Search results for: first years
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 10136

Search results for: first years

9716 Prevalence and Factors Associated to Work Accidents in the Construction Sector in Benin: Cases of CFIR – Consulting

Authors: Antoine Vikkey Hinson, Menonli Adjobimey, Gemayel Ahmed Biokou, Rose Mikponhoue

Abstract:

Introduction: Construction industry is a critical concern with regard to Health and Safety Service worldwide. World health Organization revealed that work-related disease and trauma were held responsible for the death of one million nine hundred thousand people in 2016. The aim of this study it was to determine the prevalence and factors associated with the occurrence of work accidents in a construction industry in Benin. Method: It was a descriptive cross-sectional and analytical study. Data analysis was performed with R software 4.1.1. In multivariate analysis, we performed a binary logistic regression. OR adjusted (ORa) association measures and their 95% confidence interval [CI95%] were presented for the explanatory variables used in the final model. The significance threshold for all tests selected was 5% (p < 0.05) Result: In this study, 472 workers were included, and, of these, 452 (95.7%) were men corresponding to a sex ratio of 22.6. The average age of the workers was 33 years ± 8.8 years. Workers were mostly laborers (84.7%), and had declared having inadequate personal protective equipment (50.6%, n=239). The prevalence of work accidents is 50.8%. Collision with a rolling stock (25.8%), cut (16.2%), and stumbling (16.2%) were the main types of work accidents on the construction site. Four factors were associated with contributing to work accidents. Fatigue or exhaustion (ORa : 1.53[1.03 ; 2.28]); The use of dangerous tools (ORa : 1.81 [1.22 ; 2.71]); The various laborers’ jobs (ORa : 4.78 [2.62 ; 9.21]); and seniority in the company ≥ 4 years (ORa : 2.00 [1.35 ; 2.96]). Conclusion: This study allowed us to identify the associated factors. It is imperative to implement a rigorous policy of occupational health and security mostly the continuing training for workers safe, the supply of appropriate work tools and protective

Keywords: prevalence, work accident, associated factors, construction, benin

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9715 Proposals of Exposure Limits for Infrasound From Wind Turbines

Authors: M. Pawlaczyk-Łuszczyńska, T. Wszołek, A. Dudarewicz, P. Małecki, M. Kłaczyński, A. Bortkiewicz

Abstract:

Human tolerance to infrasound is defined by the hearing threshold. Infrasound that cannot be heard (or felt) is not annoying and is not thought to have any other adverse or health effects. Recent research has largely confirmed earlier findings. ISO 7196:1995 recommends the use of G-weighted characteristics for the assessment of infrasound. There is a strong correlation between G-weighted SPL and annoyance perception. The aim of this study was to propose exposure limits for infrasound from wind turbines. However, only a few countries have set limits for infrasound. These limits are usually no higher than 85-92 dBG, and none of them are specific to wind turbines. Over the years, a number of studies have been carried out to determine hearing thresholds below 20 Hz. It has been recognized that 10% of young people would be able to perceive 10 Hz at around 90 dB, and it has also been found that the difference in median hearing thresholds between young adults aged around 20 years and older adults aged over 60 years is around 10 dB, irrespective of frequency. This shows that older people (up to about 60 years of age) retain good hearing in the low frequency range, while their sensitivity to higher frequencies is often significantly reduced. In terms of exposure limits for infrasound, the average hearing threshold corresponds to a tone with a G-weighted SPL of about 96 dBG. In contrast, infrasound at Lp,G levels below 85-90 dBG is usually inaudible. The individual hearing threshold can, therefore be 10-15 dB lower than the average threshold, so the recommended limits for environmental infrasound could be 75 dBG or 80 dBG. It is worth noting that the G86 curve has been taken as the threshold of auditory perception of infrasound reached by 90-95% of the population, so the G75 and G80 curves can be taken as the criterion curve for wind turbine infrasound. Finally, two assessment methods and corresponding exposure limit values have been proposed for wind turbine infrasound, i.e. method I - based on G-weighted sound pressure level measurements and method II - based on frequency analysis in 1/3-octave bands in the frequency range 4-20 Hz. Separate limit values have been set for outdoor living areas in the open countryside (Area A) and for noise sensitive areas (Area B). In the case of Method I, infrasound limit values of 80 dBG (for areas A) and 75 dBG (for areas B) have been proposed, while in the case of Method II - criterion curves G80 and G75 have been chosen (for areas A and B, respectively).

Keywords: infrasound, exposure limit, hearing thresholds, wind turbines

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9714 Dietary Habits and Cardiovascular Risk factors Among the Patients of the Coronary Artery Disease: A Case Control Study

Authors: Muhammad Kamran Hanif Khan, Fahad Mushtaq

Abstract:

Globally, the death rate from cardiovascular disease has risen over the past 20 years, but especially in low and middle-income countries (LMICS), reports the World Health Organization (WHO). Around 17.5 million deaths, or 31% of all deaths worldwide in 2012, were attributed to CVD, 80% of which occurred in low- and middle-income nations, and eighty five percent of all worldwide disability is attributable to cardiovascular disease. This study assessed the dietary habit and Cardiovascular Risk factors among the patients of coronary artery disease against matched controls. The research was a case-control study. Sample size for this case-control study was 410 CAD cases and 410 healthy controls. The case-control ratio was 1:1. Patients diagnosed with coronary artery disease were recruited from the outpatient departments and emergency rooms of four hospitals in Pakistan. The ages of people who were diagnosed with coronary artery disease were not significantly different from (mean 57.97 7.39 years) the healthy controls (mean 57.12 6.73 years). In order to determine the relationship between food consumption and the two binary outcomes, logistic regression analysis was carried out. Chicken (0.340 (0.245-0.47), p-value 0.0001), beef (0.38 (0.254-0.56), p-value 0.0001), eggs (0.297 (0.208-0.426), p-value 0.0001), and junk food (0.249 (0.167-0.372), p-value 0.0001)) were protective, while yogurt consumption more than twice weekly was risk. Conclusion: In conclusion, poor dietary habits are closely linked to the risk of CAD. Investigations based on dietary trends offer vital and practical knowledge about societal patterns.

