded from the analysis to ensure a clear understanding of the combined clinic's impact. This data was then compared with the United Kingdom’s Index of Multiple Deprivation (IMD) datasets to assess if inequalities of care affected this population. Results: The study concluded that the effectiveness of combining haematology and ophthalmology clinics was reduced following the intervention. The DNA rates increased to 40% for the haematology clinic. Additionally, a significant proportion of the cohort was classified as residing in areas of deprivation, suggesting a possible link between socioeconomic factors and non-attendance rates Conclusion: These findings underscore the challenges of integrating care for SCD patients, particularly in relation to socioeconomic barriers. Despite the intent to streamline care and improve patient outcomes, the increase in DNA rates points to the need for further investigation into the underlying causes of non-attendance. Addressing these issues, especially in deprived areas, could enhance the effectiveness of combined clinics and ensure that patients receive the necessary monitoring and interventions for their eye health and overall well-being. Future strategies may need to focus on improving accessibility, outreach, and support for patients to mitigate the impact of socioeconomic factors on healthcare attendance.

Keywords: south yorkshire, sickle cell anemia, deprivation, factors, haematology

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Authors: Cinzia Federico, Gaetano Giudice, Salvatore Inguaggiato, Marco Liuzzo, Maria Pedone, Fabio Vita, Christoph Kern, Leonardo La Pica, Giovannella Pecoraino, Lorenzo Calderone, Vincenzo Francofonte

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The periods of increased fumarolic activity at La Fossa volcano have been characterized, since early 80's, by changes in the gas chemistry and in the output rate of fumaroles. Excepting the direct measurements of the steam output from fumaroles performed from 1983 to 1995, the mass output of the single gas species has been recently measured, with various methods, only sporadically or for short periods. Since 2008, a scanning DOAS system is operating in the Palizzi area for the remote measurement of the in-plume SO₂ flux. On these grounds, the need of a cross-comparison of different methods for the in situ measurement of the output rate of different gas species is envisaged. In 2015, two field campaigns have been carried out, aimed at: 1. The mapping of the concentration of CO₂, H₂S and SO₂ in the fumarolic plume at 1 m from the surface, by using specific open-path diode tunable lasers (GasFinder Boreal Europe Ltd.) and an Active DOAS for SO₂, respectively; these measurements, coupled to simultaneous ultrasonic wind speed and meteorological data, have been elaborated to obtain the dispersion map and the output rate of single species in the overall fumarolic field; 2. The mapping of the concentrations of CO₂, H₂S, SO₂, H₂O in the fumarolic plume at 0.5 m from the soil, by using an integrated system, including IR spectrometers and specific electrochemical sensors; this has provided the concentration ratios of the analysed gas species and their distribution in the fumarolic field; 3. The in-fumarole sampling of vapour and measurement of the steam output, to validate the remote measurements. The dispersion map of CO₂, obtained from the tunable laser measurements, shows a maximum CO₂ concentration at 1m from the soil of 1000 ppmv along the rim, and 1800 ppmv in the inner slopes. As observed, the largest contribution derives from a wide fumarole of the inner-slope, despite its present outlet temperature of 230°C, almost 200°C lower than those measured at the rim fumaroles. Actually, fumaroles in the inner slopes are among those emitting the largest amount of magmatic vapour and, during the 1989-1991 crisis, reached the temperature of 690°C. The estimated CO₂ and H₂S fluxes are 400 t/d and 4.4 t/d, respectively. The coeval SO₂ flux, measured by the scanning DOAS system, is 9±1 t/d. The steam output, recomputed from CO₂ flux measurements, is about 2000 t/d. The various direct and remote methods (as described at points 1-3) have produced coherent results, which encourage to the use of daily and automatic DOAS SO₂ data, coupled with periodic in-plume measurements of different acidic gases, to obtain the total mass rates.

Keywords: DOAS, fumaroles, plume, tunable laser

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Authors: Eric Shannon, Mark J. McGuire, John P. Parmigiani

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A hazard associated with the use of timber harvesters is chain shot. Harvester saw chain is subjected to large dynamic mechanical stresses which can cause it to fracture. The resulting open loop of saw chain can fracture a second time and create a projectile consisting of several saw-chain links referred to as a chain shot. Its high kinetic energy enables it to penetrate operator enclosures and be a significant hazard. Accurate data on projectile composition, mass, and speed are needed for the design of both operator enclosures resistant to projectile penetration and for saw chain resistant to fracture. The work presented here contributes to providing this data through the use of a test machine designed and built at Oregon State University. The machine’s enclosure is a standard shipping container. To safely contain any anticipated chain shot, the container was lined with both 9.5 mm AR500 steel plates and 50 mm high-density polyethylene (HDPE). During normal operation, projectiles are captured virtually undamaged in the HDPE enabling subsequent analysis. Standard harvester components are used for bar mounting and chain tensioning. Standard guide bars and saw chains are used. An electric motor with flywheel drives the system. Testing procedures follow ISO Standard 11837. Chain speed at break was approximately 45.5 m/s. Data was collected using both a 75 cm solid bar (Oregon 752HSFB149) and 90 cm solid bar (Oregon 902HSFB149). Saw chains used were 89 Drive Link .404”-18HX loops made from factory spools. Standard 16-tooth sprockets were used. Projectile speed was measured using both a high-speed camera and a chronograph. Both rotational and translational kinetic energy are calculated. For this study 50 chain shot events were executed. Results showed that projectiles consisted of a variety combinations of drive links, tie straps, and cutter links. Most common (occurring in 60% of the events) was a drive-link / tie-strap / drive-link combination having a mass of approximately 10.33 g. Projectile mass varied from a minimum of 2.99 g corresponding to a drive link only to a maximum of 18.91 g corresponding to a drive-link / tie-strap / drive-link / cutter-link / drive-link combination. Projectile translational speed was measured to be approximately 270 m/s and rotational speed of approximately 14000 r/s. The calculated translational and rotational kinetic energy magnitudes each average over 600 J. This study provides useful information for both timber harvester manufacturers and saw chain manufacturers to design products that reduce the hazards associated with timber harvesting.

