Search results for: Lead
3826 Impact of Mucormycosis Infection In Limb Salvage for Trauma Patients
Authors: Katie-Beth Webster
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Mucormycosis is a rare opportunistic fungal infection that, if left untreated, can cause large scale tissue necrosis and death. There are a number of cases of this in the literature, most commonly in the head and neck region arising from sinuses. It is also usually found in immunocompromised patient subgroups. This study reviewed a number of cases of mucormycosis in previously fit and healthy young trauma patients to assess predisposing factors for infection and adequacy of current treatment paradigms. These trauma patients likely contracted the fungal infection from the soil at the site of the incident. Despite early washout and debridement of the wounds at the scene of the injury and on arrival in hospital, both these patients contracted mucormycosis. It was suspected that inadequate early debridement of soil contaminated limbs was one of the major factors that can lead to catastrophic tissue necrosis. In both cases, this resulted in the patients having a higher level of amputation than would have initially been required based on the level of their injury. This was secondary to cutaneous and soft tissue necrosis secondary to the fungal infiltration leading to osteomyelitis and systemic sepsis. In the literature, it appears diagnosis is often protracted in this condition secondary to inadequate early treatment and long processing times for fungal cultures. If fungal cultures were sent at the time of first assessment and adequate debridements are performed aggressively early, it could lead to these critically unwell trauma patients receiving appropriate antifungal and surgical treatment earlier in their episode of care. This is likely to improve long term outcomes for these patients.Keywords: mucormycosis, plastic surgery, osteomyelitis, trauma
Procedia PDF Downloads 2083825 Surfactant-Modified Chitosan Beads: An Efficient and Cost Effective Material for Adsorptive Removal of Lead from Aqueous Solutions
Authors: Preeti Pal, Anjali Pal
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Chitosan is an effective sorbent for removal of contaminants from wastewater. However, the ability of pure chitosan is specific because of its cationic charge. It causes repulsion in the removal process of various cationic charged molecules. The present study has been carried out for the successful removal of Pb²⁺ ions from aqueous solution by modified chitosan beads. Surface modification of chitosan (CS) beads was performed by using the anionic surfactant (AS), sodium dodecyl sulfate (SDS). Micelle aggregation property of SDS has been utilized for the formation of bilayer over the CS beads to produce surfactant modified chitosan (SMCS) beads. Prepared adsorbents were characterized by Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM) in order to find out their composition and surface morphology. SMCS beads, when compared to the pure CS beads, showed three times higher adsorption. This higher adsorption is believed to be due to the adsolubilization of Pb²⁺ ions on SDS bilayer. This bilayer provides more adsorption sites for quick and effective removal of Pb²⁺ ions from the aqueous phase. Moreover, the kinetic and adsorption isotherm models were employed to the obtained data for the description of the lead adsorption processes. It was found that the removal kinetics follows pseudo-second order model. Adsorption isotherm data fits well to the Langmuir model. The maximum adsorption capacity obtained is 100 mg/g at the dosage of 0.675 g/L for 50 mg/L of Pb²⁺. The adsorption capacity is subject to increase with increasing the Pb²⁺ ions concentration in the solution. The results indicated that the prepared hydrogel beads are efficient adsorbent for removal of Pb²⁺ ions from the aqueous medium.Keywords: adsolubilisation, anionic surfactant, bilayer, chitosan, Pb²⁺
Procedia PDF Downloads 2403824 Exploration of Professional Skepticism among Entry-level Auditors in China from Psychological and Cultural Perspectives
Authors: Sammy Xiaoyan Ying
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Professional skepticism remains one of the most important and controversial topics in auditing. This study examines the influence of client cooperativeness and fraud risk on judgments of professional skepticism among Chinese entry-level auditors in the context of evaluation of client-provided audit evidence. Given that the essence of auditors’ PS rests on distrust of clients, this study invokes trust-related theories from psychological and cultural perspectives. Specifically, invoking psychology theories of trust concerning positive relationship between risk and distrust, this study hypothesizes that professional skepticism is likely to be positively associated with client fraud risk. The results support the hypothesis and show that lower (higher) levels of client fraud risk lead to lower (higher) levels of professional skepticism. Furthermore, drawing on analysis of relationship between cooperation and trust, with particular reference to guanxi dynamics in the Chinese culture, this study hypothesizes that professional skepticism is likely to be negatively associated with client cooperativeness. The results support the hypothesis and show that higher (lower) levels of client cooperativeness lead to lower (higher) levels of professional skepticism. The findings may assist audit firms and auditing educators in improving training and education programs and enhancing entry-level auditors’ abilities to maintain professional skepticism. Also, practitioners and regulators may benefit from increasing awareness of psychological factors in influencing professional skepticism.Keywords: audit judgment, Chinese culture, entry-level auditor, professional skepticism
Procedia PDF Downloads 2923823 Effect of Solid Waste on the Sustainability of the Water Resource Quality in the Gbarain Catchment of the Niger Delta Region of Nigeria
Authors: Davidson E. Egirani, Nanfe R. Poyi, Napoleon Wessey
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This paper would report on the effect of solid waste on water resource quality in the Gbarain catchment of the Niger Delta Region of Nigeria. The Gbarain catchment presently hosts two waste-dump sites located along the flanks of a seasonal flow stream and perennially waterlogged terrain. The anthropogenic activity has significantly affected the quality of surface and groundwater in the Gbarain catchment. These wastes have made the water resource environment toxic leading to the poisoning of aquatic life. The contaminated water resources could lead to serious environmental and human health challenges such as low agricultural yields to loss of vital human organs. The contamination is via geological processes such as seepage and direct infiltration of contaminants into watercourses. The results obtained from field and experimental investigations followed by modeling, and graphical interpretation indicate heavy metal load and fecal pollution in some of the groundwater. The metal load, Escherichia coli, and total coliforms counts exceed the international and regional recommended limits. The contaminate values include Lead (> 0.01 mg/L), Mercury (> 0.006 mg/L), Manganese (> 0.4 mg/L and Escherichia coli (> 0 per 100ml) of the samples. Land use planning, enactment, and implementation of environmental laws are necessary for this region, for effective surface water and groundwater resource management.Keywords: aquatic life, solid waste, environmental health, human health, waste-dump site, water-resource environment
Procedia PDF Downloads 1433822 Implementation of Lean Tools (Value Stream Mapping and ECRS) in an Oil Refinery
Authors: Ronita Singh, Yaman Pattanaik, Soham Lalwala
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In today’s highly competitive business environment, every organization is striving towards lean manufacturing systems to achieve lower Production Lead Times, lower costs, less inventory and overall improvement in supply chains efficiency. Based on the similar idea, this paper presents the practical application of Value Stream Mapping (VSM) tool and ECRS (Eliminate, Combine, Reduce, and Simplify) technique in the receipt section of the material management center of an oil refinery. A value stream is an assortment of all actions (value added as well as non-value added) that are required to bring a product through the essential flows, starting with raw material and ending with the customer. For drawing current state value stream mapping, all relevant data of the receipt cycle has been collected and analyzed. Then analysis of current state map has been done for determining the type and quantum of waste at every stage which helped in ascertaining as to how far the warehouse is from the concept of lean manufacturing. From the results achieved by current VSM, it was observed that the two processes- Preparation of GRN (Goods Receipt Number) and Preparation of UD (Usage Decision) are both bottle neck operations and have higher cycle time. This root cause analysis of various types of waste helped in designing a strategy for step-wise implementation of lean tools. The future state thus created a lean flow of materials at the warehouse center, reducing the lead time of the receipt cycle from 11 days to 7 days and increasing overall efficiency by 27.27%.Keywords: current VSM, ECRS, future VSM, receipt cycle, supply chain, VSM
