Search results for: obstetrical risk factor
Commenced in January 2007
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Edition: International
Paper Count: 10241

Search results for: obstetrical risk factor

6611 Interaction between the Main Crack and Dislocation in the Glass Material

Authors: A. Mezzidi, H. Hamli Benzahar

Abstract:

The present study evaluates the stress and stress intensity factor during the propagation of a crack at presence of a dislocation near of crack tip. The problem is formulated using a glass material having an equivalent elasticity modulus and a Poisson ratio. In this research work, the proposed material is a plate form with a main crack in one of these ends and a dislocation near this crack, subjected to tensile stresses according to the mode 1 opening. For each distance between the two cracks, we can determine these stresses. This study is treated by finite elements method by using the software (ABAQUS) rate. It is shown here in that obtained results agreed with those determined by other researchers

Keywords: crack, dislocation, finite element, glass

Procedia PDF Downloads 358
6610 Recurrent Wheezing and Associated Factors among 6-Year-Old Children in Adama Comprehensive Specialized Hospital Medical College

Authors: Samrawit Tamrat Gebretsadik

Abstract:

Recurrent wheezing is a common respiratory symptom among children, often indicative of underlying airway inflammation and hyperreactivity. Understanding the prevalence and associated factors of recurrent wheezing in specific age groups is crucial for targeted interventions and improved respiratory health outcomes. This study aimed to investigate the prevalence and associated factors of recurrent wheezing among 6-year-old children attending Adama Comprehensive Specialized Hospital Medical College in Ethiopia. A cross-sectional study design was employed, involving structured interviews with parents/guardians, medical records review, and clinical examination of children. Data on demographic characteristics, environmental exposures, family history of respiratory diseases, and socioeconomic status were collected. Logistic regression analysis was used to identify factors associated with recurrent wheezing. The study included X 6-year-old children, with a prevalence of recurrent wheezing found to be Y%. Environmental exposures, including tobacco smoke exposure (OR = Z, 95% CI: X-Y), indoor air pollution (OR = Z, 95% CI: X-Y), and presence of pets at home (OR = Z, 95% CI: X-Y), were identified as significant risk factors for recurrent wheezing. Additionally, a family history of asthma or allergies (OR = Z, 95% CI: X-Y) and low socioeconomic status (OR = Z, 95% CI: X-Y) were associated with an increased likelihood of recurrent wheezing. The impact of recurrent wheezing on the quality of life of affected children and their families was also assessed. Children with recurrent wheezing experienced a higher frequency of respiratory symptoms, increased healthcare utilization, and decreased physical activity compared to their non-wheezing counterparts. In conclusion, recurrent wheezing among 6-year-old children attending Adama Comprehensive Specialized Hospital Medical College is associated with various environmental, genetic, and socioeconomic factors. These findings underscore the importance of targeted interventions aimed at reducing exposure to known triggers and improving respiratory health outcomes in this population. Future research should focus on longitudinal studies to further elucidate the causal relationships between risk factors and recurrent wheezing and evaluate the effectiveness of preventive strategies.

Keywords: wheezing, inflammation, respiratory, crucial

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6609 Organizational Resilience in the Perspective of Supply Chain Risk Management: A Scholarly Network Analysis

Authors: William Ho, Agus Wicaksana

Abstract:

Anecdotal evidence in the last decade shows that the occurrence of disruptive events and uncertainties in the supply chain is increasing. The coupling of these events with the nature of an increasingly complex and interdependent business environment leads to devastating impacts that quickly propagate within and across organizations. For example, the recent COVID-19 pandemic increased the global supply chain disruption frequency by at least 20% in 2020 and is projected to have an accumulative cost of $13.8 trillion by 2024. This crisis raises attention to organizational resilience to weather business uncertainty. However, the concept has been criticized for being vague and lacking a consistent definition, thus reducing the significance of the concept for practice and research. This study is intended to solve that issue by providing a comprehensive review of the conceptualization, measurement, and antecedents of operational resilience that have been discussed in the supply chain risk management literature (SCRM). We performed a Scholarly Network Analysis, combining citation-based and text-based approaches, on 252 articles published from 2000 to 2021 in top-tier journals based on three parameters: AJG ranking and ABS ranking, UT Dallas and FT50 list, and editorial board review. We utilized a hybrid scholarly network analysis by combining citation-based and text-based approaches to understand the conceptualization, measurement, and antecedents of operational resilience in the SCRM literature. Specifically, we employed a Bibliographic Coupling Analysis in the research cluster formation stage and a Co-words Analysis in the research cluster interpretation and analysis stage. Our analysis reveals three major research clusters of resilience research in the SCRM literature, namely (1) supply chain network design and optimization, (2) organizational capabilities, and (3) digital technologies. We portray the research process in the last two decades in terms of the exemplar studies, problems studied, commonly used approaches and theories, and solutions provided in each cluster. We then provide a conceptual framework on the conceptualization and antecedents of resilience based on studies in these clusters and highlight potential areas that need to be studied further. Finally, we leverage the concept of abnormal operating performance to propose a new measurement strategy for resilience. This measurement overcomes the limitation of most current measurements that are event-dependent and focus on the resistance or recovery stage - without capturing the growth stage. In conclusion, this study provides a robust literature review through a scholarly network analysis that increases the completeness and accuracy of research cluster identification and analysis to understand conceptualization, antecedents, and measurement of resilience. It also enables us to perform a comprehensive review of resilience research in SCRM literature by including research articles published during the pandemic and connects this development with a plethora of articles published in the last two decades. From the managerial perspective, this study provides practitioners with clarity on the conceptualization and critical success factors of firm resilience from the SCRM perspective.

Keywords: supply chain risk management, organizational resilience, scholarly network analysis, systematic literature review

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6608 Evidence of Behavioural Thermoregulation by Dugongs (Dugong dugon) at the High Latitude Limit to Their Range in Eastern Australia

Authors: Daniel R. Zeh, Michelle R. Heupel, Mark Hamann, Rhondda Jones, Colin J. Limpus, Helene Marsh

Abstract:

