Search results for: bridge stay cables

Authors: Farah Al-Fityani, Aljohara Alsowail, Shatha Bindawood, Heba Balrbeah

Abstract:

Locket is a popular app that lets users share spontaneous photos with a close circle of friends. The app offers a unique way to stay connected with loved ones by allowing users to see glimpses of their day through photos displayed on a widget on their home screen. This summary outlines the process of developing an app like Locket, highlighting the importance of user privacy and security. It also details the findings of a study on user engagement with the Locket app, revealing positive sentiment towards its features and concept but also identifying areas for improvement. Overall, the summary portrays Locket as a successful app that is changing the way people connect on social media.

Keywords: locket, app, machine learning, connect

Procedia PDF Downloads 48

Authors: M. Abdollahi, S. N. Moghaddas Tafreshi

Abstract:

Expanded polystyrene (EPS) geofoam is often used in below ground applications in geotechnical engineering. A most recent configuration system implemented in roadways to protect lifelines such as buried pipes, electrical cables and culvert systems could be consisted of two EPS geofoam blocks, “posts” placed on each side of the structure, an EPS block capping, “beam” put atop two posts, and soil cover on the beam. In this configuration, a rectangular void space will be built atop the lifeline. EPS blocks will stand all the imposed vertical forces due to their strength and deformability, thus the lifeline will experience no vertical stress. The present paper describes the results of a numerical study on the post and beam configuration subjected to the static loading. Three-dimensional finite element analysis using ABAQUS software is carried out to investigate the effect of different parameters such as beam thickness, soil thickness over the beam, post height to width ratio, EPS density, and free span between two posts, on the stress distribution and the deflection of the beam. The results show favorable performance of EPS geofoam for protecting sensitive infrastructures.

Keywords: beam, EPS block, numerical analysis, post, stress distribution

Procedia PDF Downloads 244

Authors: Mehdi Radmehr, Amir Hamed Mashhadzadeh, Mehdi Jafari

Abstract:

Traditional HVDC systems are tough to DC short circuits as they are current regulated with a large reactance connected in series with cables. Multi-terminal DC wind farm topologies are attracting increasing research attempt. With AC/DC converters on the generator side, this topology can be developed into a multi-terminal DC network for wind power collection, which is especially suitable for large-scale offshore wind farms. For wind farms, the topology uses high-voltage direct-current transmission based on voltage-source converters (VSC-HVDC). Therefore, they do not suffer from over currents due to DC cable faults and there is no over current to react to. In this study, the multi-terminal DC wind farm topology is introduced. Then, possible internal DC faults are analyzed according to type and characteristic. Fault over current expressions are given in detail. Under this characteristic analysis, fault detection and detailed protection methods are proposed. Theoretical analysis and PSCAD/EMTDC simulations are provided.

Keywords: DC short circuits, multi-terminal DC wind farm topologies, HVDC transmission based on VSC, fault analysis

Procedia PDF Downloads 422

Authors: Syed Ibrahim, Syed Muneer Ahmed

Abstract:

It is a global phenomenon that fitness is a pre-requisite to the desired end of optimum efficiency in elite class basketballers achieved through appropriate conditioning program. This study was undertaken to find out the effect of gymnastic oriented training program on the physical fitness and the level of technical performance of basketball players. Method: 27 basketballers were divided into 12 experimental and 15 control groups aged between 19 to 25 years. Physical fitness tests comprising of vertical jump, push-ups, chin ups, sit ups, back strength, 30 m sprint, boomerangs test, 600 m run, sit and reach, bridge up and shoulder rotation and technical skill tests like dribbling, layup shots and rebound collection were used for the study. A pre- and post-test was conducted before and after the training program of 6 weeks. Results: The results indicated no significant difference in the anthropometric measurements of age, height and weight between the experimental and control group as the ‘t’ values observed were 0.28, 1.63 and 1.60 respectively . There were significant improvements in vertical jump, push-ups, sit-ups, modified boomerang test, bridge test and shoulder rotation index with the ‘t’ values being 2.60, 3.41, 3.91, 4.02, 3.55 and 2.33 respectively. However, no significant differences existed in chin-ups, back strength, 30 m sprint and 6000 m run with the ‘t’ values being 2.08, 1.77, 1.28 and 0.80 respectively. There was significant improvement in the post-test for the technical skills tests in the experimental group with ‘t’ values being 3.65, 2.57, and 3.62 for the dribble, layup shots and rebound collection respectively. There was no significant difference in the values of the control group except in the rebound collection which showed significant difference. Conclusion: It was found that both the physical fitness and skill proficiency of the basketballers increased through the participation in the gymnastics oriented program.

Keywords: gymnastic, technical, pre-requisite, elite class

Procedia PDF Downloads 401

Authors: Hesamaddin Khoshnoodi, Ahmad Rahbar Ranji

Abstract:

Corrosion in steel structures is one of the most important issues that should be considered in designing and constructing. Corrosion reduces the cross section and load capacity of element and leads to costly damage of structures. In this paper, the corrosion has been modeled for moment stresses. Moreover, the steel beam has been modeled using ABAQUS advanced finite element software. The conclusions of this study demonstrated that the displacement of the analyzed composite steel girder bridge might increase.

Keywords: Abaqus, Corrosion, deformation, Steel Beam

Procedia PDF Downloads 354

Authors: Prabu Duplex

Abstract:

Due to stringent emission regulation targets, large-scale transition to renewable energy sources is a global challenge, and wind power plays a significant role in the solution vector. This scenario has led to the construction of offshore wind farms, and several wind farms are planned in the shallow waters where the marine habitat exists. It raises concerns over impacts of underwater noise on marine species, for example bridge constructions in the ocean straits. Dangerous to aquatic life, the environmental organisations say, the bridge would be devastating, since ocean straits are important place of transit for marine mammals. One of the highest concentrations of biodiversity in the world is concentrated these areas. The investigation of ship noise and piling noise that may happen during bridge construction and in operation is therefore vital. Once the source levels are known the receiver levels can be modelled. With this objective this work investigates the key requirement of the software that can model transmission loss in high frequencies that may occur during construction or operation phases. Most propagation models are 2D solutions, calculating the propagation loss along a transect, which does not include horizontal refraction, reflection or diffraction. In many cases, such models provide sufficient accuracy and can provide three-dimensional maps by combining, through interpolation, several two-dimensional (distance and depth) transects. However, in some instances the use of 2D models may not be sufficient to accurately model the sound propagation. A possible example includes a scenario where an island or land mass is situated between the source and receiver. The 2D model will result in a shadow behind the land mass where the modelled transects intersect the land mass. Diffraction will occur causing bending of the sound around the land mass. In such cases, it may be necessary to use a 3D model, which accounts for horizontal diffraction to accurately represent the sound field. Other scenarios where 2D models may not provide sufficient accuracy may be environments characterised by a strong up-sloping or down sloping seabed, such as propagation around continental shelves. In line with these objectives by means of a case study, this work addresses the importance of 3D interactions in underwater acoustics. The methodology used in this study can also be used for other 3D underwater sound propagation studies. This work assumes special significance given the increasing interest in using underwater acoustic modeling for environmental impacts assessments. Future work also includes inter-model comparison in shallow water environments considering more physical processes known to influence sound propagation, such as scattering from the sea surface. Passive acoustic monitoring of the underwater soundscape with distributed hydrophone arrays is also suggested to investigate the 3D propagation effects as discussed in this article.