Procedia PDF Downloads 3153821 Toxicological Standardization of Heavy Metals and Microbial Contamination Haematinic Herbal Formulations Marketed in India
Authors: A. V. Chandewar, Sanjay Bais
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Backgound: In India, drugs of herbal origin have been used in traditional systems of medicines such as Unani and Ayurveda since ancient times. WHO limit for Escherichia coli is 101/gm cfu, for Staphylococus aureus 105/gm cfu, and for Pseudomonas aeruginosa 103/gm cfu and for Salmonella species nil cfu. WHO mentions maximum permissible limits in raw materials only for arsenic, cadmium, and lead, which amount to 1.0, 0.3, and 10 ppm, respectively. Aim: The main purpose of the investigation was to document evidence for the users, and practitioners of marketed haematinic herbal formulations. In the present study haematinic herbal formulations marketed in Yavatmal India were determined for the presence of microbial and heavy metal content. Method: The investigations were performed by using specific medias and atomic absorption spectrometry. Result: The present work indicates the presence of heavy metal contents in herbal formulations selected for study. It was found that arsenic content in formulations was below the permissible limit in all formulations. The cadmium and lead content in six formulations were above the permissible limits. Such formulations are injurious to health of patient if consumed regularly. The specific medias were used to determining the presence of Escherichia coli 4 samples, Staphylococcus aureus 3 samples, and P. aeruginosa 4 samples. The data indicated suggest that there is requirement of in process improvement to provide better quality for consumer health in order to be competitive in international markets. Summary/Conclusion: The presence of microbial and heavy metal content above WHO limits indicates that the GMP was not followed during manufacturing of herbal formulations marketed in India.Keywords: toxicological standardization, heavy metals, microbial contamination, haematinic herbal formulations
Procedia PDF Downloads 4483820 Effect of High-Energy Ball Milling on the Electrical and Piezoelectric Properties of (K0.5Na0.5)(Nb0.9Ta0.1)O3 Lead-Free Piezoceramics
Authors: Chongtham Jiten, K. Chandramani Singh, Radhapiyari Laishram
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Nanocrystalline powders of the lead-free piezoelectric material, tantalum-substituted potassium sodium niobate (K0.5Na0.5)(Nb0.9Ta0.1)O3 (KNNT), were produced using a Retsch PM100 planetary ball mill by setting the milling time to 15h, 20h, 25h, 30h, 35h and 40h, at a fixed speed of 250rpm. The average particle size of the milled powders was found to decrease from 12nm to 3nm as the milling time increases from 15h to 25h, which is in agreement with the existing theoretical model. An anomalous increase to 98nm and then a drop to 3nm in the particle size were observed as the milling time further increases to 30h and 40h respectively. Various sizes of these starting KNNT powders were used to investigate the effect of milling time on the microstructure, dielectric properties, phase transitions and piezoelectric properties of the resulting KNNT ceramics. The particle size of starting KNNT was somewhat proportional to the grain size. As the milling time increases from 15h to 25h, the resulting ceramics exhibit enhancement in the values of relative density from 94.8% to 95.8%, room temperature dielectric constant (εRT) from 878 to 1213, and piezoelectric charge coefficient (d33) from 108pC/N to 128pC/N. For this range of ceramic samples, grain size refinement suppresses the maximum dielectric constant (εmax), shifts the Curie temperature (Tc) to a lower temperature and the orthorhombic-tetragonal phase transition (Tot) to a higher temperature. Further increase of milling time from 25h to 40h produces a gradual degradation in the values of relative density, εRT, and d33 of the resulting ceramics.Keywords: perovskite, dielectric, ceramics, high-energy milling
Procedia PDF Downloads 3233819 Neuroecological Approach for Anthropological Studies in Archaeology
Authors: Kalangi Rodrigo
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The term Neuroecology elucidates the study of customizable variation in cognition and the brain. Subject marked the birth since 1980s, when researches began to apply methods of comparative evolutionary biology to cognitive processes and the underlying neural mechanisms of cognition. In Archaeology and Anthropology, we observe behaviors such as social learning skills, innovative feeding and foraging, tool use and social manipulation to determine the cognitive processes of ancient mankind. Depending on the brainstem size was used as a control variable, and phylogeny was controlled using independent contrasts. Both disciplines need to enriched with comparative literature and neurological experimental, behavioral studies among tribal peoples as well as primate groups which will lead the research to a potential end. Neuroecology examines the relations between ecological selection pressure and mankind or sex differences in cognition and the brain. The goal of neuroecology is to understand how natural law acts on perception and its neural apparatus. Furthermore, neuroecology will eventually lead both principal disciplines to Ethology, where human behaviors and social management studies from a biological perspective. It can be either ethnoarchaeological or prehistoric. Archaeology should adopt general approach of neuroecology, phylogenetic comparative methods can be used in the field, and new findings on the cognitive mechanisms and brain structures involved mating systems, social organization, communication and foraging. The contribution of neuroecology to archaeology and anthropology is the information it provides on the selective pressures that have influenced the evolution of cognition and brain structure of the mankind. It will shed a new light to the path of evolutionary studies including behavioral ecology, primate archaeology and cognitive archaeology.Keywords: Neuroecology, Archaeology, Brain Evolution, Cognitive Archaeology
Procedia PDF Downloads 1203818 A Novel Rapid Well Control Technique Modelled in Computational Fluid Dynamics Software
Authors: Michael Williams
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The ability to control a flowing well is of the utmost important. During the kill phase, heavy weight kill mud is circulated around the well. While increasing bottom hole pressure near wellbore formation, the damage is increased. The addition of high density spherical objects has the potential to minimise this near wellbore damage, increase bottom hole pressure and reduce operational time to kill the well. This operational time saving is seen in the rapid deployment of high density spherical objects instead of building high density drilling fluid. The research aims to model the well kill process using a Computational Fluid Dynamics software. A model has been created as a proof of concept to analyse the flow of micron sized spherical objects in the drilling fluid. Initial results show that this new methodology of spherical objects in drilling fluid agrees with traditional stream lines seen in non-particle flow. Additional models have been created to demonstrate that areas of higher flow rate around the bit can lead to increased probability of wash out of formations but do not affect the flow of micron sized spherical objects. Interestingly, areas that experience dimensional changes such as tool joints and various BHA components do not appear at this initial stage to experience increased velocity or create areas of turbulent flow, which could lead to further borehole stability. In conclusion, the initial models of this novel well control methodology have not demonstrated any adverse flow patterns, which would conclude that this model may be viable under field conditions.Keywords: well control, fluid mechanics, safety, environment