Keywords: dietary habbits, cardiovasculardisease, CVD risk factors, hypercholesterolemia

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9713 A High Amylose-Content and High-Yielding Elite Line Is Favorable to Cook 'Nanhan' (Semi-Soft Rice) for Nursing Care Food Particularly for Serving Aged Persons

Authors: M. Kamimukai, M. Bhattarai, B. B. Rana, K. Maeda, H. B. Kc, T. Kawano, M. Murai

Abstract:

Most of the aged people older than 70 have difficulty in chewing and swallowing more or less. According to magnitude of this difficulty, gruel, “nanhan” (semi-soft rice) and ordinary cooked rice are served in general, particularly in sanatoriums and homes for old people in Japan. Nanhan is the name of a cooked rice used in Japan, having softness intermediate between gruel and ordinary cooked rice, which is boiled with intermediate amount of water between those of the latter two kinds of cooked rice. In the present study, nanhan was made in the rate of 240g of water to 100g of milled rice with an electric rice cooker. Murai developed a high amylose-content and high-yielding elite line ‘Murai 79’. Sensory eating-quality test was performed for nanhan and ordinary cooked rice of Murai 79 and the standard variety ‘Hinohikari’ which is a high eating-quality variety representative in southern Japan. Panelists (6 to 14 persons) scored each cooked rice in six items viz. taste, stickiness, hardness, flavor, external appearance and overall evaluation. Grading (-3 ~ +3) in each trait was performed, regarding the value of the standard variety Hinohikari as 0. Paddy rice produced in a farmer’s field in 2013 and 2014 and in an experimental field of Kochi University in 2015 and 2016 were used for the sensory test. According to results of the sensory eating-quality test for nanhan, Murai 79 is higher in overall evaluation than Hinohikari in the four years. The former was less sticky than the latter in the four years, but the former was statistically significantly harder than the latter throughout the four years. In external appearance, the former was significantly higher than the latter in the four years. In the taste, the former was significantly higher than the latter in 2014, but significant difference was not noticed between them in the other three years. There were no significant differences throughout the four years in flavor. Regarding amylose content, Murai 79 is higher by 3.7 and 5.7% than Hinohikari in 2015 and 2016, respectively. As for protein content, Murai 79 was higher than Hinohikari in 2015, but the former was lower than the latter in 2016. Consequently, the nanhan of Murai 79 was harder and less sticky, keeping the shape of grains as compared with that of Hinohikari, which may be due to its higher amylose content. Hence, the nanhan of Murai 79 may be recognized as grains more easily in a human mouth, which could make easier the continuous performance of mastication and deglutition particularly in aged persons. Regarding ordinary cooked rice, Murai 79 was similar to or higher in both overall evaluation and external appearance as compared with Hinohikari, despite its higher hardness and lower stickiness. Additionally, Murai 79 had brown-rice yield of 1.55 times as compared with Hinohikari, suggesting that it would enable to supply inexpensive rice for making nanhan with high quality particularly for aged people in Japan.

Keywords: high-amylose content, high-yielding rice line, nanhan, nursing care food, sensory eating quality test

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9712 The Research about Environmental Assessment Index of Brownfield Redevelopment in Taiwan - A Case Study on Formosa Chemicals and Fibre Corporation, Changhua Branch

Authors: Yang, Min-chih, Shih-Jen Feng, Bo-Tsang Li

Abstract:

The concept of “Brownfield” has been developed for nearly 35 years since it was put forward in 《Comprehensive Environmental Response, Compensation, and Liability Act, CERCLA》of USA in 1980 for solving the problem of soil contamination of those old industrial lands, and later, many countries have put forward relevant policies and researches continuously. But the related concept in Taiwan, a country has developed its industry for 60 years, is still in its infancy. This leads to the slow development of Brownfield related research and policy in Taiwan. When it comes to build the foundation of Brownfield development, we have to depend on the related experience and research of other countries. They are four aspects about Brownfield: 1. Contaminated Land; 2. Derelict Land; 3. Vacant Land; 4. Previously Development Land. This study will focus on and deeply investigate the Vacant land and contaminated land.

Keywords: brownfield, industrial land, redevelopment, assessment index

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9711 Peculiarities of the Clinical Course of the Osteoarthritis in Shift-Workers: Analysis of Clinical Data and Questionnaries

Authors: Oksana Mykytyuk

Abstract:

Chronic desynchronosis is an important factor of progression of osteoarthritis in shift workers. 80 patients with primary osteoarthritis (female:male ratio = 3:1, average age: 57.6 years, average disease duration: 6.4 years, radiological stage: II-III) were examined, 42% reported systematic night shift-work for more than two years. Full clinical examination was performed, all patients filled in SF-36, WOMAC questonnaries, marked visual analog scales for estimation of pain intensity and general well-being. Patients who had been exposed to night work had significantly worse clinical course of osteoarthritis marked by more (27.5%, p < 0.05) extensive pain syndrome, especially at night hours, (10.00 pm-2.00 am period) and estimated life quality as poorer comparing those working at day time. Osteoarthritis initiation occurred at earlier age in them comparing those who worked in non-shifted regimen. They showed a trend to generalized affliction of bigger quantity of joint groups, higher frequency of synovitis as well. Shift-workers administered higher doses of non-steroid anti-inflammatory drugs (NSAIDs) and estimated their effect as lower (39.6% average daily relief vs 62.5% in non-shift workers after 10 days of regular application of therapy). Frequency of chronic NSAID-induced gastropathy was 25% higher among night-workers. Shift-workers are predisposed to worse course of osteoarthritis with marked clinical symptoms, requiring higher doses on NSAIDs and with inclination towards bigger frequency of complication. That should be kept in mind while developing individual treatment and secondary prophylaxis strategy.

Keywords: desynchronosis, osteoarthritis, questionnaries, shift-work

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9710 Relationship between Demographic Characteristics and Lifestyle among Indonesian Pregnant Women with Hypertension

Authors: Yosi Maria Wijaya, Florisma Arista Riti Tegu

Abstract:

Background: Hypertension in pregnancy can be prevented by controlling the lifestyle. However, the majority of research on this topic has been conducted on lifestyle in women with normal pregnancy. Few studies of lifestyle have focused on Indonesian pregnant women with hypertension. Aim: The purpose of this study is to determine the association of demographic characteristics and the lifestyle of pregnant women who have hypertension. Methods: In this cross-sectional study, 76 women with hypertension during pregnancy were recruited from primary health care, West Java, Indonesia. Inclusion criteria were gestational age ≥ 28 weeks with the blood pressure systole ≥ 140 mmHg and diastole ≥ 90 mmHg. Data were collected using two instruments: demographic data and Health Promoting Life Style Profile (HPLP II). Data were analyzed with descriptive statistic and linear regression analysis. Results: The majority of participants were married, mean age was 27.96 years old (SD=6.77) with the mean of gestational age 33.21 (SD=3.49), most of them unemployed (94.7%) and more than a half participants have an education less than twelve years (59.2%). The total score of lifestyle was 2.44 (SD=0.34), more than a half participants experience unhealthy lifestyle (59.2%). Lifestyle was predicted by income, education years, occupation, and access to health care services, accounting for 20.8% of the total variance. Conclusion: Pregnant women with hypertension with low income, low level of education, non-occupational and hard to access health care services were related to unhealthy lifestyle. Understanding the lifestyle and associated factors contributes to health care providers ability to design effective interventions intended to improve healthy lifestyle among pregnant women with hypertension.

