Search results for: tertiary treatment
8325 Sport-Related Hand and Wrist Injuries Treatment
Authors: Sergei Kosarev
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Wrong treatment tactics for hand and wrist sport-related injuries can lead to the inability to play sports in the future. It is especially important for professional athletes. The members of the Russian Olympic Team are treated in our hospital -Federal Clinical Research Center (Moscow). For their treatment, we use minimally invasive methods such as wrist arthroscopy and also orthobiologics procedures. In 2022 we had cases with scaphoid fracture and TFCC injuries. In all the cases, we were using the arthroscopy technic for treatment. The scaphoid fracture was fixed by K-wires with free bone grafting. For TFCC injures we used transossal sutures. Rehabilitation started the next day after surgery. Rehabilitation included hand therapy and physiotherapy. All athletes returned to the sport after 8-12 weeks after surgery. One of them had pain in the wrist after 12 weeks after surgery, not more than 4 point VAS. Pain syndrome was blocked after 2 PRP injections in the ulnar side of the wrist.Keywords: sport trauma, wrist arthroscopy, wrist pain, scaphoid fracture
Procedia PDF Downloads 998324 Optimization of Alkali Silicate Glass Heat Treatment for the Improvement of Thermal Expansion and Flexural Strength
Authors: Stephanie Guerra-Arias, Stephani Nevarez, Calvin Stewart, Rachel Grodsky, Denis Eichorst
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The objective of this study is to describe the framework for optimizing the heat treatment of alkali silicate glasses, to enhance the performance of hermetic seals in extreme environments. When connectors are exposed to elevated temperatures, residual stresses develop due to the mismatch of thermal expansions between the glass, metal pin, and metal shell. Excessive thermal expansion mismatch compromises the reliability of hermetic seals. In this study, a series of heat treatment schedules will be performed on two commercial sealing glasses (one conventional sealing glass and one crystallizable sealing glass) using a design of experiments (DOE) approach. The coefficient of thermal expansion (CTE) will be measured pre- and post-heat treatment using thermomechanical analysis (TMA). Afterwards, the flexural strength of the specimen will be measured using a four-point bend fixture mounted in a static universal testing machine. The measured material properties will be statistically analyzed using MiniTab software to determine which factors of the heat treatment process have a strong correlation to the coefficient of thermal expansion and/or flexural strength. Finally, a heat-treatment will be designed and tested to ensure the optimal performance of the hermetic seals in connectors.Keywords: glass-ceramics, design of experiment, hermetic connectors, material characterization
Procedia PDF Downloads 1508323 Effects of the Treatment by Polypill Combinations vs Identical Monopill Therapies in Patients with Cardiovascular Comorbid Diseases
Authors: Denys Sebov, Viktoriia Korotaieva, Kateryna Markina
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The clinical advantage of the multipill combination drugs administration (polypill-strategy) over single-component drugs (monopill-strategy) has been established in patients with comorbid arterial hypertension, heart failure, chronic coronary syndrome, diabetes. It was found that polypill-strategy provides better treatment adherence in 33.4% of the patients. It was proven a significant decrease in systolic and diastolic blood pressure, as well as a decrease in dispersion index due to the stability of the blood pressure profile in patients with the polypill-strategy treatment.Keywords: polypill, artetial hypertension, cardiovascular disease, compliance
Procedia PDF Downloads 608322 Photo Catalytic Treatment of Wastewater from Processing Poultry by-Products
Authors: J. Franco Macías, E. Montes Alba, A. López Vásquez
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The growing development in the poultry industry has generated a strong and adverse impact on quality and availability of water resources. Inside this industry, is finding out the treatment of by-products such as feathers, viscera and blood demanding highly water consumption, generating contaminant discharges as well. As one of current of treatment of by-products is the effluent of cooking condensate steam that has contaminant organic load; therefore, it is necessary to implement removal treatments before discharging it toward water sources. The photo catalysis appears as a promising alternative of treatment due to the different advantages it has, among others, includes low cost, easily operation, high efficiency and elimination of a wide variety of contaminants in a watery environment. This study has evaluated a heterogeneous photo catalytic treatment for removal contaminant organic load. This process was developed in oxidation and reduction conditions. It was analyzed the effect of factors such as pH, catalyst and sacrifice agent concentration. Finally, good conditions to removal contaminant organic load were achieved to determine percentage of contaminant organic load by means of response surface methodology.Keywords: poultry industry, advanced oxidation process, photocatalysis, photodegradation, TiO2
