Search results for: severe acute respiratory syndrome (SARS)

Authors: Samantha Ramachandra, Avanthi Rupasinghe

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Demographic transition from lower to higher percentage of elderly population eventually coupled with epidemiological transition from communicable to non-communicable diseases (NCD). Higher percentage of NCD overload the health system as NCD survivors claims continuous health care. The demands are challenging to a resource constrained setting but reorganizing the system may find solutions. The study focused on the facilities available and their utilization at outpatient department (OPD) setting of the public hospitals of Sri Lanka for continuous medical care. This will help in identifying steps of reorganizing the system to provide better care with the maximum utilization of available facilities. The study was conducted as a situation analysis with secondary data at hospital planning units. Variable were identified according to the world health organization (WHO) recommendation on continuous health care for elders in “age-friendly primary health care toolkit”. Data were collected from secondary and tertiary care hospitals of Sri Lanka where most of the continuous care services are available. Out of 58 secondary and tertiary care hospitals, 16 were included in the study to represent each hospital categories. Average number of patient attending for episodic treatment at OPD and Clinical follow-up of chronic conditions shows vast disparity according to the category of the hospital ranging from 3750 – 800 per day at OPD and 1250 – 200 per clinic session. Average time spent per person at OPD session is low, range from 1.54 - 2.28 minutes, the time was increasing as the hospital category goes down. 93.7% hospitals had special arrangements for providing acute care on chronic conditions such as catheter, feeding tube and wound care. 25% hospitals had special clinics for elders, 81.2% hospitals had healthy lifestyle clinics (HLC), 75% hospitals had physical rehabilitation facilities and 68.8% hospitals had facilities for counselling. Elderly clinics and HLC were mostly available at lower grade hospitals where as rehabilitation and counselling facilities were mostly available at bigger hospitals. HLC are providing health education for both patients and their family members, refer patients for screening of complication but not provide medical examinations, investigations or treatments even though they operate in the hospital setting. Physical rehabilitation is basically offered for patients with rheumatological conditions but utilization of centers for injury rehabilitation and rehabilitation of survivors following major illness such as myocardial infarctions, stroke, cancer is not satisfactory (12.5%). Human Resource distribution within hospital shows vast disparity and there are 103 physiotherapists in the biggest hospital where only 36 physiotherapists available at the next level hospital. Counselling facilities also provided mainly for the patient with psychological conditions (100%) but they were not providing counselling for newly diagnosed patients with major illnesses (0%). According to results, most of the public-sector hospitals in Sri Lanka have basic facilities required in providing continuous care but the utilization of services need more focus. Hospital administration or the government need to have initial steps in proper utilization of them in improving continuous health care incorporating team approach of rehabilitation. The author wishes to acknowledge that this paper was made possible by the support and guidance given by the “Australia Awards Fellowships Program for Sri Lanka – 2017,” which was funded by the Department of Foreign Affairs and Trade, Australia, and co-hosted by Monash University, Australia and the Sri Lanka Institute of Development Administration.

Keywords: continuous care, outpatient department, non communicable diseases, rehabilitation

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Authors: Andrea Dragu, Solen Kinayyigit, Valerie Colliere, Karin Karin Philippot, Camelia Bala, Vasile I. Parvulescu

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The production of transportation fuels from biomass has gained a growing attention due to diminishing fossil fuel reserves, rising petroleum prices and increasing concern about global warming. In recent years, renewable hydrocarbons that are completely fungible with fossil fuels have been suggested to be efficiently produced by catalytic deoxygenation of fatty acids and their derivatives viadecarboxylation / decarbonylation. Several triglycerides (tall oil fatty acids) and saturated/unsaturated fatty acids and their corresponding esters were used as feedstocks. Their impact together with the influence of the reaction conditions and the catalyst composition on the nature of the reaction pathways of the deoxygenation of vegetable oils and their derivatives were recently reviewed. Following this state of the art the aim of the present study was the investigation of Pd NPs deposited onto mesoporous carbon supports as active and stable catalysts for the deoxygenation of oleic acid. The catalysts were prepared by the deposition of Pd NPs synthesised following an organometallic route on mesoporous carbons with different characteristics. Experiments were carried out under both batch and flow conditions. They demonstrated that under batch conditions (200 atm; 573K), the extent of the reaction depended, firstly, on the Pd loading and then on the metal dispersion and the oxidation state of palladium, both influenced by the way the support has been treated before the NPs deposition and by the preparation/stabilization methodology of Pd NPs. No aromatic compounds were detected in the reaction products but octadecanol and octadecane were observed in large extents. Under flow conditions (4 atm; 573 K), the conversion of stearic acid was superior to that observed in batch conditions. The product mixture contained over 20% heptadecane. No octadecanol, octadecane, and aromatic compounds were detected. The maxima in performances are obtained after only 0.5 h. After that, the yields in heptadecane suffer from a severe decrease until 3h reaction time. However, at that time, stopping feeding the reactor with oleic acid and flushing the catalyst only with mesitylene recovered the activity and the selectivity of the catalysts. With the complete removal of H2, the analysis revealed the presence of heptadecene in high excess compared to heptadecane (almost 7 to 1), thus suggesting decarbonylation as the main route. ICP-OES measurements indicated no leaching of palladium and simple washing of catalysts with mesitylene allowed recycling without any change in conversion or product distribution. Noteworthy, mesitylene as solvent exhibited no effect in this reaction. In conclusion, this study demonstrates the feasibility of such catalysts for the green production of fuels from biomass.

Keywords: fuels from biomass, green catalyst, Pd nano-particles , recycble catalyst

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Authors: Laura Isabel Guarin, Juliana Vargas, Philippe Chang

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The analysis and study of Open Channel flow dynamics for River applications has been based on flow modelling using discreet numerical models based on hydrodynamic equations. The overall spatial characteristics of rivers, i.e. its length to depth to width ratio generally allows one to correctly disregard processes occurring in the vertical or transverse dimensions thus imposing hydrostatic pressure conditions and considering solely a 1D flow model along the river length. Through a calibration process an accurate flow model may thus be developed allowing for channel study and extrapolation of various scenarios. The Magdalena River in Colombia is a large river basin draining the country from South to North with 1550 km with 0.0024 average slope and 275 average width across. The river displays high water level fluctuation and is characterized by a series of meanders. The city of La Dorada has been affected over the years by serious flooding in the rainy and dry seasons. As the meander is evolving at a steady pace repeated flooding has endangered a number of neighborhoods. This study has been undertaken in pro of correctly model flow characteristics of the river in this region in order to evaluate various scenarios and provide decision makers with erosion control measures options and a forecasting tool. Two field campaigns have been completed over the dry and rainy seasons including extensive topographical and channel survey using Topcon GR5 DGPS and River Surveyor ADCP. Also in order to characterize the erosion process occurring through the meander, extensive suspended and river bed samples were retrieved as well as soil perforation over the banks. Hence based on DEM ground digital mapping survey and field data a 2DH flow model was prepared using the Iber freeware based on the finite volume method in a non-structured mesh environment. The calibration process was carried out comparing available historical data of nearby hydrologic gauging station. Although the model was able to effectively predict overall flow processes in the region, its spatial characteristics and limitations related to pressure conditions did not allow for an accurate representation of erosion processes occurring over specific bank areas and dwellings. As such a significant helical flow has been observed through the meander. Furthermore, the rapidly changing channel cross section as a consequence of severe erosion has hindered the model’s ability to provide decision makers with a valid up to date planning tool.

Keywords: erosion, finite volume method, flow dynamics, flow modelling, meander

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Authors: Melese Wondatir

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Flooding ranks among the most destructive natural disasters, impacting millions of individuals globally and resulting in substantial economic, social, and environmental repercussions. This study's objective was to create a comprehensive model that assesses the Nile River basin's susceptibility to flood damage and improves existing flood risk management strategies. Authorities responsible for enacting policies and implementing measures may benefit from this research to acquire essential information about the flood, including its scope and susceptible areas. The identification of severe flood damage locations and efficient mitigation techniques were made possible by the use of geospatial data. Slope, elevation, distance from the river, drainage density, topographic witness index, rainfall intensity, distance from road, NDVI, soil type, and land use type were all used throughout the study to determine the vulnerability of flood damage. Ranking elements according to their significance in predicting flood damage risk was done using the Analytic Hierarchy Process (AHP) and geospatial approaches. The analysis finds that the most important parameters determining the region's vulnerability are distance from the river, topographic witness index, rainfall, and elevation, respectively. The consistency ratio (CR) value obtained in this case is 0.000866 (<0.1), which signifies the acceptance of the derived weights. Furthermore, 10.84m2, 83331.14m2, 476987.15m2, 24247.29m2, and 15.83m2 of the region show varying degrees of vulnerability to flooding—very low, low, medium, high, and very high, respectively. Due to their close proximity to the river, the northern-western regions of the Nile River basin—especially those that are close to Sudanese cities like Khartoum—are more vulnerable to flood damage, according to the research findings. Furthermore, the AUC ROC curve demonstrates that the categorized vulnerability map achieves an accuracy rate of 91.0% based on 117 sample points. By putting into practice strategies to address the topographic witness index, rainfall patterns, elevation fluctuations, and distance from the river, vulnerable settlements in the area can be protected, and the impact of future flood occurrences can be greatly reduced. Furthermore, the research findings highlight the urgent requirement for infrastructure development and effective flood management strategies in the northern and western regions of the Nile River basin, particularly in proximity to major towns such as Khartoum. Overall, the study recommends prioritizing high-risk locations and developing a complete flood risk management plan based on the vulnerability map.