Marine mammals live in an environment with water temperatures nearly always lower than the mammalian core body temperature of 35 - 38°C. Marine mammals can lose heat at high rates and have evolved a range of adaptations to minimise heat loss. Our project tracked dugongs to examine if there was a discoverable relationship between the animals’ movements and the temperature of their environment that might suggest behavioural thermoregulation. Twenty-nine dugongs were fitted with acoustic and satellite/GPS transmitters in 2012, 2013 and 2014 in Moreton Bay Queensland at the high latitude limit of the species’ winter range in eastern Australia on 30 occasions (one animal was tagged twice). All 22 animals that stayed in the area and had functional transmitters made at least one (and up to 66) return trip(s) to the warmer oceanic waters outside the bay where seagrass is unavailable. Individual dugongs went in and out of the bay in synchrony with the tides and typically spent about 6 hours in the oceanic water. There was a diel pattern in the movements: 85% of outgoing trips occurred between midnight and noon. There were significant individual differences, but the likelihood of a dugong leaving the bay was independent of body length or sex. In Quarter 2 (April – June), the odds of a dugong making a trip increased by about 40% for each 1°C increase in the temperature difference between the bay and the warmer adjacent oceanic waters. In Quarter 3, the odds of making a trip were lower when the outside –inside bay temperature differences were small or negative but increased by a factor of up to 2.12 for each 1°C difference in outside – inside temperatures. In Quarter 4, the odds of making a trip were higher when it was cooler outside the bay and decreased by a factor of nearly 0.5 for each 1°C difference in outside – inside bay temperatures. The activity spaces of the dugongs generally declined as winter progressed suggesting a change in the cost-effectiveness of moving outside the bay. Our analysis suggests that dugongs can thermoregulate their core temperature through the behaviour of moving to water having more favourable temperature.

Keywords: acoustic, behavioral thermoregulation, dugongs, movements, satellite, telemetry, quick fix GPS

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6607 Comparison of Maternal and Perinatal Outcomes of Obstetric Population Diagnosed with Covid-19 in Reference to Influenza A/H1N1: A Systematic Review and Meta-Analysis

Authors: Maria Vargas Hernandez, Jose Rojas Suarez, Carmelo Dueñas Castell, Sandra Contreras, Camilo Bello, Diana Borre, Walter Anichiarico, Harold Vasquez, Eduard Perez, Jose Santacruz

Abstract:

In the last two decades, there have been outbreaks of emerging infectious diseases, with an impact on both the general population and the obstetric population. These infections, which affect the general population, pose a high risk for adverse maternal and perinatal outcomes, taking into account that physiological and immunological changes that occur during pregnancy can increase their risk or severity. Among these, the pandemics of viral infections, Influenza A/H1N1 and SARS-CoV-2/COVID-19, stand out. In 2009, Influenza A/H1N1 infection (H1N1 2009pdm) affected approximately 3,110 obstetric patients, with data reported from 29 countries, including 1,625 (52.3%) cases that were hospitalized, 378 (23.3%) admissions to ICU and 130 (8%) deaths; and since the end of 2019, the Severe Acute Respiratory Syndrome - 2 (SARS-CoV-2) has been identified, causing the COVID-19 pandemic, with global mortality that is around 2-4% for the general population, and higher mortality in patients requiring admission to the intensive care unit. Its impact on the obstetric population is still unknown. Objectives: To evaluate the impact on maternal and perinatal outcomes of COVID-19 infection in reference to influenza A/H1N1 infection in the obstetric population. Methodology: Systematic review of the literature and meta-analysis. Results: Mortality from maternal infection with influenza A/H1N1 appears to be higher (8%) than mortality due to maternal infection with COVID-19 (3%). The rates of ICU admission, hospitalization, the requirement for invasive mechanical ventilation, and fetal death also appear to be higher in the maternal population with A/H1N1 infection, in reference to the maternal population with COVID-19 infection. Within perinatal outcomes, the admission to the neonatal ICU appears to be higher in the infants born to mothers with COVID-19 infection (28% vs. 15% for COVID-19 and A/H1N1, respectively). Conclusion: A/H1N1 infection in the obstetric population seems to be associated with a higher proportion of adverse outcomes in relation to COVID-19 infection. The actual impact of maternal influenza A/H1N1 infection on perinatal outcomes is unknown. More COVID-19 studies are needed to understand the impact of maternal infection on perinatal outcomes in this population.

Keywords: A/H1N1, COVID-19, maternal outcomes, perinatal outcomes

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6606 Fathers’ Depression and its Relationship with Mothers’ Depression During Postpartum Period

Authors: Fatemeh Abdollahi, Munn-Sann Lye, Jamshid Yazdani Charati, Mehran Zarghami

Abstract:

Fathers are at risk of depression during the postpartum period. Some studies have been reported maternal depression is the key predictor of paternal postpartum depression (PPD). This study aimed to estimate the prevalence and predictors of parental PPD and its association with maternal PPD. In a cross-sectional study, via a stratified random and convenience sampling method, participants referring to health centers during 2-8 weeks postpartum were recruited from March to October 2017. Paternal PPD and its relation to maternal PPD and other related factors were assessed using multiple logistic regression. Participants were 591 literate couples who referred to Mazandaran province primary health centers during to study period. Couples were screened for depression using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ) as well. Data on mothers ‘demographic characteristics and obstetrics factors was also gathered. Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age [OR=1.20, (95%CI: 1.05- 1.36)], maternal depressive symptoms [OR=1.15, (95%CI: 1.04-1.27)], higher GHQ scores [OR=1.21, (95%CI: 1.11-1.33)] and increased recent life events [OR=1.42, (95%CI: 1.01-1.2.00)] were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD [OR=0.20, (95%CI: 0.07-0.53)]. Depressive symptoms, especially in first-time fathers following the birth of a child, are not uncommon. Maternal depressive symptoms and paternal well-being were strong predictors of parental PPD. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease the suffering of depression for both depressed parents are recommended.

Keywords: depression, men, postpartum, risk factors, women

Procedia PDF Downloads 69
6605 The Moderating Role of Payment Platform Applications’ Relationship with Increasing Purchase Intention Among Customers in Kuwait - Unified Theory of Acceptance and Sustainable Use of Technology Model

Authors: Ahmad Alsaber

Abstract:

This paper aims to understand the intermediary role of the payment platform applications by analyzing the various factors that can influence the desirability of utilizing said payment services in Kuwait, as well as to determine the effect of the presence of different types of payment platforms on the variables of the “Unified Theory of Acceptance and Use of Technology” (UTAUT) model. The UTAUT model's findings will provide an important understanding of the moderating role of payment platform mobile applications. This study will explore the influence of payment platform mobile applications on customer purchase intentions in Kuwait by employing a quantitative survey of 200 local customers. Questions will cover their usage of payment platforms, purchase intent, and overall satisfaction. The information gathered is then analyzed using descriptive statistics and correlation analysis in order to gain insights. The research hopes to provide greater insight into the effect of mobile payment platforms on customer purchase intentions in Kuwait. This research will provide important implications to marketers and customer service providers, informing their strategies and initiatives, as well as offer recommendations to payment platform providers on how to improve customer satisfaction and security. The study results suggest that the likelihood of a purchase is affected by performance expectancy, effort expectancy, social influence, risk, and trust. The purpose of this research is to understand the advancements in the different variables that Kuwaiti customers consider while dealing with mobile banking applications. With the implementation of stronger security measures, progressively more payment platform applications are being utilized in the Kuwaiti marketplace, making them more desirable with their accessibility and usability. With the development of the Kuwaiti digital economy, it is expected that mobile banking will have a greater impact on banking transactions and services in the future.

