Search results for: Increased intrauterine pressure
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 11717

Search results for: Increased intrauterine pressure

7337 Macronutrients and the FTO Gene Expression in Hypothalamus: A Systematic Review of Experimental Studies

Authors: Saeid Doaei

Abstract:

The various studies have examined the relationship between FTO gene expression and macronutrients levels. In order to obtain better viewpoint from this interactions, all of the existing studies were reviewed systematically. All published papers have been obtained and reviewed using standard and sensitive keywords from databases such as CINAHL, Embase, PubMed, PsycInfo, and the Cochrane, from 1990 to 2016. The results indicated that all of 6 studies that met the inclusion criteria (from a total of 428 published article) found FTO gene expression changes at short-term follow-ups. Four of six studies found an increased FTO gene expression after calorie restriction, while two of them indicated decreased FTO gene expression. The effect of protein, carbohydrate and fat were separately assessed and suggested by all of six studies. In conclusion, the level of FTO gene expression in hypothalamus is related to macronutrients levels. Future research should evaluate the long-term impact of dietary interventions.

Keywords: obesity, gene expression, FTO, macronutrients

Procedia PDF Downloads 253
7336 Addressing Primary Care Clinician Burnout in a Value Based Care Setting During the COVID-19 Pandemic

Authors: Robert E. Kenney, Efrain Antunez, Samuel Nodal, Ameer Malik, Richard B. Aguilar

Abstract:

Physician burnout has gained much attention during the COVID pandemic. After-hours workload, HCC coding, HEDIS metrics, and clinical documentation negatively impact career satisfaction. These and other influences have increased the rate of physicians leaving the workforce. In addition, roughly 1% of the entire physician workforce will be retiring earlier than expected based on pre-pandemic trends. The two Medical Specialties with the highest rates of burnout are Family Medicine and Primary Care. With a predicted shortage of primary care physicians looming, the need to address physician burnout is crucial. Commonly reported issues leading to clinician burnout are clerical documentation requirements, increased time working on Electronic Health Records (EHR) after hours, and a decrease in work-life balance. Clinicians experiencing burnout with physical and emotional exhaustion are at an increased likelihood of providing lower quality and less efficient patient care. This may include a lack of suitable clinical documentation, medication reconciliation, clinical assessment, and treatment plans. While the annual baseline turnover rates of physicians hover around 6-7%, the COVID pandemic profoundly disrupted the delivery of healthcare. A report found that 43% of physicians switched jobs during the initial two years of the COVID pandemic (2020 and 2021), tripling the expected average annual rate to 21.5 %/yr. During this same time, an average of 4% and 1.5% of physicians retired or left the workforce for a non-clinical career, respectively. The report notes that 35.2% made career changes for a better work-life balance and another 35% reported the reason as being unhappy with their administration’s response to the pandemic. A physician-led primary care-focused health organization, Cano Health (CH), based out of Florida, sought to preemptively address this problem by implementing several supportive measures. Working with >120 clinics and >280 PCPs from Miami to Tampa and Orlando, managing nearly 120,000 Medicare Advantage lives, CH implemented a number of changes to assist with the clinician’s workload. Supportive services such as after hour and home visits by APRNs, in-clinic care managers, and patient educators were implemented. In 2021, assistive Artificial Intelligence Software (AIS) was integrated into the EHR platform. This AIS converts free text within PDF files into a usable (copy-paste) format facilitating documentation. The software also systematically and chronologically organizes clinical data, including labs, medical records, consultations, diagnostic images, medications, etc., into an easy-to-use organ system or chronic disease state format. This reduced the excess time and documentation burden required to meet payor and CMS guidelines. A clinician Documentation Support team was employed to improve the billing/coding performance. The effects of these newly designed workflow interventions were measured via analysis of clinician turnover from CH’s hiring and termination reporting software. CH’s annualized average clinician turnover rate in 2020 and 2021 were 17.7% and 12.6%, respectively. This represents a 30% relative reduction in turnover rate compared to the reported national average of 21.5%. Retirement rates during both years were 0.1%, demonstrating a relative reduction of >95% compared to the national average (4%). This model successfully promoted the retention of clinicians in a Value-Based Care setting.

Keywords: clinician burnout, COVID-19, value-based care, burnout, clinician retirement

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7335 Organizational Management and Leadership

Authors: Osman Yildiz

Abstract:

As it is predicted 2559 years before there is nothing permanent except change. In our turbulent World, Organizations will always be faced with the challenge of determining the path that will always keep them on balance en route that will bring success. That means from top to bottom, every organisation is exposed to fight to stay afloat and compete while they face the continuous prospect of change in an increasingly competitive and globalized World. Otherwise, they would fail to realize their goals and targets, and ultimately would disappear. But the organizations that will celebrate success five or ten years from now will be the winners of the fight by having recognizing that planning the change was only the first step in the journey and put sufficient efforts into the task of leading change. Increasingly unpredictable and competitive organizational environments have put pressure on leaders across all industries to better manage the change. The key of establishing effective change and transformation in organisations lies on the steps taken before the change happens depending to the quality of the human sources; readiness for change, acknowledgement by management, prepared leaders, motivated employees, overcoming the resistance to change and ultimately adapting change into the organization. Due to these factors, leaders managing the organisational development can ensure organizations and employees to meet new performance targets, motivation and skills rapidly and effectively. Finally, this article will provide some tools for leaders, and discuss how to catch organisational development and manage the innovations in effective ways.

Keywords: managing the change, organizational change, human factor, leaders, globalization, organisational development

Procedia PDF Downloads 267
7334 Theoretical Study of Structural and Electronic Properties of Matlockite CaFX (X = I and Br) Compounds

Authors: Meriem Harmel, Houari Khachai

Abstract:

The full potential linearized augmented plane wave (FP-LAPW)method within density functional theory is applied to study, for the first time, the structural and electronic properties of CaFI and to compare them with CaFCl and CaFBr, all compounds belonging to the tetragonal PbFCl structure group with space group P4/nmm. We used the generalized gradient approximation (GGA) based on exchange–correlation energy optimization to calculate the total energy and also the Engel– Vosko GGA formalism, which optimizes the corresponding potential for band structure calculations. Ground state properties such as the lattice parameters, c/a ratio, bulk modulus, pressure derivative of the bulk modulus and cohesive energy are calculated, as well as the optimized internal parameters, by relaxing the atomic position in the force directions. The variations of the calculated interatomic distances and angles between different atomic bonds are discussed. CaFCl was found to have a direct band gap at whereas CaFBr and BaFI have indirect band gaps. From these computed bands, all three materials are found to be insulators having band gaps of 6.28, 5.46, and 4.50 eV, respectively. We also calculated the valence charge density and the total density of states at equilibrium volume for each compound. The results are in reasonable agreement with the available experimental data.