Procedia PDF Downloads 1713817 Comparison of Budgeting Reforms: A Case Study of Thailand and OECD Member Countries
Authors: Nattapol Pourprasert, Siriwan Manowan
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This study aims to find out what budget problems Thailand is facing with and how the results from the comparison between the budgeting reform by Thailand and the reforms by OECD member countries can be used for carrying out budgeting reform of Thailand. The findings from the study on the budget problems that Thailand is facing with reveal that the budgeting system of Thailand lacks of the assessment for the cost-effectiveness of the expenditure of borrowed money and budgets in order to determine whether the expenses are worth the taxes collected from people or not. This is because most popularity policies have unlimited budgets which can lead to the financial risks. Also, these policies create great tax burdens for the descendants in the future and affect the fair distribution of incomes but the Parliament of Thailand never considers these facts. The findings from the comparison between Thai budgeting reform and those by OECD member countries manifest that the traditional budgeting system of Thailand is the department-based budgeting, which is still used without being changed or adjusted in order to fit the new administrative regimes. This traditional budgeting system suggests that a department is responsible for budgeting tasks. Meanwhile, in OECD member countries, budgeting reforms are carried out simultaneously with the reforms of civil service systems so that they are driven in the same directions. The budgeting reforms that rely only on the analyses on economic or technical dimension can hardly lead to success. The budgeting systems of OECD member countries are designed to deal with the unique problems that each of the member countries is facing with rather than adopting the modern system developed by other countries. The budgeting system that has a complicated concept and practice has to be implemented under a flexible strategy so that the departments that implement it can learn about and adjust itself to the system. Continuous and consistent development and training for staff members are also necessary.Keywords: budgeting reforms, Thailand, OECD member countries, budget problems
Procedia PDF Downloads 2873816 Net Regularity and Its Ethical Implications on Internet Stake Holders
Authors: Nourhan Elshenawi
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Net Neutrality (NN) is the principle of treating all online data the same without any prioritization of some over others. A research gap in current scholarship about “violations of NN” and the subsequent ethical concerns paves the way for the following research question: To what extent violations of NN entail ethical concerns and implications for Internet stakeholders? To answer this question, NR is examined using the two major action-based ethical theories, Kantian and Utilitarian, across the relevant Internet stakeholders. First some necessary IT background is provided that shapes how the Internet works and who the key stakeholders are. Following the IT background, the relationship between the stakeholders, users, Internet Service Providers (ISPs) and content providers is discussed and illustrated. Then some violations of NN that are currently occurring is covered, without attracting any attention from the general public from an ethical perspective, as a new term Net Regularity (NR). Afterwards, the current scholarship on NN and its violations are discussed, that are mainly from an economic and sociopolitical perspectives to highlight the lack of ethical discussions on the issue. Before moving on to the ethical analysis however, websites are presented as digital entities that are affected by NR and their happiness is measured using functionalism. The analysis concludes that NR is prone to an unethical treatment of Internet stakeholders in the perspective of both theories. Finally, the current Digital Divide in the world is presented to be able to better illustrate the implications of NR. The implications present the new Internet divide that will take place between individuals within society. Through answering the research question using ethical analysis, it attempts to shed some light on the issue of NR and what kind of society it would lead to. NR would not just lead to a divided society, but divided individuals that are separated by something greater than distance, the Internet.Keywords: digital divide, digital entities, digital ontology, internet ethics, internet law, net neutrality, internet service providers, websites as beings
Procedia PDF Downloads 2743815 Expounding the Evolution of the Proto-Femme Fatale and Its Correlation with the New Woman: A Close Study of David Mamet's Oleanna
Authors: Silvia Elias
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The 'Femme Fatale' figure has become synonymous with a mysterious and seductive woman whose charms captivate her lovers into bonds of irresistible desire, often leading them to compromise or downfall. Originally, a Femme Fatale typically uses her beauty to lead men to their destruction but in modern literature, she represents a direct attack on traditional womanhood and the nuclear family as she refuses to abide by the pillars of mainstream society creating an image of a strong independent woman who defies the control of men and rejects the institution of the family. This research aims at discussing the differences and similarities between the femme fatale and the New Woman and how they are perceived by the audience. There is often confusion between the characteristics that define a New Woman and a Femme Fatale since both women desire independence, challenge typical gender role casting, push against the limits of the patriarchal society and take control of their sexuality. The study of the femme fatale remains appealing in modern times because the fear of gender equality gives life to modern femme fatale versions and post-modern literary works introduce their readers to new versions of the deadly seductress. One that does not fully depend on her looks to destroy men. The idea behind writing this paper was born from reading David Mamet's two-character play Oleanna (1992) and tracing the main female protagonist/antagonist's transformation from a helpless inarticulate girl into a powerful controlling negotiator who knows how to lead a bargain and maintain the upper hand.Keywords: Circe, David, Eve, evolution, feminist, femme fatale, gender, Mamet, new, Odysseus, Oleanna, power, Salome, schema, seduction, temptress, woman
Procedia PDF Downloads 4553814 Sustainable Energy Supply through the Microgrid Concept: A Case Study of University of Nigeria, Nsukka
Authors: Christian Ndubisi Madu, Benjamin C. Ozumba, Ifeanyi E. Madu, Valentine E. Nnadi, Ikenna C. Ezeasor
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The ability to generate power and achieve energy security is one of the driving forces behind the emerging ‘microgrid’ concept. Traditional power supply often operates with centralized infrastructure for generating, transmitting and distributing electricity. The inefficiency and the incessant power outages associated with the centralized power supply system in Nigeria has alienated many users who frequently turn to electric power generator sets to power their homes and offices. Such acts are unsustainable and lead to increase in the use of fossil fuels, generation of carbon dioxide emissions and other gases, and noise pollution. They also pose significant risks as they entail random purchases and storage of gasolines which are fire hazards. It is therefore important that organizations rethink their relationships to centralized power suppliers in other to improve energy accessibility and security. This study explores the energy planning processes and learning taking place at the University of Nigeria Enugu Campus as the school lead microgrid feasibility studies in its community. There is need to develop community partners to deal with the issue of energy efficiency and also to create a strategic alliance to confront political, regulatory and economic barriers to locally-based energy planning. Community-based microgrid can help to reduce the cost of adoption and diversify risks. This study offers insights into the ways in which microgrids can further democratize energy planning, procurement, and access, while simultaneously promoting efficiency and sustainability.Keywords: microgrid, energy efficiency, sustainability, energy security
Procedia PDF Downloads 3743813 Green Public Procurement in Open Access and Traditional Journals: A Comparative Bibliometric Analysis
Authors: Alonso-Cañadas J., Galán-Valdivieso F., Saraite-Sariene L., García-Tabuyo M., Alonso-Morales N.