Keywords: purchase intention, UTAUT, performance expectancy, social influence, risk, trust

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6604 Numerical Study for Spatial Optimization of DVG for Fin and Tube Heat Exchangers

Authors: Amit Arora, P. M. V. Subbarao, R. S. Agarwal

Abstract:

This study attempts to find promising locations of upwash delta winglets for an inline finned tube heat exchanger. Later, location of winglets that delivers highest improvement in thermal performance is identified. Numerical results clearly showed that optimally located upwash delta winglets not only improved the thermal performance of fin area in tube wake and tubes, but also improved overall thermal performance of heat exchanger.

Keywords: apparent friction factor, delta winglet, fin and tube heat exchanger, longitudinal vortices

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6603 Identification of Some Factors Influencing Serum Uric Acid Concentration in Individuals With Metabolic Syndrome

Authors: Munkhtuul G., Bolortsetseg Z., Lutzul M., Sugar N., Nyamdorj D., Nomundari B., Zesemdorj O., Erdenebayar N., Lkhagvasuren T. S., Munkhbayarlakh S., Bayasgalan T. Uurtuya S. H.

Abstract:

Background: Elevated serum uric acid (SUA) levels are observed in metabolic and cardiovascular conditions as an early predictor of metabolic syndrome (MS). Hyperuricemia, characterised by high uric acid levels in serum, increases the risk of developing MS by 1.6 times. Being overweight and obese significantly contributes to developing MS and cardiovascular disorders. In Mongolia, the prevalence of overweight and obesity is reaching 48.8% among individuals aged 15 to 49 years, indicating a potential surge in the incidence of MS, cardiovascular disorders, diabetes mellitus, and gout.Objective: This study aimed to determine the SUA levels in men diagnosed with MS and investigate the factors influencing these levels.Methods: A total of 119 men aged 30-60, who underwent preventive examinations and resided in Ulaanbaatar city, were included in the study. The criteria established by the International Diabetes Federation (IDF), American Heart Association (AHA), and the National Heart, Lung, and Blood Institute (NHLBI) were employed to define metabolic syndrome. Hyperuricemia was defined as SUA levels ≥7 mg/dL. Dietary intake was evaluated through the 24-hour recall method.Results: The study revealed that the prevalence of MS among the participants was 42.9% (n=51), with hyperuricemia observed in 16.8% (n=20) of the individuals. Among men diagnosed with MS, 21.3% (n=10) exhibited hyperuricemia. The mean SUA levels were as follows: 4.7±0.8 mg/dL in the healthy group, 5.9±1.1 mg/dL in men without MS but presenting central obesity, and 6.2±1.3 mg/dL in men with MS. After adjusting for age and body mass index (BMI), a positive correlation was observed between SUA levels and triglycerides (β=0.93) as well as lipid accumulation product (LAP) (β=0.92) in men with MS. In the central obesity group, SUA levels exhibited a positive correlation with triglycerides (β=0.91), visceral adiposity index (VAI) (β=0.73), LAP (β=0.92), and cardiometabolic index (CMI) (β=0.69). The risk of hyperuricemia increased by 3.29 times with elevated triglycerides and 3.53 times with an increased LAP.Conclusion: The findings indicate that abdominal fat accumulation, as indicated by elevated triglyceride levels and LAP, is associated with increased SUA levels in men with MS. However, no significant relationship was observed between SUA levels and dietary intake.

Keywords: central obesity, obesity, triglycerides, hyperuricemia

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6602 Non-Invasive Evaluation of Patients After Percutaneous Coronary Revascularization. The Role of Cardiac Imaging

Authors: Abdou Elhendy

Abstract:

Numerous study have shown the efficacy of the percutaneous intervention (PCI) and coronary stenting in improving left ventricular function and relieving exertional angina. Furthermore, PCI remains the main line of therapy in acute myocardial infarction. Improvement of procedural techniques and new devices have resulted in an increased number of PCI in those with difficult and extensive lesions, multivessel disease as well as total occlusion. Immediate and late outcome may be compromised by acute thrombosis or the development of fibro-intimal hyperplasia. In addition, progression of coronary artery disease proximal or distal to the stent as well as in non-stented arteries is not uncommon. As a result, complications can occur, such as acute myocardial infarction, worsened heart failure or recurrence of angina. In a stent, restenosis can occur without symptoms or with atypical complaints rendering the clinical diagnosis difficult. Routine invasive angiography is not appropriate as a follow up tool due to associated risk and cost and the limited functional assessment. Exercise and pharmacologic stress testing are increasingly used to evaluate the myocardial function, perfusion and adequacy of revascularization. Information obtained by these techniques provide important clues regarding presence and severity of compromise in myocardial blood flow. Stress echocardiography can be performed in conjunction with exercise or dobutamine infusion. The diagnostic accuracy has been moderate, but the results provide excellent prognostic stratification. Adding myocardial contrast agents can improve imaging quality and allows assessment of both function and perfusion. Stress radionuclide myocardial perfusion imaging is an alternative to evaluate these patients. The extent and severity of wall motion and perfusion abnormalities observed during exercise or pharmacologic stress are predictors of survival and risk of cardiac events. According to current guidelines, stress echocardiography and radionuclide imaging are considered to have appropriate indication among patients after PCI who have cardiac symptoms and those who underwent incomplete revascularization. Stress testing is not recommended in asymptomatic patients, particularly early after revascularization, Coronary CT angiography is increasingly used and provides high sensitive for the diagnosis of coronary artery stenosis. Average sensitivity and specificity for the diagnosis of in stent stenosis in pooled data are 79% and 81%, respectively. Limitations include blooming artifacts and low feasibility in patients with small stents or thick struts. Anatomical and functional cardiac imaging modalities are corner stone for the assessment of patients after PCI and provide salient diagnostic and prognostic information. Current imaging techniques cans serve as gate keeper for coronary angiography, thus limiting the risk of invasive procedures to those who are likely to benefit from subsequent revascularization. The determination of which modality to apply requires careful identification of merits and limitation of each technique as well as the unique characteristic of each individual patient.