Keywords: DFT, matlockite, structural properties, electronic structure

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7333 Reproductive Behaviour of the Red Sea Immigrant Lagocephalus sceleratus (Gmelin, 1789) from the Mediterranean Coast, Egypt

Authors: Mahmoud Farrag, Alaa Elhaweet, El-Sayed Akel, Mohsen Moustafa

Abstract:

The present work aimed to study the reproductive strategy of the common lesspsian puffer fish Lagocephalus sceleratus (Gmeln, 1879) from the Egyptian Mediterranean Waters. It is a famous migratory species plays an important role in the field of fisheries and ecology of aquatic ecosystem. The obtained results illustrated seven maturity stages of gonads as; I- Thread like stage: II- Immature stage (Virgin stage), III- Maturing stage (Developing Virgin and recovering spent), IV - Nearly ripe stage, V- Fully ripe; VI-Spawning stage, VII- Spent stage. Sex ratio, exhibited males had higher number than females representing 52.44 % of the total fishes with sex ratio 1: 0.91. Fish length corresponding to 50% maturation was 38.5 cm for males and 41 cm for females. The corresponding ages (age at first maturity) are equal to 2.14 and 2.27 years for male and female respectively. The gonado somatic index (GSI) increased from April for both sexes with peak in June (8.567±4.729) for males and May (6.769±4.662) for females, then the sharp decrease was observed in October showing prolong spawning season from April to September for both sexes. The hepato somatic indices (HSI) for males were lower values than those of females, it were high from December to early spawning (April & May), with the peak in April (5.217 ± 2.167) for males, and in March (5.453± 1.792) for females, then these values started to decrease towards the end of spawning period. The ova diameter ranged from 0.02 to 0.85mm, the mature ova ranged from 0.16 to 0.85mm and showed progressive increase from April towards September during spawning period introducing one peak of mature and ripe eggs. The absolute fecundity increased as the fish grew in weight and length; it was ranged from 260288 to 2372931 for fish weight and ranged from 698 to 3285 cm for length with an average of 1449522±720975. The relative fecundity ranged from 373 to 722 for fish weight with an average of 776±231, while it range from 5784 to 32957 for fish length groups ranged from 43-45 to 70-72 cm with an average of 24478 ±10011 eggs. Histological characters of gonads during the year of study indicating this fish species has prolonged spawning season from April to September where ripe oocytes were observed during this period. This species is considered totally or uni spawner with synchronous group as it contained one to two developmental stages at the same gonad and releases its ripe ova in one batch during the spawning season. These results illustrated more adaptation of this species in new habitat.

Keywords: reproductive biology, histology, Lagocephalus sceleratus, Mediterranean Sea, Egypt

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7332 The Association between Prior Antibiotic Use and Subsequent Risk of Infectious Disease: A Systematic Review

Authors: Umer Malik, David Armstrong, Mark Ashworth, Alex Dregan, Veline L'Esperance, Lucy McDonnell, Mariam Molokhia, Patrick White

Abstract:

Introduction: The microbiota lining epithelial surfaces is thought to play an important role in many human physiological functions including defense against pathogens and modulation of immune response. The microbiota is susceptible to disruption from external influences such as exposure to antibiotic medication. It is thought that antibiotic-induced disruption of the microbiota could predispose to pathogen overgrowth and invasion. We hypothesized that antibiotic use would be associated with increased risk of future infections. We carried out a systematic review of evidence of associations between antibiotic use and subsequent risk of community-acquired infections. Methods: We conducted a review of the literature for observational studies assessing the association between antibiotic use and subsequent community-acquired infection. Eligible studies were published before April 29th, 2016. We searched MEDLINE, EMBASE, and Web of Science and screened titles and abstracts using a predefined search strategy. Infections caused by Clostridium difficile, drug-resistant organisms and fungal organisms were excluded as their association with prior antibiotic use has been examined in previous systematic reviews. Results: Eighteen out of 21,518 retrieved studies met the inclusion criteria. The association between past antibiotic exposure and subsequent increased risk of infection was reported in 16 studies, including one study on Campylobacter jejuni infection (Odds Ratio [OR] 3.3), two on typhoid fever (ORs 5.7 and 12.2), one on Staphylococcus aureus skin infection (OR 2.9), one on invasive pneumococcal disease (OR 1.57), one on recurrent furunculosis (OR 16.6), one on recurrent boils and abscesses (Risk ratio 1.4), one on upper respiratory tract infection (OR 2.3) and urinary tract infection (OR 1.1), one on invasive Haemophilus influenzae type b (Hib) infection (OR 1.51), one on infectious mastitis (OR 5.38), one on meningitis (OR 2.04) and five on Salmonella enteric infection (ORs 1.4, 1.59, 1.9, 2.3 and 3.8). The effect size in three studies on Salmonella enteric infection was of marginal statistical significance. A further two studies on Salmonella infection did not demonstrate a statistically significant association between prior antibiotic exposure and subsequent infection. Conclusion: We have found an association between past antibiotic exposure and subsequent risk of a diverse range of infections in the community setting. Our findings provide evidence to support the hypothesis that prior antibiotic usage may predispose to future infection risk, possibly through antibiotic-induced alteration of the microbiota. The findings add further weight to calls to minimize inappropriate antibiotic prescriptions.