Keywords: analytic hierarchy process, Blue Nile Basin, geospatial techniques, flood vulnerability, multi-criteria decision making

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Authors: Gabrielle Peck, Ryan Hayes

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Polyurethane (PU) foam is typically sold as acoustic foam that is often used as sound insulation in settings such as night clubs and bars. As a construction product, PU is tested by being glued to the walls and ceiling of the ISO 9705 room corner test room. However, when heat is applied to PU foam, it melts and burns as a pool fire due to it being a thermoplastic. The current test layout is unable to accurately measure mass loss and doesn’t allow for the material to burn as a pool fire without seeping out of the test room floor. The lack of mass loss measurement means gas yields pertaining to smoke toxicity analysis can’t be calculated, which makes data comparisons from any other material or test method difficult. Additionally, the heat release measurements are not representative of the actual measurements taken as a lot of the material seeps through the floor (when a tray to catch the melted material is not used). This research aimed to modify the ISO 9705 test to provide the ability to measure mass loss to allow for better calculation of gas yields and understanding of decomposition. It also aimed to accurately measure smoke toxicity in both the doorway and duct and enable dilution factors to be calculated. Finally, the study aimed to examine if doubling the fuel loading would force under-ventilated flaming. The test layout was modified to be a combination of the SBI (single burning item) test set up inside oof the ISO 9705 test room. Polyurethane was tested in two different ways with the aim of altering the ventilation condition of the tests. Test one was conducted using 1 x SBI test rig aiming for well-ventilated flaming. Test two was conducted using 2 x SBI rigs (facing each other inside the test room) (doubling the fuel loading) aiming for under-ventilated flaming. The two different configurations used were successful in achieving both well-ventilated flaming and under-ventilated flaming, shown by the measured equivalence ratios (measured using a phi meter designed and created for these experiments). The findings show that doubling the fuel loading will successfully force under-ventilated flaming conditions to be achieved. This method can therefore be used when trying to replicate post-flashover conditions in future ISO 9705 room corner tests. The radiative heat generated by the two SBI rigs facing each other facilitated a much higher overall heat release resulting in a more severe fire. The method successfully allowed for accurate measurement of smoke toxicity produced from the PU foam in terms of simple gases such as oxygen depletion, CO and CO2. Overall, the proposed test modifications improve the ability to measure the smoke toxicity of materials in different fire conditions on a large-scale.

Keywords: flammability, ISO9705, large-scale testing, polyurethane, smoke toxicity

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Authors: Sina Kazemi, Farshid Torabi, Todd Peterson

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Drilling in shale formations is frequently time-consuming, challenging, and fraught with mechanical failures such as stuck pipes or hole packing off when the cutting removal rate is not sufficient to clean the bottom hole. Crossing the heavy oil shale and sand reservoirs with active shale and microfractures is generally associated with severe fluid losses causing a reduction in the rate of the cuttings removal. These circumstances compromise a well’s integrity and result in a lower rate of penetration (ROP). This study presents collective results of field studies and theoretical analysis conducted on data from South Pars and North Dome in an Iran-Qatar offshore field. Solutions to complications related to drilling in shale formations are proposed through systemically analyzing and applying modeling techniques to select field mud logging data. Field data measurements during actual drilling operations indicate that in a shale formation where the return flow of polymer mud was almost lost in the upper dolomite layer, the performance of hole cleaning and ROP progressively change when higher string rotations are initiated. Likewise, it was observed that this effect minimized the force of rotational torque and improved well integrity in the subsequent casing running. Given similar geologic conditions and drilling operations in reservoirs targeting shale as the producing zone like the Bakken formation within the Williston Basin and Lloydminster, Saskatchewan, a drill bench dynamic modeling simulation was used to simulate borehole cleaning efficiency and mud optimization. The results obtained by altering RPM (string revolution per minute) at the same pump rate and optimized mud properties exhibit a positive correlation with field measurements. The field investigation and developed model in this report show that increasing the speed of string revolution as far as geomechanics and drilling bit conditions permit can minimize the risk of mechanically stuck pipes while reaching a higher than expected ROP in shale formations. Data obtained from modeling and field data analysis, optimized drilling parameters, and hole cleaning procedures are suggested for minimizing the risk of a hole packing off and enhancing well integrity in shale reservoirs. Whereas optimization of ROP at a lower pump rate maintains the wellbore stability, it saves time for the operator while reducing carbon emissions and fatigue of mud motors and power supply engines.

Keywords: ROP, circulating density, drilling parameters, return flow, shale reservoir, well integrity

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Authors: Huidan Yu, Anurag Deb, Rou Chen, I-Wen Wang

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The use of left ventricle assist devices (LVADs) in patients with heart failure has been a proven and effective therapy for patients with severe end-stage heart failure. Due to the limited availability of suitable donor hearts, LVADs will probably become the alternative solution for patient with heart failure in the near future. While the LVAD is being continuously improved toward enhanced performance, increased device durability, reduced size, a better understanding of implantation management becomes critical in order to achieve better long-term blood supplies and less post-surgical complications such as thrombi generation. Important issues related to the LVAD implantation include the location of outflow grafting (OG), the angle of the OG, the combination between LVAD and native heart pumping, uniform or pulsatile flow at OG, etc. We have hypothesized that an optimal implantation of LVAD is patient specific. To test this hypothesis, we employ a novel in-house computational modeling technique, named InVascular, to conduct a systematic evaluation of cardiac output at aortic arch together with other pertinent hemodynamic quantities for each patient under various implantation scenarios aiming to get an optimal implantation strategy. InVacular is a powerful computational modeling technique that integrates unified mesoscale modeling for both image segmentation and fluid dynamics with the cutting-edge GPU parallel computing. It first segments the aortic artery from patient’s CT image, then seamlessly feeds extracted morphology, together with the velocity wave from Echo Ultrasound image of the same patient, to the computation model to quantify 4-D (time+space) velocity and pressure fields. Using one NVIDIA Tesla K40 GPU card, InVascular completes a computation from CT image to 4-D hemodynamics within 30 minutes. Thus it has the great potential to conduct massive numerical simulation and analysis. The systematic evaluation for one patient includes three OG anastomosis (ascending aorta, descending thoracic aorta, and subclavian artery), three combinations of LVAD and native heart pumping (1:1, 1:2, and 1:3), three angles of OG anastomosis (inclined upward, perpendicular, and inclined downward), and two LVAD inflow conditions (uniform and pulsatile). The optimal LVAD implantation is suggested through a comprehensive analysis of the cardiac output and related hemodynamics from the simulations over the fifty-four scenarios. To confirm the hypothesis, 5 random patient cases will be evaluated.

Keywords: graphic processing unit (GPU) parallel computing, left ventricle assist device (LVAD), lumped-parameter model, patient-specific computational hemodynamics

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Authors: Pedro M. Rodrigues, Claudia Raposo, Denise Schrama, Marco Cerqueira

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Farmed fish welfare is a very recent concept, widely discussed among the scientific community. Consumers’ interest regarding farmed animal welfare standards has significantly increased in the last years posing a huge challenge to producers in order to maintain an equilibrium between good welfare principles and productivity, while simultaneously achieve public acceptance. The major bottleneck of standard aquaculture is to impair considerably fish welfare throughout the production cycle and with this, the quality of fish protein. Welfare assessment in farmed fish is undertaken through the evaluation of fish stress responses. Primary and secondary stress responses include release of cortisol and glucose and lactate to the blood stream, respectively, which are currently the most commonly used indicators of stress exposure. However, the reliability of these indicators is highly dubious, due to a high variability of fish responses to an acute stress and the adaptation of the animal to a repetitive chronic stress. Our objective is to use comparative proteomics to identify and validate a fingerprint of proteins that can present an more reliable alternative to the already established welfare indicators. In this way, the culture conditions will improve and there will be a higher perception of mechanisms and metabolic pathway involved in the produced organism’s welfare. Due to its high economical importance in Portuguese aquaculture Gilthead seabream will be the elected species for this study. Protein extracts from Gilthead Seabream fish muscle, liver and plasma, reared for a 3 month period under optimized culture conditions (control) and induced stress conditions (Handling, high densities, and Hipoxia) are collected and used to identify a putative fish welfare protein markers fingerprint using a proteomics approach. Three tanks per condition and 3 biological replicates per tank are used for each analisys. Briefly, proteins from target tissue/fluid are extracted using standard established protocols. Protein extracts are then separated using 2D-DIGE (Difference gel electrophoresis). Proteins differentially expressed between control and induced stress conditions will be identified by mass spectrometry (LC-Ms/Ms) using NCBInr (taxonomic level - Actinopterygii) databank and Mascot search engine. The statistical analysis is performed using the R software environment, having used a one-tailed Mann-Whitney U-test (p < 0.05) to assess which proteins were differentially expressed in a statistically significant way. Validation of these proteins will be done by comparison of the RT-qPCR (Quantitative reverse transcription polymerase chain reaction) expressed genes pattern with the proteomic profile. Cortisol, glucose, and lactate are also measured in order to confirm or refute the reliability of these indicators. The identified liver proteins under handling and high densities induced stress conditions are responsible and involved in several metabolic pathways like primary metabolism (i.e. glycolysis, gluconeogenesis), ammonia metabolism, cytoskeleton proteins, signalizing proteins, lipid transport. Validition of these proteins as well as identical analysis in muscle and plasma are underway. Proteomics is a promising high-throughput technique that can be successfully applied to identify putative welfare protein biomarkers in farmed fish.