Keywords: underwater acoustics, naval, maritime, cetaceans

Procedia PDF Downloads 20

Authors: Estelle Démoulin, Dionysios Adamopoulos, Tornike Sologashvili, Mathieu Van Steenberghe, Jalal Jolou, Haran Burri, Christoph Huber, Mustafa Cikirikcioglu

Abstract:

Background & objective: Mitral valve surgeries are mainly performed by median sternotomy with conventional direct atriotomy. Good exposure to the mitral valve is challenging, especially for acute pathologies, where left atrium dilation does not occur. Other atriotomies, such as transseptal or superior septal, are used as they allow better access and visualization. Peri- and postoperative outcomes of these three different left atriotomies were compared. Methods: Patients undergoing mitral valve surgery between January 2010 and December 2020 were included and divided into three groups: group 1 (conventional direct, n=115), group 2 (transseptal, n=33) and group 3 (superior septal, n=59). To improve the sampling size, all patients underwent mitral valve surgery with or without associated procedures (CABG, aortic-tricuspid surgery, Maze procedure). The study protocol was approved by SwissEthics. Results: No difference was shown for the etiology of mitral valve disease, except endocarditis, which was more frequent in group 3 (p = 0.014). Elective surgeries and isolated mitral valve surgery were more frequent in group 1 (p = 0.008, p = 0.011) and aortic clamping and cardiopulmonary bypass were shorter (p = 0.002, p<0.001). Group 3 had more emergency procedures (p = 0.011) and longer lengths of intensive care unit and hospital stay (p = 0.000, p = 0.003). There was no difference in permanent pacemaker implantation, postoperative complications and mortality between the groups. Conclusion: Mitral valve surgeries can be safely performed using those three left atriotomies. Conventional direct may lead to shorter aortic clamping and cardiopulmonary bypass times. Superior septal is mostly used for acute pathologies, and it does not increase postoperative arrhythmias and permanent pacemaker implantation. However, intensive care unit and hospital lengths of stay were found to be longer in this group. In our opinion, this outcome is more related to the pathology and type of surgery than the incision itself.

Keywords: Mitral valve surgery, cardiac surgery, atriotomy, Operative outcomes

Procedia PDF Downloads 77

Authors: A. A. Purohit, M. M. Vaidya, M. D. Kudale

Abstract:

Among the various developing countries in the world like China, Malaysia, Korea etc., India is also developing its infrastructures in the form of Road/Rail/Airports and Waterborne facilities at an exponential rate. Mumbai, the financial epicenter of India is overcrowded and to relieve the pressure of congestion, Navi Mumbai suburb is being developed on the east bank of Thane creek near Mumbai. The government due to limited space at existing Mumbai Airports (domestic and international) to cater for the future demand of airborne traffic, proposes to build a new international airport near Panvel at Navi Mumbai. Considering the precedence of extreme rainfall on 26^th July 2005 and nearby townships being in a low-lying area, wherein new airport is proposed, it is inevitable to study this complex confluence area from a hydrodynamic consideration under both tidal and extreme events (predicted discharge hydrographs), to avoid inundation of the surrounding due to the proposed airport reclamation (1160 hectares) and to determine the safe grade elevation (SGE). The model studies conducted using the application of unstructured mesh to simulate the Panvel estuarine area (93 km²), calibration, validation of a model for hydraulic field measurements and determine the maxima water levels around the airport for various extreme hydrodynamic events, namely the simultaneous occurrence of highest tide from the Arabian Sea and peak flood discharges (Probable Maximum Precipitation and 26^th July 2005) from five rivers, the Gadhi, Kalundri, Taloja, Kasadi and Ulwe, meeting at the proposed airport area revealed that: (a) The Ulwe River flowing beneath the proposed airport needs to be diverted. The 120m wide proposed Ulwe diversion channel having a wider base width of 200 m at SH-54 Bridge on the Ulwe River along with the removal of the existing bund in Moha Creek is inevitable to keep the SGE of the airport to a minimum. (b) The clear waterway of 80 m at SH-54 Bridge (Ulwe River) and 120 m at Amra Marg Bridge near Moha Creek is also essential for the Ulwe diversion and (c) The river bank protection works on the right bank of Gadhi River between the NH-4B and SH-54 bridges as well as upstream of the Ulwe River diversion channel are essential to avoid inundation of low lying areas. The maxima water levels predicted around the airport keeps SGE to a minimum of 11m with respect to Chart datum of Ulwe Bundar and thus development is not only technologically-economically feasible but also sustainable. The unstructured mesh modeling is a promising tool to simulate complex extreme hydrodynamic events and provides a reliable solution to evolve optimal SGE of airport.

Keywords: airport, hydrodynamics, safe grade elevation, tides

Procedia PDF Downloads 262

Authors: Gichun Cha, Changgil Lee, Seunghee Park

Abstract:

The objective of the study is to construct the shape management method contributing to the safety of the large structure. In Korea, the research of the shape management is lack because of the new attempted technology. Terrestrial Laser Scanning (TLS) is used for measurements of large structures. TLS provides an efficient way to actively acquire accurate the point clouds of object surfaces or environments. The point clouds provide a basis for rapid modeling in the industrial automation, architecture, construction or maintenance of the civil infrastructures. TLS produce a huge amount of point clouds. Registration, Extraction and Visualization of data require the processing of a massive amount of scan data. The octree can be applied to the shape management of the large structure because the scan data is reduced in the size but, the data attributes are maintained. The octree space partitioning generates the voxel of 3D space, and the voxel is recursively subdivided into eight sub-voxels. The point cloud of scan data was converted to voxel and sampled. The experimental site is located at Sungkyunkwan University. The scanned structure is the steel-frame bridge. The used TLS is Leica ScanStation C10/C5. The scan data was condensed 92%, and the octree model was constructed with 2 millimeter in resolution. This study presents octree space partitioning for handling the point clouds. The basis is created by shape management of the large structures such as double-deck tunnel, building and bridge. The research will be expected to improve the efficiency of structural health monitoring and maintenance. "This work is financially supported by 'U-City Master and Doctor Course Grant Program' and the National Research Foundation of Korea(NRF) grant funded by the Korea government (MSIP) (NRF- 2015R1D1A1A01059291)."