Procedia PDF Downloads 4048321 Clinicopathological Characteristics in Male Breast Cancer: A Case Series and Literature Review
Authors: Mohamed Shafi Mahboob Ali
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Male breast cancer (MBC) is a rare entity with overall cases reported less than 1%. However, the incidence of MBC is regularly rising every year. Due to the lack of data on MBC, diagnosis and treatment are tailored to female breast cancer. MBC risk increases with age and is usually diagnosed ten years late as the disease progression is slow compared to female breast cancer (FBC). The most common feature of MBC is an intra-ductal variant, and often, upon diagnosis, the stage of the disease is already advanced. The Prognosis of MBC is often flawed, but new treatment modalities are emerging with the current knowledge and advancement. We presented a series of male breast cancer in our center, highlighting the clinicopathological, radiological and treatment options.Keywords: male, breast, cancer, clinicopathology, ultrasound, CT scan
Procedia PDF Downloads 978320 Computation of Radiotherapy Treatment Plans Based on CT to ED Conversion Curves
Authors: B. Petrović, L. Rutonjski, M. Baucal, M. Teodorović, O. Čudić, B. Basarić
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Radiotherapy treatment planning computers use CT data of the patient. For the computation of a treatment plan, treatment planning system must have an information on electron densities of tissues scanned by CT. This information is given by the conversion curve CT (CT number) to ED (electron density), or simply calibration curve. Every treatment planning system (TPS) has built in default CT to ED conversion curves, for the CTs of different manufacturers. However, it is always recommended to verify the CT to ED conversion curve before actual clinical use. Objective of this study was to check how the default curve already provided matches the curve actually measured on a specific CT, and how much it influences the calculation of a treatment planning computer. The examined CT scanners were from the same manufacturer, but four different scanners from three generations. The measurements of all calibration curves were done with the dedicated phantom CIRS 062M Electron Density Phantom. The phantom was scanned, and according to real HU values read at the CT console computer, CT to ED conversion curves were generated for different materials, for same tube voltage 140 kV. Another phantom, CIRS Thorax 002 LFC which represents an average human torso in proportion, density and two-dimensional structure, was used for verification. The treatment planning was done on CT slices of scanned CIRS LFC 002 phantom, for selected cases. Interest points were set in the lungs, and in the spinal cord, and doses recorded in TPS. The overall calculated treatment times for four scanners and default scanner did not differ more than 0.8%. Overall interest point dose in bone differed max 0.6% while for single fields was maximum 2.7% (lateral field). Overall interest point dose in lungs differed max 1.1% while for single fields was maximum 2.6% (lateral field). It is known that user should verify the CT to ED conversion curve, but often, developing countries are facing lack of QA equipment, and often use default data provided. We have concluded that the CT to ED curves obtained differ in certain points of a curve, generally in the region of higher densities. This influences the treatment planning result which is not significant, but definitely does make difference in the calculated dose.Keywords: Computation of treatment plan, conversion curve, radiotherapy, electron density
Procedia PDF Downloads 4868319 Constructed Wetlands: A Sustainable Approach for Waste Water Treatment
Authors: S. Sehar, S. Khan, N. Ali, S. Ahmed