Keywords: antibiotic, infection, risk factor, side effect

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7331 A Bibliometric Analysis of the Structural Equation Modeling in Education

Authors: Lim Yi Wei

Abstract:

Structural equation modelling (SEM) is well-known in statistics due to its flexibility and accessibility. It plays an increasingly important role in the development of the education field. The number of research publications using SEM in education has increased in recent decades. However, there is a lack of scientific review conducted on SEM in education. The purpose of this study is to investigate research trends related to SEM in education. The researcher will use Vosviewer, Datawrapper, and SciMAT to do bibliometric analysis on 5549 papers that have been published in the Scopus database in the last five years. The result will show the publication trends of the most cited documents, the top contributing authors, countries, institutions, and journals in the research field. It will also look at how they relate to each other in terms of co-citation, collaboration, and co-occurrence of keywords. This study will benefit researchers and practitioners by identifying research trends and the current state of SEM in education.

Keywords: structural equation modeling, education, bibliometric analysis, Vosviewer

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7330 Crystallization Fouling from Potable Water in Heat Exchangers and Evaporators

Authors: Amthal Al-Gailani, Olujide Sanni, Thibaut Charpentier, Anne Neville

Abstract:

Formation of inorganic scale on heat transfer surfaces is a serious problem encountered in industrial, commercial, and domestic heat exchangers and systems. Several industries use potable/groundwater sources such as rivers, lakes, and oceans to use water as a working fluid in heat exchangers and steamers. As potable/surface water contains diverse salt ionic species, the scaling kinetics and deposit morphology are expected to be different from those found in artificially hardened solutions. In this work, scale formation on the heat transfer surfaces from potable water has been studied using a once-through open flow cell under atmospheric pressure. The surface scaling mechanism and deposit morphology are investigated at high surface temperature. Thus the water evaporation process has to be considered. The effect of surface temperature, flow rate, and inhibitor deployment on the thermal resistance and morphology of the scale have been investigated. The study findings show how an increase in surface temperature enhances the crystallization reaction kinetics on the surface. There is an increase in the amount of scale and the resistance to heat transfer. The fluid flow rate also increases the fouling resistance and the thickness of the scale layer.

Keywords: fouling, heat exchanger, thermal resistance, crystallization, potable water

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7329 Flow-Through Supercritical Installation for Producing Biodiesel Fuel

Authors: Y. A. Shapovalov, F. M. Gumerov, M. K. Nauryzbaev, S. V. Mazanov, R. A. Usmanov, A. V. Klinov, L. K. Safiullina, S. A. Soshin

Abstract:

A flow-through installation was created and manufactured for the transesterification of triglycerides of fatty acids and production of biodiesel fuel under supercritical fluid conditions. Transesterification of rapeseed oil with ethanol was carried out according to two parameters: temperature and the ratio of alcohol/oil mixture at the constant pressure of 19 MPa. The kinetics of the yield of fatty acids ethyl esters (FAEE) was determined in the temperature range of 320-380 °C at the alcohol/oil molar ratio of 6:1-20:1. The content of the formed FAEE was determined by the method of correlation of the resulting biodiesel fuel by its kinematic viscosity. The maximum FAEE yield (about 90%) was obtained within 30 min at the ethanol/oil molar ratio of 12:1 and a temperature of 380 °C. When studying of transesterification of triglycerides, a kinetic model of an isothermal flow reactor was used. The reaction order implemented in the flow reactor has been determined. The first order of the reaction was confirmed by data on the conversion of FAEE during the reaction at different temperatures and the molar ratios of the initial reagents (ethanol/oil). Using the Arrhenius equation, the values of the effective constants of the transesterification reaction rate were calculated at different reaction temperatures. In addition, based on the experimental data, the activation energy and the pre-exponential factor of the transesterification reaction were determined.

Keywords: biodiesel, fatty acid esters, supercritical fluid technology, transesterification

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7328 Methylphenidate Use by Canadian Children and Adolescents and the Associated Adverse Reactions

Authors: Ming-Dong Wang, Abigail F. Ruby, Michelle E. Ross

Abstract:

Methylphenidate is a first-line treatment drug for attention deficit hyperactivity disorder (ADHD), a common mental health disorder in children and adolescents. Over the last several decades, the rate of children and adolescents using ADHD medication has been increasing in many countries. A recent study found that the prevalence of ADHD medication use among children aged 3-18 years increased in 13 different world regions between 2001 and 2015, where the absolute increase ranged from 0.02 to 0.26% per year. The goal of this study was to examine the use of methylphenidate in Canadian children and its associated adverse reactions. Methylphenidate use information among young Canadians aged 0-14 years was extracted from IQVIA data on prescriptions dispensed by pharmacies between April 2014 and June 2020. The adverse reaction information associated with methylphenidate use was extracted from the Canada Vigilance database for the same time period. Methylphenidate use trends were analyzed based on sex, age group (0-4 years, 5-9 years, and 10-14 years), and geographical location (province). The common classes of adverse reactions associated with methylphenidate use were sorted, and the relative risks associated with methylphenidate use as compared with two second-line amphetamine medications for ADHD were estimated. This study revealed that among Canadians aged 0-14 years, every 100 people used about 25 prescriptions (or 23,000 mg) of methylphenidate per year during the study period, and the use increased with time. Boys used almost three times more methylphenidate than girls. The amount of drug used was inversely associated with age: Canadians aged 10-14 years used nearly three times as many drugs compared to those aged 5-9 years. Seasonal methylphenidate use patterns were apparent among young Canadians, but the seasonal trends differed among the three age groups. Methylphenidate use varied from region to region, and the highest methylphenidate use was observed in Quebec, where the use of methylphenidate was at least double that of any other province. During the study period, Health Canada received 304 adverse reaction reports associated with the use of methylphenidate for Canadians aged 0-14 years. The number of adverse reaction reports received for boys was 3.5 times higher than that for girls. The three most common adverse reaction classes were psychiatric disorders, nervous system disorders and injury, poisoning procedural complications. The number one commonly reported adverse reaction for boys was aggression (11.2%), while for girls, it was a tremor (9.6%). The safety profile in terms of adverse reaction classes associated with methylphenidate use was similar to that of the selected control products. Methylphenidate is a commonly used pharmaceutical product in young Canadians, particularly in the province of Quebec. Boys used approximately three times more of this product as compared to girls. Future investigation is needed to determine what factors are associated with the observed geographic variations in Canada.