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Green Public Procurement (GPP) has recently gained attention in the academic and policy arenas since climate change has shown the need to be addressed by both private companies and public entities. Such growing interest motivates this article, aiming to explore the most influential journals, publishers, categories, and topics, as well as the recent trends and future research lines in GPP. Based on the Web of Science database, 578 articles from 2004 to February 2022 devoted to GPP are analyzed using Bibliometrix, an R-tool to perform bibliometric analysis, and Google’s Big Query and Data Studio. This article introduces a variety of findings. First, the most influential journals by far are “Journal of Cleaner Production” and “Sustainability,” differing in that the latter is open access while the former publishes via traditional subscription. This result also occurs regarding the main publishers (Elsevier and MDPI). These features lead us to split the sample into open-access journals and traditional journals to deepen into the similarities and differences between them, confirming that traditional journals exhibit a higher degree of influence in the literature than their open-access counterparts in terms of the number of documents, number of citations and impact (according to the H index). Second, this research also highlights the recent emergence of green-related terms (sustainable, environment) and, parallelly, the increase in categorizing GPP papers in “green” WoS categories, particularly since 2019. Finally, a number of related topics are emerging and will lead the research, such as food security, infrastructures, and implementation barriers of GPP.Keywords: bibliometric analysis, green public procurement, open access, traditional journals
Procedia PDF Downloads 1043812 Acceleration-Based Motion Model for Visual Simultaneous Localization and Mapping
Authors: Daohong Yang, Xiang Zhang, Lei Li, Wanting Zhou
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Visual Simultaneous Localization and Mapping (VSLAM) is a technology that obtains information in the environment for self-positioning and mapping. It is widely used in computer vision, robotics and other fields. Many visual SLAM systems, such as OBSLAM3, employ a constant-speed motion model that provides the initial pose of the current frame to improve the speed and accuracy of feature matching. However, in actual situations, the constant velocity motion model is often difficult to be satisfied, which may lead to a large deviation between the obtained initial pose and the real value, and may lead to errors in nonlinear optimization results. Therefore, this paper proposed a motion model based on acceleration, which can be applied on most SLAM systems. In order to better describe the acceleration of the camera pose, we decoupled the pose transformation matrix, and calculated the rotation matrix and the translation vector respectively, where the rotation matrix is represented by rotation vector. We assume that, in a short period of time, the changes of rotating angular velocity and translation vector remain the same. Based on this assumption, the initial pose of the current frame is estimated. In addition, the error of constant velocity model was analyzed theoretically. Finally, we applied our proposed approach to the ORBSLAM3 system and evaluated two sets of sequences on the TUM dataset. The results showed that our proposed method had a more accurate initial pose estimation and the accuracy of ORBSLAM3 system is improved by 6.61% and 6.46% respectively on the two test sequences.Keywords: error estimation, constant acceleration motion model, pose estimation, visual SLAM
Procedia PDF Downloads 933811 Investigation of the IL23R Psoriasis/PsA Susceptibility Locus
Authors: Shraddha Rane, Richard Warren, Stephen Eyre
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L-23 is a pro-inflammatory molecule that signals T cells to release cytokines such as IL-17A and IL-22. Psoriasis is driven by a dysregulated immune response, within which IL-23 is now thought to play a key role. Genome-wide association studies (GWAS) have identified a number of genetic risk loci that support the involvement of IL-23 signalling in psoriasis; in particular a robust susceptibility locus at a gene encoding a subunit of the IL-23 receptor (IL23R) (Stuart et al., 2015; Tsoi et al., 2012). The lead psoriasis-associated SNP rs9988642 is located approximately 500 bp downstream of IL23R but is in tight linkage disequilibrium (LD) with a missense SNP rs11209026 (R381Q) within IL23R (r2 = 0.85). The minor (G) allele of rs11209026 is present in approximately 7% of the population and is protective for psoriasis and several other autoimmune diseases including IBD, ankylosing spondylitis, RA and asthma. The psoriasis-associated missense SNP R381Q causes an arginine to glutamine substitution in a region of the IL23R protein between the transmembrane domain and the putative JAK2 binding site in the cytoplasmic portion. This substitution is expected to affect the receptor’s surface localisation or signalling ability, rather than IL23R expression. Recent studies have also identified a psoriatic arthritis (PsA)-specific signal at IL23R; thought to be independent from the psoriasis association (Bowes et al., 2015; Budu-Aggrey et al., 2016). The lead PsA-associated SNP rs12044149 is intronic to IL23R and is in LD with likely causal SNPs intersecting promoter and enhancer marks in memory CD8+ T cells (Budu-Aggrey et al., 2016). It is therefore likely that the PsA-specific SNPs affect IL23R function via a different mechanism compared with the psoriasis-specific SNPs. It could be hypothesised that the risk allele for PsA located within the IL23R promoter causes an increase IL23R expression, relative to the protective allele. An increased expression of IL23R might then lead to an exaggerated immune response. The independent genetic signals identified for psoriasis and PsA in this locus indicate that different mechanisms underlie these two conditions; although likely both affecting the function of IL23R. It is very important to further characterise these mechanisms in order to better understand how the IL-23 receptor and its downstream signalling is affected in both diseases. This will help to determine how psoriasis and PsA patients might differentially respond to therapies, particularly IL-23 biologics. To investigate this further we have developed an in vitro model using CD4 T cells which express either wild type IL23R and IL12Rβ1 or mutant IL23R (R381Q) and IL12Rβ1. Model expressing different isotypes of IL23R is also underway to investigate the effects on IL23R expression. We propose to further investigate the variants for Ps and PsA and characterise key intracellular processes related to the variants.Keywords: IL23R, psoriasis, psoriatic arthritis, SNP
Procedia PDF Downloads 1683810 Alternative of Lead-Based Ionization Radiation Shielding Property: Epoxy-Based Composite Design
Authors: Md. Belal Uudin Rabbi, Sakib Al Montasir, Saifur Rahman, Niger Nahid, Esmail Hossain Emon