Keywords: demographic characteristics, hypertension, lifestyle, pregnancy

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9709 Inequality of Opportunities in the Health of the Adult Population of Russia

Authors: Marina Kartseva, Polina Kuznetsova

Abstract:

In our work, we estimate the contribution of inequality of opportunity to inequality in the health of the Russian population aged 25 to 74 years. The empirical basis of the study is the nationally representative data of the RLMS for 2018. Individual health is measured using a self-reported status on five-point scale. The startconditions are characterized by parental education and place of birth (country, type of settlement). Personal efforts to maintain health include the level of education, smoking status, and physical activity. To understand how start opportunities affect an individual's health, we use the methodology proposed in (Trannoy et al., 2010), which takes into account both direct and indirect (through the influence on efforts) effects. Regression analysis shows that all other things being equal, the starting capabilities of individuals have a significant impact on their health. In particular, parental education has a positive effect on self-reported health. Birth in another country, in another settlement, and in an urban area, on the contrary, reduceself-reported health. This allows to conclude that there exists an unfair inequality in health, namely inequality caused by factors that are independent of a person's own efforts. We estimate the contribution of inequality of opportunity to inequality in health using a nonparametric approach (Checchi, Peragine, 2010; Lazar, 2013). According to the obtained results, the contribution of unfair inequality as 72-74% for the population as a whole, being slightly higher for women (62-74% and 60-69% for men and women, respectively) and for older age (59- 62% and 67-75% for groups 25-44 years old and 45-74 years old, respectively). The obtained estimates are comparable with the results for other countries and indicate the importance of the problem of inequality of opportunities in health in Russia.

Keywords: inequality of opportunity, inequality in health, self-reported health, efforts, health-related lifestyle, Russia, RLMS

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9708 The Experiences of Claiming Welfare Benefits for People with Disabilities in the UK

Authors: Jennifer McNeill

Abstract:

Over the years UK Governments have extended the use of welfare conditionality to more marginalised groups. Whereas in the past, disabled people’s rights to unconditional welfare were defended, significant numbers of disabled people have in recent years been re-classified as ‘fit for work’ as a result of this policy shift towards increased conditionality targeting more welfare service user groups. This paper discusses findings from a five-year project exploring the ethics and efficacy of welfare conditionality. Drawing on repeat interviews over three years with 58 disabled welfare service users across England and Scotland, the paper explores the experience of, and impact of conditionality upon, disabled participants. In particular, participants described the process of claiming disability-related benefits as stigmatising, with some describing the medical assessments as demeaning, traumatic and even painful. The medical assessments are conducted by private contractors and participants felt they were treated unfairly, under suspicion and under surveillance. This finding is important in line with a recent UN report concerned with the practice of such assessments. The findings reveal that notions of ‘deservedness’ are embedded in this system as disabled recipients argue for their entitlement to welfare claims relative to what are deemed to be less deserving groups of benefit claimants. This indicates an increasing competition ethic within different sections of the most marginalised social groups that facilitate further forms of social fragmentation, particularly in relation to opposition to benefit cuts and other changes requiring concerted and organised forms of resistance. The impact of media and political scapegoating of the most marginal has generated divisions within even those who position themselves as legitimate recipients.

Keywords: disability, medical assessments, stigma, welfare conditionality

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9707 Estimation of Dynamic Characteristics of a Middle Rise Steel Reinforced Concrete Building Using Long-Term

Authors: Fumiya Sugino, Naohiro Nakamura, Yuji Miyazu

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In earthquake resistant design of buildings, evaluation of vibration characteristics is important. In recent years, due to the increment of super high-rise buildings, the evaluation of response is important for not only the first mode but also higher modes. The knowledge of vibration characteristics in buildings is mostly limited to the first mode and the knowledge of higher modes is still insufficient. In this paper, using earthquake observation records of a SRC building by applying frequency filter to ARX model, characteristics of first and second modes were studied. First, we studied the change of the eigen frequency and the damping ratio during the 3.11 earthquake. The eigen frequency gradually decreases from the time of earthquake occurrence, and it is almost stable after about 150 seconds have passed. At this time, the decreasing rates of the 1st and 2nd eigen frequencies are both about 0.7. Although the damping ratio has more large error than the eigen frequency, both the 1st and 2nd damping ratio are 3 to 5%. Also, there is a strong correlation between the 1st and 2nd eigen frequency, and the regression line is y=3.17x. In the damping ratio, the regression line is y=0.90x. Therefore 1st and 2nd damping ratios are approximately the same degree. Next, we study the eigen frequency and damping ratio from 1998 after 3.11 earthquakes, the final year is 2014. In all the considered earthquakes, they are connected in order of occurrence respectively. The eigen frequency slowly declined from immediately after completion, and tend to stabilize after several years. Although it has declined greatly after the 3.11 earthquake. Both the decresing rate of the 1st and 2nd eigen frequencies until about 7 years later are about 0.8. For the damping ratio, both the 1st and 2nd are about 1 to 6%. After the 3.11 earthquake, the 1st increases by about 1% and the 2nd increases by less than 1%. For the eigen frequency, there is a strong correlation between the 1st and 2nd, and the regression line is y=3.17x. For the damping ratio, the regression line is y=1.01x. Therefore, it can be said that the 1st and 2nd damping ratio is approximately the same degree. Based on the above results, changes in eigen frequency and damping ratio are summarized as follows. In the long-term study of the eigen frequency, both the 1st and 2nd gradually declined from immediately after completion, and tended to stabilize after a few years. Further it declined after the 3.11 earthquake. In addition, there is a strong correlation between the 1st and 2nd, and the declining time and the decreasing rate are the same degree. In the long-term study of the damping ratio, both the 1st and 2nd are about 1 to 6%. After the 3.11 earthquake, the 1st increases by about 1%, the 2nd increases by less than 1%. Also, the 1st and 2nd are approximately the same degree.