Keywords: adverse reaction risk, methylphenidate, prescription trend, use variation

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7327 The Effect of Resistance and Progressive Training on Hsp 70 and Glucose

Authors: F. Nameni, H. Poursadra

Abstract:

The present study investigated resistance and progressive training alters the expression of chaperone proteins. These proteins function to maintain homeostasis, facilitate repair from injury, and provide protection. Nineteen training female in 2 groups taking part in the intervention volunteered to give blood samples. Levels of chaperone proteins were measured in response to resistance and progressive training. Hsp 70 levels were increased immediately after 2 h progressive training but decreased after resistance training. The data showed that human skeletal muscle responds to the stress of a single period of progressive training by up-regulating and resistance training by down-regulating expression of HSP70. Physical exercise can elevate core temperature and muscle temperatures and the expression pattern of HSP70 due to training status may be attributed to adaptive mechanisms.

Keywords: resistance training, heat shock proteins, leukocytes, Hsp 70

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7326 Limestone Briquette Production and Characterization

Authors: André C. Silva, Mariana R. Barros, Elenice M. S. Silva, Douglas. Y. Marinho, Diego F. Lopes, Débora N. Sousa, Raphael S. Tomáz

Abstract:

Modern agriculture requires productivity, efficiency and quality. Therefore, there is need for agricultural limestone implementation that provides adequate amounts of calcium and magnesium carbonates in order to correct soil acidity. During the limestone process, fine particles (with average size under 400#) are generated. These particles do not have economic value in agricultural and metallurgical sectors due their size. When limestone is used for agriculture purposes, these fine particles can be easily transported by wind generated air pollution. Therefore, briquetting, a mineral processing technique, was used to mitigate this problem resulting in an agglomerated product suitable for agriculture use. Briquetting uses compressive pressure to agglomerate fine particles. It can be aided by agglutination agents, allowing adjustments in shape, size and mechanical parameters of the mass. Briquettes can generate extra profits for mineral industry, presenting as a distinct product for agriculture, and can reduce the environmental liabilities of the fine particles storage or disposition. The produced limestone briquettes were subjected to shatter and water action resistance tests. The results show that after six minutes completely submerged in water, the briquettes where fully diluted, a highly favorable result considering its use for soil acidity correction.

Keywords: agglomeration, briquetting, limestone, soil acidity correction

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7325 Quantitative Analysis of the High-Value Bioactive Components of Pre-Germinated and Germinated Pigmented Rice (Oryza sativa L. Cv. Superjami and Superhongmi)

Authors: Lara Marie Pangan Lo, Soo Im Chung, Yao Cheng Zhang, Xingyue Jin, Mi Young Kang

Abstract:

Being the world’s most consumed grain crop, rice (Oryza sativa L.) demands’ have increase and this prompted the development of new rice cultivars with high bio-functional properties than the commonly used white rice. Ordinary rice variety is already known to be a potential source for a number of nutritional as well as bioactive compounds. To further enhance the rice’s nutritive values, germination is done in addition to making it more tasty and palatable when cooked. Pigmented rice, on the other hand, has become increasingly popular in the recent years for their greater antioxidant potential and other nutraceutical properties which can help alleviate the occurrence of the increasing incidence of metabolic diseases. Combining these two (2) parameters, this research study is sought to quantitatively determine the pre-germinated and germinated quantities of the major bioactive compounds of South Korea’s newly developed purplish pigmented rice grain cultivar Superjami (SJ) and red pigmented rice grain Superhongmi (SH) and compare them against the non-pigmented Normal Brown (NB) rice variety. Powdered rice grain cultivars were subjected to 72-hour germination period and the quantities of GABA, γ-oryzanol, ferulic acid, tocopherol and tocotrienol homologues were compared against their pre-germinated condition using γ- amino butyric acid (GABA) analysis and High Performance Liquid Chromatography (HPLC). Results revealed the effectiveness of germination in enhancing the bioactive components in all rice samples. GABA contents in germinated rice cultivars increased by more than 10-fold following the order: SJ >SH >NB. In addition, purple rice variety (SJ) has higher total γ-oryzanol and ferulic acid contents which increased by > 2-fold after germination followed by the red cultivar SH then the control, NB. Germinated varieties also possess higher total tocotrienol content than their pre-germinated state. As for the total tocopherol content, SJ has higher quantity, but the red-pigmented SH (0.16 mg/kg) is shown to have lower total tocopherol content than the control rice NB (0.86 mg/kg). However, all tocopherol and tocotrienol homologues were present only in small amounts ( < 3.0 mg/kg) in all pre-germinated and germinated samples. In general, all of the analyzed pigmented rice cultivars were found to possess higher bioactive compounds than the control NB rice variety. Also, regardless of their strain, germinated rice samples have higher bioactive compounds than their pre-germinated counterparts. This only shows the effectiveness of germinating rice in enhancing bioactive constituents. Overall, these results suggest the potential of the pigmented rice varieties as natural source of nutraceuticals in bio-functional food development.

Keywords: bioactive compounds, germinated rice, superhongmi, superjami

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7324 Power and Efficiency of Photovoltaic Module: Effect of Cell Temperature

Authors: R. Nasrin, M. Ferdows

Abstract:

Among the renewable energy sources, photovoltaic (PV) is a high potential, effective, and sustainable system. Irradiation intensity from 200 W/m2 to 1000 W/m2 has been considered to observe the performance of PV module. Generally, this module converts only about 15% - 20% of incident irradiation into electrical energy and the rest part is converted into heat energy. Finite element method has been used to solve the problem numerically. Simulation has been performed by considering the ambient temperature 30°C. Higher irradiation increase solar cell temperature and electrical power. The electrical efficiency of PV module decreases with the variation of solar radiation. The efficiency of PV module can be increased if cell temperature is reduced. Thus the effect of irradiation is significant to enhance the efficiency of PV module if the solar cell temperature is kept at a certain level.