Keywords: chain shot, timber harvesters, safety, testing

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Authors: Domenico Panno, Antonino D’amico, Hamed Jafargholi

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This paper presents an experimental analysis of the performance of a system for freezing fish products equipped with a modulating vapour injection scroll compressor operating with R448A refrigerant. Freezing is a critical process for the preservation of seafood products, as it influences quality, food safety, and environmental sustainability. The use of a modulating scroll compressor with vapour injection, associated with the R448A refrigerant, is proposed as a solution to optimize the performance of the system, reducing energy consumption and mitigating the environmental impact. The stream injection modulating scroll compressor represents an advanced technology that allows you to adjust the compressor capacity based on the actual cooling needs of the system. Vapour injection allows the optimization of the refrigeration cycle, reducing the evaporation temperature and improving the overall efficiency of the system. The use of R448A refrigerant, with a low Global Warming Potential (GWP), is part of an environmental sustainability perspective, helping to reduce the climate impact of the system. The aim of this research was to evaluate the performance of the system through a series of experiments conducted on a pilot plant for the freezing of fish products. Several operational variables were monitored and recorded, including evaporation temperature, condensation temperature, energy consumption, and freezing time of seafood products. The results of the experimental analysis highlighted the benefits deriving from the use of the modulating vapour injection scroll compressor with the R448A refrigerant. In particular, a significant reduction in energy consumption was recorded compared to conventional systems. The modulating capacity of the compressor made it possible to adapt the cold production to variations in the thermal load, ensuring optimal operation of the system and reducing energy waste. Furthermore, the use of an electronic expansion valve highlighted greater precision in the control of the evaporation temperature, with minimal deviation from the desired set point. This helped ensure better quality of the final product, reducing the risk of damage due to temperature changes and ensuring uniform freezing of the fish products. The freezing time of seafood has been significantly reduced thanks to the configuration of the entire system, allowing for faster production and greater production capacity of the plant. In conclusion, the use of a modulating vapour injection scroll compressor operating with R448A has proven effective in improving the performance of a system for freezing fish products. This technology offers an optimal balance between energy efficiency, temperature control, and environmental sustainability, making it an advantageous choice for food industries.

Keywords: scroll compressor, vapor injection, refrigeration system, EER

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Authors: Hannah Kuhar

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This paper delves into the attitudes of professional and semi-professional rugby union athletes in regard to socio-emotional vulnerability, or the willingness to express the full spectrum of human emotion in a social context. Like all humans, athletes of all sports regularly experience feelings of shame, powerlessness, and loneliness, and often feel unable to express such feelings due to factors including lack of situational support, absence of adequate expressive language and lack of resource. To this author’s knowledge, however, no previous research has considered the particular demographic of professional rugby union athletes, despite the sport’s immense popularity and economic contribution to global communities. Hence, this paper aims to extend previous research by exploring the experiences of professional rugby union athletes and their unwillingness and inability to express socio-emotional vulnerability. By having a better understanding of vulnerability in rugby and sports, this paper is able to contribute to the growing field of mental health and wellbeing research, particularly towards the emerging themes of resilience and belonging. Based on qualitative fieldwork conducted over a period of seven months across France and Australia, via the mechanisms of semi-structured interview and observation, this work uses the field theory framework of Pierre Bourdieu to construct an analysis of multidisciplinary thought. Approaching issues of gender, sexuality, physicality, education, and family, this paper shows that socio-emotional vulnerability is experienced by all players regardless of their background, in a variety of ways. Common themes and responses are drawn to show the universality of rugby’s pitfalls, which have previously been limited to specific demographics in isolation of their broader contexts. With the author themselves a semi-professional athlete, the provision of unique ‘insider’ access facilitates a deeper and more comprehensive understanding of first-hand athlete experiences, often unexplored within the context of the academic arena. The primary contention of this paper is to argue that by celebrating socio-emotional vulnerability, there becomes an opportunity to improve on-field team outcomes. Ultimately, players play better when they feel supported by their teammates, and this logic extends to the outcome of the team when socio-emotional team initiatives are widely embraced. The creation of such a culture requires deliberate and purposeful efforts, where player ownership and buy-in are high. Further study in this field may assist teams to better understand the elements which contribute to strong team culture and to strong results on the pitch.

Keywords: rugby, vulnerability, athletes, France, Bourdieu

Procedia PDF Downloads 138

Authors: Wilai Masanga, Chirapha Tannanonta, Sangutid Thongsawad, Sasikarn Chamchod, Todsaporn Fuangrod