Keywords: eigenfrequency, damping ratio, ARX model, earthquake observation records

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9706 Evaluation of Occupational Exposure to Chromium for Welders of Stainless Steel

Authors: L. Musak, J. Valachova, T. Vasicko, O. Osina

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Stainless steel is resistant to electrochemical corrosion by passivation. Welders are greatly exposed to welding fumes of toxic metals, which added to this steel. The content of chromium (Cr) is above 11.5%, Ni and Mo from 2 to 6.5%. The aim of the study was the evaluation of occupational exposure to Cr, chromosome analysis and valuation of individual susceptibility polymorphism of gene CCND1 c.870 G>A. The exposed group was consisted from 117 welders of stainless steels. The average age was 38.43 years and average exposure time 7.14 years. Smokers represented 40.17%. The control group consisted of 123 non-exposed workers with an average age of 39.74 years and time employment 16.67 years. Smokers accounted for 22.76%. Analysis of Cr in blood and urine was performed by atomic absorption spectrophotometry (AAS Varian SpectraAA 30P) with electrothermal decomposition of the sample in the graphite furnace. For the evaluation of chromosomal aberrations (CA) cytogenetic analysis of peripheral blood lymphocytes was used. Gene polymorphism was determined by PCR-RFLP reaction using appropriate primers and restriction enzymes. For statistic analysis the Mann-Whitney U-test was used. The mean Cr level in blood of exposed group was 0.095 µmol/l (0.019 min - max 0.504). No value exceeds the average normal value. The mean value Cr in urine was 7.9 µmol/mol creatinine (min 0.026 to max 19.26). The total number of CA was 1.86% in compared to 1.70% controls. (CTA-type 0.90% vs. 0.80% and CSA-type 0.96% vs. 0.90%). In the number of total CA statistical difference was observed between smokers and non-smokers of exposed group (S-1.57% vs. NS-2.04%, P<0.05). In CCND1 gene polymorphisms was observed the increasing of the total CA with wild-type allele (WT) via heterozygous to the VAR genotype (1.44% <1.82% <2.13%). A statistically higher incidence of CTA-type aberrations in variant genotypes between exposed and control groups was observed (1.22% vs. 0.59%, P <0.05). The work place is usually higher source of exposure to harmful factors. Workers need consistent and frequent health control. In assessing the risk of adverse effects of metals it is important to consider their persistence, behavior and bioavailability. Prolonged exposure to carcinogens may not manifest symptoms of poisoning, but delayed effects may occur, which resulted in a higher incidence of malignant tumors.

Keywords: CCND1, genotoxicity, polymorphism, stainless steel, welders

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9705 Weight Status, Body Appreciation Correlated with Husbands' Satisfaction in Saudi Women

Authors: Hala Hzam Al Otaibi

Abstract:

Background: Obesity is more common among Saudi women compared to men, with 75–88% of adult women suffering from overweight or obesity and most of them married. Weight status and body appreciation are an important factor in maintaining or loss weight behaviors and for husbands satisfaction. Aims: To assess weight status, body appreciation and related factors, including age, level of education, occupation status husbands satisfaction in adult women. Methods: A cross-sectional study conducted among 326 married women, aged 18 to 60 years old in Eastern of Saudi Arabia. Data were collected by face to face interview, height and weight were measured to calculate body mass index (BMI). Body Appreciation Scale (BAS) and husbands satisfied were evaluated through questioning. Results: The majority of women has a university education, not employed and less than 40 years old (66.5%, 69.9%, 67.5%; respectively). Fifty-four percent of women overweight/obese and the rest were normal weight, BAS mean score was lower in younger women (>40 years) 7.39+2.20 and obese women (6.83+2.16) which is reflected lower body appreciation. Husbands' satisfaction regarding the weight status shows 47.6% of normal weight believed their husbands were dissatisfied with their weight and consider them as overweight/obese, 28.3% of overweight/obese thought their husbands satisfied with their weight and consider them as normal weight. Body appreciation correlated with age (r.139,p<0.05) and no correlation found for level of education and employed status. Husbands satisfaction strongly correlated with body appreciation (r.189,p<0.01) and weight status (r .570,p <0.01). Conclusion: Our findings indicate that women had a low body appreciation related to age, weight status and husbands' dissatisfaction. Future interventions aimed to weight reduction, it is important to consider husband satisfaction, as well as we need more assessment of weight satisfaction in younger women.

Keywords: body appreciation, husbands satisfaction, weight status, women

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9704 Osseointegration Outcomes Following Amputee Lengthening

Authors: Jason Hoellwarth, Atiya Oomatia, Anuj Chavan, Kevin Tetsworth, Munjed Al Muderis

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Introduction: Percutaneous EndoProsthetic Osseointegration for Limbs (PEPOL) facilitates improved quality of life (QOL) and objective mobility for most amputees discontent with their traditional socket prosthesis (TSP) experience. Some amputees desiring PEPOL have residual bone much shorter than the currently marketed press-fit implant lengths of 14-16 cm, potentially a risk for failure to integrate. We report on the techniques used, complications experienced, the management of those complications, and the overall mobility outcomes of seven patients who had femur distraction osteogenesis (DO) with a Freedom nail followed by PEPOL. Method: Retrospective evaluation of a prospectively maintained database identified nine patients (5 females) who had transfemoral DO in preparation for PEPOL with two years of follow-up after PEPOL. Six patients had traumatic causes of amputation, one had perinatal complications, one was performed to manage necrotizing fasciitis and one was performed as a result of osteosarcoma. Result: The average age at which DO commenced was 39.4±15.9 years, and seven patients had their amputation more than ten years prior (average 25.5±18.8 years). The residual femurs, on average, started at 102.2±39.7 mm and were lengthened 58.1±20.7 mm, 98±45% of the goal (99±161% of the original bone length). Five patients (56%) had a complication requiring additional surgery: four events of inadequate regeneration were managed with continued lengthening to the desired goal followed by autograft placement harvested from contralateral femur reaming; one patient had the cerclage wires break, which required operative replacement. All patients had osseointegration performed at 355±123 days after the initial lengthening nail surgery. One patient had K-level >2 before DO, at a mean of 3.4±0.6 (2.6-4.4) years following osseointegration. Six patients had K-level >2. The 6-Minute Walk Test remained unchanged (267±56 vs. 308 ± 117 meters). Patient self-rating of prosthesis function, problems, and amputee situation did not significantly change from before DO to after osseointegration. Six patients required additional surgery following osseointegration: six to remove fixation plates placed to maintain distraction osteogenesis length at osseointegration; two required irritation and debridement for infection. Conclusion: Extremely short residual femurs, which make TSP use troublesome, can be lengthened with externally controlled telescoping nails and successfully achieve osseointegration. However, it is imperative to counsel patients that additional surgery to address inadequate regeneration or to remove painful hardware used to maintain fixation may be necessary. This may improve the amputee’s expectations before beginning a potentially arduous process.