Keywords: aquaculture, fish welfare, proteomics, welfare biomarkers

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Authors: Ana Violante, Jodie Maccarrone, Maria Fimiani

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In the United States, over 30 million people are hospitalized annually for conditions that require acute, 24-hour, supervised care. The experience of hospitalization can be traumatic, exposing the patient to loss of control, autonomy, and productivity. Furthermore, 40% of patients admitted to hospitals for general medical illness have a comorbid psychiatric diagnosis. Research suggests individuals admitted with psychiatric comorbidities experience poorer health outcomes, higher utilization rates and increased overall cost of care. Empirical work suggests hospital settings that include a consultation liaison (CL) service report reduced length of stay, lower costs per patient, improved medical staff and patient satisfaction and reduced readmission after 180 days. Despite the overall positive impact CL services can have on patient care, it is estimated that only 1% - 2.8% of hospital admits receive these services, and most research has been conducted by the field of psychiatry. Health psychologists could play an important role in increasing access to this valuable service, though the extent to which health psychologists participate in CL settings is not well known. Objective: Outline the preliminary findings from an empirical study to understand how many APPIC internship training programs offer adult consultation liaison rotations within inpatient hospital settings nationally, as well as describe the specific nature of these training experiences. Research Method/Design: Data was exported into Excel from the 2022-2023 APPIC Directory categorized as “health psychology” sites. It initially returned a total of 537 health training programs out 1518 total programs (35% of all APPIC programs). A full review included a quantitative and qualitative comprehensive review of the APPIC program summary, the site website, and program brochures. The quantitative review extracted the number of training positions; amount of stipend; location or state of program, patient, population, and rotation. The qualitative review examined the nature of the training experience. Results: 29 (5%) of all APPIC health psychology internship training programs (2%) respectively of all APPIC training internship programs offering internship CL training were identified. Of the 29 internship training programs, 16 were exclusively within a pediatric setting (55%), 11 were exclusively within an adult setting (38%), and two were a mix of pediatric and adult settings (7%). CL training sites were located to 19 states, offering a total of 153 positions nationally, with Florida containing the largest number of programs (4). Only six programs offered 12-month training opportunities while the rest offered CL as a major (6 month) to minor (3-4 month) rotation. The program’s stipend for CL training positions ranged from $25,000 to $62,400, with an average of $32,056. Conclusions: These preliminary findings suggest CL training and services are currently limited. Training opportunities that do exist are mostly limited to minor, short rotations and governed by psychiatry. Health psychologists are well-positioned to better define the role of psychology in consultation liaison services and enhance and formalize existing training protocols. Future research should explore in more detail empirical outcomes of CL services that employ psychology and delineate the contributions of psychology from psychiatry and other disciplines within an inpatient hospital setting.

Keywords: consultation liaison, health psychology, hospital setting, training

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Authors: Ankita Jadon, Sidi Souvi, Nathalie Girault, Denis Petitprez

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The interaction of fission products (FP) with sodium carbonate (Na₂CO₃) aerosols is of a high safety concern because of their potential role in the radiological source term mitigation by FP trapping. In a sodium-cooled fast nuclear reactor (SFR) experiencing a severe accident, sodium (Na) aerosols can be formed after the ejection of the liquid Na coolant inside the containment. The surface interactions between these aerosols and different FP species have been investigated using ab-initio, density functional theory (DFT) calculations using Vienna ab-initio simulation package (VASP). In addition, an improved thermodynamic model has been proposed to treat DFT-VASP calculated energies to extrapolate them to temperatures and pressures of interest in our study. A combined experimental and theoretical chemistry study has been carried out to have both atomistic and macroscopic understanding of the chemical processes; the theoretical chemistry part of this approach is presented in this paper. The Perdew, Burke, and Ernzerhof functional were applied in combination with Grimme’s van der Waals correction to compute exchange-correlational energy at 0 K. Seven different surface cleavages were studied of Ƴ-Na₂CO₃ phase (stable at 603.15 K), it was found that for defect-free surfaces, the (001) facet is the most stable. Furthermore, calculations were performed to study surface defects and reconstructions on the ideal surface. All the studied surface defects were found to be less stable than the ideal surface. More than one adsorbate-ligand configurations were found to be stable confirming that FP vapors could be trapped on various adsorption sites. The calculated adsorption energies (Eads, eV) for the three most stable adsorption sites for I₂ are -1.33, -1.088, and -1.085. Moreover, the adsorption of the first molecule of I₂ changes the surface in a way which would favor stronger adsorption of a second molecule of I2 (Eads, eV = -1.261). For HI adsorption, the most favored reactions have the following Eads (eV) -1.982, -1.790, -1.683 implying that HI would be more reactive than I₂. In addition to FP species, adsorption of H₂O was also studied as the hydrated surface can have different reactivity than the bare surface. One thermodynamically favored site for H₂O adsorption was found with an Eads, eV of -0.754. Finally, the calculations of hydrated surfaces of Na₂CO₃ show that a layer of water adsorbed on the surface significantly reduces its affinity for iodine (Eads, eV = -1.066). According to the thermodynamic model built, the required partial pressure at 373 K to have adsorption of the first layer of iodine is 4.57×10⁻⁴ bar. The second layer will be adsorbed at partial pressures higher than 8.56×10⁻⁶ bar; a layer of water on the surface will increase these pressure almost ten folds to 3.71×10⁻³ bar. The surface interacts with elemental Cs with an Eads (eV) of -1.60, while interacts even strongly with CsI with an Eads (eV) of -2.39. More results on the interactions between Na₂CO₃ (001) and cesium-based FP will also be presented in this paper.

Keywords: iodine uptake, sodium carbonate surface, sodium-cooled fast nuclear reactor, DFT calculations, fission products

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Authors: Kai-Cheng Yang, Yen-Ling Chen, Er-Chieh Cho, Kuen-Chan Lee

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Titanium dioxide nanomaterials offer superior protection for human skin against the full spectrum of ultraviolet light. However, some literature reviews indicated that it might be associated with adverse effects such as cytotoxicity or reactive oxygen species (ROS) due to their nanoscale. The surface of fullerene is covered with π electrons constituting aromatic structures, which can effectively scavenge large amount of radicals. Unfortunately, fullerenes are poor solubility in water, severe aggregation, and toxicity in biological applications when dispersed in solvent have imposed the limitations to the use of fullerenes. Carboxyfullerene acts as the scavenger of radicals for several years. Some reports indicate that carboxyfullerene not only decrease the concentration of free radicals in ambience but also prevent cells from reducing the number or apoptosis under UV irradiation. The aim of this study is to decorate fullerene –C70-carboxylic acid (C70-COOH) on the surface of titanium dioxide nanoparticles (P25) for the purpose of scavenging ROS during the irradiation. The modified material is prepared through the esterification of C70-COOH with P25 (P25/C70-COOH). The binding edge and structure are studied by using Transmission electron microscope (TEM) and Fourier transform infrared (FTIR). The diameter of P25 is about 30 nm and C70-COOH is found to be conjugated on the edge of P25 in aggregation morphology with the size of ca. 100 nm. In the next step, the FTIR was used to confirm the binding structure between P25 and C70-COOH. There are two new peaks are shown at 1427 and 1720 cm-1 for P25/C70-COOH, resulting from the C–C stretch and C=O stretch formed during esterification with dilute sulfuric acid. The IR results further confirm the chemically bonded interaction between C70-COOH and P25. In order to provide the evidence of scavenging radical ability of P25/C70-COOH, we chose pyridoxine (Vit.B6) and terephthalic acid (TA) to react with singlet oxygen and hydroxyl radicals. We utilized these chemicals to observe the radicals scavenging statement via detecting the intensity of ultraviolet adsorption or fluorescence emission. The UV spectra are measured by using different concentration of C70-COOH modified P25 with 1mM pyridoxine under UV irradiation for various duration times. The results revealed that the concentration of pyridoxine was increased when cooperating with P25/C70-COOH after three hours as compared with control (only P25). It indicates fewer radicals could be reacted with pyridoxine because of the absorption via P25/C70-COOH. The fluorescence spectra are observed by measuring P25/C70-COOH with 1mM terephthalic acid under UV irradiation for various duration times. The fluorescence intensity of TAOH was decreased in ten minutes when cooperating with P25/C70-COOH. Here, it was found that the fluorescence intensity was increased after thirty minutes, which could be attributed to the saturation of C70-COOH in the absorption of radicals. However, the results showed that the modified P25/C70-COOH could reduce the radicals in the environment. Therefore, we expect that P25/C70-COOH is a potential materials in using for antioxidant.

Keywords: titanium dioxide, fullerene, radical scavenging activity, antioxidant

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Authors: Anne-Margré C. Vink

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Background: Food-related allergies and intolerances are frequently occurring in dogs. Diagnosis and monitoring according to ‘Golden Standard’ of elimination efficiency are time-consuming, expensive, and requires expert clinical setting. In order to facilitate rapid and robust, quantitative testing of intolerance, and determining the individual offending foods, a serological test is implicated. Method: As we developed Medisynx IgG Human Screening Test ELISA before and the dog’s immune system is most similar to humans, we were able to develop Medisynx IgG Dog Screening Test ELISA as well. In this study, 47 dogs suffering from Canine Atopic Dermatitis (CAD) and several secondary induced reactions were included to participate in serological Medisynx IgG Dog Screening Test ELISA (within < 0,02 % SD). Results were expressed as titers relative to the standard OD readings to diagnose alimentary induced diseases and monitoring the efficacy of an individual eliminating diet in dogs. Split sample analysis was performed by independently sending 2 times 3 ml serum under two unique codes. Results: The veterinarian monitored these dogs to check dog’ results at least at 3, 7, 21, 49, 70 days and after period of 6 and 12 months on an individual negative diet and a positive challenge (retrospectively) at 6 months. Data of each dog were recorded in a screening form and reported that a complete recovery of all clinical manifestations was observed at or less than 70 days (between 50 and 70 days) in the majority of dogs(44 out of 47 dogs =93.6%). Conclusion: Challenge results showed a significant result of 100% in specificity as well as 100% positive predicted value. On the other hand, sensitivity was 95,7% and negative predictive value was 95,7%. In conclusion, an individual diet based on IgG ELISA in dogs provides a significant improvement of atopic dermatitis and pruritus including all other non-specific defined allergic skin reactions as erythema, itching, biting and gnawing at toes, as well as to several secondary manifestations like chronic diarrhoea, chronic constipation, otitis media, obesity, laziness or inactive behaviour, pain and muscular stiffness causing a movement disorders, excessive lacrimation, hyper behaviour, nervous behaviour and not possible to stay alone at home, anxiety, biting and aggressive behaviour and disobedience behaviour. Furthermore, we conclude that a relatively more severe systemic candidiasis, as shown by relatively higher titer (class 3 and 4 IgG reactions to Candida albicans), influence the duration of recovery from clinical manifestations in affected dogs. These findings are consistent with our preliminary human clinical studies.