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In the last decade, the hunt for cost-effective, eco-friendly and energy sustainable technologies for waste water treatment are gaining much attention due to emerging water crisis and rapidly depleting existing water reservoirs all over the world. In this scenario, constructed wetland being a “green technology” could be a reliable mean for waste water treatment especially in small communities due to cost-effectiveness, ease in management, less energy consumption and sludge production. Therefore, a low cost, lab-scale sub-surface flow hybrid constructed wetland (SS-HCW) was established for domestic waste water treatment.It was observed that not only the presence but also choice of suitable vegetation along with hydraulic retention time (HRT) are key intervening ingredients which directly influence pollutant removals in constructed wetlands. Another important aspect of vegetation is that it may facilitate microbial attachment in rhizosphere, thus promote biofilm formation via microbial interactions. The major factors that influence initial aggregation and subsequent biofilm formation i.e. divalent cations (Ca2+) and extra cellular DNA (eDNA) were also studied in detail. The presence of Ca2+ in constructed wetland demonstrate superior performances in terms of effluent quality, i.e BOD5, COD, TDS, TSS, and PO4- than in absence of Ca2+. Finally, light and scanning electron microscopies coupled with EDS were carried out to get more insights into the mechanics of biofilm formation with or without Ca addition. Therefore, the same strategy can be implemented in other waste water treatment technologies.Keywords: hybrid constructed wetland, biofilm formation, waste water treatment, waste water
Procedia PDF Downloads 4028318 A Top-down vs a Bottom-up Approach on Lower Extremity Motor Recovery and Balance Following Acute Stroke: A Randomized Clinical Trial
Authors: Vijaya Kumar, Vidayasagar Pagilla, Abraham Joshua, Rakshith Kedambadi, Prasanna Mithra
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Background: Post stroke rehabilitation are aimed to accelerate for optimal sensorimotor recovery, functional gain and to reduce long-term dependency. Intensive physical therapy interventions can enhance this recovery as experience-dependent neural plastic changes either directly act at cortical neural networks or at distal peripheral level (muscular components). Neuromuscular Electrical Stimulation (NMES), a traditional bottom-up approach, mirror therapy (MT), a relatively new top down approach have found to be an effective adjuvant treatment methods for lower extremity motor and functional recovery in stroke rehabilitation. However there is a scarcity of evidence to compare their therapeutic gain in stroke recovery.Aim: To compare the efficacy of neuromuscular electrical stimulation (NMES) and mirror therapy (MT) in very early phase of post stroke rehabilitation addressed to lower extremity motor recovery and balance. Design: observer blinded Randomized Clinical Trial. Setting: Neurorehabilitation Unit, Department of Physical Therapy, Tertiary Care Hospitals. Subjects: 32 acute stroke subjects with first episode of unilateral stroke with hemiparesis, referred for rehabilitation (onset < 3 weeks), Brunnstorm lower extremity recovery stages ≥3 and MMSE score more than 24 were randomized into two group [Group A-NMES and Group B-MT]. Interventions: Both the groups received eclectic approach to remediate lower extremity recovery which includes treatment components of Roods, Bobath and Motor learning approaches for 30 minutes a day for 6 days. Following which Group A (N=16) received 30 minutes of surface NMES training for six major paretic muscle groups (gluteus maximus and medius,quadriceps, hamstrings, tibialis anterior and gastrocnemius). Group B (N=16) was administered with 30 minutes of mirror therapy sessions to facilitate lower extremity motor recovery. Outcome measures: Lower extremity motor recovery, balance and activities of daily life (ADLs) were measured by Fugyl Meyer Assessment (FMA-LE), Berg Balance Scale (BBS), Barthel Index (BI) before and after intervention. Results: Pre Post analysis of either group across the time revealed statistically significant improvement (p < 0.001) for all the outcome variables for the either group. All parameters of NMES had greater change scores compared to MT group as follows: FMA-LE (25.12±3.01 vs. 23.31±2.38), BBS (35.12±4.61 vs. 34.68±5.42) and BI (40.00±10.32 vs. 37.18±7.73). Between the groups comparison of pre post values showed no significance with FMA-LE (p=0.09), BBS (p=0.80) and BI (p=0.39) respectively. Conclusion: Though either groups had significant improvement (pre to post intervention), none of them were superior to other in lower extremity motor recovery and balance among acute stroke subjects. We conclude that eclectic approach is an effective treatment irrespective of NMES or MT as an adjunct.Keywords: balance, motor recovery, mirror therapy, neuromuscular electrical stimulation, stroke