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The major factors of radiotherapy for head and neck (HN) cancers include patient’s anatomical changes and tumour shrinkage. These changes can significantly affect the planned dose distribution that causes the treatment plan deterioration. A measured transit EPID images compared to a predicted EPID images using gamma analysis has been clinically implemented to verify the dose accuracy as part of adaptive radiotherapy protocol. However, a global gamma analysis dose not sensitive to some critical organ changes as the entire treatment field is compared. The objective of this feasibility study is to evaluate the dosimetric response to patient anatomical changes during the treatment course in HN IMRT (Head and Neck Intensity-Modulated Radiation Therapy) using a novel comparison method; organ-of-interest gamma analysis. This method provides more sensitive to specific organ change detection. Random replanned 5 HN IMRT patients with causes of tumour shrinkage and patient weight loss that critically affect to the parotid size changes were selected and evaluated its transit dosimetry. A comprehensive physics-based model was used to generate a series of predicted transit EPID images for each gantry angle from original computed tomography (CT) and replan CT datasets. The patient structures; including left and right parotid, spinal cord, and planning target volume (PTV56) were projected to EPID level. The agreement between the transit images generated from original CT and replanned CT was quantified using gamma analysis with 3%, 3mm criteria. Moreover, only gamma pass-rate is calculated within each projected structure. The gamma pass-rate in right parotid and PTV56 between predicted transit of original CT and replan CT were 42.8%( ± 17.2%) and 54.7%( ± 21.5%). The gamma pass-rate for other projected organs were greater than 80%. Additionally, the results of organ-of-interest gamma analysis were compared with 3-dimensional cone-beam computed tomography (3D-CBCT) and the rational of replan by radiation oncologists. It showed that using only registration of 3D-CBCT to original CT does not provide the dosimetric impact of anatomical changes. Using transit EPID images with organ-of-interest gamma analysis can provide additional information for treatment plan suitability assessment.

Keywords: re-plan, anatomical change, transit electronic portal imaging device, EPID, head, and neck

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Authors: İlknur Gökşin, Sultan Ayaz Alkaya

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Objective: Progressive muscle relaxation (PMR) include the deliberate stretching and relaxation of the major muscle groups of the human body. This study was conducted to evaluate the effect of PMR applied in women on the postpartum depression and general comfort level. Methods: The study population of this quasi-experimental study with pre-test, post-test and control group consisted of primipara women who had vaginal delivery in the obstetric service of a university hospital. The experimental and control groups consisted of 35 women each. The data were collected by questionnaire, the Edinburgh Postnatal Depression Scale (EPDS) and the General Comfort Questionnaire (GCQ). The women were matched according to their age and education level and divided into the experimental and control groups by simple random selection. Postpartum depression risk and general comfort was evaluated at the 2nd and 5th days, 10th and 15th days, fourth week and eighth week after birth. The experimental group was visited at home and PMR was applied. After the first visit, women were asked to apply PMR regularly three times a week for eight weeks. During the application, the researcher called the participants twice a week to follow up the continuity of the application. No intervention was performed in the control group. For data analysis, descriptive statistics such as number, percentage, mean, standard deviation, significance test of difference between two means and ANOVA were used. Approval of the ethics committee and permission of the institution were obtained for the study. Results: There were no significant differences between the women in the experimental and control groups in terms of age, education status and employment status (p>0.05). There was no statistically significant difference between the experimental and control groups in terms of EPDS pre-test, 1st, 2nd and 3rd follow-up mean scores (p>0.05). There was a statistically significant difference between EPDS pre-test and 3rd follow-up scores of the experimental group (p<0.05), whereas there was no such difference in the control group (p>0.05). There was no statistically significant difference between the experimental and control groups in terms of mean GCQ pre-test scores (p>0.05), whereas in the 1st, 2nd and 3rd follow-ups there was a statistically significant difference between the mean GCQ scores (p<0.05). It was found that there was a significant increase in the GCQ physical, psychospiritual and sociocultural comfort sub-scales, relief and relaxation levels of the experimental group between the pre-test and 3rd follow-ups scores (p<0.05). And, a significant decrease was found between pre-test and 3rd follow-up GCQ psychospiritual, environmental and sociocultural comfort sub-scale, relief, relaxation and superiority levels (p<0.05). Conclusion: Progressive muscle relaxation was effective on reducing the postpartum depression risk and increasing general comfort. It is recommended to provide progressive muscle relaxation training to women in the postpartum period as well as ensuring the continuity of this practice.

Keywords: general comfort, postpartum depression, postpartum period, progressive muscle relaxation

Procedia PDF Downloads 256

Authors: Tamar Grdzelishvili, Zaza Sinauridze

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Introduction: Preeclampsia is a complication of the second trimester of pregnancy, which is characterized by high morbidity and multiorgan damage. Many complex pathogenic mechanisms are now implicated to be responsible for this disease (1). Preeclampsia is one of the leading causes of maternal mortality worldwide. Statistics are enough to convince you of the seriousness of this pathology: about 100,000 women die of preeclampsia every year. It occurs in 3-14% (varies significantly depending on racial origin or ethnicity and geographical region) of pregnant women, in 75% of cases - in a mild form, and in 25% - in a severe form. During severe pre-eclampsia-eclampsia, perinatal mortality increases by 5 times and stillbirth by 9.6 times. Considering that the only way to treat the disease is to end the pregnancy, the main thing is timely diagnosis and prevention of the disease. Identification of high-risk pregnant women for PE and giving prophylaxis would reduce the incidence of preterm PE. First-trimester screening model developed by the Fetal Medicine Foundation (FMF), which uses the Bayes-theorem to combine maternal characteristics and medical history together with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor, has been proven to be effective and have superior screening performance to that of traditional risk factor-based approach for the prediction of PE (2) Methods: Retrospective single center screening study. The study population consisted of women from the Tbilisi maternity hospital “Pineo medical ecosystem” who met the following criteria: they spoke Georgian, English, or Russian and agreed to participate in the study after discussing informed consent and answering questions. Prior to the study, the informed consent forms approved by the Institutional Review Board were obtained from the study subjects. Early assessment of preeclampsia was performed between 11-13 weeks of pregnancy. The following were evaluated: anamnesis, dopplerography of the uterine artery, mean arterial blood pressure, and biochemical parameter: Pregnancy-associated plasma protein A (PAPP-A). Individual risk assessment was performed with performed by Fast Screen 3.0 software ThermoFisher scientific. Results: A total of 513 women were recruited and through the study, 51 women were diagnosed with preeclampsia (34.5% in the pregnant women with high risk, 6.5% in the pregnant women with low risk; P<0.000 1). Conclusions: First-trimester screening combining maternal factors with uterine artery Doppler, blood pressure, and pregnancy-associated plasma protein-A is useful to predict PE in a routine care setting. More patient studies are needed for final conclusions. The research is still ongoing.