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The practice of radiation shielding protects against the detrimental effects of ionizing radiation. Radiation shielding depletes radiation by inserting a shield of absorbing material between any radioactive source. It is a primary concern when building several industrial fields, so using potent (high activity) radioisotopes in food preservation, cancer treatment, and particle accelerator facilities is significant. Radiation shielding is essential for radiation-emitting equipment users to reduce or mitigate radiation damage. Polymer composites (especially epoxy based) with high atomic number fillers can replace toxic Lead in ionizing radiation shielding applications because of their excellent mechanical properties, superior solvent and chemical resistance, good dimensional stability, adhesive, and less toxic. Due to being lightweight, good neutron shielding ability in almost the same order as concrete, epoxy-based radiation shielding can be the next big thing. Micro and nano-particles for the epoxy resin increase the epoxy matrix's radiation shielding property. Shielding is required to protect users of such facilities from ionizing radiation as recently, and considerable attention has been paid to polymeric composites as a radiation shielding material. This research will examine the radiation shielding performance of epoxy-based nano-WO3 reinforced composites, exploring the performance of epoxy-based nano-WO3 reinforced composites. The samples will be prepared using the direct pouring method to block radiation. The practice of radiation shielding protects against the detrimental effects of ionizing radiation.Keywords: radiation shielding materials, ionizing radiation, epoxy resin, Tungsten oxide, polymer composites
Procedia PDF Downloads 1143809 Flood Early Warning and Management System
Authors: Yogesh Kumar Singh, T. S. Murugesh Prabhu, Upasana Dutta, Girishchandra Yendargaye, Rahul Yadav, Rohini Gopinath Kale, Binay Kumar, Manoj Khare
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The Indian subcontinent is severely affected by floods that cause intense irreversible devastation to crops and livelihoods. With increased incidences of floods and their related catastrophes, an Early Warning System for Flood Prediction and an efficient Flood Management System for the river basins of India is a must. Accurately modeled hydrological conditions and a web-based early warning system may significantly reduce economic losses incurred due to floods and enable end users to issue advisories with better lead time. This study describes the design and development of an EWS-FP using advanced computational tools/methods, viz. High-Performance Computing (HPC), Remote Sensing, GIS technologies, and open-source tools for the Mahanadi River Basin of India. The flood prediction is based on a robust 2D hydrodynamic model, which solves shallow water equations using the finite volume method. Considering the complexity of the hydrological modeling and the size of the basins in India, it is always a tug of war between better forecast lead time and optimal resolution at which the simulations are to be run. High-performance computing technology provides a good computational means to overcome this issue for the construction of national-level or basin-level flash flood warning systems having a high resolution at local-level warning analysis with a better lead time. High-performance computers with capacities at the order of teraflops and petaflops prove useful while running simulations on such big areas at optimum resolutions. In this study, a free and open-source, HPC-based 2-D hydrodynamic model, with the capability to simulate rainfall run-off, river routing, and tidal forcing, is used. The model was tested for a part of the Mahanadi River Basin (Mahanadi Delta) with actual and predicted discharge, rainfall, and tide data. The simulation time was reduced from 8 hrs to 3 hrs by increasing CPU nodes from 45 to 135, which shows good scalability and performance enhancement. The simulated flood inundation spread and stage were compared with SAR data and CWC Observed Gauge data, respectively. The system shows good accuracy and better lead time suitable for flood forecasting in near-real-time. To disseminate warning to the end user, a network-enabled solution is developed using open-source software. The system has query-based flood damage assessment modules with outputs in the form of spatial maps and statistical databases. System effectively facilitates the management of post-disaster activities caused due to floods, like displaying spatial maps of the area affected, inundated roads, etc., and maintains a steady flow of information at all levels with different access rights depending upon the criticality of the information. It is designed to facilitate users in managing information related to flooding during critical flood seasons and analyzing the extent of the damage.Keywords: flood, modeling, HPC, FOSS
Procedia PDF Downloads 893808 Factors That Affect the Mental Health Status of Syrian Refugee Girls in Post-Resettlement Context
Authors: Vivian Khamis
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Exposure to war and forced migration have been widely linked to child subsequent adaptation. What remains sparse is research spanning multiple risk and protective factors and examining their unique and relative implications to difficulties in mental health among refugee girls. This study investigated the mechanisms through which posttraumatic stress disorder (PTSD), emotion dysregulation , neuroticism, and behavioral and emotional disorders in Syrian refugee girls is impacted by exposure to war traumas, age, and other risk and protective factors such as coping styles, family relationships, and school environment. The sample consisted of 539 Syrian refugee girls who ranged in age from 7 to 18 years attending public schools in various governorates in Lebanon and Jordan. Two school counselors carried out the interviews with children at school. Results indicated that war trauma, older age, and a combination of negative copying style associated with conflict in the family could lead to an overall state of emotion dysregulation, neuroticism, behavioral and emotional disorders, and PTSD in refugee girls. On the other hand, lapse of time since resettlement in host country, positive copying style, cohesion, and expressiveness in the family would lead to more positive mental health status, including lower levels of emotion dysregulation, neuroticism, behavioral and emotional disorders, and PTSD . Enhanced understanding of the mechanistic role of risk and protective factors in contributing to difficulties in mental health in refugee girls may contribute to the development of effective interventions to target the psychological effects of the refugee experience.Keywords: refugee girls, PTSD, emotion dysregulation, neuroticism, behavioral and emotional disorders
Procedia PDF Downloads 783807 The Control of Type 2 Diabetes with Specific References to Dietary Factors
Authors: Reham Algheshairy
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The purpose of this research study is to identify the beneficial effects of Nigella sativa seeds, cherries and Ajwah dates on blood glucose levels among people with type 2 diabetes in the KSA population and healthy people in the UK. My hypothesis questions whether or not people with type 2 diabetes can lead a healthier life using these dietary supplements.Keywords: diabetes type 2, cherry, nigella seeds, Ajwa date
Procedia PDF Downloads 4733806 2D Convolutional Networks for Automatic Segmentation of Knee Cartilage in 3D MRI
Authors: Ananya Ananya, Karthik Rao