Keywords: allergy, canine atopic dermatitis, CAD, food allergens, IgG-ELISA, food-incompatibility

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Authors: Raheel Shakoor Siddiqui, Shahbaz Malik, Manikandar Srinivas Cheruvu, Sanjay Narayana Murthy, Livio DiMascio

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Background: elderly traumatic hip fracture patients frequently present to trauma services globally. Rising low energy falls amongst an osteoporotic aging population is the commonest cause for injury. Hip fractures in this population are a major cause for severe pain, morbidity and mortality. The term hip fracture is interchangeable with neck of femur fracture, fractured neck of femur or proximal femur fracture. Hip fracture pain management protocols and guidelines suggest conventional analgesia, nerve block and opioid based treatment as rescue analgesia. There is a current global opioid crisis with overuse, abuse and dependence. Adverse opioid related complications in vulnerable elderly patients further adds to morbidity and mortality. Systematic reviews in literature have evidenced superiority of multimodal analgesia in osteoarthritic primary joint replacements compared to opioids however, this has not yet been conducted for elderly traumatic hip fracture patients. Aims: The primary aim of this systematic review is to provide standardised evidence following Cochrane and PRISMA guidance in determining advantages of perioperative multimodal analgesia over conventional opioid based treatments in elderly traumatic hip fractures. Methods: 5 databases were searched from January 2000-2023 which identified 8 randomised controlled trials and 446 total participants. These trials met defined PICOS eligibility criteria of patient mean age ≥ 65 years presenting with a unilateral traumatic fractured neck of femur for operative intervention. Analgesic intervention with perioperative multimodal analgesia has been compared to conventional opioid based analgesia. Outcomes of interest include, primarily, the change in postoperative opioid consumption within a 0-30 postoperative period and secondarily, the change in postoperative adverse events and complications. A qualitative synthesis has been performed due to clinical heterogenicity and variance amongst trials. Results: GRADE evidence of moderate quality supports perioperative multimodal analgesia leads to a reduction in postoperative opioid consumption however, low quality evidence supports a reduction of adverse effects and complications. Conclusion: Perioperative multimodal analgesia whether used preoperative, intraoperative and/or postoperative leads to a reduction in postoperative opioid consumption for elderly traumatic hip fracture patients. This review recommends the use of perioperative multimodal analgesia as part of hip fracture pain protocols however, caution and clinical judgement should be used as the risk of adverse effects may not be lower.

Keywords: trauma, orthopaedics, hip, fracture, neck of femur fracture, analgesia, multimodal analgesia, opioid

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Authors: Aipeng Zhu, Yun Zhang

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The growing grievous environment problems together with the exhaustion of energy resources put urgent demands for developing high energy density. Considering the factors including capacity, resource and environment, Manganese-based lithium-rich layer-structured cathode materials xLi₂MnO₃⋅(1-x)LiMO₂ (M = Ni, Co, Mn, and other metals) are drawing increasing attention due to their high reversible capacities, high discharge potentials, and low cost. They are expected to be one type of the most promising cathode materials for the next-generation Li-ion batteries (LIBs) with higher energy densities. Unfortunately, their commercial applications are hindered with crucial drawbacks such as poor rate performance, limited cycle life and continuous falling of the discharge potential. With decades of extensive studies, significant achievements have been obtained in improving their cyclability and rate performances, but they cannot meet the requirement of commercial utilization till now. One major problem for lithium-rich layer-structured cathode materials (LLOs) is the side reaction during cycling, which leads to severe surface degradation. In this process, the metal ions can dissolve in the electrolyte, and the surface phase change can hinder the intercalation/deintercalation of Li ions and resulting in low capacity retention and low working voltage. To optimize the LLOs cathode material, the surface coating is an efficient method. Considering the price and stability, Al₂O₃ was used as a coating material in the research. Meanwhile, due to the low initial Coulombic efficiency (ICE), the pristine LLOs was pretreated by KMnO₄ to increase the ICE. The precursor was prepared by a facile coprecipitation method. The as-prepared precursor was then thoroughly mixed with Li₂CO₃ and calcined in air at 500℃ for 5h and 900℃ for 12h to produce Li₁.₂[Ni₀.₂Mn₀.₆]O₂ (LNMO). The LNMO was then put into 0.1ml/g KMnO₄ solution stirring for 3h. The resultant was filtered and washed with water, and dried in an oven. The LLOs obtained was dispersed in Al(NO₃)₃ solution. The mixture was lyophilized to confer the Al(NO₃)₃ was uniformly coated on LLOs. After lyophilization, the LLOs was calcined at 500℃ for 3h to obtain LNMO@LMO@ALO. The working electrodes were prepared by casting the mixture of active material, acetylene black, and binder (polyvinglidene fluoride) dissolved in N-methyl-2-pyrrolidone with a mass ratio of 80: 15: 5 onto an aluminum foil. The electrochemical performance tests showed that the multiple surface modified materials had a higher initial Coulombic efficiency (84%) and better capacity retention (91% after 100 cycles) compared with that of pristine LNMO (76% and 80%, respectively). The modified material suggests that the KMnO₄ pretreat and Al₂O₃ coating can increase the ICE and cycling stability.

Keywords: Li-rich materials, surface coating, lithium ion batteries, Al₂O₃

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Authors: Idowu R. Akomolafe, Naven Chetty

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Background: The widespread medical application of ionizing radiation has raised public concern about radiation exposure and, thus, associated cancer risk. The production of reactive oxygen species and free radicals as a result of radiation exposure can cause severe damage to deoxyribonucleic acid (DNA) of cells, thus leading to biological effect. Radiotherapy is an excellent modality in the treatment of cancerous cells, comes with a few challenges. A significant challenge is the exposure of healthy cells surrounding the tumour to radiation. The last few decades have witnessed lots of attention shifted to plants, herbs, and natural product as an alternative to synthetic compound for radioprotection. Thus, the study investigated the radioprotective efficacy of Costus afer against whole-body radiation-induced haematological, histopathological disorder in mice. Materials and Method: Fifty-four mice were randomly divided into nine groups. Animals were pretreated with the extract of Costus afer by oral gavage for six days before irradiation. Control: 6 mice received feed and water only; 6 mice received feed, water, and 3Gy; 6 mice received feed, water, and 6Gy; experimental: 6 mice received 250 mg/kg extract; 6 mice received 500 mg/kg extract; 6 mice received 250 mg/kg extract and 3Gy; 6 mice received 500 mg/kg extract and 3Gy; 6 mice received 250 mg/kg extract and 6Gy; 6 mice received 500 mg/kg extract and 6Gy in addition to feeding and water. The irradiation was done at the Radiotherapy and Oncology Department of Grey's Hospital using linear accelerator (LINAC). Thirty-six mice were sacrificed by cervical dislocation 48 hours after irradiation, and blood was collected for haematology tests. Also, the liver and kidney of the sacrificed mice were surgically removed for histopathology tests. The remaining eighteen (18) mice were used for mortality and survival studies. Data were analysed by one-way ANOVA, followed by Tukey's multiple comparison test. Results: Prior administration of Costus afer extract decreased the symptoms of radiation sickness and caused a significant delay in the mortality as demonstrated in the experimental mice. The first mortality was recorded on day-5 post irradiation, and this happened to the group E- that is, mice that received 6Gy but no extract. There was significant protection in the experimental mice, as demonstrated in the blood counts against hematopoietic and gastrointestinal damage when compared with the control. The protection was seen in the increase in blood counts of experimental animals and the number of survivor. The protection offered by Costus afer may be due to its ability to scavenge free radicals and restore gastrointestinal and bone marrow damage produced by radiation. Conclusions: The study has demonstrated that exposure of mice to radiation could cause modifications in the haematological and histopathological parameters of irradiated mice. However, the changes were relieved by the methanol extract of Costus afer, probably through its free radical scavenging and antioxidant properties.

Keywords: costus afer, hematological, mortality, radioprotection, radiotherapy

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Authors: Aakriti Chetan Shah, Elle Sein

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Background/purpose: Group B Streptococcus(GBS) is the leading cause of severe early onset infection in newborns, with the incidence of Early Onset Group B Streptococcus (EOGBS) in the UK and Ireland rising from 0.48 to 0.57 per 1000 births from 2000 to 2015. A WHO study conducted in 2017, has shown that 38.5% of cases can result in stillbirth and infant deaths. This is an important problem to consider as 20% of women worldwide have GBS colonisation and can suffer from these detrimental effects. Current Royal College of Obstetricians and Midwives (RCOG) guidelines do not recommend bacteriological screening for pregnant women due to its low sensitivity in antenatal screening correlating with the neonate having GBS but advise a patient information leaflet be given to pregnant women. However, a Healthcare Safety Investigation Branch (HSIB) 2019 learning report found that only 50% of trusts and health boards reported giving GBS information leaflets to all pregnant mothers. Therefore, this audit aimed to assess current practices of information dissemination about GBS at Chelsea & Westminster (C&W) Hospital. Methodology: A quantitative cross-sectional study was carried out using a questionnaire based on the RCOG GBS guidelines and the HSIB Learning report. The study was conducted in antenatal clinics at Chelsea & Westminster Hospital, from 29th January 2021 to 14th February 2021, with twenty-two practicing obstetricians and midwives participating in the survey. The main outcome measure was the proportion of obstetricians and midwives who disseminate information about GBS to pregnant women, and the reasons behind why they do or do not. Results: 22 obstetricians and midwives responded with 18 complete responses. Of which 12 were obstetricians and 6 were midwives. Only 17% of clinical staff routinely inform all pregnant women about GBS, and do so at varying timeframes of the pregnancy, with an equal split in the first, second and third trimester. The primary reason for not informing women about GBS was influenced by three key factors: Deemed relevant only for patients at high risk of GBS, lack of time in clinic appointments and no routine NHS screening available. Interestingly 58% of staff in the antenatal clinic believe it is necessary to inform all women about GBS and its importance. Conclusion: It is vital for obstetricians and midwives to inform all pregnant women about GBS due to the high prevalence of incidental carriers in the population, and the harmful effects it can cause for neonates. Even though most clinicians believe it is important to inform all pregnant women about GBS, most do not. To ensure that RCOG and HSIB recommendations are followed, we recommend that women should be given this information at 28 weeks gestation in the antenatal clinic. Proposed implementations include an information leaflet to be incorporated into the Mum and Baby app, an informative video and end-to-end digital clinic documentation to include this information sharing prompt.