Keywords: 3D scan data, octree space partitioning, shape management, structural health monitoring, terrestrial laser scanning

Procedia PDF Downloads 297

Authors: John Mark Payawal, Francis Aldrine Uy, John Paul Carreon

Abstract:

This paper shows the application of Structural Health Monitoring, SHM into bridges. Bridges are structures built to provide passage over a physical obstruction such as rivers, chasms or roads. The Philippines has a total of 8,166 national bridges as published on the 2015 atlas of the Department of Public Works and Highways (DPWH) and only 2,924 or 35.81% of these bridges are in good condition. As a result, PHP 30.464 billion of the 2016 budget of DPWH is allocated on roads and/or bridges maintenance alone. Intensive spending is owed to the present practice of outdated manual inspection and assessment, and poor structural health monitoring of Philippine infrastructures. As the School of Civil, Environmental, & Geological Engineering of Mapua Institute of Technology (MIT) continuous its well driven passion in research based projects, a partnership with the Department of Science and Technology (DOST) and the DPWH launched the application of Structural Health Monitoring, (SHM) in Padre Jacinto Zamora Flyover. The flyover is located along Nagtahan Boulevard in Sta. Mesa, Manila that connects Brgy. 411 and Brgy. 635. It gives service to vehicles going from Lacson Avenue to Mabini Bridge passing over Legarda Flyover. The flyover is chosen among the many located bridges in Metro Manila as the focus of the pilot testing due to its site accessibility, and complete structural built plans and specifications necessary for SHM as provided by the Bureau of Design, BOD department of DPWH. This paper focuses on providing a method to calibrate theoretical readings from STAAD Vi8 Pro and sync the data to actual MEMS accelerometer readings. It is observed that while the design standards used in constructing the flyover was reflected on the model, actual readings of MEMS accelerometer display a large difference compared to the theoretical data ran and taken from STAAD Vi8 Pro. In achieving a true seismic response of the modeled bridge or hence syncing the theoretical data to the actual sensor reading also called as the independent variable of this paper, analysis using single degree of freedom (SDOF) of the flyover under free vibration without damping using STAAD Vi8 Pro is done. The earthquake excitation and bridge responses are subjected to earthquake ground motion in the form of ground acceleration or Peak Ground Acceleration, PGA. Translational acceleration load is used to simulate the ground motion of the time history analysis acceleration record in STAAD Vi8 Pro.

Keywords: accelerometer, analysis using single degree of freedom, micro electro mechanical system, peak ground acceleration, structural health monitoring

Procedia PDF Downloads 322

Authors: King Kumire, Amos Kubeka

Abstract:

The synergy of machine learning and astronomical technology advancement is giving rise to the new space age, which is pronounced by better habitability assessments. To initiate this discussion, it should be recorded for definition purposes that the symbiotic relationship between astronomy and improved computing has been code-named the Cis-Astro gateway concept. The cosmological fate of this phrase has been unashamedly plagiarized from the cis-lunar gateway template and its associated LaGrange points which act as an orbital bridge to the moon from our planet Earth. However, for this study, the scientific audience is invited to bridge toward the discovery of new habitable planets. It is imperative to state that cosmic probes of this magnitude can be utilized as the starting nodes of the astrobiological search for galactic life. This research can also assist by acting as the navigation system for future space telescope launches through the delimitation of target exoplanets. The findings and the associated platforms can be harnessed as building blocks for the modeling of climate change on planet earth. The notion that if the human genus exhausts the resources of the planet earth or there is a bug of some sort that makes the earth inhabitable for humans explains the need to find an alternative planet to inhabit. The scientific community, through interdisciplinary discussions of the International Astronautical Federation so far has the common position that engineers can reduce space mission costs by constructing a stable cis-lunar orbit infrastructure for refilling and carrying out other associated in-orbit servicing activities. Similarly, the Cis-Astro gateway can be envisaged as a budget optimization technique that models extra-solar bodies and can facilitate the scoping of future mission rendezvous. It should be registered as well that this broad and voluminous catalog of exoplanets shall be narrowed along the way using machine learning filters. The gist of this topic revolves around the indirect economic rationale of establishing a habitability scoping platform.

Keywords: machine-learning, habitability, exoplanets, supercomputing

Procedia PDF Downloads 90

Authors: King Kumire, Amos Kubeka

Abstract:

The synergy of machine learning and astronomical technology advancement is giving rise to the new space age, which is pronounced by better habitability assessments. To initiate this discussion, it should be recorded for definition purposes that the symbiotic relationship between astronomy and improved computing has been code-named the Cis-Astro gateway concept. The cosmological fate of this phrase has been unashamedly plagiarized from the cis-lunar gateway template and its associated LaGrange points which act as an orbital bridge to the moon from our planet Earth. However, for this study, the scientific audience is invited to bridge toward the discovery of new habitable planets. It is imperative to state that cosmic probes of this magnitude can be utilized as the starting nodes of the astrobiological search for galactic life. This research can also assist by acting as the navigation system for future space telescope launches through the delimitation of target exoplanets. The findings and the associated platforms can be harnessed as building blocks for the modeling of climate change on planet earth. The notion that if the human genus exhausts the resources of the planet earth or there is a bug of some sort that makes the earth inhabitable for humans explains the need to find an alternative planet to inhabit. The scientific community, through interdisciplinary discussions of the International Astronautical Federation so far, has the common position that engineers can reduce space mission costs by constructing a stable cis-lunar orbit infrastructure for refilling and carrying out other associated in-orbit servicing activities. Similarly, the Cis-Astro gateway can be envisaged as a budget optimization technique that models extra-solar bodies and can facilitate the scoping of future mission rendezvous. It should be registered as well that this broad and voluminous catalog of exoplanets shall be narrowed along the way using machine learning filters. The gist of this topic revolves around the indirect economic rationale of establishing a habitability scoping platform.