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Accurate segmentation of knee cartilage in 3-D magnetic resonance (MR) images for quantitative assessment of volume is crucial for studying and diagnosing osteoarthritis (OA) of the knee, one of the major causes of disability in elderly people. Radiologists generally perform this task in slice-by-slice manner taking 15-20 minutes per 3D image, and lead to high inter and intra observer variability. Hence automatic methods for knee cartilage segmentation are desirable and are an active field of research. This paper presents design and experimental evaluation of 2D convolutional neural networks based fully automated methods for knee cartilage segmentation in 3D MRI. The architectures are validated based on 40 test images and 60 training images from SKI10 dataset. The proposed methods segment 2D slices one by one, which are then combined to give segmentation for whole 3D images. Proposed methods are modified versions of U-net and dilated convolutions, consisting of a single step that segments the given image to 5 labels: background, femoral cartilage, tibia cartilage, femoral bone and tibia bone; cartilages being the primary components of interest. U-net consists of a contracting path and an expanding path, to capture context and localization respectively. Dilated convolutions lead to an exponential expansion of receptive field with only a linear increase in a number of parameters. A combination of modified U-net and dilated convolutions has also been explored. These architectures segment one 3D image in 8 – 10 seconds giving average volumetric Dice Score Coefficients (DSC) of 0.950 - 0.962 for femoral cartilage and 0.951 - 0.966 for tibia cartilage, reference being the manual segmentation.Keywords: convolutional neural networks, dilated convolutions, 3 dimensional, fully automated, knee cartilage, MRI, segmentation, U-net
Procedia PDF Downloads 2613805 Chemometric-Based Voltammetric Method for Analysis of Vitamins and Heavy Metals in Honey Samples
Authors: Marwa A. A. Ragab, Amira F. El-Yazbi, Amr El-Hawiet
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The analysis of heavy metals in honey samples is crucial. When found in honey, they denote environmental pollution. Some of these heavy metals as lead either present at low or high concentrations are considered to be toxic. Other heavy metals, for example, copper and zinc, if present at low concentrations, they considered safe even vital minerals. On the contrary, if they present at high concentrations, they are toxic. Their voltammetric determination in honey represents a challenge due to the presence of other electro-active components as vitamins, which may overlap with the peaks of the metal, hindering their accurate and precise determination. The simultaneous analysis of some vitamins: nicotinic acid (B3) and riboflavin (B2), and heavy metals: lead, cadmium, and zinc, in honey samples, was addressed. The analysis was done in 0.1 M Potassium Chloride (KCl) using a hanging mercury drop electrode (HMDE), followed by chemometric manipulation of the voltammetric data using the derivative method. Then the derivative data were convoluted using discrete Fourier functions. The proposed method allowed the simultaneous analysis of vitamins and metals though their varied responses and sensitivities. Although their peaks were overlapped, the proposed chemometric method allowed their accurate and precise analysis. After the chemometric treatment of the data, metals were successfully quantified at low levels in the presence of vitamins (1: 2000). The heavy metals limit of detection (LOD) values after the chemometric treatment of data decreased by more than 60% than those obtained from the direct voltammetric method. The method applicability was tested by analyzing the selected metals and vitamins in real honey samples obtained from different botanical origins.Keywords: chemometrics, overlapped voltammetric peaks, derivative and convoluted derivative methods, metals and vitamins
Procedia PDF Downloads 1503804 Performance Evaluation of Next Generation Shale Stabilizer
Authors: N. K. Thakur
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A major proportion of the formations drilled for the production of hydrocarbons consists of clay containing shales. The petroleum industry has hugely investigated the role of clay minerals and their subsequent effect on wellbore stability during the drilling and production of hydrocarbons. It has been found that when the shale formation comes in contact with water-based drilling fluid, the interaction of clay minerals like montmorillonite with infiltrated water leads to hydration of the clay minerals, which causes shale swelling. When shale swelling proceeds further, it may lead to major drilling complications like caving, pipe sticking, which invariably influences wellbore stability, wellbore diameter, the mechanical strength of shale, stress distribution in the wellbore, etc. These problems ultimately lead to an increase in nonproductive time and additional costs during drilling. Several additives are used to prevent shale instability. Among the popular additives used for shale inhibition in drilling muds, ionic liquids and nanoparticles are emerging to be the best additives. The efficiency of the proposed additives will be studied and compared with conventional clay inhibitors like KCl. The main objective is to develop a highly efficient water-based mud for mitigating shale instability and reducing fluid loss which is environmentally friendly and does not alter the formation permeability. The use of nanoparticles has been exploited to enhance the rheological and fluid loss properties in water-based drilling fluid ionic liquid have attracted significant research interest due to its unique thermal stability. It is referred to as ‘green chemical’. The preliminary experimental studies performed are promising. The application of more effective mud additives is always desirable to make the drilling process techno-economically proficient.Keywords: ionic liquid, shale inhibitor, wellbore stability, unconventional
Procedia PDF Downloads 1943803 Potential and Problems That Lead to Best Solutions for Establishment of Wat Sai Musuem of Local Boats, Bang Kradang-Nga, Bang Khontee District, Samut Songkram Province
Authors: Threera Intarareaung
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This research aims to study guidelines of organizing the Wat Sai Museum of Local Boats, of Ruam Sai Pattana Community 789, Kradangnga sub-district, Bang Khon Tee district, Samut Songkram province. The procedures are to seek for potentials and problems within the community to properly organize the said museum. The research contains methodology of qualitative by studying from the population from Ruam Sai Pattana 789, a community that located within the area of the museum. The sample contains 40 persons. The procedures are in-depth interview, observation, focus group by discussing ideas, problems and the importance of the museum. After that, the information received is synthesized and analyzed. The result finds that the local temple requires setting up the boat museum. However, there are several factors that limit the possibility which are the museum manager, resources, exhibition and service and knowledge management. These factors reflect mutual potentials and problems that lead us to seek the best solutions to set up the local boat museum. In conclusion, there are 4 issues regarding the management. First, the knowledge management should be conducted to indicate the purposes of the museum. Second, exhibition and service should be categorized. In addition, the serviced should be assisted by local guides. Third, the museum should employ staffs to correspond to other entities such as related authorities. Fourth is regarding location and condition of the building. This is considered as a major factor that needs discussion from different parties. However, the condition of the existing resource is proper. All the information is collected by field trip and interview the locals and person of interest. Therefore, the idea is inconsistent with the community’s requirement that can proceed to real practice.Keywords: museum, boat museum, heritage tourism, conservation lifestyle