Procedia PDF Downloads 2818317 Wastewater Treatment Using Sodom Apple Tree in Arid Regions
Authors: D. Oulhaci, M. Zehah, S. Meguellati
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Collected by the sewerage network, the wastewater contains many polluting elements, coming from the population, commercial, industrial and agricultural activities. These waters are collected and discharged into the natural environment and pollute it. Hence the need to transport them before discharge to a treatment plant to undergo several treatment phases. The objective of this study is to highlight the purification performance of the "Sodom apple tree" which is a very common shrub in the region of Djanet and Illizi in Algeria. As material, we used small buckets filled with sand with a gravel substrate. We sowed seeds that we let grow a few weeks. The water supply is under a horizontal flow regime under-ground. The urban wastewater used is preceded by preliminary treatment. The water obtained after purification is collected using a tap in a container placed under the seal. The comparison between the inlet and the outlet waters showed that the presence of the Sodom apple tree contributes to reducing their pollutant parameters with significant rates: 81% for COD, 84%, for BOD , 95% for SM , 82% for NO⁻² , and 85% for NO⁻³ and can be released into the environment without risk of pollutionKeywords: arid zone, pollution, purification, re-use, wastewater.
Procedia PDF Downloads 808316 Endodontic Pretreatments, Clinical Opportunities and Challenges
Authors: Ilma Robo, Manola Kelmendi, Saimir Heta, Megi Tafa, Vera Ostreni
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Preservation of a natural tooth, even if endodontically treated, is more indicated than its replacement with an artificial tooth placed in prosthetic ways or with implant treatment. It is known how technology and endodontic treatment procedures have evolved significantly. It is also known that significant developments have been made in both dental prostheses and implant treatments, and again, in both specialties, it is emphasized that both the tooth placed with dental prostheses and the tooth placed with implant treatment cannot replace the natural tooth. The issue is whether long-term periapical tissue healing is achieved after a successful endodontic treatment, and for this, clinical data should be collected. In the cases when the apical closure or "apical filling" with the endodontic filling was carried out correctly clinically, but for various reasons, the healing of the periapical tissues did not occur, but also for those cases when the endodontic treatment did not reach the "apical filling" of the root canal. Teeth Endodontic retreatments have their clinical difficulty, but knowing the reason why endodontic treatment success has not been achieved clinically, the clinical endodontic approach is easier. In this process, it is important for the dentist to recognize the clinical and radiographic signs of persistent apical periodontitis or renewed apical periodontitis. After this initial procedure, dentists must know and evaluate the possibility of clinical endodontic retreatment by reporting, not precisely, but with very approximate values, the percentage of clinical success of endodontic retreatment. Depending on the reason for the performance, endodontic re-treatment may also need more specialized equipment or tools, for which even the professional who undertakes the re-treatment must be equipped with the relevant knowledge of their use and clinical application. Evaluating the clinical success of endodontic re-treatment is actually a more difficult process and requires more clinical responsibility since it must be considered that the initial treatment was performed by the same specialist as the specialist who undertakes the same endodontic re-treatment. Tooth So, the clinical endodontic re-treatment of a tooth should not be seen as a fund of clinical practice only of a good successful endodontist, but as part of routine endodontic treatments, nor should it be seen as a typical case where the tools and the most advanced technological devices in the endodontic field. So, the clinical picture of endodontic re-treatments offers the possibility of finding endodontic malpractice, the possibility of more accurate assessment of dental morphological anomalies, and above all, the cognitive and professional possibilities of the diagnosis of persistent apical periodontitis. This study offers the possibility of evaluating these three directions by presenting in numbers and in percentage the frequency of the reasons why the endodontic success of the root canal treatment is not always achieved.Keywords: apical periodontitis, clinical susccess, endodontics, E.faecalis