Keywords: exoplanets, habitability, machine-learning, supercomputing

Procedia PDF Downloads 118

Authors: Sherif Keddis, Mohamed Azzam, Norbert Schwesinger

Abstract:

Harvesting mechanical energy from footsteps or other impacts is a possibility to enable wireless autonomous sensor nodes. These can be used for a highly efficient control of connected devices such as lights, security systems, air conditioning systems or other smart home applications. They can also be used for accurate location or occupancy monitoring. Converting the mechanical energy into useful electrical energy can be achieved using the piezoelectric effect offering simple harvesting setups and low deflections. The challenge facing piezoelectric transducers is the achievable amount of energy per impact in the lower mJ range and the management of such low energies. Simple setups for energy extraction such as a full wave bridge connected directly to a capacitor are problematic due to the mismatch between high impedance sources and low impedance storage elements. Efficient energy circuits for piezoelectric harvesters are commonly designed for vibration harvesters and require periodic input energies with predictable frequencies. Due to the sporadic nature of impact harvesters, such circuits are not well suited. This paper presents a self-powered circuit that avoids the impedance mismatch during energy extraction by disconnecting the load until the source reaches its charge peak. The switch is implemented with passive components and works independent from the input frequency. Therefore, this circuit is suited for impact harvesting and sporadic inputs. For the same input energy, this circuit stores 150% of the energy in comparison to a directly connected capacitor to a bridge rectifier. The total efficiency, defined as the ratio of stored energy on a capacitor to available energy measured across a matched resistive load, is 63%. Although the resulting energy is already sufficient to power certain autonomous applications, further optimization of the circuit are still under investigation in order to improve the overall efficiency.

Keywords: autonomous sensors, circuit design, energy harvesting, energy management, impact harvester, piezoelectricity

Procedia PDF Downloads 155

Authors: Shengxin Yu

Abstract:

Earthquakes can cause varying degrees of damage to building and bridge structures. Traditional laminated natural rubber bearings (NRB) exhibit inadequate energy dissipation and restraint, particularly under near-fault ground motions, resulting in excessive displacements in the superstructure. This paper presents a composite natural rubber bearing (NFUD-NRB) incorporating two types of shape memory alloy (SMA) U-shaped dampers (UD). The bearing exhibits adjustable features, predominantly characterized by partial self-centering and multi-level energy dissipation, facilitated by nickel-titanium-based SMA (NiTi-SMA) and iron-based SMA (Fe-SMA) UDs. The hysteresis characteristics of NFUD-NRB can be tailored by manipulating the configuration of NiTi-SMA and Fe-SMA UDs. Firstly, the proposed bearing's geometric configuration and working principle are introduced. The rationality of the modeling strategy for the bearing is validated through existing experimental results. Parameterized numerical simulations are subsequently performed to investigate the partially self-centering behavior of NFUD-NRB. The findings indicate that NFUD-NRB can attain the anticipated nonlinear behavior and deliver adequate energy dissipation. Finally, the impact of NFUD-NRB on improving the seismic resilience of highway bridges is examined using the OpenSees software, with particular emphasis on the seismic performance of NFUD-NRB under near-fault ground motions. System-level analysis reveals that bridge systems equipped with NFUD-NRBs exhibit satisfactory residual deformations and higher energy dissipation than those equipped with traditional NRBs. Moreover, NFUD-NRB markedly mitigates the detrimental impacts of near-fault ground motions on the main structure of bridges.

Keywords: partially self-centering behavior, energy dissipation, natural rubber bearing, shape memory alloy, U-shaped damper, numerical investigation, near-fault ground motion

Procedia PDF Downloads 58

Authors: Hansraj Bookun, Angela Tan, Rachel Xuan, Linheng Zhao, Kejia Wang, Animesh Singla, David Kim, Christopher Loupos

Abstract:

Introduction: Incisional wound complications in vascular surgery patients represent a significant clinical and econometric burden of morbidity and mortality. The objective of this study was to trial the feasibility of applying the Prevena negative pressure incision management system as a routine dressing in patients who had undergone arterial surgery. Conventionally, Prevena has been applied to groin incisions, but this study features applications on multiple wound sites such as the thigh or major amputation stumps. Method: This was a cross-sectional observational, single-centre case series of 12 patients who had undergone major vascular surgery. Their wounds were managed with the Prevena system being applied either intra-operatively or on the first post-operative day. Demographic and operative details were collated as well as the length of stay and complication rates. Results: There were 9 males (75%) with mean age of 66 years and the comorbid burden was as follows: ischaemic heart disease (92%), diabetes (42%), hypertension (100%), stage 4 or greater kidney impairment (17%) and current or ex-smoking (83%). The main indications were acute ischaemia (33%), claudication (25%), and gangrene (17%). There were single instances of an occluded popliteal artery aneurysm, diabetic foot infection, and rest pain. The majority of patients (50%) had hybrid operations with iliofemoral endarterectomies, patch arterioplasties, and further peripheral endovascular treatment. There were 4 complex arterial bypass operations and 2 major amputations. The mean length of stay was 17 ± 10 days, with a range of 4 to 35 days. A single complication, in the form of a lymphocoele, was encountered in the context of an iliofemoral endarterectomy and patch arterioplasty. This was managed conservatively. There were no deaths. Discussion: The Prevena wound management system shows that in conjunction with safe vascular surgery, absolute wound complication rates remain low and that it remains a valuable adjunct in the treatment of vasculopaths.

Keywords: wound care, negative pressure, vascular surgery, closed incision

Procedia PDF Downloads 138

Authors: Liza Michaeli

Abstract:

Fermata, from fermare, means to be on hold, conjoining contenere (contain), fissare (fasten), and rimanere (stay). It is a musical indication that a note should be (that is, calls to be) prolonged beyond the "normal duration" the note value would indicate. To be "held up" is to be held impractically in the lunga pausa, where the breath "is to be taken," taken in, but the release is impeded. In this pause of unspecified length, life is being prolonged against your discretion but given to you to inhabit. That is why the note value, the recognized "normative value," does not "accept" the significance of the prolongation. The value is interested in "saving time." The query at the heart of "Life in the fermata" will therefore be: is this life on hold, or rather, life holding. The paper shall meditate, via musical notation, on the significance of experience "inside": namely, the hold.

Keywords: fermata, experience, significance, the hold, prolongation

Procedia PDF Downloads 177

Authors: S. H. Park, D. W. You

Abstract:

This study is about to the field survey and repair works in a marine approach-bride. In order to evaluate the stability of the ground and the structure, field surveys such as exterior inspection, non-destructive inspection, measurement, and geophysical exploration are carried out. Numerical analysis is conducted to investigate the cause of the abutment displacement at the same time. In addition, repair works are practiced to the region damaged with intent to sustain long-term safety.