Procedia PDF Downloads 3323802 The Effect of Four-Week Resistance Exercise along with Milk Consumption on NT-proBNP and Plasma Troponin I
Authors: Rostam Abdi, Ahmad Abdi, Zahra Vahedi Langrodi
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The aim of this study is to investigate four-week resistance exercise and milk supplement on NT-proBNP and plasma troponin I of male students. Concerning the methodology of the study, 21 senior high school students of Ardebil city were selected. The selected subjects were randomly shared in three groups of control, exercise- water and exercise- milk. The exercise program includes resistance exercise for a big muscle group. The subjects of control group rested during the study and did not participate in any training. The subjects of exercise- water experimental group immediately received 400 cc water after exercise and exercise- milk group immediately received 400 cc low fat milk. Control-water groups consumed the same amount of water. 48 hours before and after the last exercise session, the blood sample of the subjects were taken for measuring the variables. NT-proBNP and Troponin I concentrations were measured by ELISA. For data analysis, one-way variance analysis test, correlated t-test and Bonferroni post hoc test were used. The significant difference of p ≤ 0.05 was accepted. Resistance training along with milk consumption leads to increase of plasma NT-proBNP, however; this increase has not reached the significant level. Furthermore, meaningful increase was observed in plasma NT–proBNP in exercise group between pretest and posttest values. Furthermore, no meaningful difference was observed between groups in terms of Troponin I after milk consumption. It seems that endurance exercises lead to change in the structure of heart muscle and is along with an increase of NT-proBNP. Furthermore, there is the possibility that milk consumption can lead to release of heart troponin I. The mechanism through which protein supplements have been put on heart troponin I is unknown and requires more research.Keywords: resistance exercise, milk, NT-proBNP, Troponin I
Procedia PDF Downloads 2623801 Lessons Learnt from a Patient with Pseudohyperkalaemia Secondary to Polycythaemia Rubra Vera in a Neuro-ICU Patient Resulting in Dangerous Interventions: Lessons Learnt on Patient Safety Improvement
Authors: Dinoo Kirthinanda, Sujani Wijeratne
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Pseudohyperkalaemia is a common benign in vitro phenomenon caused by the release of potassium ions (K+) from cells during specimen processing. Analysis of haemolysed blood samples for predominantly intracellular electrolytes may lead to re-investigation and potentially harmful interventions. We report a case of a 52-year male with myeloproliferative disease manifested as Polycythaemia Rubra Vera, Hypertension and hypertensive nephropathy with stage 3 chronic kidney disease admitted to Neuro-intensive care unit (NICU) with an intra-cerebral haemorrhage secondary to hypertensive bleed. His initial blood investigations showed hyperkalemia with serum K+ 6.2 mmol/L yet the bedside arterial blood gas analysis yielded K+ of 4.6 mmol/L. The patient was however given hyperkalemia regime twice based on venous electrolyte analysis. The discrepancy between the bedside electrolyte analysis using arterial blood and venous blood prompted further evaluation. The 12 lead Electrocardiogram showed U waves and sinus bradycardia corresponding to the serum K+ of 2.8 mmol/L on arterial blood gas analysis. Immediate K+ replacement ensured the patient did not develop life-threatening cardiac complications. Pseudohyperkalaemia may pose diagnostic challenges in the absence of detectable haemolysis and should be suspected in susceptible patients with normal Electrocardiogram and Glomerular Filtration Rate to avoid potentially life-threatening interventions. When in doubt, rapid analysis of arterial blood gas may be useful for accurate quantification of potassium.Keywords: patient safety, pseudohyperkalaemia, haemolysis, myeloproliferative disorder
Procedia PDF Downloads 1523800 High Throughput Virtual Screening against ns3 Helicase of Japanese Encephalitis Virus (JEV)
Authors: Soma Banerjee, Aamen Talukdar, Argha Mandal, Dipankar Chaudhuri
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Japanese Encephalitis is a major infectious disease with nearly half the world’s population living in areas where it is prevalent. Currently, treatment for it involves only supportive care and symptom management through vaccination. Due to the lack of antiviral drugs against Japanese Encephalitis Virus (JEV), the quest for such agents remains a priority. For these reasons, simulation studies of drug targets against JEV are important. Towards this purpose, docking experiments of the kinase inhibitors were done against the chosen target NS3 helicase as it is a nucleoside binding protein. Previous efforts regarding computational drug design against JEV revealed some lead molecules by virtual screening using public domain software. To be more specific and accurate regarding finding leads, in this study a proprietary software Schrödinger-GLIDE has been used. Druggability of the pockets in the NS3 helicase crystal structure was first calculated by SITEMAP. Then the sites were screened according to compatibility with ATP. The site which is most compatible with ATP was selected as target. Virtual screening was performed by acquiring ligands from databases: KinaseSARfari, KinaseKnowledgebase and Published inhibitor Set using GLIDE. The 25 ligands with best docking scores from each database were re-docked in XP mode. Protein structure alignment of NS3 was performed using VAST against MMDB, and similar human proteins were docked to all the best scoring ligands. The low scoring ligands were chosen for further studies and the high scoring ligands were screened. Seventy-three ligands were listed as the best scoring ones after performing HTVS. Protein structure alignment of NS3 revealed 3 human proteins with RMSD values lesser than 2Å. Docking results with these three proteins revealed the inhibitors that can interfere and inhibit human proteins. Those inhibitors were screened. Among the ones left, those with docking scores worse than a threshold value were also removed to get the final hits. Analysis of the docked complexes through 2D interaction diagrams revealed the amino acid residues that are essential for ligand binding within the active site. Interaction analysis will help to find a strongly interacting scaffold among the hits. This experiment yielded 21 hits with the best docking scores which could be investigated further for their drug like properties. Aside from getting suitable leads, specific NS3 helicase-inhibitor interactions were identified. Selection of Target modification strategies complementing docking methodologies which can result in choosing better lead compounds are in progress. Those enhanced leads can lead to better in vitro testing.Keywords: antivirals, docking, glide, high-throughput virtual screening, Japanese encephalitis, ns3 helicase