Keywords: group B Streptococcus, early onset sepsis, Antenatal care, Neonatal morbidity, GBS

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Authors: Priyanka Mondal, Santosh K. Sarkar

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The present study investigated the spatiotemporal distribution and ecological risk assessment of trace elements of surface sediments (top 0 - 5 cm; grain size ≤ 0.63 µm) in relevance to sediment quality characteristics along the Ganges River Estuary, India. Sediment samples were collected during ebb tide from intertidal regions covering seven sampling sites of diverse environmental stresses. The elements were analyzed with the help of ICPAES. This positive, mixohaline, macro-tidal estuary has global significance contributing ecological and economic services. Presence of fine-clayey particle (47.03%) enhances the adsorption as well as transportation of trace elements. There is a remarkable inter-metallic variation (mg kg-1 dry weight) in the distribution pattern in the following manner: Al (31801± 15943) > Fe (23337± 7584) > Mn (461±147) > S(381±235) > Zn(54 ±18) > V(43 ±14) > Cr(39 ±15) > As (34±15) > Cu(27 ±11) > Ni (24 ±9) > Se (17 ±8) > Co(11 ±3) > Mo(10 ± 2) > Hg(0.02 ±0.01). An overall trend of enrichment of majority of trace elements was very much pronounced at the site Lot 8, ~ 35km upstream of the estuarine mouth. In contrast, the minimum concentration was recorded at site Gangasagar, mouth of the estuary, with high energy profile. The prevalent variations in trace element distribution are being liable for a set of cumulative factors such as hydrodynamic conditions, sediment dispersion pattern and textural variations as well as non-homogenous input of contaminants from point and non-point sources. In order to gain insight into the trace elements distribution, accumulation, and their pollution status, geoaccumulation index (Igeo) and enrichment factor (EF) were used. The Igeo indicated that surface sediments were moderately polluted with As (0.60) and Mo (1.30) and strongly contaminated with Se (4.0). The EF indicated severe pollution of Se (53.82) and significant pollution of As (4.05) and Mo (6.0) and indicated the influx of As, Mo and Se in sediments from anthropogenic sources (such as industrial and municipal sewage, atmospheric deposition, agricultural run-off, etc.). The significant role of the megacity Calcutta in relevance to the untreated sewage discharge, atmospheric inputs and other anthropogenic activities is worthwhile to mention. The ecological risk for different trace elements was evaluated using sediment quality guidelines, effects range low (ERL), and effect range median (ERM). The concentration of As, Cu and Ni at 100%, 43% and 86% of the sampling sites has exceeded the ERL value while none of the element concentration exceeded ERM. The potential ecological risk index values revealed that As at 14.3% of the sampling sites would pose relatively moderate risk to benthic organisms. The effective role of finer clay particles for trace element distribution was revealed by multivariate analysis. The authors strongly recommend regular monitoring emphasizing on accurate appraisal of the potential risk of trace elements for effective and sustainable management of this estuarine environment.

Keywords: pollution assessment, sediment contamination, sediment quality, trace elements

Procedia PDF Downloads 250

Authors: Ekta Yadav, Sukanta Bhattacharya, Brijesh Yadav, Ariel Hus, Jagjit Yadav

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Background and Significance: Respiratory exposure to toxicants (chemicals or particulates) causes disruption of lung homeostasis leading to lung toxicity/injury manifested as pulmonary inflammation, edema, and/or other effects depending on the type and extent of exposure. This emphasizes the need for investigating toxicant type-specific mechanisms to understand therapeutic targets. Aquaporins, aka water channels, are known to play a role in lung homeostasis. Particularly, the two major lung aquaporins AQP5 and AQP1 expressed in alveolar epithelial and vasculature endothelia respectively allow for movement of the fluid between the alveolar air space and the associated vasculature. In view of this, the current study is focused on understanding the regulation of lung aquaporins and other targets during inhalation exposure to toxic chemicals (Cigarette smoke chemicals) versus toxic particles (Carbon nanoparticles) or co-exposures to understand their relevance as markers of injury and intervention. Methodologies: C57BL/6 mice (5-7 weeks old) were used in this study following an approved protocol by the University of Cincinnati Institutional Animal Care and Use Committee (IACUC). The mice were exposed via oropharyngeal aspiration to multiwall carbon nanotube (MWCNT) particles suspension once (33 ugs/mouse) followed by housing for four weeks or to Cigarette smoke Extract (CSE) using a daily dose of 30µl/mouse for four weeks, or to co-exposure using the combined regime. Control groups received vehicles following the same dosing schedule. Lung toxicity/injury was assessed in terms of homeostasis changes in the lung tissue and lumen. Exposed lungs were analyzed for transcriptional expression of specific targets (AQPs, surfactant protein A, Mucin 5b) in relation to tissue homeostasis. Total RNA from lungs extracted using TRIreagent kit was analyzed using qRT-PCR based on gene-specific primers. Total protein in bronchoalveolar lavage (BAL) fluid was determined by the DC protein estimation kit (BioRad). GraphPad Prism 5.0 (La Jolla, CA, USA) was used for all analyses. Major findings: CNT exposure alone or as co-exposure with CSE increased the total protein content in the BAL fluid (lung lumen rinse), implying compromised membrane integrity and cellular infiltration in the lung alveoli. In contrast, CSE showed no significant effect. AQP1, required for water transport across membranes of endothelial cells in lungs, was significantly upregulated in CNT exposure but downregulated in CSE exposure and showed an intermediate level of expression for the co-exposure group. Both CNT and CSE exposures had significant downregulating effects on Muc5b, and SP-A expression and the co-exposure showed either no significant effect (Muc5b) or significant downregulating effect (SP-A), suggesting an increased propensity for infection in the exposed lungs. Conclusions: The current study based on the lung toxicity mouse model showed that both toxicant types, particles (CNT) versus chemicals (CSE), cause similar downregulation of lung innate defense targets (SP-A, Muc5b) and mostly a summative effect when presented as co-exposure. However, the two toxicant types show differential induction of aquaporin-1 coinciding with the corresponding differential damage to alveolar integrity (vascular permeability). Interestingly, this implies the potential of AQP1 as a differential marker of toxicant type-specific lung injury.

Keywords: aquaporin, gene expression, lung injury, toxicant exposure

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Authors: C. Deangeli, P. Obentaku Obenebot, O. Omwanghe

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The study focuses on the analysis of wellbore instability in rock masses affected by weakness planes. The occurrence of failure in such a type of rocks can occur in the rock matrix and/ or along the weakness planes, in relation to the mud weight gradient. In this case the simple Kirsch solution coupled with a failure criterion cannot supply a suitable scenario for borehole instabilities. Two different numerical approaches have been used in order to investigate the onset of local failure at the wall of a borehole. For each type of approach the influence of the inclination of weakness planes has been investigates, by considering joint sets at 0°, 35° and 90° to the horizontal. The first set of models have been carried out with FLAC 2D (Fast Lagrangian Analysis of Continua) by considering the rock material as a continuous medium, with a Mohr Coulomb criterion for the rock matrix and using the ubiquitous joint model for accounting for the presence of the weakness planes. In this model yield may occur in either the solid or along the weak plane, or both, depending on the stress state, the orientation of the weak plane and the material properties of the solid and weak plane. The second set of models have been performed with PFC2D (Particle Flow code). This code is based on the Discrete Element Method and considers the rock material as an assembly of grains bonded by cement-like materials, and pore spaces. The presence of weakness planes is simulated by the degradation of the bonds between grains along given directions. In general the results of the two approaches are in agreement. However the discrete approach seems to capture more complex phenomena related to local failure in the form of grain detachment at wall of the borehole. In fact the presence of weakness planes in the discontinuous medium leads to local instability along the weak planes also in conditions not predicted from the continuous solution. In general slip failure locations and directions do not follow the conventional wellbore breakout direction but depend upon the internal friction angle and the orientation of the bedding planes. When weakness plane is at 0° and 90° the behaviour are similar to that of a continuous rock material, but borehole instability is more severe when weakness planes are inclined at an angle between 0° and 90° to the horizontal. In conclusion, the results of the numerical simulations show that the prediction of local failure at the wall of the wellbore cannot disregard the presence of weakness planes and consequently the higher mud weight required for stability for any specific inclination of the joints. Despite the discrete approach can simulate smaller areas because of the large number of particles required for the generation of the rock material, however it seems to investigate more correctly the occurrence of failure at the miscroscale and eventually the propagation of the failed zone to a large portion of rock around the wellbore.