Keywords: field survey, expansion joint, repair, maintenance

Procedia PDF Downloads 292

Authors: Hossam Shalabi, George Hadjisophocleous

Abstract:

The Canadian Nuclear Power Plants (NPPs) use some portions of NUREG/CR-6850 in carrying out Fire Probabilistic Risk Assessment (PRA). An assessment for the applicability of NUREG/CR-6850 to CANDU reactors was performed and a CANDU Fire PRA was introduced. There are 19 operating CANDU reactors in Canada at five sites (Bruce A, Bruce B, Darlington, Pickering and Point Lepreau). A fire load density survey was done for all Fire Safe Shutdown Analysis (FSSA) fire zones in all CANDU sites in Canada. National Fire Protection Association (NFPA) Standard 557 proposes that a fire load survey must be conducted by either the weighing method or the inventory method or a combination of both. The combination method results in the most accurate values for fire loads. An updated CANDU Fire PRA model is demonstrated in this paper that includes the fuel survey in all Canadian CANDU stations. A qualitative screening step for the CANDU fire PRA is illustrated in this paper to include any fire events that can damage any part of the emergency power supply in addition to FSSA cables.

Keywords: fire safety, CANDU, nuclear, fuel densities, FDS, qualitative analysis, fire probabilistic risk assessment

Procedia PDF Downloads 138

Authors: Armita Ghobadi, Samantha Emerson, Seyda Ozcaliskan

Abstract:

Being a bilingual involves mastery of both speech and gesture patterns in a second language (L2). We know from earlier work in first language (L1) production contexts that speech and co-speech gesture form a tightly integrated system: co-speech gesture mirrors the patterns observed in speech, suggesting an online effect of language on nonverbal representation of events in gesture during the act of speaking (i.e., “thinking for speaking”). Relatively less is known about the online effect of language on gesture in bilinguals speaking structurally different languages. The few existing studies—mostly with small sample sizes—suggests inconclusive findings: some show greater achievement of L2 patterns in gesture with more advanced L2 speech production, while others show preferences for L1 gesture patterns even in advanced bilinguals. In this study, we focus on advanced bilingual speakers of two structurally different languages (Spanish L1 with English L2) in comparison to L1 English speakers. We ask whether bilingual speakers will follow target L2 patterns not only in speech but also in gesture, or alternatively, follow L2 patterns in speech but resort to L1 patterns in gesture. We examined this question by studying speech and gestures produced by 23 advanced adult Spanish (L1)-English (L2) bilinguals (Mage=22; SD=7) and 23 monolingual English speakers (Mage=20; SD=2). Participants were shown 16 animated motion event scenes that included distinct manner and path components (e.g., "run over the bridge"). We recorded and transcribed all participant responses for speech and segmented it into sentence units that included at least one motion verb and its associated arguments. We also coded all gestures that accompanied each sentence unit. We focused on motion event descriptions as it shows strong crosslinguistic differences in the packaging of motion elements in speech and co-speech gesture in first language production contexts. English speakers synthesize manner and path into a single clause or gesture (he runs over the bridge; running fingers forward), while Spanish speakers express each component separately (manner-only: el corre=he is running; circle arms next to body conveying running; path-only: el cruza el puente=he crosses the bridge; trace finger forward conveying trajectory). We tallied all responses by group and packaging type, separately for speech and co-speech gesture. Our preliminary results (n=4/group) showed that productions in English L1 and Spanish L1 differed, with greater preference for conflated packaging in L1 English and separated packaging in L1 Spanish—a pattern that was also largely evident in co-speech gesture. Bilinguals’ production in L2 English, however, followed the patterns of the target language in speech—with greater preference for conflated packaging—but not in gesture. Bilinguals used separated and conflated strategies in gesture in roughly similar rates in their L2 English, showing an effect of both L1 and L2 on co-speech gesture. Our results suggest that online production of L2 language has more limited effects on L2 gestures and that mastery of native-like patterns in L2 gesture might take longer than native-like L2 speech patterns.

Keywords: bilingualism, cross-linguistic variation, gesture, second language acquisition, thinking for speaking hypothesis

Procedia PDF Downloads 76

Authors: P. Monginaud, J. C. Baudey

Abstract:

The synchronous, low-voltage command for JFET Rectifiers has many applications: indeed, replacing the traditional diodes by these components allows enhanced performances in gain, linearity and phase shift. We introduce here a new bridge, including JFET associated with pull-down, bipolar command systems, and double-purpose logic gates.

Keywords: synchronous, rectifier, MOSFET, JFET, bipolar command system, push-pull circuits, double-purpose logic gates

Procedia PDF Downloads 365

Authors: Ann Enright

Abstract:

More than ever, animal shelters need to identify ways to reduce the number of animals entering shelter facilities and the incidence of euthanasia. Managing animal overpopulation using euthanasia can have detrimental health and emotional consequences for the shelter staff involved. There are also community expectations with moral and financial implications to consider. To achieve the goals of reducing animal intake and the incidence of euthanasia, shelter best practice involves combining programs, procedures and partnerships to increase live release rates (LRR), reduce the incidence of disease, length of stay (LOS) and shelter intake whilst overall remaining financially viable. Analysing daily processes, tracking outcomes and implementing simple strategies enabled shelter staff to more effectively focus their efforts and achieve amazing results. The objective of this retrospective study was to assess the effect of implementing the capacity for care (C4C) management model. Data focusing on the average daily number of animals on site for a two year period (2016 – 2017) was exported from a shelter management system, Customer Logic (CL) Vet to Excel for manipulation and comparison. Following the implementation of C4C practices the average daily number of animals on site was reduced by >50%, (2016 average 103 compared to 2017 average 49), average LOS reduced by 50% from 8 weeks to 4 weeks and incidence of disease reduced from ≥ 70% to less than 2% of the cats on site at the completion of the study. The total number of stray cats entering the shelter due to council contracts reduced by 50% (486 to 248). Improved cat outcomes were attributed to strategies that increased adoptions and reduced euthanasia of poorly socialized cats, including foster programs. To continue to achieve improvements in LRR and LOS, strategies to decrease intake further would be beneficial, for example, targeted sterilisation programs. In conclusion, the study highlighted the benefits of using C4C as a management tool, delivering a significant reduction in animal intake and euthanasia with positive emotional, financial and community outcomes.