Keywords: first-trimester, preeclampsia, screening, pregnancy-associated plasma protein

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Authors: Amit Kumar Bardhan, Barnali Nag, Chandra Sekhar Mishra

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Microfinance is considered as one of the key drivers of financial inclusion and pro-poor financial growth. Microfinance in India became popular through Self Help Group (SHG) movement initiated by NABARD. In terms of outreach and loan portfolio, SHG Bank Linkage programme (SHG-BLP) has emerged as the largest microfinance initiative in the world. The success of financial inclusion lies in the successful implementation of SHG-BLP. SHGs are generally promoted by social welfare organisations like NGOs, welfare societies, government agencies, Co-operatives etc. and even banks are also involved in SHG formation. Thus, the pro-poor implementation of the scheme largely depends on the credibility of the SHG Promoting Institutions (SHPIs). The rural poor lack education, skills and financial literacy and hence need continuous support and proper training right from planning to implementation. In this study, we have made an attempt to inspect the reasons behind low penetration of SHG financing to the poorest of the poor both from demand and supply side perspective. Banks, SHPIs, and SHGs are three key essential stakeholders in SHG-BLP programmes. All of them have a vital role in programme implementation. The objective of this paper is to find out the drivers and hurdles in the path of financial inclusion through SHG-BLP and the role of SHPIs in reaching out to the ultra poor. We try to address questions like 'what are the challenges faced by SHPIs in targeting the poor?' and, 'what are factors behind the low credit linkage of SHGs?' Our work is based on a qualitative study of SHG programmes in semi-urban towns in the states of West Bengal and Odisha in India. Data are collected through unstructured questionnaire and in-depth interview from the members of SHGs, SHPIs and designated banks. The study provides some valuable insights about the programme and a comprehensive view of problems and challenges faced by SGH, SHPIs, and banks. On the basis of our understanding from the survey, some findings and policy recommendations that seem relevant are: increasing level of non-performing assets (NPA) of commercial banks and wilful default in expectation of loan waiver and subsidy are the prime reasons behind low rate of credit linkage of SHGs. Regular changes in SHG schemes and no incentive for after linkage follow up results in dysfunctional SHGs. Government schemes are mostly focused on creation of SHG and less on livelihood promotion. As a result, in spite of increasing (YoY) trend of number of SHGs promoted, there is no real impact on welfare growth. Government and other SHPIs should focus on resource based SHG promotion rather only increasing the number of SHGs.

Keywords: financial inclusion, inclusive growth, microfinance, Self-Help Group (SHG), Self-Help Group Promoting Institution (SHPI)

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Authors: Safaa S. Hassan, Mohammed H. Elbakry, Safwat A. Mangoura, Zainab M. Omar

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Background: Liver fibrosis is the main reason for increased mortality in chronic liver disease. It has no standard treatment. Antioxidants from a variety of sources are capable of slowing or preventing oxidation of other molecules. Aim: to evaluate the hepatoprotective effect of vit. C, vit. E and gallic acid in comparison to silymarin in the rat model of carbon tetrachloride induced liver fibrosis and their possible mechanisms of action. Material& Methods: A total number of 60 adult male albino rats 160-200gm were divided into six equal groups; received subcutaneous (s.c) injection for 8 weeks. Group I: as control. Group II: received 1.5 mL/kg of CCL4 .Group III: CCL4 and co- treatment with silymarin 100mg/kg p.o. daily. Group IV: CCL4 and co-treatment with vit. C 50mg/kg p.o. daily. Group V: CCL4 and co-treatment with vit. E 200mg/kg. p.o. Group VI: CCL4 and co-treatment with Gallic acid 100mg/kg. p.o. daily. Liver was processed for histological and immunohistochemical examination. Levels of AST, ALT, ALP, reduced GSH, MDA, SOD and hydroxyproline concentration were measured and evaluated statistically. Results: Light and electron microscopic examination of liver of group II exhibited foci of altered cells with dense nuclei and vacuolated, granular cytoplasm, mononuclear cell infiltration in portal areas, profuse collagen fiber deposits were found around portal tract, more intense staining α-SMA-positive cells occupied most of the liver fibrosis tissue, electron lucent areas in the cytoplasm of the hepatocytes, margination of nuclear chromatin. Treatment by any of the antioxidants variably reduced the hepatic structural changes induced by CCL4. Biochemical analysis showed that carbon tetrachloride significantly increased the levels of serum AST, ALT, ALP, hepatic malondialdehyde and hydroxyproline content. Moreover, it decreased the activities of superoxide dismutase and glutathione. Treatment with silymarin, gallic acid, vit. C and vit. E decreased significantly the AST, ALT, and ALP levels in plasma, MDA and hydroxyproline and increased the activities of SOD and glutathione in liver tissue. The effect of administration of CCl4 was improved with the used antioxidants in variable degrees. The most efficient antioxidant was silymarin followed by gallic acid and vit. C then vit. E. It is possibly due to their antioxidant effect, free radical scavenging properties and the reduction of oxidant dependent activation and proliferation of HSCs. Conclusion: So these antioxidants can be a promising drugs candidate for ameliorating liver fibrosis better than the use of the drugs and their side effects.