Keywords: PV module, solar radiation, efficiency, cell temperature

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7323 Investigation of Leakage, Cracking and Warpage Issues Observed on Composite Valve Cover in Development Phase through FEA Simulation

Authors: Ashwini Shripatwar, Mayur Biyani, Nikhil Rao, Rajendra Bodake, Sachin Sane

Abstract:

This paper documents the correlation of valve cover sealing, cracking, and warpage Finite Element Modelling with observations on engine test development. The valve cover is a component mounted on engine head with a gasket which provides sealing against oil which flows around camshaft, valves, rockers, and other overhead components. Material nonlinearity and contact nonlinearity characteristics are taken into consideration because the valve cover is made of a composite material having temperature dependent elastic-plastic properties and because the gasket load-deformation curve is also nonlinear. The leakage is observed between the valve cover and the engine head due to the insufficient contact pressure. The crack is observed on the valve cover due to force application at a region with insufficient stiffness and with elevated temperature. The valve cover shrinkage is observed during the disassembly process on hot exhaust side bolt holes after the engine has been running. In this paper, an analytical approach is developed to correlate a Finite Element Model with the observed failures and to address the design issues associated with the failure modes in question by making design changes in the model.

Keywords: cracking issue, gasket sealing analysis, nonlinearity of contact and material, valve cover

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7322 CSPG4 Molecular Target in Canine Melanoma, Osteosarcoma and Mammary Tumors for Novel Therapeutic Strategies

Authors: Paola Modesto, Floriana Fruscione, Isabella Martini, Simona Perga, Federica Riccardo, Mariateresa Camerino, Davide Giacobino, Cecilia Gola, Luca Licenziato, Elisabetta Razzuoli, Katia Varello, Lorella Maniscalco, Elena Bozzetta, Angelo Ferrari

Abstract:

Canine and human melanoma, osteosarcoma (OSA), and mammary carcinomas are aggressive tumors with common characteristics making dogs a good model for comparative oncology. Novel therapeutic strategies against these tumors could be useful to both species. In humans, chondroitin sulphate proteoglycan 4 (CSPG4) is a marker involved in tumor progression and could be a candidate target for immunotherapy. The anti-CSPG4 DNA electrovaccination has shown to be an effective approach for canine malignant melanoma (CMM) [1]. An immunohistochemistry evaluation of CSPG4 expression in tumour tissue is generally performed prior to electrovaccination. To assess the possibility to perform a rapid molecular evaluation and in order to validate these spontaneous canine tumors as the model for human studies, we investigate the CSPG4 gene expression by RT qPCR in CMM, OSA, and canine mammary tumors (CMT). The total RNA was extracted from RNAlater stored tissue samples (CMM n=16; OSA n=13; CMT n=6; five paired normal tissues for CMM, five paired normal tissues for OSA and one paired normal tissue for CMT), retro-transcribed and then analyzed by duplex RT-qPCR using two different TaqMan assays for the target gene CSPG4 and the internal reference gene (RG) Ribosomal Protein S19 (RPS19). RPS19 was selected from a panel of 9 candidate RGs, according to NormFinder analysis following the protocol already described [2]. Relative expression was analyzed by CFX Maestro™ Software. Student t-test and ANOVA were performed (significance set at P<0.05). Results showed that gene expression of CSPG4 in OSA tissues is significantly increased by 3-4 folds when compared to controls. In CMT, gene expression of the target was increased from 1.5 to 19.9 folds. In melanoma, although an increasing trend was observed, no significant differences between the two groups were highlighted. Immunohistochemistry analysis of the two cancer types showed that the expression of CSPG4 within CMM is concentrated in isles of cells compared to OSA, where the distribution of positive cells is homogeneous. This evidence could explain the differences in gene expression results.CSPG4 immunohistochemistry evaluation in mammary carcinoma is in progress. The evidence of CSPG4 expression in a different type of canine tumors opens the way to the possibility of extending the CSPG4 immunotherapy marker in CMM, OSA, and CMT and may have an impact to translate this strategy modality to human oncology.

Keywords: canine melanoma, canine mammary carcinomas, canine osteosarcoma, CSPG4, gene expression, immunotherapy

Procedia PDF Downloads 159
7321 Solar Power Generation in a Mining Town: A Case Study for Australia

Authors: Ryan Chalk, G. M. Shafiullah

Abstract:

Climate change is a pertinent issue facing governments and societies around the world. The industrial revolution has resulted in a steady increase in the average global temperature. The mining and energy production industries have been significant contributors to this change prompting government to intervene by promoting low emission technology within these sectors. This paper initially reviews the energy problem in Australia and the mining sector with a focus on the energy requirements and production methods utilised in Western Australia (WA). Renewable energy in the form of utility-scale solar photovoltaics (PV) provides a solution to these problems by providing emission-free energy which can be used to supplement the existing natural gas turbines in operation at the proposed site. This research presents a custom renewable solution for the mining site considering the specific township network, local weather conditions, and seasonal load profiles. A summary of the required PV output is presented to supply slightly over 50% of the towns power requirements during the peak (summer) period, resulting in close to full coverage in the trench (winter) period. Dig Silent Power Factory Software has been used to simulate the characteristics of the existing infrastructure and produces results of integrating PV. Large scale PV penetration in the network introduce technical challenges, that includes; voltage deviation, increased harmonic distortion, increased available fault current and power factor. Results also show that cloud cover has a dramatic and unpredictable effect on the output of a PV system. The preliminary analyses conclude that mitigation strategies are needed to overcome voltage deviations, unacceptable levels of harmonics, excessive fault current and low power factor. Mitigation strategies are proposed to control these issues predominantly through the use of high quality, made for purpose inverters. Results show that use of inverters with harmonic filtering reduces the level of harmonic injections to an acceptable level according to Australian standards. Furthermore, the configuration of inverters to supply active and reactive power assist in mitigating low power factor problems. Use of FACTS devices; SVC and STATCOM also reduces the harmonics and improve the power factor of the network, and finally, energy storage helps to smooth the power supply.