Keywords: osseointegration, limb lengthening, quality of life, amputation

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9703 The Effect of an e-Learning Program of Basic Cardiopulmonary Resuscitation for Students of an Emergency Medical Technician Program

Authors: Itsaree Padphai, Jiranan Pakpeian, Suksun Niponchai

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This study is a descriptive research which aims to: 1) Compare the difference of knowledge before and after using the e-Learning program entitled “Basic Cardiopulmonary Resuscitation for Students in an Emergency Medical Technician Diploma Program”, and 2) Assess the students’ satisfaction after using the said program. This research is a kind of teaching and learning management supplemented with the e-Learning system; therefore, the purposively selected samples are 44 first-year and class-16 students of an emergency medical technician diploma program who attend the class in a second semester of academic year 2012 in Sirindhorn College of Public Health, Khon Kaen province. The research tools include 1) the questionnaire for general information of the respondents, 2) the knowledge tests before and after using the e-Learning program, and 3) an assessment of satisfaction in using the e-Learning program. The statistics used in data analysis percentage, include mean, standard deviation, and inferential statistics: paired t-test. 1. The general information of the respondents was mostly 37 females representing 84.09 percent. The average age was 19.5 years (standard deviation was 0.81), the maximum age was 21 years, and the minimum age was 19 years respectively. Students (35 subjects) admitted that they preferred the methods of teaching and learning by using the e-Learning systems. This was totally 79.95 percent. 2. A comparison on the difference of knowledge before and after using the e-Learning program showed that the mean before an application was 6.64 (standard deviation was 1.94) and after was 18.84 (standard deviation 1.03), which was higher than the knowledge of students before using the e-Learning program with the statistical significance (P value < 0.001). 3. For the satisfaction after using the e-Learning program, it was found that students’ satisfaction was at a very good level with the mean of 4.93 (standard deviation was 0.11).

Keywords: e-Learning, cardiopulmonary resuscitation, diploma program, Khon Kaen Province

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9702 Management of Renal Malignancies with IVC Thrombus: Our Experience

Authors: Sujeet Poudyal

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Introduction: Renal cell carcinoma is the most common malignancy associated with Inferior vena cava (IVC) thrombosis. Radical nephrectomy with tumor thrombectomy provides durable cancer-free survival. Other renal malignancies like Wilms’ tumors are also associated with IVC thrombus. We describe our experience with the management of renal malignancies associated with IVC thrombus. Methods: This prospective study included 28 patients undergoing surgery for renal malignancies associated with IVC thrombus from February 2017 to March 2023. Demographics of patients, types of renal malignancy, level of IVC thrombus, intraoperative details, need for venovenous bypass, cardiopulmonary bypass and postoperative outcomes were all documented. Results: Out of a total of 28 patients, 24 patients had clear cell Renal Cell Carcinoma,1 had renal osteosarcoma and 3 patients had Wilms tumor. The levels. of thrombus were II in eight, III in seven, and IV in six patients. The mean age of RCC was 62.81±10.2 years, renal osteosarcoma was 26 years and Wilms tumor was 23 years. There was a need for venovenous bypass in four patients and cardiopulmonary bypass in four patients, and the Postoperative period was uneventful in most cases except for two mortalities, one in Level III due to pneumonia and one in Level IV due to sepsis. All cases followed up till now have no local recurrence and metastasis except one case of RCC with Level IV IVC thrombus, which presented with paraaortic nodal recurrence and is currently managed with sunitinib. Conclusion: The complexity in the management of renal malignancy with IVC thrombus increases with the level of IVC thrombus. As radical nephrectomy with tumor thrombectomy provides durable cancer-free survival in most cases, the surgery should be undertaken in an expert and experienced setup with a strong cardiovascular backup to minimize morbidity and mortality associated with the procedure.

Keywords: renal malignancy, IVC thrombus, radical nephrectomy with tumor thrombectomy, renal cell carcinoma

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9701 The Visual Side of Islamophobia: A Social-Semiotic Analysis

Authors: Carmen Aguilera-Carnerero

Abstract:

Islamophobia, the unfounded hostility towards Muslims and Islam, has been deeply studied in the last decades from different perspectives ranging from anthropology, sociology, media studies, and linguistics. In the past few years, we have witnessed how the birth of social media has transformed formerly passive audiences into an active group that not only receives and digests information but also creates and comments publicly on any event of their interest. In this way, average citizens now have been entitled with the power of becoming potential opinion leaders. This rise of social media in the last years gave way to a different way of Islamophobia, the so called ‘cyberIslamophobia’. Considerably less attention, however, has been given to the study of islamophobic images that accompany the texts in social media. This paper attempts to analyse a corpus of 300 images of islamophobic nature taken from social media (from Twitter and Facebook) from the years 2014-2017 to see: a) how hate speech is visually constructed, b) how cyberislamophobia is articulated through images and whether there are differences/similarities between the textual and the visual elements, c) the impact of those images in the audience and their reaction to it and d) whether visual cyberislamophobia has undergone any process of permeating popular culture (for example, through memes) and its real impact. To carry out this task, we have used Critical Discourse Analysis as the most suitable theoretical framework that analyses and criticizes the dominant discourses that affect inequality, injustice, and oppression. The analysis of images was studied according to the theoretical framework provided by the visual framing theory and the visual design grammar to conclude that memes are subtle but very powerful tools to spread Islamophobia and foster hate speech under the guise of humour within popular culture.

Keywords: cyberIslamophobia, visual grammar, social media, popular culture

Procedia PDF Downloads 138
9700 Satisfaction in Supreme Financial Disbursement in the Faculty of Science and Technology, Suan Sunandha Rajabhat University

Authors: Adisai Thovicha, Jiranan Pattaphong

Abstract:

The objective of this research is to study the satisfaction of the disbursement of the Faculty of Science and Technology, Suan Sunandha Rajabhat University. The sample of this study consisted of 98 participants who are faculty members and staff of the Faculty of Science and Technology. Sample was drawn by systematic random sampling technique. Questionnaire was used to collect data. Analysis involves frequency, percentage, mean and standard deviation. It was found that: (1) Most of the 98 faculty members and staff are female, aged between 31-40 years and they have been working at the university for 1-5 years. (2) The satisfaction level of the disbursement of the Faculty of Science and Technology, Suan Sunandha Rajabhat University is high. When each aspect is considered, the satisfaction level of faculty members and staff of the Faculty of Science and Technology is high in service providing staff, process and facilitation.

Keywords: satisfaction of disbursement, petition financing, faculty members, staff

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9699 Attitudes of the Staff in the Faculty of Science and Technology towards the E-Office Documentary System of the Faculty of Science and Technology, Suan Sunandha Rajabhat University

Authors: Narinee Sophatsathit, Yuwadee Nitutorn

Abstract:

The purpose of this study was to investigate the attitudes of the staff in the Faculty of Science and Technology towards the e-office documentary system of the Faculty of Science and Technology, Suan Sunandha Rajabhat University. The subjects of this study included 98 staffs of the Faculty of Science and Technology, Suan Sunandha Rajabhat University. Questionnaires were used to ask the attitude of the staffs towards the implementation of e-office system. The results showed that most of the users of e-office are female with the age between 31-40 years old, master degree of education and in the academic positions. They have working experiences between 1-5 years and reported the time of using e-office between 8:30-12:30 during the weekday with the frequency of 3-5 times/day. Most of them reported their opinions on the e-office at high level (x=3.84) and problems and obstacles in using e-office at high level, as well (x=3.63).