Procedia PDF Downloads 58315 The Impact of an Educational Program on Knowledge, Attitude and Practices of Healthcare Professionals towards Family Presence during Resuscitation in an Emergency Department at a Tertiary Care Setting, in Karachi, Pakistan
Authors: Shaista Meghani, Rozina Karmaliani, Khairulnissa Ajani, Shireen Shahzad, Nadeem Ullah Khan
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Background: The concept of Family Presence During Resuscitation (FPDR) is gradually gaining recognition in western countries, however, it is rarely considered in South Asian countries including Pakistan. Over time, patients’ and families’ rights have gained recognition and healthcare has progressed to become more patient-family centered. Objectives: The objective of this study was to evaluate the impact of an educational program on the Knowledge, Attitude, and Practices (KAP) of healthcare professionals (HCPs) towards FPDR in Emergency Department (ED), at a tertiary care setting, in Karachi, Pakistan. Methods: This was a Pre-test and Post-test study design. A convenient universal sampling was done, and all ED nurses and physicians with more than one year of experience were eligible. The intervention included one-hour training sessions for physicians (three sessions) and nurses (eight sessions), The KAP of nurses and physicians were assessed immediately after (post-test I), and two weeks(post-test II) after the intervention using a pretested questionnaire. Results: The findings of the study revealed that the mean scores of knowledge and attitude of HCPs at both time points were statistically significant (p-value=<0.001), however, an insignificant difference was found on practice of FPDR (p-value=>0.05). Conclusion: The study findings recommend that the educational program on FPDR for HCPs needs to be offered on an ongoing basis. Moreover, training modules need to be developed for the staff, and formal guidelines need to be proposed for FPDR, through a multidisciplinary team approach.Keywords: family presence, cardiopulmonary resuscitation, attitude, education, practices, health care professionals
Procedia PDF Downloads 1868314 Prevalence of Malocclusion and Assessment of Orthodontic Treatment Needs in Malay Transfusion-Dependent Thalassemia Patients
Authors: Mohamed H. Kosba, Heba A. Ibrahim, H. Rozita
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Statement of the Problem: The life expectancy for transfusion-dependent thalassemia patients has increased dramatically with iron-chelation therapy and other modern management modalities. In these patients, the most dominant maxillofacial manifestations are protrusion of zygomatic bones and premaxilla due to the hyperplasia of bone marrow. The purpose of this study is to determine the prevalence of malocclusion and orthodontic treatment needs according to the Dental Aesthetic Index (DAI) among Malay transfusion-dependent thalassemia patients. Orientation: This is a cross-sectional study consist of 43 Malay transfusion-dependent thalassemia patients, 22 males, and 19 females with the mean age of 15.9 years old (SD 3.58). The subjects were selected randomly from patients attending Paediatrics and Internal Medicine Clinic at Hospital USM and Hospital Sultana Bahiyah. The subjects were assessed for malocclusion according to Angle’s classification, and orthodontic treatment needs using DAI. The results show that 22 of the subjects (51.1%) have class II malocclusion, 12 subjects (28%) have class І, while 9 subjects (20.9%) have class Ⅲ. The assessment of orthodontic treatment needs to reveal 22 cases (51.1%) fall in the normal/minor needs category, 12 subjects (28%) fall in the severe and very severe category, while 9 subjects (20.9%) fall in the definite category. Conclusion & Significance: Half of Malay transfusion-dependent thalassemia patients have Class Ⅱmalocclusion. About 28% had malocclusion and required orthodontic treatment. This research shows that Malay transfusion-dependent thalassemia may require orthodontic management; earlier intervention to reduce the complexity of the treatment later, suggesting functional appliance as a suitable treatment option for them, a twin block appliance together with headgear to restrict maxillary growth suggested for management. The current protocol implemented by the Malaysian Ministry of Health for the management of these patients seems to be sufficient since the result shows that about 28% require orthodontic treatment need, according to DAI.Keywords: prevalence, DAI, thalassaemia, angle classification
Procedia PDF Downloads 1438313 Causes of Death in Neuromuscular Disease Patients: 15-Year Experience in a Tertiary Care Hospital
Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong
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Background:Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods:From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results:Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences
Procedia PDF Downloads 5328312 Proposed Organizational Development Interventions in Managing Occupational Stressors for Business Schools in Batangas City
Authors: Marlon P. Perez
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The study intended to determine the level of occupational stress that was experienced by faculty members of private and public business schools in Batangas City with the end in view of proposing organizational development interventions in managing occupational stressors. Stressors such as factors intrinsic to the job, role in the organization, relationships at work, career development and organizational structure and climate were used as determinants of occupational stress level. Descriptive method of research was used as its research design. There were only 64 full-time faculty members coming from private and public business schools in Batangas City – University of Batangas, Lyceum of the Philippines University-Batangas, Golden Gate Colleges, Batangas State University and Colegio ng Lungsod ng Batangas. Survey questionnaire was used as data gathering instrument. It was found out that all occupational stressors were assessed stressful when grouped according to its classification of tertiary schools while response of subject respondents differs on their assessment of occupational stressors. Age variable has become significantly related to respondents’ assessments on factors intrinsic to the job and career development; however, it was not significantly related to role in the organization, relationships at work and organizational structure and climate. On the other hand, gender, marital status, highest educational attainment, employment status, length of service, area of specialization and classification of tertiary school were revealed to be not significantly related to all occupational stressors. Various organizational development interventions have been proposed to manage the occupational stressors that are experienced by business faculty members in the institution.Keywords: occupational stress, business school, organizational development, intervention, stressors, faculty members, assessment, manage
Procedia PDF Downloads 4318311 The Epigenetic Background Depended Treatment Planning for Glioblastoma Multiforme
Authors: Rasime Kalkan, Emine Ikbal Atli, Ali Arslantaş, Muhsin Özdemir, Sevilhan Artan
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Glioblastoma (WHO grade IV), is the malignant form of brain tumor, the genetic background of the GBM is highly variable. The tumor mass of a GBM is multilayered and every tumor layer shows distinct characteristics with a different cell population. The treatment planning of GBM should be focused on the tumor genetic characteristics. We screened primary glioblastoma multiforme (GBM) in a population-based study for MGMT and RARβ methylation and IDH1 mutation correlated them with clinical data and treatment. There was no correlation between MGMT-promoter methylation and overall survival. The overall survival time of the patients with methylated RARβ was statically (OS;p<0,05) significance between the patients who were treated with chemotherapy and radiotherapy. Here we showed the status of IDH1 gene associatied with younger age. We demonstrated that the together with MGMT gene the RARβ gene should be used as a potantial treatment decision marker for GBMs.Keywords: RARβ, primary glioblastoma multiforme, methylation, MGMT
Procedia PDF Downloads 3448310 The Effect of Undernutrition on Sputum Culture Conversion and Treatment Outcomes among People with Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis
Authors: Fasil Wagnew, Kerri Viney, Kefyalew Addis Alene, Matthew Kelly, Darren Gray