Keywords: continuous- discontinuous, numerical modelling, weakness planes wellbore, FLAC 2D

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Authors: Neusa Fernanda Torres, Buyisile Chibi, Lyn E. Middleton, Vernon P. Solomon, Tivani P. Mashamba-Thompson

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Background: Self-medication with antibiotics (SMA) is a global concern, with a higher incidence in low and middle-income countries (LMICs). Despite intense world-wide efforts to control and promote the rational use of antibiotics, continuing practices of SMA systematically exposes individuals and communities to the risk of antibiotic resistance and other undesirable antibiotic side effects. Moreover, it increases the health systems costs of acquiring more powerful antibiotics to treat the resistant infection. This review thus maps evidence on the factors influencing self-medication with antibiotics in these settings. Methods: The search strategy for this review involved electronic databases including PubMed, Web of Knowledge, Science Direct, EBSCOhost (PubMed, CINAHL with Full Text, Health Source - Consumer Edition, MEDLINE), Google Scholar, BioMed Central and World Health Organization library, using the search terms:’ Self-Medication’, ‘antibiotics’, ‘factors’ and ‘reasons’. Our search included studies published from 2007 to 2017. Thematic analysis was performed to identify the patterns of evidence on SMA in LMICs. The mixed method quality appraisal tool (MMAT) version 2011 was employed to assess the quality of the included primary studies. Results: Fifteen studies met the inclusion criteria. Studies included population from the rural (46,4%), urban (33,6%) and combined (20%) settings, of the following LMICs: Guatemala (2 studies), India (2), Indonesia (2), Kenya (1), Laos (1), Nepal (1), Nigeria (2), Pakistan (2), Sri Lanka (1), and Yemen (1). The total sample size of all 15 included studies was 7676 participants. The findings of the review show a high prevalence of SMA ranging from 8,1% to 93%. Accessibility, affordability, conditions of health facilities (long waiting, quality of services and workers) as long well as poor health-seeking behavior and lack of information are factors that influence SMA in LMICs. Antibiotics such as amoxicillin, metronidazole, amoxicillin/clavulanic, ampicillin, ciprofloxacin, azithromycin, penicillin, and tetracycline, were the most frequently used for SMA. The major sources of antibiotics included pharmacies, drug stores, leftover drugs, family/friends and old prescription. Sore throat, common cold, cough with mucus, headache, toothache, flu-like symptoms, pain relief, fever, running nose, toothache, upper respiratory tract infections, urinary symptoms, urinary tract infection were the common disease symptoms managed with SMA. Conclusion: Although the information on factors influencing SMA in LMICs is unevenly distributed, the available information revealed the existence of research evidence on antibiotic self-medication in some countries of LMICs. SMA practices are influenced by social-cultural determinants of health and frequently associated with poor dispensing and prescribing practices, deficient health-seeking behavior and consequently with inappropriate drug use. Therefore, there is still a need to conduct further studies (qualitative, quantitative and randomized control trial) on factors and reasons for SMA to correctly address the public health problem in LMICs.

Keywords: antibiotics, factors, reasons, self-medication, low and middle-income countries (LMICs)

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Authors: Reyard Mutamiswa, Frank Chidawanyika, Casper Nyamukondiwa

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Under stressful thermal environments, insects adjust their behaviour and physiology to maintain key life-history activities and improve survival. For interacting species, mutual or antagonistic, thermal stress may affect the participants in differing ways, which may then affect the outcome of the ecological relationship. In agroecosystems, this may be the fate of relationships between insect pests and their antagonistic parasitoids under acute and chronic thermal variability. Against this background, we therefore investigated the thermal tolerance of different developmental stages of Chilo partellus Swinhoe (Lepidoptera: Crambidae) and its larval parasitoid Cotesia sesamiae Cameron (Hymenoptera: Braconidae) using both dynamic and static protocols. In laboratory experiments, we determined lethal temperature assays (upper and lower lethal temperatures) using direct plunge protocols in programmable water baths (Systronix, Scientific, South Africa), effects of ramping rate on critical thermal limits following standardized protocols using insulated double-jacketed chambers (‘organ pipes’) connected to a programmable water bath (Lauda Eco Gold, Lauda DR.R. Wobser GMBH and Co. KG, Germany), supercooling points (SCPs) following dynamic protocols using a Pico logger connected to a programmable water bath, heat knock-down time (HKDT) and chill-coma recovery (CCRT) time following static protocols in climate chambers (HPP 260, Memmert GmbH + Co.KG, Germany) connected to a camera (HD Covert Network Camera, DS-2CD6412FWD-20, Hikvision Digital Technology Co., Ltd, China). When exposed for two hours to a static temperature, lower lethal temperatures ranged -9 to 6; -14 to -2 and -1 to 4ºC while upper lethal temperatures ranged from 37 to 48; 41 to 49 and 36 to 39ºC for C. partellus eggs, larvae and C. sesamiae adults respectively. Faster heating rates improved critical thermal maxima (CTmax) in C. partellus larvae and adult C. partellus and C. sesamiae. Lower cooling rates improved critical thermal minima (CTmin) in C. partellus and C. sesamiae adults while compromising CTmin in C. partellus larvae. The mean SCPs for C. partellus larvae, pupae and adults were -11.82±1.78, -10.43±1.73 and -15.75±2.47 respectively with adults having the lowest SCPs. Heat knock-down time and chill-coma recovery time varied significantly between C. partellus larvae and adults. Larvae had higher HKDT than adults, while the later recovered significantly faster following chill-coma. Current results suggest developmental stage differences in C. partellus thermal tolerance (with respect to lethal temperatures and critical thermal limits) and a compromised temperature tolerance of parasitoid C. sesamiae relative to its host, suggesting potential asynchrony between host-parasitoid population phenology and consequently biocontrol efficacy under global change. These results have broad implications to biological pest management insect-natural enemy interactions under rapidly changing thermal environments.

Keywords: chill-coma recovery time, climate change, heat knock-down time, lethal temperatures, supercooling point

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Authors: Sushmita Roy Chowdhury, Steve Holding, Sujoy Khan

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The immunogenic responses of the lung towards the fungus Aspergillus fumigatus may range from invasive aspergillosis in the immunocompromised, fungal ball or infection within a cavity in the lung in those with structural lung lesions, or allergic bronchopulmonary aspergillosis (ABPA). Patients with asthma or cystic fibrosis are particularly predisposed to ABPA. There are consensus guidelines that have established criteria for diagnosis of ABPA, but uncertainty remains on the serologic cut-off values that would increase the diagnostic specificity of ABPA. We retrospectively analyzed 80 patients with severe asthma and evidence of peripheral blood eosinophilia ( > 500) over the last 3 years who underwent all serologic tests to exclude ABPA. Total IgE, specific IgE and specific IgG levels against Aspergillus fumigatus were measured using ImmunoCAP Phadia-100 (Thermo Fisher Scientific, Sweden). The Modified ISHAM working group 2013 criteria (obligate criteria: asthma or cystic fibrosis, total IgE > 1000 IU/ml or > 417 kU/L and positive specific IgE Aspergillus fumigatus or skin test positivity; with ≥ 2 of peripheral eosinophilia, positive specific IgG Aspergillus fumigatus and consistent radiographic opacities) was used in the clinical workup for the final diagnosis of ABPA. Patients were divided into 3 groups - definite, possible, and no evidence of ABPA. Specific IgG Aspergillus fumigatus levels were not used to assign the patients into any of the groups. Of 80 patients (males 48, females 32; mean age 53.9 years ± SD 15.8) selected for the analysis, there were 30 patients who had positive specific IgE against Aspergillus fumigatus (37.5%). 13 patients fulfilled the Modified ISHAM working group 2013 criteria of ABPA (‘definite’), while 15 patients were ‘possible’ ABPA and 52 did not fulfill the criteria (not ABPA). As IgE levels were not normally distributed, median levels were used in the analysis. Median total IgE levels of patients with definite and possible ABPA were 2144 kU/L and 2597 kU/L respectively (non-significant), while median specific IgE Aspergillus fumigatus at 4.35 kUA/L and 1.47 kUA/L respectively were significantly different (comparison of standard deviations F-statistic 3.2267, significance level p=0.040). Mean levels of IgG anti-Aspergillus fumigatus in the three groups (definite, possible and no evidence of ABPA) were compared using ANOVA (Statgraphics Centurion Professional XV, Statpoint Inc). Mean levels of IgG anti-Aspergillus fumigatus (Gm3) in definite ABPA was 125.17 mgA/L ( ± SD 54.84, with 95%CI 92.03-158.32), while mean Gm3 levels in possible and no ABPA were 18.61 mgA/L and 30.05 mgA/L respectively. ANOVA showed a significant difference between the definite group and the other groups (p < 0.001). This was confirmed using multiple range tests (Fisher's least significant difference procedure). There was no significant difference between the possible ABPA and not ABPA groups (p > 0.05). The study showed that a sizeable proportion of patients with asthma are sensitized to Aspergillus fumigatus in this part of India. A higher cut-off value of Gm3 ≥ 80 mgA/L provides a higher serologic specificity towards definite ABPA. Long-term studies would provide us more information if those patients with 'possible' APBA and positive Gm3 later develop clear ABPA, and are different from the Gm3 negative group in this respect. Serologic testing with clear defined cut-offs are a valuable adjunct in the diagnosis of ABPA.