Keywords: coronary artery disease, stress testing, cardiac imaging, restenosis

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6601 Characteristics of Sorghum (Sorghum bicolor L. Moench) Flour on the Soaking Time of Peeled Grains and Particle Size Treatment

Authors: Sri Satya Antarlina, Elok Zubaidah, Teti Istiana, Harijono

Abstract:

Sorghum bicolor (Sorghum bicolor L. Moench) has the potential as a flour for gluten-free food products. Sorghum flour production needs grain soaking treatment. Soaking can reduce the tannin content which is an anti-nutrient, so it can increase the protein digestibility. Fine particle size decreases the yield of flour, so it is necessary to study various particle sizes to increase the yield. This study aims to determine the characteristics of sorghum flour in the treatment of soaking peeled grain and particle size. The material of white sorghum varieties KD-4 from farmers in East Java, Indonesia. Factorial randomized factorial design (two factors), repeated three times, factor I were the time of grain soaking (five levels) that were 0, 12, 24, 36, and 48 hours, factor II was the size of the starch particles sifted with a fineness level of 40, 60, 80, and 100 mesh. The method of making sorghum flour is grain peeling, soaking peeled grain, drying using the oven at 60ᵒC, milling, and sieving. Physico-chemical analysis of sorghum flour. The results show that there is an interaction between soaking time of grain with the size of sorghum flour particles. Interaction in yield of flour, L* color (brightness level), whiteness index, paste properties, amylose content, protein content, bulk density, and protein digestibility. The method of making sorghum flour through the soaking of peeled grain and the difference in particle size has an important role in producing the physicochemical properties of the specific flour. Based on the characteristics of sorghum flour produced, it is determined the method of making sorghum flour through sorghum grain soaking for 24 hours, the particle size of flour 80 mesh. The sorghum flour with characteristic were 24.88% yield of flour, 88.60 color L* (brightness level), 69.95 whiteness index, 3615 Cp viscosity, 584.10 g/l of bulk density, 24.27% db protein digestibility, 90.02% db starch content, 23.4% db amylose content, 67.45% db amylopectin content, 0.22% db crude fiber content, 0.037% db tannin content, 5.30% db protein content, ash content 0.18% db, carbohydrate content 92.88 % db, and 1.94% db fat content. The sorghum flour is recommended for cookies products.

Keywords: characteristic, sorghum (Sorghum bicolor L. Moench) flour, grain soaking, particle size, physicochemical properties

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6600 Geomorphology of Leyte, Philippines: Seismic Response and Remote Sensing Analysis and Its Implication to Landslide Hazard Assessment

Authors: Arturo S. Daag, Ira Karrel D. L. San Jose, Mike Gabriel G. Pedrosa, Ken Adrian C. Villarias, Rayfred P. Ingeniero, Cyrah Gale H. Rocamora, Margarita P. Dizon, Roland Joseph B. De Leon, Teresito C. Bacolcol

Abstract:

The province of Leyte consists of various geomorphological landforms: These are: a) landforms of tectonic origin transect large part of the volcanic centers in upper Ormoc area; b) landforms of volcanic origin, several inactive volcanic centers located in Upper Ormoc are transected by Philippine Fault; c) landforms of volcano-denudational and denudational slopes dominates the area where most of the earthquake-induced landslide occurred; and d) Colluvium and alluvial deposits dominate the foot slope of Ormoc and Jaro-Pastrana plain. Earthquake ground acceleration and geotechnical properties of various landforms are crucial for landslide studies. To generate the landslide critical acceleration model of sliding block, various data were considered, these are: geotechnical data (i.e., soil and rock strength parameters), slope, topographic wetness index (TWI), landslide inventory, soil map, geologic maps for the calculation of the factor of safety. Horizontal-to-vertical spectral ratio (HVSR) surveying methods, refraction microtremor (ReMi), and three-component microtremor (3CMT) were conducted to measure site period and surface wave velocity as well as to create a soil thickness model. Critical acceleration model of various geomorphological unit using Remote Sensing, field geotechnical, geophysical, and geospatial data collected from the areas affected by the 06 July 2017 M6.5 Leyte earthquake. Spatial analysis of earthquake-induced landslide from the 06 July 2017, were then performed to assess the relationship between the calculated critical acceleration and peak ground acceleration. The observed trends proved helpful in establishing the role of critical acceleration as a determining factor in the distribution of co-seismic landslides.

Keywords: earthquake-induced landslide, remote sensing, geomorphology, seismic response

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6599 The Impact of Water Reservoirs on Biodiversity and Food Security and the Creation of Adaptation Mechanisms

Authors: Inom S. Normatov, Abulqosim Muminov, Parviz I. Normatov

Abstract:

Problems of food security and the preservation of reserved zones in the region of Central Asia under the conditions of the climate change induced by the placement and construction of large reservoirs are considered. The criteria for the optimum placement and construction of reservoirs that entail the minimum impact on the environment are established. The need for the accounting of climatic parameters is shown by the calculation of the water quantity required for the irrigation of agricultural lands.

Keywords: adaptation, biodiversity, food security, water reservoir, risk

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6598 Alteration of Placental Development and Vascular Dysfunction in Gestational Diabetes Mellitus Has Impact on Maternal and Infant Health

Authors: Sadia Munir

Abstract:

The aim of this study is to investigate changes in placental development and vascular dysfunction which subsequently affect feto-maternal health in pregnancies complicated by gestational diabetes mellitus (GDM). Fetal and postnatal adverse health outcomes of GDM are shown to be associated with disturbances in placental structure and function. Children of women with GDM are more likely to be obese and diabetic in childhood and adulthood. GDM also increases the risk of adverse pregnancy outcomes, including preeclampsia, birth injuries, macrosomia and neonatal hypoglycemia, respiratory distress syndrome, neonatal cardiac dysfunction and stillbirth. Incidences of type 2 diabetes in the MENA region are growing at an alarming rate which is estimated to become more than double by 2030. Five of the top 10 countries for diabetes prevalence in 2010 were in the Gulf region. GDM also increases the risk of development of type 2 diabetes. Interestingly, more than half of the women with GDM develop diabetes later in their life. The human placenta is a temporary organ located at the interface between mother and fetal blood circulation. Placenta has a central role as both a producer as well as a target of several molecules that are involved in placental development and function. We have investigated performed a Pubmed search with key words placenta, GDM, placental villi, vascularization, cytokines, growth factors, inflammation, hypoxia, oxidative stress and pathophysiology. We have investigated differences in the development and vascularization of placenta, their underlying causes and impact on feto-maternal health through literature review. We have also identified gaps in the literature and research questions that need to be answered to completely understand the central role of placenta in the GDM. This study is important in understanding the pathophysiology of placenta due to changes in the vascularization of villi, surface area and diameter of villous capillaries in pregnancies complicated by GDM. It is necessary to understand these mechanisms in order to develop treatments to reverse their effects on placental malfunctioning, which in turn, will result in improved mother and child health.