Keywords: antioxidant, ccl4, gallic acid, liver fibrosis

Procedia PDF Downloads 272

Authors: Enes Huylu, Sude Erkin, Nur A. Özdemir, Hatice K. Güney, Cemre S. Atılgan, Hüseyin Y. Altıntaş, Aysemin Top, Muammer Yılman, Özak Durmuş

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Remanufacturing (reman) applications allow manufacturers to contribute to the circular economy and help to introduce products with almost the same quality, environment-friendly, and lower cost. The objective of this study is to present that the carbon footprint of automotive spare parts used in vehicles could be reduced by reman applications based on Life Cycle Analysis which was framed with ISO 14040 principles. In that case, it was aimed to investigate reman applications for 21 parts in total. So far, research and calculations have been completed for the alternator, turbocharger, starter motor, compressor, manual transmission, auto transmission, and DPF (diesel particulate filter) parts, respectively. Since the aim of Ford Motor Company and Ford OTOSAN is to achieve net zero based on Science-Based Targets (SBT) and the Green Deal that the European Union sets out to make it climate neutral by 2050, the effects of reman applications are researched. In this case, firstly, remanufacturing articles available in the literature were searched based on the yearly high volume of spare parts sold. Paper review results related to their material composition and emissions released during incoming production and remanufacturing phases, the base part has been selected to take it as a reference. Then, the data of the selected base part from the research are used to make an approximate estimation of the carbon footprint reduction of the relevant part used in Ford OTOSAN. The estimation model is based on the weight, and material composition of the referenced paper reman activity. As a result of this study, it was seen that remanufacturing applications are feasible to apply technically and environmentally since it has significant effects on reducing the emissions released during the production phase of the vehicle components. For this reason, the research and calculations of the total number of targeted products in yearly volume have been completed to a large extent. Thus, based on the targeted parts whose research has been completed, in line with the net zero targets of Ford Motor Company and Ford OTOSAN by 2050, if remanufacturing applications are preferred instead of recent production methods, it is possible to reduce a significant amount of the associated greenhouse gas (GHG) emissions of spare parts used in vehicles. Besides, it is observed that remanufacturing helps to reduce the waste stream and causes less pollution than making products from raw materials by reusing the automotive components.

Keywords: greenhouse gas emissions, net zero targets, remanufacturing, spare parts, sustainability

Procedia PDF Downloads 82

Authors: Ahmed Borg, Elsa Aristodemou, Attia Attia

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Well control involves managing the circulating drilling fluid within the wells and avoiding kicks and blowouts as these can lead to losses in human life and drilling facilities. Current practices for good control incorporate predictions of pressure losses through computational models. Developing a realistic hydraulic model for a good control problem is a very complicated process due to the existence of a complex multiphase region, which usually contains a non-Newtonian drilling fluid and the miscibility of formation gas in drilling fluid. The current approaches assume an inaccurate flow fluid model within the well, which leads to incorrect pressure loss calculations. To overcome this problem, researchers have been considering the more complex two-phase fluid flow models. However, even these more sophisticated two-phase models are unsuitable for applications where pressure dynamics are important, such as in managed pressure drilling. This study aims to develop and implement new fluid flow models that take into consideration the miscibility of fluids as well as their non-Newtonian properties for enabling realistic kick treatment. furthermore, a corresponding numerical solution method is built with an enriched data bank. The research work considers and implements models that take into consideration the effect of two phases in kick treatment for well control in conventional drilling. In this work, a corresponding numerical solution method is built with an enriched data bank. Software STARCCM+ for the computational studies to study the important parameters to describe wellbore multiphase flow, the mass flow rate, volumetric fraction, and velocity of each phase. Results showed that based on the analysis of these simulation studies, a coarser full-scale model of the wellbore, including chemical modeling established. The focus of the investigations was put on the near drill bit section. This inflow area shows certain characteristics that are dominated by the inflow conditions of the gas as well as by the configuration of the mud stream entering the annulus. Without considering the gas solubility effect, the bottom hole pressure could be underestimated by 4.2%, while the bottom hole temperature is overestimated by 3.2%. and without considering the heat transfer effect, the bottom hole pressure could be overestimated by 11.4% under steady flow conditions. Besides, larger reservoir pressure leads to a larger gas fraction in the wellbore. However, reservoir pressure has a minor effect on the steady wellbore temperature. Also as choke pressure increases, less gas will exist in the annulus in the form of free gas.

Keywords: multiphase flow, well- control, STARCCM+, petroleum engineering and gas technology, computational fluid dynamic