Keywords: allergic bronchopulmonary aspergillosis, Aspergillus fumigatus, asthma, IgE level

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Authors: Maha Atout, Pippa Hemingway, Jane Seymour

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A preliminary systematic review shows that health professionals experience a tension when communicating with the parents and family members of children with life-threatening and life-limiting conditions. On the one hand, they want to promote open and honest communication, while on the other, they are apprehensive about fostering an unrealistic sense of hope. Defining the boundaries between information that might offer reasonable hope versus that which results in false reassurance is challenging. Some healthcare providers worry that instilling a false sense of hope could motivate parents to seek continued aggressive treatment for their child, which in turn might cause the patient further unnecessary suffering. To date, there has been a lack of research in the Middle East regarding how healthcare providers do or should communicate bad news; in particular, the issue of hope in the field of paediatric palliative care has not been researched thoroughly. This study aims to explore, from the perspective of patients’ mothers, physicians, and nurses, the experience of communicating and receiving bad news in the care of children with palliative care needs. Data were collected using a collective qualitative case study approach across three paediatric units in a Jordanian hospital. Two data collection methods were employed: participant observation and semi-structured interviews. The overall number of cases was 15, with a total of 56 interviews with mothers (n=24), physicians (n=12), and nurses (n=20) completed, as well as 197 observational hours logged. The findings demonstrate that mothers wanted their doctors to provide them with hopeful information about the future progression of their child’s illness. Although some mothers asked their doctors to provide them with honest information regarding the condition of their child, they still considered a sense of hope to be essential for coping with caring for their child. According to mothers, hope was critical to treatment as it helped them to stay committed to the treatment and protected them to some extent from the extreme emotional suffering that would occur if they lost hope. The health professionals agreed with the mothers on the importance of hope, so long as it was congruent with the stage and severity of each patient’s disease. The findings of this study conclude that while parents typically insist on knowing all relevant information when their child is diagnosed with a severe illness, they considered hope to be an essential part of life, and they found it very difficult to handle suffering without any glimmer of it. This study finds that using negative terms has extremely adverse effects on the parents’ emotions. Hence, although the mothers asked the doctors to be as honest as they could, they still wanted the physicians to provide them with a positive message by communicating this information in a sensitive manner including hope.

Keywords: health professionals, children, communication, hope, information, mothers, palliative care

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Authors: Muteb Alotaibi, Graham Clarke, Nick Malleson

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The Hajj religious festival at Mina in Saudi Arabia has always presented the opportunity for injuries or deaths. For example, in 1990, a stampede killed 1426 pilgrims, whilst in 1997, 343 people were killed and 1500 injured due to a fire fuelled by high winds sweeping through the tent city in Mina.Many more minor incidents have occurred since then. It is predicted that 5 million pilgrims will soon perform the ritual at Mina (which is, in effect, a temporary city built each year in the desert), which might lead in the future to severe congestion and accidents unless the research is conducted on actions that contribute positively to improving the management of the crowd and facilitating the flow of pilgrims safely and securely. To help prevent further disasters, it is important to first plan better, more accessible locations for emergency services across Mina to ensure a good service for pilgrims. In this paper, we first use a Location Allocation Model (LAM) within a network GIS to examine the optimal locations for key services in the temporary city of Mina. This has been undertaken in relation to the location and movement of the pilgrims during the six day religious festival. The results of various what-if scenarios have been compared against the current location of services. A major argument is that planners should be flexible and locate facilities at different locations throughout the day and night. The use of location-allocation models in this type of comparative static mode has rarely been operationalised in the literature. Second, we model pilgrim movements and behaviours along with the most crowded parts of the network. This has been modelled using an agent-based model. This model allows planners to understand the key bottlenecks in the network and at what usage levels the paths become critically congested. Thus the paper has important implications and recommendations for future disaster planning strategies. This will enable planners to see at what stage in the movements of pilgrims problems occur in terms of potential crushes and trampling incidents. The main application of this research was only customised for pedestrians as the concentration only for pedestrians who move to Jamarat via foot. Further, the network in the middle of Mina was only dedicated for pedestrians for safety, so no Buses, trains and private cars were allowed in this area to prevent the congestion within this network. Initially, this research focus on Mina city as ‘temporary city’ and also about service provision in temporary cities, which is not highlighted in literature so far. Further, it is the first study which use the dynamic demand to optimise the services in the case of day and night time. Moreover, it is the first study which link the location allocation model for optimising services with ABM to find out whether or not the service location is located in the proper location in which it’s not affecting on crowd movement in mainstream flow where some pilgrims need to have health services.

Keywords: ABM, crowd management, hajj, temporary city

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Authors: Ankita Baidya, Vanishri Ganakumar, Ranveer S. Jadon, Piyush Ranjan, Rita Sood

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Septic embolism can have varied presentations and clinical considerations. Infected central venous catheters are commonly associated with septic emboli but peripheral vascular catheters are rarely implicated. We describe a rare case of septic pulmonary emboli related to infected peripheral venous cannulation caused by an unusual etiological agent. A young male presented with complaints of fever, productive cough, sudden onset shortness of breath and cellulitis in both the upper limbs. He was recently hospitalised for dengue fever and administered intravenous fluids through peripheral venous line. The patient was febrile, tachypneic and in respiratory distress, there were multiple pus filled bullae in left hand alongwith swelling and erythema involving right forearm that started at the site of cannulation. Chest examination showed active accessory muscles of respiration, stony dull percussion at the base of right lung and decreased breath sounds at right infrascapular, infraaxillary and mammary area. Other system examination was within normal limits. Chest X-ray revealed bilateral multiple patchy heterogenous peripheral opacities and infiltrates with right-sided pleural effusion. Contrast-enhanced computed tomography (CECT) chest showed feeding vessel sign confirming the diagnosis as septic emboli. Venous Doppler and 2D-echocardiogarm were normal. Laboratory findings showed marked leucocytosis (22000/mm3). Pus aspirate, blood sample, and sputum sample were sent for microbiological testing. The patient was started empirically on ceftriaxone, vancomycin, and clindamycin. The Pus culture and sputum culture showed Klebsiella pneumoniae sensitive to cefoperazone-sulbactum, piperacillin-tazobactum, meropenem and amikacin. The antibiotics were modified accordingly to antimicrobial sensitivity profile to Cefoperazone-sulbactum. Bronchoalveolar lavage (BAL) was done and sent for microbiological investigations. BAL culture showed Klebsiella pneumoniae with same antimicrobial resistance profile. On day 6 of starting cefoperazone-sulbactum, he became afebrile. The skin lesions improved significantly. He was administered 2 weeks of cefoperazone–sulbactum and discharged on oral faropenem for 4 weeks. At the time of discharge, TLC was 11200/mm3 with marked radiological resolution of infection and healed skin lesions. He was kept in regular follow up. Chest X-ray and skin lesions showed complete resolution after 8 weeks. Till date, only couple of case reports of septic emboli through peripheral intravenous line have been reported in English literature. This case highlights that a simple procedure of peripheral intravenous cannulation can lead to catastrophic complication of septic pulmonary emboli and widespread cellulitis if not done with proper care and precautions. Also, the usual pathogens in such clinical settings are gram positive bacteria, but with the history of recent hospitalization, empirical therapy should also cover drug resistant gram negative microorganisms. It also emphasise the importance of appropriate healthcare practices to be taken care during all procedures.

Keywords: antibiotics, cannula, Klebsiella pneumoniae, septic emboli

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Authors: Syeda Fatima Manzelat

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This study investigates the algal genera responsible for biodeterioration, biodegradation, and biological pollution in two historic parks in Milton Keynes, UK: Campbell Park and Great Linford Manor Park. Various sites within these parks were selected to evaluate the morphological, aesthetic, and physical effects of algal growth on park structures and natural features. Specimens and swabs were mechanically collected from the selected sites. Algal specimens were preserved in Lugol’s solution and labelled with standard information for subsequent analysis. Using photomicrography and taxonomic keys, researchers identified algal species from aerial, terrestrial, and aquatic habitats. This comprehensive analysis revealed a diverse range of algae, both homogeneously and non-homogeneously mixed across different environments. The qualitative study identified seven classes of algae. Chlorophyceae, the predominant class, was represented by eleven genera: Chlorella, Chlorococcum, Cladophora, Coenochloris, Cylindrocapsa, Microspora, Prasiola, Spirogyra, Trentepholia, Ulothrix, and Zygnema. Charophyceae included four genera: Cosmarium, Klebsormidium, Mesotaenium, and Mougeotia. Xanthophyceae had two genera: Tribonema and Vaucheria. Bacillariophyceae (diatoms) included six genera: Acnanthes, Bacillaria, Fragilaria, Gomphonema, Synedra, and Tabellaria. Dinophyceae had one Dinoflagellate genus. Rhodophyceae included Bangia and Batrachospermum. Cyanophyceae comprised five genera: Chroococcus, Gloeocapsa, Scytonema, Stigonema, and Oscillatoria. Quantitative analysis revealed that Chlorophyceae was the predominant class across the two parks. Coenochloris, a member of Chlorophyceae, was isolated from thirteen sites, while Gloeocapsa from Cyanophyceae was found at twelve sites. These algae impart various shades of green to the surfaces they colonise, forming biofilms that affect the aesthetic and physical integrity of the structures. Certain algae were park-specific. Prasiola, Vaucheria, and Trentepholia were isolated exclusively from Great Linford Park, with Trentepholia imparting a distinctive orange colour to walls and trees due to the pigments chlorophyll, β-carotene, and quinone. Mesotaenium, Dinoflagellate, Gomphonema, Fragilaria, Tabellaria, and two unidentified genera were exclusive to Campbell Park. The study found the highest number of algal genera (25) in Campbell Park's canal, followed by 21 in the canal at Great Linford Manor Park. Algae were also found on walls, wooden fences, metal sculptures, and railings, causing surface erosion, natural weathering, and cracking. These physical changes lead to technical and mechanical instability, resulting in significant damage to building materials. Algal biofilms secrete organic acids that contribute to the biosolubilisation and biodeterioration of these materials. Additionally, aquatic algal blooms identified during the study release toxins that pose health risks, including allergies, skin rashes, vomiting, diarrhoea, fever, muscle spasms, and respiratory infections. This study highlights specific areas within these historic sites that need attention and provides valuable insights into conservation strategies to mitigate the negative impacts of algal biocolonisation. Recommendations include regular monitoring and preventive measures through various treatments to preserve the integrity of these historic parks.