Keywords: attitudes, e-office, staff, documentary system

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9698 How to Reach Adolescents Vulnerable for Suicidal Behaviour: A Qualitative Study

Authors: Birgit Reime, Sonja Gscheidle, Toni Hübener, Lara Hübener

Abstract:

Suicide in individuals under 30 years is a global public health concern. The objective of this study was to identify strategies for the prevention of suicide and suicidal behavior preferred by adolescents and young adults who are vulnerable to suicidal behavior and by relevant experts. Using semi-structured interviews with n= 17 adolescents and young adults (18-25 years of age) and with n= 11 experts from relevant fields, we have applied an inductive approach and applied thematic content analysis. Six strategies for suicide prevention in young individuals were reported. These were digital solutions with appealing designs, anonymous support, trained peer support, spiritual support, improving existing structures, and raising suicide literacy. Accessibility of anonymous digital support may contribute to suicide prevention in young people.

Keywords: suicide prevention, adolescents, E-health, Germany

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9697 Determining the Factors Affecting Social Media Addiction (Virtual Tolerance, Virtual Communication), Phubbing, and Perception of Addiction in Nurses

Authors: Fatima Zehra Allahverdi, Nukhet Bayer

Abstract:

Objective: Three questions were formulated to examine stressful working units (intensive care units, emergency unit nurses) utilizing the self-perception theory and social support theory. This study provides a distinctive input by inspecting the combination of variables regarding stressful working environments. Method: The descriptive research was conducted with the participation of 400 nurses working at Ankara City Hospital. The study used Multivariate Analysis of Variance (MANOVA), regression analysis, and a mediation model. Hypothesis one used MANOVA followed by a Scheffe post hoc test. Hypothesis two utilized regression analysis using a hierarchical linear regression model. Hypothesis three used a mediation model. Result: The study utilized mediation analyses. Findings supported the hypotheses that intensive care units have significantly high scores in virtual communication and virtual tolerance. The number of years on the job, virtual communication, virtual tolerance, and phubbing significantly predicted 51% of the variance of perception of addiction. Interestingly, the number of years on the job, while significant, was negatively related to perception of addiction. Conclusion: The reasoning behind these findings and the lack of significance in the emergency unit is discussed. Around 7% of the variance of phubbing was accounted for through working in intensive care units. The model accounted for 26.80 % of the differences in the perception of addiction.

Keywords: phubbing, social media, working units, years on the job, stress

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9696 Hybridization and Evaluation of Jatropha to Improve High Yield Varieties in Indonesia

Authors: Rully D. Purwati, Tantri D.A. Anggraeni, Bambang Heliyanto, M. Machfud, Joko Hartono

Abstract:

The availability of fuel in the world will be reduced in next few years, it is necessary to find alternative energy sources. Jatropha curcas L. is one of oil crops producing non-edible oil which is potential for bio-diesel. Jatropha cultivation and development program in Indonesia is facing several problems especially low seed yield resulting in inefficient crop cultivation cost. To cope with the problem, development of high yielding varieties is necessary. Development of new varieties to improve seed yield was conducted by hybridization and selection and resulted in fourteen potential genotypes. The yield potential of the fourteen genotypes were evaluated and compared with two check varieties. The objective of the evaluation was to find Jatropha hybrids with some characters i.e. their productivity was higher than check varieties, oil content > 40% and harvesting age ≤ 110 days. Hybridization and individual plant selection were carried out from 2010 to 2014. Evaluation of high yield was conducted in Asembagus experimental station, Situbondo, East Java in three years (2015-2017). The experimental designed was Randomized Complete Block Design with three replication, and plot size 10 m x 8 m. The characters observed were number of capsules per plant, dry seed yield (kg/ha) and seed oil content (%). The results of this experiment indicated that all the hybrids evaluated have higher productivity than check variety IP-3A. There were two superior hybrids i.e. HS-49xSP-65/32 and HS-49xSP-19/28 with highest seed yield per hectare and number of capsules per plant for three years.

Keywords: Jatropha, bio energy, hybrid, high seed yield

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9695 Still Hepatocellular Carcinoma Risk Despite Proper Treatment of Chronic Viral Hepatitis

Authors: Sila Akhan, Muge Toygar, Murat Sayan, Simge Fidan

Abstract:

Chronic viral hepatitis B, C, and D can cause hepatocellular carcinoma (HCC), cirrhosis and death. The proper treatment reduce the risk of development of HCC importantly, but not to zero point. Materials and Methods: We analysed retrospectively our chronic viral hepatitis B, C and D patients who attended to our Infectious Diseases policlinic between 2004-2018. From 589 biopsy-proven chronic hepatitis patients 3 have hepatocellular carcinoma on our follow up. First case is 74 years old patient. His HCV infection diagnosis was made 8 years ago. First treatment was pegylated interferon plus ribavirin only 28 weeks, because of HCV RNA breakthrough under treatment. In 2013 he was retreated with telaprevir, pegylated interferon plus ribavirin 24 weeks. But at the end of the therapy HCV RNA was found 1.290.000 IU/mL. He has abdominal ultrasonography (US) controls and alpha-fetoprotein (AFP) at 6 months intervals. All seemed normal until 2015 then he has an abdominal magnetic resonance imaging (MRI) and found HCC by chance. His treatment began in Oncology Clinic after verified with biopsy of HCC. And then sofosbuvir/ledipasvir was given to him for HCV 24 weeks. Sustained virologic response (SVR) was obtained. He is on cure for HCV infection and under control of Oncology for HCC. Second patient is 36 years old man. He knows his HBV infection since 2008. HBsAg and HBeAg positive; HDV RNA negative. Liver biopsy revealed grade:4, stage 3-4 according modified Knodell scoring system. In 2010 tenofovir treatment was began. His abdominal US and AFP were normal. His controls took place at 6 months intervals and HBV DNA negative, US, and AFP were normal until 2016 continuously. AFP found 37 above the normal range and then HCC was found in MRI. Third patient is 57 years old man. As hepatitis B infection was first diagnosed; he has cirrhosis and was began tenofovir as treatment. In short time he has HCC despite normal AFP values. Conclusion: In Mediterranian countries including Turkey naturally occurring pre-S/S variants are more than 75% of all chronic hepatitis B patients. This variants may contribute to the development of progressive liver damage and hepatocarcinogenesis. HCV-induced development of HCC is a gradual process and is affected by the duration of disease and viral genotype. All the chronic viral hepatitis patients should be followed up in 6 months intervals not only with US and AFP for HCC. Despite they have proper treatment there is always the risk development of HCC. Chronic hepatitis patients cannot be dropped from follow up even treated well.