Procedia PDF Downloads 119

Authors: Restituto I. Rodelas

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The higher education has adopted the outcomes-based education from K-12. In this approach, the teacher uses any teaching and learning strategies that enable the students to achieve the learning outcomes. The students may be required to exert more effort and figure things out on their own. Hence, outcomes-based students are assumed to be more responsible and more capable of applying the knowledge learned. Another approach that the higher education in the Philippines is starting to adopt from other countries is blended learning. This combination of classroom and fully online instruction and learning is expected to be more effective. Participating in the online sessions, however, is entirely up to the students. Thus, the effect of blended learning on the performance of students in Statistics may be mediated by outcomes-based education. If there is a significant positive mediating effect, then blended learning can be optimized by integrating outcomes-based education. In this study, the sample will consist of four blended learning Statistics classes at Jose Rizal University in the second semester of AY 2015–2016. Two of these classes will be assigned randomly to the experimental group that will be handled using outcomes-based education. The two classes in the control group will be handled using the traditional lecture approach. Prior to the discussion of the first topic, a pre-test will be administered. The same test will be given as posttest after the last topic is covered. In order to establish equality of the groups’ initial knowledge, single factor ANOVA of the pretest scores will be performed. Single factor ANOVA of the posttest-pretest score differences will also be conducted to compare the performance of the experimental and control groups. When a significant difference is obtained in any of these ANOVAs, post hoc analysis will be done using Tukey's honestly significant difference test (HSD). Mediating effect will be evaluated using correlation and regression analyses. The groups’ initial knowledge are equal when the result of pretest scores ANOVA is not significant. If the result of score differences ANOVA is significant and the post hoc test indicates that the classes in the experimental group have significantly different scores from those in the control group, then outcomes-based education has a positive effect. Let blended learning be the independent variable (IV), outcomes-based education be the mediating variable (MV), and score difference be the dependent variable (DV). There is mediating effect when the following requirements are satisfied: significant correlation of IV to DV, significant correlation of IV to MV, significant relationship of MV to DV when both IV and MV are predictors in a regression model, and the absolute value of the coefficient of IV as sole predictor is larger than that when both IV and MV are predictors. With a positive mediating effect of outcomes-base education on the effect of blended learning on student performance, it will be recommended to integrate outcomes-based education into blended learning. This will yield the best learning results.

Keywords: outcome-based teaching, blended learning, face-to-face, student-centered

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Authors: Kang Lin Peng

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Space tourism emerged in 2001 and became famous in 2021, following the development of space technology. The space market is twisted because of the excess demand. Space tourism is currently rare and extremely expensive, with biased luxury product pricing, which is the seller’s market that consumers can not bargain with. Spaceship companies such as Virgin Galactic, Blue Origin, and Space X have been charged space tourism prices from 200 thousand to 55 million depending on various heights in space. There should be a reasonable price based on a fair basis. This study aims to derive a spacetime pricing model, which is different from the general pricing model on the earth’s surface. We apply general relativity theory to deduct the mathematical formula for the space tourism pricing model, which covers the traditional time-independent model. In the future, the price of space travel will be different from current flight travel when space travel is measured in lightyear units. The pricing of general commodities mainly considers the general equilibrium of supply and demand. The pricing model considers risks and returns with the dependent time variable as acceptable when commodities are on the earth’s surface, called flat spacetime. Current economic theories based on the independent time scale in the flat spacetime do not consider the curvature of spacetime. Current flight services flying the height of 6, 12, and 19 kilometers are charging with a pricing model that measures time coordinate independently. However, the emergence of space tourism is flying heights above 100 to 550 kilometers that have enlarged the spacetime curvature, which means tourists will escape from a zero curvature on the earth’s surface to the large curvature of space. Different spacetime spans should be considered in the pricing model of space travel to echo general relativity theory. Intuitively, this spacetime commodity needs to consider changing the spacetime curvature from the earth to space. We can assume the value of each spacetime curvature unit corresponding to the gradient change of each Ricci or energy-momentum tensor. Then we know how much to spend by integrating the spacetime from the earth to space. The concept is adding a price p component corresponding to the general relativity theory. The space travel pricing model degenerates into a time-independent model, which becomes a model of traditional commodity pricing. The contribution is that the deriving of the space tourism pricing model will be a breakthrough in philosophical and practical issues for space travel. The results of the space tourism pricing model extend the traditional time-independent flat spacetime mode. The pricing model embedded spacetime as the general relativity theory can better reflect the rationality and accuracy of space travel on the universal scale. The universal scale from independent-time scale to spacetime scale will bring a brand-new pricing concept for space traveling commodities. Fair and efficient spacetime economics will also bring to humans’ travel when we can travel in lightyear units in the future.

Keywords: space tourism, spacetime pricing model, general relativity theory, spacetime curvature

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Authors: Einat E. Peles, Shaul Schreiber, Miriam Adelson

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Background: Since established more than 50 years ago, methadone maintenance treatment (MMT) is the most effective treatment for opioid addiction, a chronic relapsing brain disorder that became an epidemic in western societies. Treatment includes daily individual optimal medication methadone dose (a long acting mu opioid receptor full agonist), accompanied with psychosocial therapy. It is well established that the longer retention in treatment the better outcome and survival occur. It reduces the likelihood to infectious diseases and overdose death that associated with drug injecting, enhanced social rehabilitation and eliminate criminal activity, and lead to healthy productive life. Aim: To evaluate predictors for long term retention in treatment we analyzed our prospective follow up of a major MMT clinic affiliated to a big tertiary medical center. Population Methods: Between June 25, 1993, and June 24, 2016, all 889 patients ( ≥ 18y) who ever admitted to the clinic were prospectively followed-up until May 2017. Duration in treatment from the first admission until the patient quit treatment or until the end of follow-up (24 years) was taken for calculating cumulative retention in treatment using survival analyses (Kaplan Meier) with log-rank and Cox regression for multivariate analyses. Results: Of the 889 patients, 25.2% were females who admitted to treatment at younger age (35.0 ± 7.9 vs. 40.6 ± 9.8, p < .0005), but started opioid usage at same age (22.3 ± 6.9). In addition to opioid use, on admission to MMT 58.5% had positive urine for benzodiazepines, 25% to cocaine, 12.4% to cannabis and 6.9% to amphetamines. Hepatitis C antibody tested positive in 55%, and HIV in 7.8% of the patients and 40%. Of all patients, 75.7% stayed at least one year in treatment, and of them, 67.7% stopped opioid usage (based on urine tests), and a net reduction observed in all other substance abuse (proportion of those who stopped minus proportion of those who have started). Long term retention up to 24 years was 8.0 years (95% Confidence Interval (CI) 7.4-8.6). Predictors for longer retention in treatment (Cox regression) were being older on admission ( ≥ 30y) Odds Ratio (OR) =1.4 (CI 1.1-1.8), not abusing opioids after one year OR=1.8 (CI 1.5-2.1), not abusing benzodiazepine after one year OR=1.7 (CI 1.4-2.1) and treating with methadone dose ≥ 100mg/day OR =1.8 (CI 1.5-2.3). Conclusions: Treating and following patients over 24 years indicate success of two main outcomes, high rate of retention after one year (75.7%) and high proportion of opiate abuse cessation (67.7%). As expected, longer cumulative retention was associated with patients treated with high adequate methadone dose that successfully result in opioid cessation. Based on these findings, in order to reduce morbidity and mortality, we find the establishment of more MMT clinics within a general hospital, a most urgent necessity.