Keywords: biodeterioration, historic parks, algae, UK

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Authors: Giovana Vesentini, Fernanda Piculo, Gabriela Marini, Debora Damasceno, Angelica Barbosa, Selma Martheus, Marilza Rudge

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Problem statement: Skeletal muscle is highly adaptable, muscle fiber composition and size can respond to a variety of stimuli, such physiologic, as pregnancy, and metabolic abnormalities, as Diabetes mellitus. This study aimed to analyze the effects of pregnancy-associated diabetes on the rectus abdominis muscle (RA), and to compare this changes in rats and women. Methods: Female Wistar rats were maintained under controlled conditions and distributed in Pregnant (P) and Long-term mild pregnant diabetic (LTMd) (n=3 r/group). Diabetes in rats was induced by streptozotocin (100mg/Kg, sc) on the first day of life, for a hyperglycemic state between 120-300 mg/dL in adult life. Female rats were mated overnight, at day 21 of pregnancy were anesthetized, and killed for the harvesting of maternal RA. Pregnant women who attended the Diabetes Prenatal Care Clinic of Botucatu Medical School were distributed in Pregnant non-diabetic (Pnd) and Gestational Diabetic (GDM) (n=3 w/group). The diagnosis of GDM was established according to ADA’s criteria (2016). The harvesting of RA was during the cesarean section. Transversal cross-sections of the RA of both women and rats were analyzed by transmission electron microscopy. All procedures were approved by the Ethics Committee on Animal Experiments of the Botucatu Medical School (Protocol Number 1003/2013) and by the Botucatu Medical School Ethical Committee for Human Research in Medical Sciences (CAAE: 41570815.0.0000.5411). Results: The photomicrographs of the RA of rats revealed disorganized Z lines, thinning sarcomeres, and a usual quantity of intermyofibrillar mitochondria in the P group. The LTMd group showed swollen sarcoplasmic reticulum, dilated T tubes and areas with sarcomere disruption. The ultrastructural analysis of Pnd non-diabetic women in the RA showed well-organized myofibrils forming intact sarcomeres, organized Z lines and a normal distribution of intermyofibrillar mitochondria. The GDM group revealed increase in intermyofibrillar mitochondria, areas with sarcomere disruption and increased lipid droplets. Conclusion: Pregnancy and diabetes induce adaptations in the ultrastructure of the rectus abdominis muscle for both women and rats, changing the architectural design of these tissues. However, in rats these changes are more severe maybe because, besides the high blood glucose levels, the quadrupedal animal may suffer an excessive mechanical tension during pregnancy by gravity. Probably, these findings may suggest that these alterations are a risk factor that contributes to the development of muscle dysfunction in women with GDM and may motivate treatment strategies in these patients.

Keywords: gestational diabetes, muscle dysfunction, pregnancy, rectus abdominis

Procedia PDF Downloads 283

Authors: M. J. Eichner, Y. S. Sarhan

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Overall study purpose has been the evaluation of ‘Vertical Villages’ as a new sustainable building typology, reducing significantly negative impacts of rapid urbanization processes in third world capital cities. Commonly in fast-growing cities, housing and job supply, educational and recreational opportunities, as well as public transportation infrastructure, are not accommodating rapid population growth, exposing people to high noise and emission polluted living environments with low-quality neighborhoods and a lack of recreational areas. Like many others, Egypt’s capital city Cairo, according to the UN facing annual population growth rates of up to 428.000 people, is struggling to address the general deterioration of urban living conditions. New settlements typologies and urban reconstruction approach hardly follow sustainable urbanization principles or socio-ecologic urbanization models with severe effects not only for inhabitants but also for the local environment and global climate. The authors prove that ‘Vertical Village’ buildings can offer a sustainable solution for increasing urban density with at the same time improving the living quality and urban environment significantly. Inserting them within high-density urban fabrics the ecologic and socio-cultural conditions of low-quality neighborhoods can be transformed towards districts, considering all needs of sustainable and social urban life. This study analyzes existing building typologies in Cairo’s «low quality - high density» districts Ard el Lewa, Dokki and Mohandesen according to benchmarks for sustainable residential buildings, identifying major problems and deficits. In 3 case study design projects, the sustainable transformation potential through ‘Vertical Village’ buildings are laid out and comparative studies show the improvement of the urban microclimate, safety, social diversity, sense of community, aesthetics, privacy, efficiency, healthiness and accessibility. The main result of the paper is that the disadvantages of density and overpopulation in developing countries can be converted with ‘Vertical Village’ buildings into advantages, achieving attractive and environmentally friendly living environments with multiple synergies. The paper is documenting based on scientific criteria that mixed-use vertical building structures, designed according to sustainable principles of low rise housing, can serve as an alternative to convert «low quality - high density» districts in megacities, opening a pathway for governments to achieve sustainable urban transformation goals. Neglected informal urban districts, home to millions of the poorer population groups, can be converted into healthier living and working environments.

Keywords: sustainable, architecture, urbanization, urban transformation, vertical village

Procedia PDF Downloads 110

Authors: Shotiros Protong

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The incidents of sudden landslides in Thailand during the past decade have occurred frequently and more severely. It is necessary to focus on the principal parameters used for analysis such as land cover land use, rainfall values, characteristic of soil and digital elevation model (DEM). The combination of intense rainfall and severe monsoons is increasing due to global climate change. Landslide occurrences rapidly increase during intense rainfall especially in the rainy season in Thailand which usually starts around mid-May and ends in the middle of October. The rain-triggered landslide hazard analysis is the focus of this research. The combination of geotechnical and hydrological data are used to determine permeability, conductivity, bedding orientation, overburden and presence of loose blocks. The regional landslide hazard mapping is developed using the Slope Stability Index SINMAP model supported on Arc GIS software version 10.1. Geological and land use data are used to define the probability of landslide occurrences in terms of geotechnical data. The geological data can indicate the shear strength and the angle of friction values for soils above given rock types, which leads to the general applicability of the approach for landslide hazard analysis. To address the research objectives, the methods are described in this study: setup and calibration of the SINMAP model, sensitivity of the SINMAP model, geotechnical laboratory, landslide assessment at present calibration and landslide assessment under future climate simulation scenario A2 and B2. In terms of hydrological data, the millimetres/twenty-four hours of average rainfall data are used to assess the rain triggered landslide hazard analysis in slope stability mapping. During 1954-2012 period, is used for the baseline of rainfall data at the present calibration. The climate change in Thailand, the future of climate scenarios are simulated by spatial and temporal scales. The precipitation impact is need to predict for the climate future, Statistical Downscaling Model (SDSM) version 4.2, is used to assess the simulation scenario of future change between latitude 16o 26’ and 18o 37’ north and between longitude 98o 52’ and 103o 05’ east by SDSM software. The research allows the mapping of risk parameters for landslide dynamics, and indicates the spatial and time trends of landslide occurrences. Thus, regional landslide hazard mapping under present-day climatic conditions from 1954 to 2012 and simulations of climate change based on GCM scenarios A2 and B2 from 2013 to 2099 related to the threshold rainfall values for the selected the study area in Uttaradit province in the northern part of Thailand. Finally, the landslide hazard mapping will be compared and shown by areas (km2 ) in both the present and the future under climate simulation scenarios A2 and B2 in Uttaradit province.

Keywords: landslide hazard, GIS, slope stability index (SINMAP), landslides, Thailand

Procedia PDF Downloads 544

Authors: Hui-mei Huang, Huei-Jiun Cheng

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Introduction Many patients are aware of the health benefits associated with an active lifestyle, but they are often hindered from engaging in physical activity due to the presence of pain. The majority of patients experience pain, which can fluctuate over time and is influenced by various factors, including gender. Gender differences in clinical pain and pain-related conditions are widely recognized. Existing literature strongly supports the notion that men and women exhibit distinct responses to pain. Previous studies conducted in Taiwan have highlighted gender differences in pain assessment, but only a limited number of studies have investigated the gender-related factors that influence pain during daily activities. The objective of this study was to examine gender differences in pain assessment among inpatients in Taiwan and investigate whether gender and surgical procedures are factors that impact the daily activities of pain. Method In this study, a prospective and structured questionnaire survey method was utilized, employing intentional sampling to gather data from inpatients admitted to a medical center in central Taiwan. The research period covered in this study is from October 1, 2019, to June 30, 2020. In this study, participants who were hospitalized within 48 hours were requested to self-assess their pain using the Numeric Rating Scale (NRS) and indicate the impact of pain on their activities. The data were analyzed to explore the potential influence of gender and surgical procedures on daily activities affected by pain. Result A total of 722 cases were included in the study, with the mean age of the subjects is 54.38 years old (SD=16.3), and the range varied from 18 to 93 years old. Among the subjects, 48.23% (n=348) were male, and 62.3% (n=450) of them had received more than 12 years of education., and 56.9% (n=411) underwent surgery. The results indicated that regardless of whether the participants underwent surgery or not, females experienced higher perceived severe pain intensity than males (t=2.248, P < .05). However, in surgical patients, there was no significant difference in gender (t=1.75, P > .05). Regarding the impact of pain on daily activities when pain intensity reached 7 , male subjects experienced a 5-point effect on their daily activities (AUC=0.84, 95% CI 0.79-0.89, P <0.01), while female subjects experienced a 7-point effect (AUC=0.88, 95% CI 0.80-0.87, P <0.01). Discussion Some studies suggest that women experience painful stimuli as more intense than men, this difference has been observed in various types of experimental pain, including mechanical and thermal stimuli. Our study reached the same conclusion, female patients exhibited greater intensity of pain. According to the research findings, The research findings highlight the significant impact of gender on individuals' response to intense pain (NRS>7) during their daily activities, with men showing a higher pain tolerance. The higher pain tolerance often observed in men may be attributed to societal conditioning, which encourages them to conceal outward expressions of pain. Further research in this area could help provide a more comprehensive understanding of the topic in Taiwan.

Keywords: pain assessment, gender, surgery, activities of daily living

Procedia PDF Downloads 59