Keywords: animal welfare, capacity for care, cat, euthanasia, length of stay, managed intake, shelter

Procedia PDF Downloads 143

Authors: Khosro Barkhordari, Fateme Sadr, Mina Pashang

Abstract:

Back ground: Blood transfusion is one of the major issues in cardiac surgery patients. Transfusing patients based on fixed cut-off points of hemoglobin is the current protocol in most institutions. The hemoglobin level of 7- 10 has been suggested for blood transfusion in cardiac surgery patients. We aimed to evaluate if blood transfusion based on change in percentage of hematocrit has different outcomes. Methods: In this retrospective cohort study, we investigated the early postoperative outcome of cardiac surgery patients who received blood transfusions at Tehran Heart Center Hospital, IRAN. We reviewed and analyzed the basic characteristics and clinical data of 700 patients who met our exclusion and inclusion criteria. The two groups of blood transfused patients were compared, those who have 30-50 percent decrease in basal hematocrit versus those with 10 -29 percent decrease. Results: This is ongoing study, and the results would be completed in two weeks after analysis of the date. Conclusion: Early analysis has shown no difference in early post-operative outcomes between the two groups, but final analysis will be completed in two weeks. 1-Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IRAN 2- Department of Research, Tehran Heart Center, Tehran, IRAN Quantitative variables were compared using the Student t-test or the Mann‐Whitney U test, as appropriate, while categorical variables were compared using the χ2 or the Fisher exact test, as required. Our intention was to compare the early postoperative outcomes between the two groups, which include 30 days mortality, Length of ICU stay, Length of hospital stay, Intubation time, Infection rate, acute kidney injury, and respiratory complications. The main goal was to find if transfusing blood based on changes in hematocrit from a basal level was better than to fixed cut-off point regarding early post-operative outcomes. This has not been studied enough and may need randomized control trials.

Keywords: post-operative, cardiac surgery, outcomes, blood transfusion

Procedia PDF Downloads 86

Authors: Magdalena Barbara Kaziuk

Abstract:

Introduction: In December 2019, the first case of an acute infectious disease of the respiratory system caused by the SARS-CoV-2 virus was recorded in Wuhan in Central China. On March 11, 2020, the World Health Organization restrictions, among others, in the travel industry. Aim: The aim of the study was the assessment of the preparedness of European cultural institutions and catering establishments within the sanitary and epidemiological dimension during the COVID-19 pandemic by Polish tourists and their sense of safety in selected destinations. Material and methods: The study involved 300 Polish tourists (125 females, 175 males, age 46.5+/-12.9 years) who traveled during the COVID-19 pandemic to Southern European countries. 5 most popular travel destinations were selected: Italy, Austria, Greece, Croatia, and Mediterranean islands. The tourists assessed cultural institutions and catering establishments with the use of a proprietary questionnaire which concerned the preparedness regarding the sanitary and epidemiological requirements and the tourists' sense of safety. The number of respondents was deliberate - 60 persons per each country. Results: The more stringent sanitary regimes, the higher the sense of safety in the study group of females aged 45-50 (p<0.005), while the more stringent sanitary and epidemiological issues are implemented, the shorter the stay (p<0.001). Less stringent restrictions resulted in increased sense of freedom and mental rest in the group of studied males (p<0.005). Conclusions: The respondents' opinions revealed that the highest level of safety with regard to sanitary and epidemiological requirements (masks covering mouth and nose worn by both personnel and society, the necessity to present the COVID passport, the possibility to disinfect hands) was observed in Austria and Italy, while shorter length of the stay in these countries resulted from high prices, particularly in catering establishments. According to the respondents, less stringent restrictions, among others lack of the necessity to own the COVID passport, were linked to Croatia and Mediterranean islands. The sense of safety was satisfying, while the sense of freedom and mental rest was high. declared a string of COVID-19 cases a pandemic. Most countries implemented numerous sanitary and epidemiological

Keywords: sanitary and epidemiological regimes, tourist facilities, COVID-19 pandemic, sense of safety

Procedia PDF Downloads 125

Authors: S. Ben Fredj, H. Ghali, M. Ben Rejeb, S. Layouni, S. Khefacha, L. Dhidah, H. Said

Abstract:

Background: The Intensive Care Unit (ICU) provides continuous care and uses a high level of treatment technologies. Although developed country hospitals allocate only 5–10% of beds in critical care areas, approximately 20% of nosocomial infections (NI) occur among patients treated in ICUs. Whereas in the developing countries the situation is still less accurate. The aim of our study is to assess mortality rates in ICUs and to determine its predictive factors. Methods: We carried out a nested case-control study in a 630-beds public tertiary care hospital in Eastern Tunisia. We included in the study all patients hospitalized for more than two days in the surgical or medical ICU during the entire period of the surveillance. Cases were patients who died before ICU discharge, whereas controls were patients who survived to discharge. NIs were diagnosed according to the definitions of ‘Comité Technique des Infections Nosocomiales et les Infections Liées aux Soins’ (CTINLIS, France). Data collection was based on the protocol of Rea-RAISIN 2009 of the National Institute for Health Watch (InVS, France). Results: Overall, 301 patients were enrolled from medical and surgical ICUs. The mean age was 44.8 ± 21.3 years. The crude ICU mortality rate was 20.6% (62/301). It was 35.8% for patients who acquired at least one NI during their stay in ICU and 16.2% for those without any NI, yielding an overall crude excess mortality rate of 19.6% (OR= 2.9, 95% CI, 1.6 to 5.3). The population-attributable fraction due to ICU-NI in patients who died before ICU discharge was 23.46% (95% CI, 13.43%–29.04%). Overall, 62 case-patients were compared to 239 control patients for the final analysis. Case patients and control patients differed by age (p=0,003), simplified acute physiology score II (p < 10-3), NI (p < 10-3), nosocomial pneumonia (p=0.008), infection upon admission (p=0.002), immunosuppression (p=0.006), days of intubation (p < 10-3), tracheostomy (p=0.004), days with urinary catheterization (p < 10-3), days with CVC ( p=0.03), and length of stay in ICU (p=0.003). Multivariate analysis demonstrated 3 factors: age older than 65 years (OR, 5.78 [95% CI, 2.03-16.05] p=0.001), duration of intubation 1-10 days (OR, 6.82 [95% CI, [1.90-24.45] p=0.003), duration of intubation > 10 days (OR, 11.11 [95% CI, [2.85-43.28] p=0.001), duration of CVC 1-7 days (OR, 6.85[95% CI, [1.71-27.45] p=0.007) and duration of CVC > 7 days (OR, 5.55[95% CI, [1.70-18.04] p=0.004). Conclusion: While surveillance provides important baseline data, successful trials with more active intervention protocols, adopting multimodal approach for the prevention of nosocomial infection incited us to think about the feasibility of similar trial in our context. Therefore, the implementation of an efficient infection control strategy is a crucial step to improve the quality of care.