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Background: Undernutrition is a risk factor for tuberculosis (TB), including poor treatment outcomes. However, evidence regarding the effect of undernutrition on TB treatment outcomes is not well understood. We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multi-drug resistance (MDR)-TB. Methods: We searched for publications in the Medline, Embase, Scopus, and Web of Science databases without restrictions on geography or year of publication. We conducted a random-effect meta-analysis to estimate the effects of undernutrition on sputum culture conversion and treatment outcomes. Two reviewers independently assessed the study eligibility, extracted the necessary information, and assessed the risk of bias. Depending on the nature of the data, odds ratio (OR) and hazard ratio (HR) with 95% confidence intervals (CIs) were used to summarize the effect estimates. Potential publication bias was checked using funnel plots and Egger’s tests. Results: Of 2358 records screened, 59 studies comprising a total of 31,254 people with MDR-TB were included. Undernutrition was significantly associated with a lower sputum culture conversion rate (HR 0·7, 95% CI 0·6–0·9, I2=67·1%) and a higher rate of mortality (OR 2·9, 95%CI 2·1–3·8, I2=23·7%) and unfavourable treatment outcomes (OR 1·8, 95%CI 1·5–2·0, I2=72·7%). There was no statistically significant publication bias in the included studies. Three studies were low, forty-two studies were moderate, and fourteen studies were high quality. Interpretations: Undernutrition was significantly associated with unfavourable treatment outcomes, including mortality and lower sputum culture conversion among people with MDR-TB. These findings have implications for supporting targeted nutritional interventions alongside standardised second-line TB drugs.Keywords: undernutrition, MDR-TB, sputum culture conversion, treatment outcomes, meta-analysis
Procedia PDF Downloads 1528309 Energy Savings with the Use of LED Lights at the Wastewater Treatment Plant
Authors: Kishen Prathivadi
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The Sewer Authority Mid-Coastside (SAM) is a Joint Powers Authority formed in 1976 and provides secondary wastewater treatment to an average flow of 2.0 million gallons per day. SAM owns and operates a Wastewater Treatment Plant (WWTP) and a sanitary sewage collection system that collects sewage from its three member agencies: the City of Half Moon Bay, the Granada Community Services District and Montara Water and Sanitary District. The Sewer Authority Mid-Coastside (SAM) partnered with Pacific Gas & Electric, and its contractor GEL America, to review and replace all inefficient lighting fixtures and bulbs at the SAM treatment plant and administrative office. The project focused on replacing old and inefficient lighting fixtures and bulbs, reducing annual operating and maintenance costs, and reducing SAM’s carbon footprint. The project resulted in a 55% overall energy reduction, higher light quality and acuity, and a total operational savings of $495,000 over ten years.Keywords: energy savings, LED, lighting, electrical
Procedia PDF Downloads 1398308 Effect of Cellulase Pretreatment for n-Hexane Extraction of Oil from Garden Cress Seeds
Authors: Boutemak Khalida, Dahmani Siham
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Garden cress (Lepidium Sativum L.) belonging to the family Brassicaceae, is edible growing annual herb. Its various parts (roots, leaves and seeds) have been used to treat various human ailments. Its seed extracts have been screened for various biological activities like hypotensive, antimicrobial, bronchodilator, hypoglycaemic and antianemic. The aim of the present study is to optimize the process parameters (cellulase concentration and incubation time) of enzymatic pre-treatment of the garden cress seeds and to evaluate the effect of cellulase pre-treatment of the crushed seeds on the oil yield, physico-chemical properties and antibacterial activity and comparing to non-enzymatic method. The optimum parameters of cellulase pre-treatment were as follows: cellulase of 0,1% w/w and incubation time of 2h. After enzymatic pre-treatment, the oil was extracted by n-hexane for 1.5 h, the oil yield was 4,01% for cellulase pre-treatment as against 10,99% in the control sample. The decrease in yield might be caused a result of mucilage. Garden cress seeds are covered with a layer of mucilage which gels on contact with water. At the same time, the antibacterial activity was carried out using agar diffusion method against 4 food-borne pathogens (Escherichia coli, Salmonella typhi,Staphylococcus aureus, Bacillus subtilis). The results showed that bacterial strains are very sensitive to the oil with cellulase pre-treatment. Staphylococcus aureus is extremely sensitive with the largest zone of inhibition (40 mm), Escherichia coli and salmonella typhi had a very sensitive to the oil with a zone of inhibition (26 mm). Bacillus subtilizes is averagely sensitive which gave an inhibition of 16 mm. But it does not exhibit sensivity to the oil without enzymatic pre-treatment with a zone inhibition (< 8 mm). Enzymatic pre-treatment could be useful for antimicrobial activity of the oil, and hold a good potential for use in food and pharmaceutical industries.Keywords: Lepidium sativum L., cellulase, enzymatic pretreatment, antibacterial activity.