Keywords: climate change, mitigation strategies, photovoltaic (PV), power quality

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7320 Change of Substrate in Solid State Fermentation Can Produce Proteases and Phytases with Extremely Distinct Biochemical Characteristics and Promising Applications for Animal Nutrition

Authors: Paula K. Novelli, Margarida M. Barros, Luciana F. Flueri

Abstract:

Utilization of agricultural by-products, wheat ban and soybean bran, as substrate for solid state fermentation (SSF) was studied, aiming the achievement of different enzymes from Aspergillus sp. with distinct biological characteristics and its application and improvement on animal nutrition. Aspergillus niger and Aspergillus oryzea were studied as they showed very high yield of phytase and protease production, respectively. Phytase activity was measure using p-nitrophenilphosphate as substrate and a standard curve of p-nitrophenol, as the enzymatic activity unit was the quantity of enzyme necessary to release one μmol of p-nitrophenol. Protease activity was measure using azocasein as substrate. Activity for phytase and protease substantially increased when the different biochemical characteristics were considered in the study. Optimum pH and stability of the phytase produced by A. niger with wheat bran as substrate was between 4.0 - 5.0 and optimum temperature of activity was 37oC. Phytase fermented in soybean bran showed constant values at all pHs studied, for optimal and stability, but low production. Phytase with both substrates showed stable activity for temperatures higher than 80oC. Protease from A. niger showed very distinct behavior of optimum pH, acid for wheat bran and basic for soybean bran, respectively and optimal values of temperature and stability at 50oC. Phytase produced by A. oryzae in wheat bran had optimum pH and temperature of 9 and 37oC, respectively, but it was very unstable. On the other hand, proteases were stable at high temperatures, all pH’s studied and showed very high yield when fermented in wheat bran, however when it was fermented in soybean bran the production was very low. Subsequently the upscale production of phytase from A. niger and proteases from A. oryzae were applied as an enzyme additive in fish fed for digestibility studies. Phytases and proteases were produced with stable enzyme activity of 7,000 U.g-1 and 2,500 U.g-1, respectively. When those enzymes were applied in a plant protein based fish diet for digestibility studies, they increased protein, mineral, energy and lipids availability, showing that these new enzymes can improve animal production and performance. In conclusion, the substrate, as well as, the microorganism species can affect the biochemical character of the enzyme produced. Moreover, the production of these enzymes by SSF can be up to 90% cheaper than commercial ones produced with the same fungi species but submerged fermentation. Add to that these cheap enzymes can be easily applied as animal diet additives to improve production and performance.

Keywords: agricultural by-products, animal nutrition, enzymes production, solid state fermentation

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7319 A Randomized Controlled Trial Study on the Effect of Adding Dexmedetomidine to Bupivacaine in Supraclavicular Block Using Ultrasound Guidance

Authors: Nazia Nazir

Abstract:

Background: The benefits of regional anesthetic techniques are well established. Use of additives to local anesthetics can prolong these benefits. The aim of this study was to observe the effect of adding dexmedetomidine to bupivacaine for the supraclavicular block. Methods (Design): In this randomized, double-blind study, seventy ASA I & II patients of either sex undergoing elective surgeries on the upper limb were given supraclavicular block under ultrasound guidance. Group C (n=35), received 38 mL 0.25% bupivacaine + 2mL normal saline and group D received 38 mL 0.25% bupivacaine + 1 µg/kg dexmedetomidine (2mL). Patients were observed for onset, duration of motor and sensory block, duration of analgesia, sedation score, hemodynamic changes and any adverse events. Results: In group D the onset was faster (P < 0.001), duration of sensory and motor block, as well as duration of analgesia, was prolonged as compared to group C (P < 0.0001). There was significant drop in heart rate (HR) from the baseline in group D (P < 0.05) at 30, 60, 90 and 120 min, however, none of the patients dropped HR below 50/min. Mean arterial Pressure (MAP) remained unaffected. The patients in group D were effectively sedated than those in group C (P < 0.05). No adverse event was reported in either group. Conclusion: Dexmedetomidine as adjuvant to bupivacaine in supraclavicular block resulted in faster action, prolonged motor and sensory block, prolonged analgesia with hemodynamic stability and adequate sedation.

Keywords: Analgesia, bupivacaine, dexmedetomidine, supraclavicular block

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7318 Torrefaction of Spelt Husks to Increase Its Fuel Properties

Authors: Abubakar Halidu, Paul E. Bilsborrow, Anh N. Phan

Abstract:

Torrefaction is a term that refers to the moderate pyrolysis of biomass at temperatures between 200 and 300oC in an oxygen-free environment to boost its heating value, grindability, and storability. This process can also be used as a pre-treatment for other thermochemical processes. The torrefaction of spelt husks was carried out at temperatures of 200, 250, and 300oC in an inert nitrogen environment with a heating rate of 20oC.min-1 and a residence time of 15–60 min, respectively. We examined the influence of torrefaction temperatures and residence time. The results indicated that increasing the torrefaction temperature increased the higher heating values (HHV) and improved grindability. Torrefied spelt husks at 300oC for 15 minutes exhibited the highest increase in HHV at 30.88 MJ kg-1, compared to non-torrefied spelt husks at 17.56 MJ kg-1.

Keywords: grindability, higher heating value, residence time, temperature, torrefaction

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7317 Investigation of the NO2 Formation in the Exhaust Duct of a Dual Fuel Test Engine

Authors: Ehsan Arabian, Thomas Sattelmayer

Abstract:

The formation of nitrogen dioxide NO2 in the exhaust duct of a MAN dual fuel test engine has been investigated numerically. The dual fuel engine concept with premixed lean methane combustion ignited through diesel pilot flames reveals high potential for the abatement of the NOx formation. The drawback of this combustion method, however, is the high NO2 formation due to the increasing concentration of unburned hydrocarbons. This promotes the conversion of NO to NO2, which is toxic and characterized through its yellow color. The results presented in this paper cover a wide range of engine operation points from full load to part load for different air to fuel ratios. The effects of temperature, pressure and concentrations of unburned methane and nitric oxide on NO2 formation in the exhaust duct has been investigated on the basis of a zero-dimensional well stirred reactor model implemented in Cantera, which calculates the steady state of a uniform composition for a certain residence time. It can be shown that the simulated conversion of NO to NO2 match the experimental results fairly well. The partial oxidation of methane followed by CO production can be predicted as well. It can also be concluded that the lower temperature limit for which no conversion takes place, depends mainly on the concentration of the unburned hydrocarbons in the exhaust.