Keywords: intensive care unit, mortality, nosocomial infection, risk factors

Procedia PDF Downloads 408

Authors: John Yahng, Hansraj Riteesh Bookun

Abstract:

Objective: This was a retrospective cross-sectional study evaluating the safety of discharge on the first postoperative day following carotid surgery - principally carotid endarterectomy. Methods: Between January 2010 to October 2017, 252 patients with mean age of 72 years, underwent carotid surgery by seven surgeons. Their medical records were consulted and their operative as well as complication timelines were databased. Descriptive statistics were used to analyse pooled responses and our indicator variables. The statistical package used was STATA 13. Results: There were 183 males (73%) and the comorbid burden was as follows: ischaemic heart disease (54%), diabetes (38%), hypertension (92%), stage 4 kidney impairment (5%) and current or ex-smoking (77%). The main indications were transient ischaemic attacks (42%), stroke (31%), asymptomatic carotid disease (16%) and amaurosis fugax (8%). 247 carotid endarterectomies (109 with patch arterioplasty, 88 with eversion and transection technique, 50 with endarterectomy only) were performed. 2 carotid bypasses, 1 embolectomy, 1 thrombectomy with patch arterioplasty and 1 excision of a carotid body tumour were also performed. 92% of the cases were performed under general anaesthesia. A shunt was used in 29% of cases. The mean length of stay was 5.1 ± 3.7days with the range of 2 to 22 days. No patient was discharged on day 1. The mean time from admission to surgery was 1.4 ± 2.8 days, ranging from 0 to 19 days. The mean time from surgery to discharge was 2.7 ± 2.0 days with the of range 0 to 14 days. 36 complications were encountered over this period, with 12 failed repairs (5 major strokes, 2 minor strokes, 3 transient ischaemic attacks, 1 cerebral bleed, 1 occluded graft), 11 bleeding episodes requiring a return to the operating theatre, 5 adverse cardiac events, 3 cranial nerve injuries, 2 respiratory complications, 2 wound complications and 1 acute kidney injury. There were no deaths. 17 complications occurred on postoperative day 0, 11 on postoperative day 1, 6 on postoperative day 2 and 2 on postoperative day 3. 78% of all complications happened before the second postoperative day. Out of the complications which occurred on the second or third postoperative day, 4 (1.6%) were bleeding episodes, 1 (0.4%) failed repair , 1 respiratory complication (0.4%) and 1 wound complication (0.4%). Conclusion: Although it has been common practice to discharge patients on the second postoperative day following carotid endarterectomy, we find here that discharge on the first operative day is safe. The overall complication rate is low and most complications are captured before the second postoperative day. We suggest that patients having an uneventful first 24 hours post surgery be discharged on the first day. This should reduce hospital length of stay and the health economic burden.

Keywords: carotid, complication, discharge, surgery

Procedia PDF Downloads 166

Authors: Fatih Ercin Guney, Hami Karagol

Abstract:

Day by day, humanity's energy needs increase, to facilitate access to energy sources by energy importing countries is of great importance in terms of issues both in terms of economic security and political security. The geographical location of the oil exporting countries in the Middle East (Iran, Iraq, Kuwait, Libya, Saudi Arabia, United Arab Emirates, Qatar) today, it is observed that evaluated by emerging Arab Spring(from Tunisia to Egypt) and freedom battles(in Syria) with security issues arise sourced from terrorist activities(ISIS). Progresses related with limited natural resources, energy and it's transportation issues which worries the developing countries, the energy in the region is considered to how to transfer safely. North Region of the Black Sea , the beginning of the conflict in the regional nature formed between Russia and Ukraine (2010), followed by the relevant regions of the power transmission line (From Russia to Europe) the discovery is considered to be the east's hand began to strengthen in terms of both the economical and political sides. With the growing need for safe access to the west of the new energy transmission lines are followed by Turkey, re-interest is considered to be shifted to the Mediterranean and the Middle East by West. Also, Russia, Iran and China (three axis of east) are generally performing as carry out parallel policies about energy , economical side and security in both United Nations Security Council (Two of Five Permanent Members are Russia and China) and Shanghai Cooperation Organization. In addition, Eastern Mediterranean Region Tension are rapidly increasing about research new oil and natural gas sources by Israel, Egypt, Cyprus, Lebanon. This paper provides, new energy corridor(s) are needed to transfer sources (Oil&Natural Gas) by Europe from East to West. So The West needs either safe bridge country to transfer natural sources to Europe in region or is needed to discovery new natural sources in extraterritorial waters of Eastern Mediterranean Region. But in two opportunities are evaluated with secure transfer corridors form region to Europe in safely. Even if the natural sources can be discovered, they are considered to transfer in safe manner. This paper involved, Turkey’s importance as a leader country in region over both of political and safe energy transfer sides as bridge country between south and north of Turkey why natural sources shall be transferred over Turkey, Even if diplomatic issues-For Example; Cyprus membership in European Union, Turkey membership candidate duration, Israel-Cyprus- Egypt-Lebanon researches about new natural sources in Mediterranean - occurred. But politic balance in Middle-East is changing quickly because of lack of democratic governments in region. So it is evaluated that the alliance of natural sources researches may not be long-time relations due to share sources after discoveries. After evaluating over causes and reasons, aim to reach finding foresight about future of region for energy transfer periods in secure manner.

Keywords: Middle East, natural gas, oil, Turkey

Procedia PDF Downloads 297

Authors: Babak Dizangian, Mohammad Reza Ghasemi, Akram Ghalandari

Abstract:

Moment frames have considerable ductility against cyclic lateral loads and displacements; however, if this feature causes the relative displacement to exceed the permissible limit, it can impose unfavorable hysteretic behavior on the frame. Therefore, adding a bracing system with the capability of preserving the capacity of high energy absorption and controlling displacements without a considerable increase in the stiffness is quite important. This paper investigates the retrofitting of a single storey steel moment frame through a delayed wire-rope bracing system using a middle steel plate. In this model, the steel plate lies where the wire ropes meet, and the model geometry is such that the cables are continuously under tension so that they can take the most advantage of the inherent potential they have in tolerating tensile stress. Using the steel plate also reduces the system stiffness considerably compared to cross bracing systems and preserves the ductile frame’s energy absorption capacity. In this research, the software models of delayed wire-rope bracing system have been studied, validated, and compared with other researchers’ laboratory test results.