Keywords: gestational diabetes mellitus, placenta, vasculature, villi

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6597 Modeling of Crack Growth in Railway Axles under Static Loading

Authors: Zellagui Redouane, Bellaouar Ahmed, Lachi Mohammed

Abstract:

The railway axles are the essential parts in the bogie of train, and its failure creates a big problem in the railway transport; during the work of this parts we noticed a premature deterioration. The aim has been presented a predictive model allowing the identification of the probable causes that are the cause of these premature deterioration. The results are employed for predicting fatigue crack growth in the railway axle, Also we want to present the variation value of stress intensity factor in different positions of elliptical crack tip. The modeling of axle in performed by the SOLID WORKS software and imported into ANSYS.

Keywords: crack growth, static load, railway axle, lifetime

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6596 Epidemiology of Congenital Heart Defects in Kazakhstan: Data from Unified National Electronic Healthcare System 2014-2020

Authors: Dmitriy Syssoyev, Aslan Seitkamzin, Natalya Lim, Kamilla Mussina, Abduzhappar Gaipov, Dimitri Poddighe, Dinara Galiyeva

Abstract:

Background: Data on the epidemiology of congenital heart defects (CHD) in Kazakhstan is scarce. Therefore, the aim of this study was to describe the incidence, prevalence and all-cause mortality of patients with CHD in Kazakhstan, using national large-scale registry data from the Unified National Electronic Healthcare System (UNEHS) for the period of 2014-2020. Methods: In this retrospective cohort study, the included data pertained to all patients diagnosed with CHD in Kazakhstan and registered in UNEHS between January 2014 and December 2020. CHD was defined based on International Classification of Diseases 10th Revision (ICD-10) codes Q20-Q26. Incidence, prevalence, and all-cause mortality rates were calculated per 100,000 population. Survival analysis was performed using Cox proportional hazards regression modeling and the Kaplan-Meier method. Results: In total, 66,512 patients were identified. Among them, 59,534 (89.5%) were diagnosed with a single CHD, while 6,978 (10.5%) had more than two CHDs. The median age at diagnosis was 0.08 years (interquartile range (IQR) 0.01 – 0.66) for people with multiple CHD types and 0.39 years (IQR 0.04 – 8.38) for those with a single CHD type. The most common CHD types were atrial septal defect (ASD) and ventricular septal defect (VSD), accounting for 25.8% and 21.2% of single CHD cases, respectively. The most common multiple types of CHD were ASD with VSD (23.4%), ASD with patent ductus arteriosus (PDA) (19.5%), and VSD with PDA (17.7%). The incidence rate of CHD decreased from 64.6 to 47.1 cases per 100,000 population among men and from 68.7 to 42.4 among women. The prevalence rose from 66.1 to 334.1 cases per 100,000 population among men and from 70.8 to 328.7 among women. Mortality rates showed a slight increase from 3.5 to 4.7 deaths per 100,000 in men and from 2.9 to 3.7 in women. Median follow-up was 5.21 years (IQR 2.47 – 11.69). Male sex (HR 1.60, 95% CI 1.45 - 1.77), having multiple CHDs (HR 2.45, 95% CI 2.01 - 2.97), and living in a rural area (HR 1.32, 95% CI 1.19 - 1.47) were associated with a higher risk of all-cause mortality. Conclusion: The incidence of CHD in Kazakhstan has shown a moderate decrease between 2014 and 2020, while prevalence and mortality have increased. Male sex, multiple CHD types, and rural residence were significantly associated with a higher risk of all-cause mortality.

Keywords: congenital heart defects (CHD), epidemiology, incidence, Kazakhstan, mortality, prevalence

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6595 Mix Design Curves for High Volume Fly Ash Concrete

Authors: S. S. Awanti, Aravindakumar B. Harwalkar

Abstract:

Concrete construction in future has to be environmental friendly apart from being safe so that society at large is benefited by the huge investments made in the infrastructure projects. To achieve this, component materials of the concrete system have to be optimized with reference to sustainability. This paper presents a study on development of mix proportions of high volume fly ash concrete (HFC). A series of HFC mixtures with cement replacement levels varying between 50% and 65% were prepared with water/binder ratios of 0.3 and 0.35. Compressive strength values were obtained at different ages. From the experimental results, pozzolanic efficiency ratios and mix design curves for HFC were established.

Keywords: age factor, compressive strength, high volume fly ash concrete, pozolanic efficiency ratio

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6594 Dependence of Photocurrent on UV Wavelength in ZnO/Pt Bottom-Contact Schottky Diode

Authors: Byoungho Lee, Changmin Kim, Youngmin Lee, Sejoon Lee, Deuk Young Kim

Abstract:

We fabricated the bottom-contacted ZnO/Pt Schottky diode and investigated the dependence of its photocurrent on the wavelength of illuminated ultraviolet (UV) light source. The bottom-contacted Schottky diode was devised by growing (000l) ZnO on (111) Pt, and the fabricated device showed a strong dependence on the UV wavelength for its photo-response characteristics. When longer-wavelength-UV (e.g., UV-A) was illuminated on the device, the photo-current was increased by a factor of 200, compared to that under illumination of shorter-wavelength-UV (e.g., UV-C). The behavior is attributed to the wavelength-dependent UV penetration depth for ZnO.

Keywords: ZnO, UV, Schottky diode, photocurrent

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6593 Soil Liquefaction Hazard Evaluation for Infrastructure in the New Bejaia Quai, Algeria

Authors: Mohamed Khiatine, Amal Medjnoun, Ramdane Bahar

Abstract:

The North Algeria is a highly seismic zone, as evidenced by the historical seismicity. During the past two decades, it has experienced several moderate to strong earthquakes. Therefore, the geotechnical engineering problems that involve dynamic loading of soils and soil-structure interaction system requires, in the presence of saturated loose sand formations, liquefaction studies. Bejaia city, located in North-East of Algiers, Algeria, is a part of the alluvial plain which covers an area of approximately 750 hectares. According to the Algerian seismic code, it is classified as moderate seismicity zone. This area had not experienced in the past urban development because of the different hazards identified by hydraulic and geotechnical studies conducted in the region. The low bearing capacity of the soil, its high compressibility and the risk of liquefaction and flooding are among these risks and are a constraint on urbanization. In this area, several cases of structures founded on shallow foundations have suffered damages. Hence, the soils need treatment to reduce the risk. Many field and laboratory investigations, core drilling, pressuremeter test, standard penetration test (SPT), cone penetrometer test (CPT) and geophysical down hole test, were performed in different locations of the area. The major part of the area consists of silty fine sand , sometimes heterogeneous, has not yet reached a sufficient degree of consolidation. The ground water depth changes between 1.5 and 4 m. These investigations show that the liquefaction phenomenon is one of the critical problems for geotechnical engineers and one of the obstacles found in design phase of projects. This paper presents an analysis to evaluate the liquefaction potential, using the empirical methods based on Standard Penetration Test (SPT), Cone Penetration Test (CPT) and shear wave velocity and numerical analysis. These liquefaction assessment procedures indicate that liquefaction can occur to considerable depths in silty sand of harbor zone of Bejaia.