Keywords: methadone maintenance treatment, epidemic, opioids, retention

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Authors: Olga Santesteban, Glorisa Canino, Hector R. Bird, Cristiane S. Duarte

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Objective: To address whether harsh discipline is associated with disruptive behavior disorders (DBD) in Puerto Rican children over time. Background: Both cross-sectional and longitudinal studies report that rates of DBD vary by gender, age and other demographics, being more frequent among boys, later in life and among those who live in urban areas. Also, the literature supports the direct, positive association between harsh discipline and externalizing behaviors. Nevertheless, scholars have underscored the important role of race and ethnicity in understanding discipline effects on children. The impact of harsh discipline in a Puerto Rican population remains to be studied. Methods: Sample: This is a secondary analysis of the Boricua Youth Study which assessed yearly (3 times) Puerto Rican children aged 5-15 in two different sites: San Juan (Puerto Rico) and the South Bronx (NY), N=2951. Participants that did not have scores of harsh discipline in the 3 waves were excluded for this analysis (N=2091). Main Measures: a) Harsh Discipline (Parent report) was measured using 6 items from the “Parental Discipline Scale” that measures various forms of punishment, including physical and verbal abuse, and withholding affection; b) Disruptive Behavior Disorder (Parent report): Parent version of the Diagnostic Interview Schedule for Children-IV (DISC-IV) was used to asses children’s conduct disorders; c) Demographic factors: Child gender, child age, family income, marital status; d) Parental factors: parental psychopathology, parental monitoring, familism, parent support; e) Children characteristics: Controlling for any diagnostic at wave 1 (internalizing or externalizing). Data Analysis: Logistic regression was carried out relating the likelihood of DBD to harsh discipline along waves controlling for potential confounders as demographics, child and parent characteristics. Results: There were no significant differences in harsh discipline by site in wave 1 and wave 2 but there was a significant difference in wave 3. Also, there were no significant differences in DBD by site in wave 1 and wave 2 but there was a significant difference in wave 3. There was a significant difference of discipline by gender and age in all the waves. We calculated unadjusted (OR) and adjusted (AOD) and 95% confidence intervals (95%CI) showing the relation between harsh discipline at wave 1 and the presence of child disruptive behavior disorder at wave 3 for both South Bronx and Puerto Rico. There was an association between harsh discipline and the likelihood of having DBD in The Bronx (AOR=1.76; 95%CI=1.13-2.74, p.013) and in Puerto Rico (AOR=2.17; 95%CI=1.28-3.67, p.004) having controlled for demographic, parental and individual factors. Conclusions: Context may be an important differential factor shaping the potential risk of harsh discipline toward DBD for Puerto Rican children.

Keywords: disruptive behavior disorders, harsh discipline, puerto rican, psychological education

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Authors: Pratima Pokharel

Abstract:

When sewer overflow due to rainfall in urban areas, this leads to public health risks when an individual is exposed to that contaminated floodwater. Nevertheless, it is still unclear the extent to which the infections pose a risk to public health. This study analyzed reported diarrheal cases by month and age in Bangkok, Thailand. The results showed that the cases are reported higher in the wet season than in the dry season. It was also found that in Bangkok, the probability of infection with diarrheal diseases in the wet season is higher for the age group between 15 to 44. However, the probability of infection is highest for kids under 5 years, but they are not influenced by wet weather. Further, this study introduced a vulnerability that leads to health risks from urban flooding. This study has found some vulnerability variables that contribute to health risks from flooding. Thus, for vulnerability analysis, the study has chosen two variables, economic status, and age, that contribute to health risk. Assuming that the people's economic status depends on the types of houses they are living in, the study shows the spatial distribution of economic status in the vulnerability maps. The vulnerability map result shows that people living in Sukhumvit have low vulnerability to health risks with respect to the types of houses they are living in. In addition, from age the probability of infection of diarrhea was analyzed. Moreover, a field survey was carried out to validate the vulnerability of people. It showed that health vulnerability depends on economic status, income level, and education. The result depicts that people with low income and poor living conditions are more vulnerable to health risks. Further, the study also carried out 1D Hydrodynamic Advection-Dispersion modelling with 2-year rainfall events to simulate the dispersion of fecal coliform concentration in the drainage network as well as 1D/2D Hydrodynamic model to simulate the overland flow. The 1D result represents higher concentrations for dry weather flows and a large dilution of concentration on the commencement of a rainfall event, resulting in a drop of the concentration due to runoff generated after rainfall, whereas the model produced flood depth, flood duration, and fecal coliform concentration maps, which were transferred to ArcGIS to produce hazard and risk maps. In addition, the study also simulates the 5-year and 10-year rainfall simulations to show the variation in health hazards and risks. It was found that even though the hazard coverage is very high with a 10-year rainfall events among three rainfall events, the risk was observed to be the same with a 5-year and 10-year rainfall events.