Keywords: HCC, HCV, HBV, DAA

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9694 Increase the Ductility of Tall Buildings Using Green Material Bamboo for Earthquake Zone

Authors: Shef Amir Arasy

Abstract:

In 2023, the world's population will be 7.8 billion, which has increased significantly in the last 20 years. Every country in the world is experiencing the impacts of climate change directly and indirectly. However, the community still needs to build massive infrastructure and buildings. The massive CO2 emissions which lead to climate change come from cement usage in construction activity. Bamboo is one of the most sustainable materials for reducing carbon emissions and releasing more than 30% oxygen compared to the mass of trees. Besides, bamboo harvest time is faster than other sustainable materials, around 3-4 years. Furthermore, Bamboo has a high tensile strength, which can provide ductility effectively to prevent damage to buildings during an earthquake. By the finite element method, this research analyzes bamboo configuration and connection for tall building structures under different earthquake frequencies and fire. The aim of this research is to provide proper design and connection of bamboo buildings that can be more reliable than concrete structures.

Keywords: bamboo, concrete, ductility, earthquake.

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9693 Contribution of Word Decoding and Reading Fluency on Reading Comprehension in Young Typical Readers of Kannada Language

Authors: Vangmayee V. Subban, Suzan Deelan. Pinto, Somashekara Haralakatta Shivananjappa, Shwetha Prabhu, Jayashree S. Bhat

Abstract:

Introduction and Need: During early years of schooling, the instruction in the schools mainly focus on children’s word decoding abilities. However, the skilled readers should master all the components of reading such as word decoding, reading fluency and comprehension. Nevertheless, the relationship between each component during the process of learning to read is less clear. The studies conducted in alphabetical languages have mixed opinion on relative contribution of word decoding and reading fluency on reading comprehension. However, the scenarios in alphasyllabary languages are unexplored. Aim and Objectives: The aim of the study was to explore the role of word decoding, reading fluency on reading comprehension abilities in children learning to read Kannada between the age ranges of 5.6 to 8.6 years. Method: In this cross sectional study, a total of 60 typically developing children, 20 each from Grade I, Grade II, Grade III maintaining equal gender ratio between the age range of 5.6 to 6.6 years, 6.7 to 7.6 years and 7.7 to 8.6 years respectively were selected from Kannada medium schools. The reading fluency and reading comprehension abilities of the children were assessed using Grade level passages selected from the Kannada text book of children core curriculum. All the passages consist of five questions to assess reading comprehension. The pseudoword decoding skills were assessed using 40 pseudowords with varying syllable length and their Akshara composition. Pseudowords are formed by interchanging the syllables within the meaningful word while maintaining the phonotactic constraints of Kannada language. The assessment material was subjected to content validation and reliability measures before collecting the data on the study samples. The data were collected individually, and reading fluency was assessed for words correctly read per minute. Pseudoword decoding was scored for the accuracy of reading. Results: The descriptive statistics indicated that the mean pseudoword reading, reading comprehension, words accurately read per minute increased with the Grades. The performance of Grade III children found to be higher, Grade I lower and Grade II remained intermediate of Grade III and Grade I. The trend indicated that reading skills gradually improve with the Grades. Pearson’s correlation co-efficient showed moderate and highly significant (p=0.00) positive co-relation between the variables, indicating the interdependency of all the three components required for reading. The hierarchical regression analysis revealed 37% variance in reading comprehension was explained by pseudoword decoding and was highly significant. Subsequent entry of reading fluency measure, there was no significant change in R-square and was only change 3%. Therefore, pseudoword-decoding evolved as a single most significant predictor of reading comprehension during early Grades of reading acquisition. Conclusion: The present study concludes that the pseudoword decoding skills contribute significantly to reading comprehension than reading fluency during initial years of schooling in children learning to read Kannada language.

Keywords: alphasyllabary, pseudo-word decoding, reading comprehension, reading fluency

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9692 Use of Dendrochronology in Estimation of Creep Velocity and Its Dependence on the Bulk Density of Soils

Authors: Mohammad Amjad Sabir, Ishtiaq Khan, Shahid Ali, Umar Shabbir, Aneel Ahmad

Abstract:

Creep, being the main silt contributor to the rivers, is a slow, downhill flow of soils. The creep velocity is measured in millimeters to a couple of centimeters per year and is determined with the help of tilt caused by creep in the vertical objects and needs at least ten years to get a reliable creep velocity. This project was devised to calculate creep velocity using dendrochronology and looking for the difference of creep velocity registered by different trees on the same slope. It was concluded that dendrochronology provides a very reliable procedure of creep velocity estimation if ‘J’ shaped trees are studied for their horizontal movement and age. The age of these trees was measured using tree coring, and the horizontal movement was measured with a conventional tape. Using this procedure it does not require decades and additionally the data reveals the creep velocity for up to 150 years and even more instead of just a decade. It was also concluded that the creep velocity does not only depend on bulk density of soil hence no pronounced effect of bulk density was detected.

Keywords: creep velocity, Galiyat, Pakistan, dendrochronology, Nagri Bala

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9691 Assessment Of Factors Affecting Sustainability of Rice (Oryza sativa) Processing and Marketing in Ogun State, Nigeria

Authors: A. M. Omoare, O. O. Sofowora, W. O. Oyediran

Abstract:

The study was carried out to assess the factors affecting the sustainability of rice processing and marketing in Ogun State, Nigeria. Multi-stage sampling technique was used to select one hundred and twenty (120) respondents for the study. Descriptive statistics was used to describe the objectives while hypotheses were analyzed with Pearson Product Moment Correlation. The result showed that most (85%) of the respondents was less than 50 years old and had been in rice business for more than 6 years. The majority (66.67%) of the respondents got their capitals from cooperative societies. All (100%) the respondents used rice as household food security and source of income. However, efficient rice processing and marketing were affected by inadequate manpower capacity development and inputs. There was a positive and significant relationship between socio-economic characteristics and processing techniques (p < 0.05). It is hereby recommended that extension service providers should introduce improved rice processing systems to the rice millers traders in the study area.