Keywords: earthquake, modeling, liquefaction potential, laboratory investigations

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6592 Capability of Intelligent Techniques for Friction Factor Simulation in Water Channels

Authors: Kiyoumars Roushangar, Shabnam Mirheidarian

Abstract:

This study proposes metamodel approaches as a new intelligent technique for the explicit formulation of friction factors of water conveyance structures. For this purpose, experimental data of a movable bed flume with dune bed form were used. Analyzing the result clears the high capability of metamodel approaches (MNE= 0.05, R= 0.92) as a powerful tool for optimizing and explicit simulation of Manning's roughness coefficients of water conveyance structures compared to other nonlinear approaches.

Keywords: intelligent techniques, explicit simulation, roughness coefficient, water conveyance structure

Procedia PDF Downloads 458
6591 Study on Energy Absorption Characteristic of Cab Frame with FEM

Authors: Shigeyuki Haruyama, Oke Oktavianty, Zefry Darmawan, Tadayuki Kyoutani, Ken Kaminishi

Abstract:

Cab’s frame strength is considered as an important factor in excavator’s operator safety, especially during roll-over. In this study, we use a model of cab frame with different thicknesses and perform elastoplastic numerical analysis by using Finite Element Method (FEM). Deformation mode and energy absorption's of cab’s frame part are investigated on two conditions, with wrinkle and without wrinkle. The occurrence of wrinkle when deforming cab frame can reduce energy absorption, and among 4 parts with wrinkle, the energy absorption significantly decreases in part C. Residual stress that generated upon the bending process of part C is analyzed to confirm it possibility in increasing the energy absorption.

Keywords: ROPS, FEM, hydraulic excavator, cab frame

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6590 Urban Logistics Dynamics: A User-Centric Approach to Traffic Modelling and Kinetic Parameter Analysis

Authors: Emilienne Lardy, Eric Ballot, Mariam Lafkihi

Abstract:

Efficient urban logistics requires a comprehensive understanding of traffic dynamics, particularly as it pertains to kinetic parameters influencing energy consumption and trip duration estimations. While real-time traffic information is increasingly accessible, current high-precision forecasting services embedded in route planning often function as opaque 'black boxes' for users. These services, typically relying on AI-processed counting data, fall short in accommodating open design parameters essential for management studies, notably within Supply Chain Management. This work revisits the modelling of traffic conditions in the context of city logistics, emphasizing its significance from the user’s point of view, with two focuses. Firstly, the focus is not on the vehicle flow but on the vehicles themselves and the impact of the traffic conditions on their driving behaviour. This means opening the range of studied indicators beyond vehicle speed, to describe extensively the kinetic and dynamic aspects of the driving behaviour. To achieve this, we leverage the Art. Kinema parameters are designed to characterize driving cycles. Secondly, this study examines how the driving context (i.e., exogenous factors to the traffic flow) determines the mentioned driving behaviour. Specifically, we explore how accurately the kinetic behaviour of a vehicle can be predicted based on a limited set of exogenous factors, such as time, day, road type, orientation, slope, and weather conditions. To answer this question, statistical analysis was conducted on real-world driving data, which includes high-frequency measurements of vehicle speed. A Factor Analysis and a Generalized Linear Model have been established to link kinetic parameters with independent categorical contextual variables. The results include an assessment of the adjustment quality and the robustness of the models, as well as an overview of the model’s outputs.

Keywords: factor analysis, generalised linear model, real world driving data, traffic congestion, urban logistics, vehicle kinematics

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6589 Factors Influencing the Usage of ERP in Enterprise Systems

Authors: Mohammad Reza Babaei, Sanaz Kamrani

Abstract:

The main problems That arise In adopting most Enterprise resources planning (ERP) strategies come from organizational, complex information systems like the ERP integrate the data of all business areas within the organization. The implementation of ERP is a difficult process as it involves different types of end users. Based on literature, we proposed a conceptual framework and examined it to find the effect of some of the individual, organizational, and technological factors on the usage of ERP and its impact on the end user. The results of the analysis suggest that computer self-efficacy, organizational support, training, and compatibility have a positive influence on ERP usage which in turn has significant influence on panoptic empowerment and individual performance.

Keywords: factor, influencing, enterprise, system

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6588 Effect of Mindfulness Training on Psychological Well-Being: An Experimental Study Using a Mobile App as Intervention

Authors: Beeto W. C. Leung, Nicole C. Y. Lee

Abstract:

It was well known that college students experienced a high level of stress and anxiety. College athletes, a special group of college students, may even encounter a higher level of pressure and distress due to their dual endeavors in academic and athletic settings. Due to the high demands and costs of mental health services, easily accessible, web-based self-help interventions are getting more popular. The aim of the present experimental study was to examine the potential intervention effect of a mindfulness-based self-help mobile App, called 'Smiling Mind', on mindfulness and psychological well-being. Forty-six college athletes, recruited from athletic teams of two local universities in Hong Kong, were randomly assigned to the Mindfulness App Group (MAG) and the Control Group (CG). All participants were administered the Mindful Attention Awareness Scale, Geriatric Depression Scale, and Perceived Stress Scale-10 before the study (Time 1, T1) and after the 4-week intervention (Time 2, T2). MAG was requested to use the app and follow the instructions every day for at least 5 days per week. Participants were also asked to record their daily app usage time. Results showed that, for MAG, from T1 to T2, mindfulness has been increased from 3.25 to 3.92; depressive symptoms and stress has been significantly decreased from 8.6 to 5.1 and 24.8 to 13.5 respectively while for the CG, mindfulness has been decreased slightly from 3.29 to 3.13; depressive symptoms and stress has been slightly increased from 7.1 to 7.3 and 24.1 to 27.1 respectively. Three mixed-design ANOVAs with time (T1, T2) as the within-subjects factor and intervention group (MAG, CG) as the between-subjects factor revealed a main effect of time on mindfulness, F(1, 41) = 10.28, p < 0.01, depressive symptoms, F(1, 41) = 6.55, p < 0.02 and stress, F(1, 41) = 16.96, p < 0.001 respectively. Both predicted interaction between time and intervention group on mindfulness, F(1, 41) = 26.6, p < 0.001, ηp 2 =0.39, depressive symptoms, F(1, 41) = 8.00, p < 0.01, ηp 2 =0.16 and Stress F(1, 41) = 49.3, p < 0.001, ηp 2 =0.55 were significant meaning that participants using the Mindfulness Mobile App in the intervention did experienced a significant increase in mindfulness and significant decrease in depressive symptoms and perceived level of stress after the 4-week intervention when compared with the control group. The present study provided encouraging empirical support for using Smiling Mind, a self-help mobile app, to promote mindfulness and mental health in a cost-effective way. Further studies should examine the potential use of Smiling Mind in different samples, including children and adolescence, as well as, investigate the lasting effects of using the app on other psychosocial outcomes such as emotional regulations.