Keywords: cantera, dual fuel engines, exhaust tract, numerical modeling of NO2 formation, well stirred reactor

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7316 Quality Improvement of the Sand Moulding Process in Foundries Using Six Sigma Technique

Authors: Cindy Sithole, Didier Nyembwe, Peter Olubambi

Abstract:

The sand casting process involves pattern making, mould making, metal pouring and shake out. Every step in the sand moulding process is very critical for production of good quality castings. However, waste generated during the sand moulding operation and lack of quality are matters that influences performance inefficiencies and lack of competitiveness in South African foundries. Defects produced from the sand moulding process are only visible in the final product (casting) which results in increased number of scrap, reduced sales and increases cost in the foundry. The purpose of this Research is to propose six sigma technique (DMAIC, Define, Measure, Analyze, Improve and Control) intervention in sand moulding foundries and to reduce variation caused by deficiencies in the sand moulding process in South African foundries. Its objective is to create sustainability and enhance productivity in the South African foundry industry. Six sigma is a data driven method to process improvement that aims to eliminate variation in business processes using statistical control methods .Six sigma focuses on business performance improvement through quality initiative using the seven basic tools of quality by Ishikawa. The objectives of six sigma are to eliminate features that affects productivity, profit and meeting customers’ demands. Six sigma has become one of the most important tools/techniques for attaining competitive advantage. Competitive advantage for sand casting foundries in South Africa means improved plant maintenance processes, improved product quality and proper utilization of resources especially scarce resources. Defects such as sand inclusion, Flashes and sand burn on were some of the defects that were identified as resulting from the sand moulding process inefficiencies using six sigma technique. The courses were we found to be wrong design of the mould due to the pattern used and poor ramming of the moulding sand in a foundry. Six sigma tools such as the voice of customer, the Fishbone, the voice of the process and process mapping were used to define the problem in the foundry and to outline the critical to quality elements. The SIPOC (Supplier Input Process Output Customer) Diagram was also employed to ensure that the material and process parameters were achieved to ensure quality improvement in a foundry. The process capability of the sand moulding process was measured to understand the current performance to enable improvement. The Expected results of this research are; reduced sand moulding process variation, increased productivity and competitive advantage.

Keywords: defects, foundries, quality improvement, sand moulding, six sigma (DMAIC)

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7315 Complementary Mathematical Model for Underwater Vehicles under Load Variation Test Conditions

Authors: Erim Koyun

Abstract:

This paper aim to construct a mathematical model for Underwater vehicles under load variation test conditions. Propeller effects on underwater vehicle are investigated. Body with counter rotating propeller model is analyzed by CFD methods, thus forces and moment are obtained. Propeller effects of vehicle’s hydrodynamic performance under load variation conditions will be investigated. Additionally, pressure contour is examined for differences between different load conditions. Axial force equation is established using hydrodynamic coefficients, which contains resistance, thrust, and additional coefficients occurs due to load variations. Additional coefficients helps to express completely axial force on underwater vehicle. When the vehicle accelerates, additional force occurs besides thrust force increment. This is propeller effect on the body. Hence, mathematical model cover this effect. For CFD analysis, the incompressible, three-dimensional, and unsteady Reynolds Averaged Navier-Stokes equations will be used Numerical results is verified with experimental results for verification. The overall goal of this study is to present complementary mathematical model for body with counter rotating propeller.

Keywords: counter rotating propeller, CFD, hydrodynamic mathematic model, hydrodynamics analysis, thrust deduction

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7314 Analyzing Keyword Networks for the Identification of Correlated Research Topics

Authors: Thiago M. R. Dias, Patrícia M. Dias, Gray F. Moita

Abstract:

The production and publication of scientific works have increased significantly in the last years, being the Internet the main factor of access and distribution of these works. Faced with this, there is a growing interest in understanding how scientific research has evolved, in order to explore this knowledge to encourage research groups to become more productive. Therefore, the objective of this work is to explore repositories containing data from scientific publications and to characterize keyword networks of these publications, in order to identify the most relevant keywords, and to highlight those that have the greatest impact on the network. To do this, each article in the study repository has its keywords extracted and in this way the network is  characterized, after which several metrics for social network analysis are applied for the identification of the highlighted keywords.

Keywords: bibliometrics, data analysis, extraction and data integration, scientometrics

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7313 Comparative Analysis of Competitive State Anxiety among Team Sport and Individual Sport Athletes in Iran

Authors: Hossein Soltani, Zahra Hojati, Seyed Reza Attarzadeh Hossini

Abstract:

Anxiety levels before and during competition are not clear due to conflicting findings; various athletes have reported different levels of anxiety from much too low. With respect to the fact that every sport field has its own special nature, and the lack of a comprehensive theory in this field made the author to compare competitive state anxiety among team sport and individual sport athletes in Iran. The sample included 120 male athletes, 60 athletes in individual sports (taekwondo, karate, and wrestling) and 60 athletes in team sports (volleyball, basketball, futsal). All participants in this study were regularly competing at the super leagues and regional level. The research instrument employed was the Persian version of the Competitive State Anxiety Inventory-2. This inventory was distributed among the subjects about 30 minutes before the first competition. Finally, using one-way ANOVA data was analyzed. The results indicated that the mean score of cognitive and somatic anxiety among individual sport athletes was higher than that of team sport athletes (P<0.05). Self-confidence levels of individual sports athletes was higher than that of team sports athletes but the difference was not significant (P >0.05). It seems the being part of a team alleviates some of the pressure experienced by those who compete alone. Conclusion: Individual sport athletes may be more exposed to evaluation and more engaged in their own skills and abilities than team sport athletes given that responsibility for performance is not distributed across several performers.

Keywords: competitive state anxiety, cognitive anxiety, somatic anxiety, team sports, individual sports

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7312 Developing a Multi-Modal Choking Intervention

Authors: R. Maher, D. Marchant, F. Fazel

Abstract:

The initial aim of the study was to capitalize on the depth of athletes’ and coaches’ knowledge pertaining to the phenomenon of choking in basketball, free-throw shooting in particular, from an ‘insiders’ perspective. The findings of this study have developed a deeper understanding of how basketball players and coaches deal with choking and potentially contribute new knowledge relevant to designing useful interventions for alleviating choking. A key element was thus, knowledge, transfer, and exchange (KTE). KTE is the process of acquiring, developing, sharing and applying knowledge. Semi-structured interviews were conducted employing a composed sample of eight elite basketball players and four elite coaches who have been experiencing the choking episode previously. All interviews have been digitally recorded and later transcribed verbatim. Then the interviews have been content analyzed. Participants of the present study have provided useful information regarding the underlying mechanisms and antecedents of choking and also suggested applicable antidotes to conquer the phenomenon of choking. According to the results of the present study, self-confidence, mental and physical preparation, and coping styles should be considered as influential factors in athletes’ performance under pressure. Moreover, using all noteworthy information and preventative strategies suggested by participants of the present study, an effective multi-modal intervention has been introduced that should be taken into account by sports psychologists, coaches and athletes.