Keywords: cyclic loading, delayed wire rope bracing, ductile moment frame, energy absorption, hysteresis curve

Procedia PDF Downloads 292

Authors: Linmin Zhang

Abstract:

Entrained-flow gasification technology is considered the most promising gasification technology because of its clean and efficient utilization characteristics. The stable fluidity of slag at high temperatures is the key to affecting the long-period operation of the gasifier. The diversity and differences of coal ash-slag systems make it difficult to meet the requirements for stable slagging in entrained-flow gasifiers. Therefore, coal blending or adding fluxes has been used in industry for a long time to improve the flow behavior of coal ash. As a by-product of the indirect coal liquefaction process, indirect coal liquefaction residue (ICLR) is a kind of industrial solid waste that is usually disposed of by stacking or landfilling. However, this disposal method will not only occupy land resources but also cause serious pollution to soil and water bodies by leachate containing toxic and harmful metals. As a carbon-containing matrix, ICLR is not only a kind of waste but also a kind of energy substance. Utilizing existing industrial gasifiers to blend combustion ICLR can not only transform industrial solid waste into fuel but also save coal resources. Moreover, the ICLR usually contains a unique ash chemical composition different from coal, which will affect the slagging performance of the gasifier. Therefore, exploring the effect of the ash addition in ICLR on the coal ash flow behavior can not only improve the slagging performance and gasification efficiency of entrained-flow gasifier by using the unique ash chemical composition of ICLR but also provide some theoretical support for the large-scale consumption of industrial solid waste. Combining molecular dynamics simulation with Raman spectroscopy experiment, the effect of ICLR addition on slag structure and fluidity was explained, and the relationship between the evolution law of slag short/medium range microstructure and macroscopic flow behavior was discussed. The research found that the high silicon and aluminum content in coal ash led to the formation of complex [SiO₄]⁴- tetrahedron and [AlO₄]⁵- tetrahedron structures at high temperature, and the [SiO₄]⁴- tetrahedron and [AlO₄]⁵- tetrahedron were connected by oxygen atoms to form a multi-membered ring structure with high polymerization degree. Due to the action of the multi-membered ring structure, the internal friction in the slag increased, and the viscosity value was higher on the macro-level. As a network-modified ion, Fe2+ could replace Si4+ and Al3+ in the multi-membered ring structure and combine with O2-, which will destroy the bridge oxygen (BO) structure and transform more complex tri cluster oxygen (TO) and bridge oxygen (BO) into simple non-bridge oxygen (NBO) structure. As a result, a large number of multi-membered rings with high polymerization degrees were depolymerized into low-membered rings with low polymerization degrees. The evolution of oxygen types and ring structures in slag reduced the structure complexity and polymerization degree of coal ash slag, resulting in a decrease in the viscosity of coal ash slag.

Keywords: ash slag, coal gasification, fluidity, industrial solid waste, slag structure

Procedia PDF Downloads 31

Authors: Inyeol Paik, Ah-Ryang Kim

Abstract:

In this research, a statistical analysis is carried out to examine the statistical properties of the formula given in the design code for concrete structures. The design formulas of the Korea highway bridge design code - the limit state design method (KHBDC) which is the current national bridge design code and the design code for concrete structures by Korea Concrete Institute (KCI) are applied for the analysis. The safety levels provided by the strength formulas of the design codes are defined based on the probabilistic and statistical theory.KHBDC is a reliability-based design code. The load and resistance factors of this code were calibrated to attain the target reliability index. It is essential to define the statistical properties for the design formulas in this calibration process. In general, the statistical characteristics of a member strength are due to the following three factors. The first is due to the difference between the material strength of the actual construction and that used in the design calculation. The second is the difference between the actual dimensions of the constructed sections and those used in design calculation. The third is the difference between the strength of the actual member and the formula simplified for the design calculation. In this paper, the statistical study is focused on the third difference. The formulas for calculating the shear strength of concrete members are presented in different ways in KHBDC and KCI. In this study, the statistical properties of design formulas were obtained through comparison with the database which comprises the experimental results from the reference publications. The test specimen was either reinforced with the shear stirrup or not. For an applied database, the bias factor was about 1.12 and the coefficient of variation was about 0.18. By applying the statistical properties of the design formula to the reliability analysis, it is shown that the resistance factors of the current design codes satisfy the target reliability indexes of both codes. Also, the minimum resistance factors of the KHBDC which is written in the material resistance factor format and KCE which is in the member resistance format are obtained and the results are presented. A further research is underway to calibrate the resistance factors of the high strength and high-performance concrete design guide.

Keywords: concrete design code, reliability analysis, resistance factor, shear strength, statistical property

Procedia PDF Downloads 321

Authors: Choon Seong Ng, P. Petrick, C. L. Lau

Abstract:

Background: Carbapenem-resistant isolates have been increasingly reported recently. Carbapenem stewardship is designed to optimize its usage particularly among medical wards with high prevalence of carbapenem prescriptions to combat such emerging resistance. Carbapenem stewardship programmes (CSP) can reduce antibiotic use but clinical outcome of such measures needs further evaluation. We examined this in a prospective manner using feedback mechanism. Methods: Our single-center prospective cohort study involved all carbapenem prescriptions across the medical wards (including medical patients admitted to intensive care unit) in a tertiary university hospital setting. The impact of such stewardship was analysed according to the accepted and the rejected groups. The primary endpoint was safety. Safety measure applied in this study was the death at 1 month. Secondary endpoints included length of hospitalisation and readmission. Results: Over the 19 months’ period, input from 144 carbapenem prescriptions was analysed on the basis of acceptance of our CSP recommendations on the use of carbapenems. Recommendations made were as follows : de-escalation of carbapenem; stopping the carbapenem; use for a short duration of 5-7 days; required prolonged duration in the case of carbapenem-sensitive Extended Spectrum Beta-Lactamases bacteremia; dose adjustment; and surgical intervention for removal of septic foci. De-escalation, shorten duration of carbapenem and carbapenem cessation comprised 79% of the recommendations. Acceptance rate was 57%. Those who accepted CSP recommendations had no increase in mortality (p = 0.92), had a shorter length of hospital stay (LOS) and had cost-saving. Infection-related deaths were found to be higher among those in the rejected group. Moreover, three rejected cases (6%) among all non-indicated cases (n = 50) were found to have developed carbapenem-resistant isolates. Lastly, Pitt’s bacteremia score appeared to be a key element affecting the carbapenem prescription’s behaviour in this trial. Conclusions: Carbapenem stewardship program in the medical wards not only saves money, but most importantly it is safe and does not harm the patients with added benefits of reducing the length of hospital stay. However, more time is needed to engage the primary clinical teams by formal clinical presentation and immediate personal feedback by senior Infectious Disease (ID) personnel to increase its acceptance.

Keywords: audit and feedback, carbapenem stewardship, medical wards, university hospital

Procedia PDF Downloads 204