Keywords: urban flooding, risk, hazard, vulnerability, health risk, framework

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Authors: M. S. Raza, A. Kapil, Sonu Tyagi, H. Gautam, S. Mohapatra, R. Chaudhry, S. Sood, V. Goyal, R. Lodha, V. Sreenivas, B. K. Das

Abstract:

Background: Acute bacterial meningitis remains the major cause of mortality and morbidity. More than half of the survivors develop the significant lifelong neurological abnormalities. Diagnosis of the hospital acquired acute bacterial meningitis (HAABM) is challenging as it appears either in the post operative patients or patients acquire the organisms from the hospital environment. In both the situations, pathogens are exposed to high dose of antibiotics. Chances of getting multidrug resistance organism are very high. We have performed this experiment to find out the etiological agents of HAABM and its antibiotics susceptibility pattern. Methodology: A perspective study was conducted at the Department of Microbiology, All India Institute of Medical Sciences, New Delhi. From March 2015 to April 2018 total 400 Cerebro spinal fluid samples were collected aseptically. Samples were processed for cell count, Gram staining, and culture. Culture plates were incubated at 37°C for 18-24 hours. Organism grown on blood and MacConkey agar were identified by MALDI-TOF Vitek MS (BioMerieux, France) and antibiotic susceptibility tests were performed by Kirby Bauer disc diffusion method as per CLSI 2015 guideline. Results: Of the 400 CSF samples processed, 43 (10.75%) were culture positive for different bacteria. Out of 43 isolates, the most prevalent Gram-positive organisms were S. aureus 4 (9.30%) followed by E. faecium 3 (6.97%) & CONS 2 (4.65%). Similarly, E. coli 13 (30.23%) was the commonest Gram-negative isolates followed by A. baumannii 12 (27.90%), K. pneumonia 5 (11.62%) and P. aeruginosa 4(9.30%). Most of the antibiotics tested against the Gram-negative isolates were resistance to them. Colistin was most effective followed by Meropenem and Imepenim for all Gram-negative HAABM isolates. Similarly, most of antibiotics tested were susceptible to S. aureus and CONS. However, E. faecium (100%) were only susceptible to vancomycin and teicoplanin. Conclusion: Hospital acquired acute bacterial meningitis (HAABM) is becoming the emerging challenge as most of isolates are showing resistance to commonly used antibiotics. Gram-negative organisms are emerging as the major player of HAABM. Great care needs to be taken especially in tertiary care hospitals. Similarly, antibiotic stewardship should be followed and antibiotic susceptibility test (AST) should be performed regularly to update the antibiotic patter and to prevent from the emergence of resistance. Updated information of the AST will be helpful for the better management of the meningitis patient.

Keywords: CSF, MALDI-TOF, hospital acquired acute bacterial meningitis, AST

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Authors: Najlaa Yousef Qusti, Steven J. Brookes, Paul A. Brunton

Abstract:

Background: Tooth discoloration can be an aesthetic problem, and tooth whitening using carbamide peroxide bleaching agents are a popular treatment option. However, there are concerns about possible adverse effects such as demineralisation of the bleached enamel; however, the cause of this demineralisation is unclear. Introduction: Teeth can become stained or discoloured over time. Tooth whitening is an aesthetic solution for tooth discoloration. Bleaching solutions of 10% carbamide peroxide (CP) have become the standard agent used in dentist-prescribed and home-applied ’vital bleaching techniques’. These materials release hydrogen peroxide (H₂O₂), the active whitening agent. However, there is controversy in the literature regarding the effect of bleaching agents on enamel integrity and enamel mineral content. The purpose of this study was to establish if carbamide peroxide bleaching agents affect the acid solubility of enamel (i.e., make teeth more prone to demineralisation). Materials and Methods: Twelve human premolar teeth were sectioned longitudinally along the midline and varnished to leave the natural enamel surface exposed. The baseline behavior of each tooth half in relation to its demineralisation in acid was established by sequential exposure to 4 vials containing 1ml of 10mM acetic acid (1 minute/vial). This was followed by exposure to 10% CP for 8 hours. After washing in distilled water, the tooth half was sequentially exposed to 4 further vials containing acid to test if the acid susceptibility of the enamel had been affected. The corresponding tooth half acted as a control and was exposed to distilled water instead of CP. The mineral loss was determined by measuring [Ca²⁺] and [PO₄³⁻] released in each vial using a calcium ion-selective electrode and the phosphomolybdenum blue method, respectively. The effect of bleaching on the tooth surfaces was also examined using SEM. Results: Exposure to carbamide peroxide did not significantly alter the susceptibility of enamel to acid attack, and SEM of the enamel surface revealed a slight alteration in surface appearance. SEM images of the control enamel surface showed a flat enamel surface with some shallow pits, whereas the bleached enamel appeared with an increase in surface porosity and some areas of mild erosion. Conclusions: Exposure to H₂O₂ equivalent to 10% CP does not significantly increase subsequent acid susceptibility of enamel as determined by Ca²⁺ release from the enamel surface. The effects of bleaching on mineral loss were indistinguishable from distilled water in the experimental system used. However, some surface differences were observed by SEM. The phosphomolybdenum blue method for phosphate is compromised by peroxide bleaching agents due to their oxidising properties. However, the Ca²⁺ electrode is unaffected by oxidising agents and can be used to determine the mineral loss in the presence of peroxides.

Keywords: bleaching, carbamide peroxide, demineralisation, teeth whitening

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