Keywords: sustainability, rice processing, marketing, constraints, millers traders

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9690 The Significance of Organizational Failure Based on the Instance of Samsung Lions Case

Authors: Jae Soo Do, Kyoung Seok Kim

Abstract:

Korea baseball experts reckoned Samsung Lions as the best baseball team. It has the unparalleled records of winning first place in the pennant race for five straight years from 2011 to 2015 and winning the Korean series for four years in a row from 2011 to 2014. However, the team made an unbelievably miserable record of ninth place in the pennant race in 2016 and 2017. How come the strong competitive superiority has gone and what kind of slump made the team how it is now. This study investigates this organizational failure case of Samsung Lions, the professional baseball team in Korea. What factors have brought the organizational failure to Samsung Lions? Based on an in-depth examination on how a league-fore-runner drastically lost its competitive superiority, this verifies the necessity of risk management to which common corporations as well as sport teams can be subject at any time in these days.

Keywords: Samsung Lions, organizational failure, baseball, slump

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9689 Impacts of Climate Change on Water Resources Management in the Mahi River Basin of India

Authors: Y. B. Sharma, K. B. Biswas

Abstract:

This research project examines a 5000 cal yr BP sediment core record to reveal the consequences of human impact and climate variability on the tropical dry forests of the Mahi river basin, western India. To date there has been little research to assess the impact of climate variability and human impact on the vegetation dynamics of this region. There has also been little work to link changes in vegetation cover to documented changes in the basin hydrology over the past 100 years – although it is assumed that the two are closely linked. The key objective of this research project therefore is to understand the driving mechanisms responsible for the abrupt changes in the Mahi river basin as detailed in historical documentation and its impact on water resource management. The Mahi river basin is located in western India (22° 11’-24° 35’ N 72° 46’-74° 52’ E). Mahi river arises in the Malwa Plateau, Madhya Pradesh near Moripara and flows through the uplands and alluvial plain of Rajasthan and Gujarat provinces before draining into the Gulf of Cambay. Palaeoecological procedures (sedimentology, geochemical analysis, C&N isotopes and fossil pollen evidences) have been applied on sedimentary sequences collected from lakes in the Mahi basin. These techniques then facilitate to reconstruct the soil erosion, nutrient cycling, vegetation changes and climatic variability over the last 5000 years. Historical documentation detailing changes in demography, climate and landscape use over the past 100 years in this region will also be collated to compare with the most recent palaeoecological records. The results of the research work provide a detailed record of vegetation change, soil erosion, changes in aridity, and rainfall patterns in the region over the past 5000 years. This research therefore aims to determine the drivers of change and natural variability in the basin. Such information is essential for its current and future management including restoration.

Keywords: human impact, climate variability, vegetation cover, hydrology, water resource management, Mahi river basin, sedimentology, geochemistry, fossil pollen, nutrient cycling, vegetation changes, palaeoecology, aridity, rainfall, drivers of change

Procedia PDF Downloads 346
9688 Application of 3-6 Years Old Children Basketball Appropriate Forms of Teaching Auxiliary Equipment in Early Childhood Basketball Game

Authors: Hai Zeng, Anqing Liu, Shuguang Dan, Ying Zhang, Yan Li, Zihang Zeng

Abstract:

Children are strong; the country strong, the development of children Basketball is a strategic advantage. Common forms of basketball equipment has been difficult to meet the needs of young children teaching the game of basketball, basketball development for 3-6 years old children in the form of appropriate teaching aids is a breakthrough basketball game teaching children bottlenecks, improve teaching critical path pleasure, but also the development of early childhood basketball a necessary requirement. In this study, literature, questionnaires, focus group interviews, comparative analysis, for domestic and foreign use of 12 kinds of basketball teaching aids (cloud computing MINI basketball, adjustable basketball MINI, MINI basketball court, shooting assist paw print ball, dribble goggles, dribbling machine, machine cartoon shooting, rebounding machine, against the mat, elastic belt, ladder, fitness ball), from fun and improve early childhood shooting technique, dribbling technology, as well as offensive and defensive rebounding against technology conduct research on conversion technology. The results show that by using appropriate forms of teaching children basketball aids, can effectively improve children's fun basketball game, targeted to improve a technology, different types of aids from different perspectives enrich the connotation of children basketball game. Recommended for children of color psychology, cartoon and environmentally friendly material production aids, and increase research efforts basketball aids children, encourage children to sports teachers aids applications.

Keywords: appropriate forms of children basketball, auxiliary equipment, appli, MINI basketball, 3-6 years old children, teaching

Procedia PDF Downloads 357
9687 A Digital Health Approach: Using Electronic Health Records to Evaluate the Cost Benefit of Early Diagnosis of Alpha-1 Antitrypsin Deficiency in the UK

Authors: Sneha Shankar, Orlando Buendia, Will Evans

Abstract:

Alpha-1 antitrypsin deficiency (AATD) is a rare, genetic, and multisystemic condition. Underdiagnosis is common, leading to chronic pulmonary and hepatic complications, increased resource utilization, and additional costs to the healthcare system. Currently, there is limited evidence of the direct medical costs of AATD diagnosis in the UK. This study explores the economic impact of AATD patients during the 3 years before diagnosis and to identify the major cost drivers using primary and secondary care electronic health record (EHR) data. The 3 years before diagnosis time period was chosen based on the ability of our tool to identify patients earlier. The AATD algorithm was created using published disease criteria and applied to 148 known AATD patients’ EHR found in a primary care database of 936,148 patients (413,674 Biobank and 501,188 in a single primary care locality). Among 148 patients, 9 patients were flagged earlier by the tool and, on average, could save 3 (1-6) years per patient. We analysed 101 of the 148 AATD patients’ primary care journey and 20 patients’ Hospital Episode Statistics (HES) data, all of whom had at least 3 years of clinical history in their records before diagnosis. The codes related to laboratory tests, clinical visits, referrals, hospitalization days, day case, and inpatient admissions attributable to AATD were examined in this 3-year period before diagnosis. The average cost per patient was calculated, and the direct medical costs were modelled based on the mean prevalence of 100 AATD patients in a 500,000 population. A deterministic sensitivity analysis (DSA) of 20% was performed to determine the major cost drivers. Cost data was obtained from the NHS National tariff 2020/21, National Schedule of NHS Costs 2018/19, PSSRU 2018/19, and private care tariff. The total direct medical cost of one hundred AATD patients three years before diagnosis in primary and secondary care in the UK was £3,556,489, with an average direct cost per patient of £35,565. A vast majority of this total direct cost (95%) was associated with inpatient admissions (£3,378,229). The DSA determined that the costs associated with tier-2 laboratory tests and inpatient admissions were the greatest contributors to direct costs in primary and secondary care, respectively. This retrospective study shows the role of EHRs in calculating direct medical costs and the potential benefit of new technologies for the early identification of patients with AATD to reduce the economic burden in primary and secondary care in the UK.

Keywords: alpha-1 antitrypsin deficiency, costs, digital health, early diagnosis

Procedia PDF Downloads 141