Procedia PDF Downloads 2303799 Investigating Elements of Identity of Traditional Neighborhoods in Isfahan and Using These Elements in the Design of Modern Neighborhoods
Authors: Saman Keshavarzi
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The process of planning, designing and building neighborhoods is a complex and multidimensional part of urban planning. Understanding the elements that give a neighborhood a sense of identity can lead to successful city planning and result in a cohesive and functional community where people feel a sense of belonging. These factors are important in ensuring that the needs of the urban population are met to live in a safe, pleasant and healthy society. This research paper aims to identify the elements of the identity of traditional neighborhoods in Isfahan and analyzes ways of using these elements in the design of modern neighborhoods to increase social interaction between communities and cultural reunification of people. The neighborhood of Jolfa in Isfahan has a unique socio-cultural identity as it dates back to the Safavid Dynasty of the 16th century, and most of its inhabitants are Christian Armenians of a religious minority. The elements of the identity of Jolfa were analyzed through the following research methods: field observations, distribution of questionnaires and qualitative analysis. The basic methodology that was used to further understand the Jolfa neighborhood and deconstruct the identity image that residents associate with their respective neighborhoods was a qualitative research method. This was done through utilizing questionnaires that respondents had to fill out in response to a series of research questions. From collecting these qualitative data, the major finding was that traditional neighborhoods that have elements of identity embedded in them are seen to have closer-knit communities whose residents have strong societal ties. This area of study in urban planning is vital to ensuring that new neighborhoods are built with concepts of social cohesion, community and inclusion in mind as they are what lead to strong, connected, and prosperous societies.Keywords: development, housing, identity, neighborhood, policy, urbanization
Procedia PDF Downloads 1733798 Level of Reactive Oxygen Species and Inflammatory Cytokines in Rheumatoid Arthritis Patients: Correlation with Disease Severity
Authors: Somaiya Mateen, Shagufta Moin, Mohammad Owais, Abdul Khan, Atif Zafar
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In rheumatoid arthritis (RA), impaired oxidative metabolism and imbalance between pro-and anti-inflammatory cytokines are responsible for causing inflammation and the degradation of cartilage and bone. The present study was done to evaluate the level and hence the role of reactive oxygen species (ROS) and inflammatory cytokines in the pathogenesis of RA. The present study was performed in the blood of 80 RA patients and 55 age and sex-matched healthy controls. The level of ROS (in 5% hematocrit) and the plasma level of pro-inflammatory cytokines [TNF-α, interleukin-6 (IL-6), IL-22] and anti-inflammatory cytokines (IL-4 and IL-5) were monitored in healthy subjects and RA patients. For evaluating the role of rheumatoid factor (RF) in the pathogenesis of RA, patients were sub-divided on the basis of presence or absence of RF. Reactive species and inflammatory cytokines were correlated with disease activity measure-Disease Activity Score for 28 joints (DAS28). The level of ROS, TNF-α, IL-6 and IL-22 were found to be significantly higher in RA patients as compared to the healthy controls, with the increase being more significant in patients positive for rheumatoid factor and those having high disease severity. On the other hand, a significant decrease in the level of IL-4 and IL-10 were observed in RA patients compared with healthy controls, with the decrease being more prominent in severe cases of RA. Higher ROS (indicative of impaired anti-oxidant defence system) and pro-inflammatory cytokines level in RA patients may lead to the damage of biomolecules which in turn contributes to tissue damage and hence to the development of more severe RA. The imbalance between pro-and anti-inflammatory cytokines may lead to the development of multi-system immune complications. ROS and inflammatory cytokines may also serve as a potential biomarker for assessing the disease severity.Keywords: rheumatoid arthritis, reactive oxygen species, pro-inflammatory cytokines, anti-inflammatory cytokines
Procedia PDF Downloads 3183797 Application of Non-Smoking Areas in Hospitals
Authors: Nur Inayah Ismaniar, Sukri Palutturi, Ansariadi, Atjo Wahyu
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Background: In various countries in the world, the problem of smoking is now considered something serious because of the effects of smoking which can not only lead to addiction but also have the potential to harm health. Public health authorities have concluded that one solution that can be done to protect the public from active smokers is to issue a policy that requires public facilities to be completely smoke-free. The hospital is one of the public facilities that has been designated as a smoke-free area. However, the implementation and maintenance of a successful program based on a smoke-free hospital are still considered an ongoing challenge worldwide due to the very low level of adherence. The low level of compliance with this smoke-free policy is also seen in other public facilities. The purpose of the literature review is to review the level of compliance with the application of the Non-Smoking Area policy, how this policy has succeeded in reducing smoking activity in hospitals, and what factors lead to such compliance in each country in the world. Methods: A literature review of articles was carried out on all types of research methods, both qualitative and quantitative. The sample is all subjects who are in the research location, which includes patients, staff and hospital visitors. Results: Various variations in the level of compliance were found in various kinds of literature. The literature with the highest level of compliance is 88.4%. Furthermore, several determinants that are known to affect the compliance of the Non-Smoking Area policies in hospitals include communication, information, knowledge, perceptions, interventions, attitudes and support. Obstacles to its enforcement are the absence of sanctions against violators of the Non-Smoking Area policy, the ineffectiveness of the function of policymakers in hospitals, and negative perceptions of smoking related to mental health. Conclusion: Violations of the Non-Smoking Area policy are often committed by the hospital staff themselves, which makes it difficult for this policy to be fully enforced at various points in the hospital.Keywords: health policy, non-smoking area, hospital, implementation
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