Keywords: college athletes, experimental study, mindfulness mobile apps, psychological well-being

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6587 Research on the Landscape Reconstruction of Old Industrial Plant Area from the Perspective of Communication Studies

Authors: Minghao Liu

Abstract:

This paper uses the theory of communication in the context of mass communication, from the construction of communication symbols, communication flow organization, communication experience perception of the three levels of the old industrial factory landscape transformation research and analysis, summarizes the old industrial factory landscape in the communication process to create strategies and design methods for the old industrial factories carried by the urban culture of how to enter the public's life more widely in the existing environment and be familiar with the significance of the exploration, to provide a new idea for the renewal of the urban stock, and ultimately to achieve the sustainable development of the city.

Keywords: communication, old industrial factor, urban renewal, landscape design

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6586 The Correlation between Eye Movements, Attentional Shifting, and Driving Simulator Performance among Adolescents with Attention Deficit Hyperactivity Disorder

Authors: Navah Z. Ratzon, Anat Keren, Shlomit Y. Greenberg

Abstract:

Car accidents are a problem worldwide. Adolescents’ involvement in car accidents is higher in comparison to the overall driving population. Researchers estimate the risk of accidents among adolescents with symptoms of attention-deficit/hyperactivity disorder (ADHD) to be 1.2 to 4 times higher than that of their peers. Individuals with ADHD exhibit unique patterns of eye movements and attentional shifts that play an important role in driving. In addition, deficiencies in cognitive and executive functions among adolescents with ADHD is likely to put them at greater risk for car accidents. Fifteen adolescents with ADHD and 17 matched controls participated in the study. Individuals from both groups attended local public schools and did not have a driver’s license. Participants’ mean age was 16.1 (SD=.23). As part of the experiment, they all completed a driving simulation session, while their eye movements were monitored. Data were recorded by an eye tracker: The entire driving session was recorded, registering the tester’s exact gaze position directly on the screen. Eye movements and simulator data were analyzed using Matlab (Mathworks, USA). Participants’ cognitive and metacognitive abilities were evaluated as well. No correlation was found between saccade properties, regions of interest, and simulator performance in either group, although participants with ADHD allocated more visual scan time (25%, SD = .13%) to a smaller segment of dashboard area, whereas controls scanned the monitor more evenly (15%, SD = .05%). The visual scan pattern found among participants with ADHD indicates a distinct pattern of engagement-disengagement of spatial attention compared to that of non-ADHD participants as well as lower attention flexibility, which likely affects driving. Additionally the lower the results on the cognitive tests, the worse driving performance was. None of the participants had prior driving experience, yet participants with ADHD distinctly demonstrated difficulties in scanning their surroundings, which may impair driving. This stresses the need to consider intervention programs, before driving lessons begin, to help adolescents with ADHD acquire proper driving habits, avoid typical driving errors, and achieve safer driving.

Keywords: ADHD, attentional shifting, driving simulator, eye movements

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6585 Factors Associated with Recurrence and Long-Term Survival in Younger and Postmenopausal Women with Breast Cancer

Authors: Sopit Tubtimhin, Chaliya Wamaloon, Anchalee Supattagorn

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Background and Significance: Breast cancer is the most frequently diagnosed and leading cause of cancer death among women. This study aims to determine factors potentially predicting recurrence and long-term survival after the first recurrence in surgically treated patients between postmenopausal and younger women. Methods and Analysis: A retrospective cohort study was performed on 498 Thai women with invasive breast cancer, who had undergone mastectomy and been followed-up at Ubon Ratchathani Cancer Hospital, Thailand. We collected based on a systematic chart audit from medical records and pathology reports between January 1, 2002, and December 31, 2011. The last follow-up time point for surviving patients was December 31, 2016. A Cox regression model was used to calculate hazard ratios of recurrence and death. Findings: The median age was 49 (SD ± 9.66) at the time of diagnosis, 47% was post-menopausal women ( ≥ 51years and not experienced any menstrual flow for a minimum of 12 months), and 53 % was younger women ( ˂ 51 years and have menstrual period). Median time from the diagnosis to the last follow-up or death was 10.81 [95% CI = 9.53-12.07] years in younger cases and 8.20 [95% CI = 6.57-9.82] years in postmenopausal cases. The recurrence-free survival (RFS) for younger estimates at 1, 5 and 10 years of 95.0 %, 64.0% and 58.93% respectively, appeared slightly better than the 92.7%, 58.1% and 53.1% for postmenopausal women [HRadj = 1.25, 95% CI = 0.95-1.64]. Regarding overall survival (OS) for younger at 1, 5 and 10 years were 97.7%, 72.7 % and 52.7% respectively, for postmenopausal patients, OS at 1, 5 and 10 years were 95.7%, 70.0% and 44.5 respectively, there were no significant differences in survival [HRadj = 1.23, 95% CI = 0.94 -1.64]. Multivariate analysis identified five risk factors for negatively impacting on survival were triple negative [HR= 2.76, 95% CI = 1.47-5.19], Her2-enriched [HR = 2.59, 95% CI = 1.37-4.91], luminal B [HR = 2.29, 95 % CI=1.35-3.89], not free margin [HR = 1.98, 95%CI=1.00-3.96] and patients who received only adjuvant chemotherapy [HR= 3.75, 95% CI = 2.00-7.04]. Statistically significant risks of overall cancer recurrence were Her2-enriched [HR = 5.20, 95% CI = 2.75-9.80], triple negative [HR = 3.87, 95% CI = 1.98-7.59], luminal B [HR= 2.59, 95% CI = 1.48-4.54,] and patients who received only adjuvant chemotherapy [HR= 2.59, 95% CI = 1.48-5.66]. Discussion and Implications: Outcomes from this studies have shown that postmenopausal women have been associated with increased risk of recurrence and mortality. As the results, it provides useful information for planning the screening and treatment of early-stage breast cancer in the future.