Keywords: anxiety, basketball, choking, free-throw shooting, psychological intervention

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7311 Bivariate Analyses of Factors That May Influence HIV Testing among Women Living in the Democratic Republic of the Congo

Authors: Danielle A. Walker, Kyle L. Johnson, Patrick J. Fox, Jacen S. Moore

Abstract:

The HIV Continuum of Care has become a universal model to provide context for the process of HIV testing, linkage to care, treatment, and viral suppression. HIV testing is the first step in moving toward community viral suppression. Countries with a lower socioeconomic status experience the lowest rates of testing and access to care. The Democratic Republic of the Congo is located in the heart of sub-Saharan Africa, where testing and access to care are low and women experience higher HIV prevalence compared to men. In the Democratic Republic of the Congo there is only a 21.6% HIV testing rate among women. Because a critical gap exists between a woman’s risk of contracting HIV and the decision to be tested, this study was conducted to obtain a better understanding of the relationship between factors that could influence HIV testing among women. The datasets analyzed were from the 2013-14 Democratic Republic of the Congo Demographic and Health Survey Program. The data was subset for women with an age range of 18-49 years. All missing cases were removed and one variable was recoded. The total sample size analyzed was 14,982 women. The results showed that there did not seem to be a difference in HIV testing by mean age. Out of 11 religious categories (Catholic, Protestant, Armee de salut, Kimbanguiste, Other Christians, Muslim, Bundu dia kongo, Vuvamu, Animist, no religion, and other), those who identified as Other Christians had the highest testing rate of 25.9% and those identified as Vuvamu had a 0% testing rate (p<0.001). There was a significant difference in testing by religion. Only 0.7% of women surveyed identified as having no religious affiliation. This suggests partnerships with key community and religious leaders could be a tool to increase testing. Over 60% of women who had never been tested for HIV did not know where to be tested. This highlights the need to educate communities on where testing facilities can be located. Almost 80% of women who believed HIV could be transmitted by supernatural means and/or witchcraft had never been tested before (p=0.08). Cultural beliefs could influence risk perception and testing decisions. Consequently, misconceptions need to be considered when implementing HIV testing and prevention programs. Location by province, years of education, and wealth index were also analyzed to control for socioeconomic status. Kinshasa had the highest testing rate of 54.2% of women living there, and both Equateur and Kasai-Occidental had less than a 10% testing rate (p<0.001). As the education level increased up to 12 years, testing increased (p<0.001). Women within the highest quintile of the wealth index had a 56.1% testing rate, and women within the lowest quintile had a 6.5% testing rate (p<0.001). This study concludes that further research is needed to identify culturally competent methods to increase HIV education programs, build partnerships with key community leaders, and improve knowledge on access to care.

Keywords: Democratic Republic of the Congo, cultural beliefs, education, HIV testing

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7310 Coupled Analysis for Hazard Modelling of Debris Flow Due to Extreme Rainfall

Authors: N. V. Nikhil, S. R. Lee, Do Won Park

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Korean peninsula receives about two third of the annual rainfall during summer season. The extreme rainfall pattern due to typhoon and heavy rainfall results in severe mountain disasters among which 55% of them are debris flows, a major natural hazard especially when occurring around major settlement areas. The basic mechanism underlined for this kind of failure is the unsaturated shallow slope failure by reduction of matric suction due to infiltration of water and liquefaction of the failed mass due to generation of positive pore water pressure leading to abrupt loss of strength and commencement of flow. However only an empirical model cannot simulate this complex mechanism. Hence, we have employed an empirical-physical based approach for hazard analysis of debris flow using TRIGRS, a debris flow initiation criteria and DAN3D in mountain Woonmyun, South Korea. Debris flow initiation criteria is required to discern the potential landslides which can transform into debris flow. DAN-3D, being a new model, does not have the calibrated values of rheology parameters for Korean conditions. Thus, in our analysis we have used the recent 2011 debris flow event in mountain Woonmyun san for calibration of both TRIGRS model and DAN-3D, thereafter identifying and predicting the debris flow initiation points, path, run out velocity, and area of spreading for future extreme rainfall based scenarios.

Keywords: debris flow, DAN-3D, extreme rainfall, hazard analysis

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7309 Jungle Justice on Emotional Health Challenges among Lagosians

Authors: Aaron Akinloye

Abstract:

This research examined the influence of jungle justice as it affects the emotional health challenges among residents in Lagos metropolitan city. Descriptive survey research design was used along with the questionnaire as research instrument. Population for the study comprised residents in Yaba and Shomolu Communities of Lagos State, Nigeria. Accidental sampling technique was used to sample 300 Residents. Self-developed questionnaire was used to obtain data on the variables under investigation. Research instrument was validated following the face, content, and construct validation of the instrument. Thereafter, the reliability coefficient yielded 0.84. It is therefore concluded and recommended that; there is a significant influence of jungle justice on trauma among residents- df (298) t= 2.33, p< 0.05; there is a significant influence of jungle justice on pressure among residents- df (298) t= 2.16, p< 0.05: there is a significant influence of jungle justice on fear among residents- df (298) t= 2.20, p< 0.05; there is a significant influence of jungle justice on depression among residents- df (298) t= 2.14, p< 0.05. Recommendations were made that; there should be deliberate effort to implement comprehensive awareness campaigns to educate the residents on the detrimental effects of jungle justice on individuals and the community members as a whole; there should be an improvement in the effectiveness and efficiency of the existing law enforcement agencies in Lagos metropolitan city; development and implementation of support systems for victims of jungle justice, which include trauma, counselling, mental health services, and rehabilitation programmes; there should be proper review and revision of the legal framework to address the issue of jungle justice effectively.

Keywords: jungle justice, emotional health, depression, fear

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7308 Reaching the Goals of Routine HIV Screening Programs: Quantifying and Implementing an Effective HIV Screening System in Northern Nigeria Facilities Based on Optimal Volume Analysis

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

Abstract:

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

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

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