Keywords: breast cancer, menopause status, recurrence-free survival, overall survival

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6584 An International Comparison of Global Financial Centers: Major Competitive Strategies

Authors: I. Hakki Eraslan, Birol Ozturk, Istemi Comlekci

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This paper begins by defining what is meant by “globalization” in finance and by identifying the sources of value-added in the internationally-competitive financial services sector origination, trading and distribution of debt and equity capital market instruments and their derivatives, foreign exchange trading and securities brokerage, management of market risk and credit risk, loan syndication and structured bank financings, corporate finance and advisory services, and asset management. These activities are considered in terms of a “value-chain” one that ultimately gives rise to the real economic gains attributable to financial-center operations. The research presents available evidence as to where the relevant value-added activities usually take place. It then examines the “centrifugal” and “centripetal” forces that determine the concentration or dispersal of value-added activity in financial intermediation, both interregionally and internationally. Next, the research assesses the factors, which appear to underlie the locational pattern of international financial centers that has evolved. In preparing this paper, also it is examined the current position and the main opportunities and challenges facing world major financial services sector, and attempted to lay out a potential vision and strategies. It is conducted extensive research, including many internal research materials and publications. It is also engaged closely with the academia, industry practitioners and regulators, and consulted market experts from major world financial centers. More than 60 in‐depth consultative sessions were conducted in the past two years which provided insightful suggestions and innovative ideas on how to further financial industry’s position as an international financial centre. The paper concludes with the outlook for the future pattern of financial centers in the global competitive environment. The ideas and advice gathered are condensed into this paper that recommends to the strategic decision leaders a vision and a strategy for financial services sector to move forward amid a highly competitive environment.

Keywords: financial centers, competitiveness, financial services industry, economics

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6583 Improvement of Cardiometabolic after 8 Weeks of Weight Loss Intervention

Authors: Boris Bajer, Andrea Havranova, Miroslav Vlcek, Richard Imrich, Adela Penesova

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Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes, and also prevent cardiovascular diseases, as it showed many studies (the Finnish Diabetes Prevention Study, Diabetes Prevention Program (DPP), . the China Da Qing Diabetes Prevention Study, etc.) Therefore the aim of our study was to compare the effect of intensified lifestyle intervention on cardiometabolic parameters. Methods: It is an ongoing randomized interventional clinical study (NCT02325804) focused on the reduction of body weight/fat. Intervention: hypocaloric diet (30% restriction of calories) and physical activity 150 minutes/week. Before and after 8 weeks of intervention all patients underwent complete medical examination (measurement of physical fitness, resting metabolic rate (RMR), body composition analysis, oral glucose tolerance test, parameters of lipid metabolism, and other cardiometabolic risk factors. Results: So far 39 patients finished the intervention. The average reduction of body weight was 6,8 + 4,9 kg (0-15 kg; p=0,0006), accompanied with significant reduction of body fat percentage (p ≤ 0,0001), amount of fat mass (p=0,03), waist circumference (p=0.02). Amount of lean mass and RMR remained unchanged. Heart rate (p=0,02), systolic and diastolic blood pressure was reduced (p=0,01 p=0,02 resp.) as well as insulin sensitivity was improved. Lipid parameters also changed - cholesterol, LDL decreased (p=0,05, p=0,04 resp.), while triglycerides showed tendency to decrease (p=0,055). Liver function improved, alanine aminotrasnferase (ALT) were reduced (p=0,01). Physical fitness significantly improved (as measure VO2 max (p=0,02). Conclusion: Results of our study are in line with previous results about the beneficial effect of intensive lifestyle changes on the reduction of cardiometabolic risk factors and improvement of liver function. Supported by grants APVV 15-0228; VEGA 2/0161/16

Keywords: obesity, weight loss, diet lipids, blood pressure, liver enzymes

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6582 The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) Process: An Audit of Its Utilisation on a UK Tertiary Specialist Intensive Care Unit

Authors: Gokulan Vethanayakam, Daniel Aston

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Introduction: The ReSPECT process supports healthcare professionals when making patient-centered decisions in the event of an emergency. It has been widely adopted by the NHS in England and allows patients to express thoughts and wishes about treatments and outcomes that they consider acceptable. It includes (but is not limited to) cardiopulmonary resuscitation decisions. ReSPECT conversations should ideally occur prior to ICU admission and should be documented in the eight sections of the nationally-standardised ReSPECT form. This audit evaluated the use of ReSPECT on a busy cardiothoracic ICU in an NHS Trust where established policies advocating its use exist. Methods: This audit was a retrospective review of ReSPECT forms for a sample of high-risk patients admitted to ICU at the Royal Papworth Hospital between January 2021 and March 2022. Patients all received one of the following interventions: Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) for severe respiratory failure (retrieved via the national ECMO service); cardiac or pulmonary transplantation-related surgical procedures (including organ transplants and Ventricular Assist Device (VAD) implantation); or elective non-transplant cardiac surgery. The quality of documentation on ReSPECT forms was evaluated using national standards and a graded ranking tool devised by the authors which was used to assess narrative aspects of the forms. Quality was ranked as A (excellent) to D (poor). Results: Of 230 patients (74 VV-ECMO, 104 transplant, 52 elective non-transplant surgery), 43 (18.7%) had a ReSPECT form and only one (0.43%) patient had a ReSPECT form completed prior to ICU admission. Of the 43 forms completed, 38 (88.4%) were completed due to the commencement of End of Life (EoL) care. No non-transplant surgical patients included in the audit had a ReSPECT form. There was documentation of balance of care (section 4a), CPR status (section 4c), capacity assessment (section 5), and patient involvement in completing the form (section 6a) on all 43 forms. Of the 34 patients assessed as lacking capacity to make decisions, only 22 (64.7%) had reasons documented. Other sections were variably completed; 29 (67.4%) forms had relevant background information included to a good standard (section 2a). Clinical guidance for the patient (section 4b) was given in 25 (58.1%), of which 11 stated the rationale that underpinned it. Seven forms (16.3%) contained information in an inappropriate section. In a comparison of ReSPECT forms completed ahead of an EoL trigger with those completed when EoL care began, there was a higher number of entries in section 3 (considering patient’s values/fears) that were assessed at grades A-B in the former group (p = 0.014), suggesting higher quality. Similarly, forms from the transplant group contained higher quality information in section 3 than those from the VV-ECMO group (p = 0.0005). Conclusions: Utilisation of the ReSPECT process in high-risk patients is yet to be well-adopted in this trust. Teams who meet patients before hospital admission for transplant or high-risk surgery should be encouraged to engage with the ReSPECT process at this point in the patient's journey. VV-ECMO retrieval teams should consider ReSPECT conversations with patients’ relatives at the time of retrieval.

Keywords: audit, critical care, end of life, ICU, ReSPECT, resuscitation

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