Procedia PDF Downloads 4618307 Organic Substance Removal from Pla-Som Family Industrial Wastewater through APCW System
Authors: W. Wararam, K. Angchanpen, T. Pattamapitoon, K. Chunkao, O. Phewnil, M. Srichomphu, T. Jinjaruk
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The research focused on the efficiency for treating high organic wastewater from pla-som production process by anaerobic tanks, oxidation ponds and constructed wetland treatment systems (APCW). The combined system consisted of 50-mm plastic screen, five 5.8 m3 oil-grease trap tanks (2-day hydraulic retention time; HRT), four 4.3 m3 anaerobic tanks (1-day HRT), 16.7 m3 oxidation pond no.1 (7-day HRT), 12.0 m3 oxidation pond no.2 (3-day HRT), and 8.2 m3 constructed wetland plot (1-day HRT). After washing fresh raw fishes, they were sliced in small pieces and were converted into ground fish meat by blender machine. The fish meat was rinsed for 8 rounds: 1, 2, 3, 5, 6 and 7 by tap water and 4 and 8 by rice-wash-water, before mixing with salt, garlic, steamed rice and monosodium glutamate, followed by plastic wrapping for 72-hour of edibility. During pla-som production processing, the rinsed wastewater about 5 m3/day was fed to the treatment systems and fully stagnating storage in its components. The result found that, 1) percentage of treatment efficiency for BOD, COD, TDS and SS were 93, 95, 32 and 98 respectively, 2) the treatment was conducted with 500-kg raw fishes along with full equipment of high organic wastewater treatment systems, 3) the trend of the treatment efficiency and quantity in all indicators was similarly processed and 4) the small pieces of fish meat and fish blood were needed more than 3-day HRT in anaerobic digestion process.Keywords: organic substance, Pla-Som family industry, wastewater, APCW system
Procedia PDF Downloads 3588306 Evaluation of Produced Water Treatment Using Advanced Oxidation Processes and Sodium Ferrate(VI)
Authors: Erica T. R. Mendonça, Caroline M. B. de Araujo, Filho, Osvaldo Chiavone, Sobrinho, Maurício A. da Motta
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Oil and gas exploration is an essential activity for modern society, although the supply of its global demand has caused enough damage to the environment, mainly due to produced water generation, which is an effluent associated with the oil and gas produced during oil extraction. It is the aim of this study to evaluate the treatment of produced water, in order to reduce its oils and greases content (OG), by using flotation as a pre-treatment, combined with oxidation for the remaining organic load degradation. Thus, there has been tested Advanced Oxidation Process (AOP) using both Fenton and photo-Fenton reactions, as well as a chemical oxidation treatment using sodium ferrate(VI), Na2[FeO4], as a strong oxidant. All the studies were carried out using real samples of produced water from petroleum industry. The oxidation process using ferrate(VI) ion was studied based on factorial experimental designs. The factorial design was used in order to study how the variables pH, temperature and concentration of Na2[FeO4] influences the O&G levels. For the treatment using ferrate(VI) ion, the results showed that the best operating point is obtained when the temperature is 28 °C, pH 3, and a 2000 mg.L-1 solution of Na2[FeO4] is used. This experiment has achieved a final O&G level of 4.7 mg.L-1, which means 94% percentage removal efficiency of oils and greases. Comparing Fenton and photo-Fenton processes, it was observed that the Fenton reaction did not provide good reduction of O&G (around 20% only). On the other hand, a degradation of approximately 80.5% of oil and grease was obtained after a period of seven hours of treatment using photo-Fenton process, which indicates that the best process combination has occurred between the flotation and the photo-Fenton reaction using solar radiation, with an overall removal efficiency of O&G of approximately 89%.Keywords: advanced oxidation process, ferrate (VI) ion, oils and greases removal, produced water treatment
Procedia PDF Downloads 3198305 Prediction Factor of Recurrence Supraventricular Tachycardia After Adenosine Treatment in the Emergency Department
Authors: Welawat Tienpratarn, Chaiyaporn Yuksen, Rungrawin Promkul, Chetsadakon Jenpanitpong, Pajit Bunta, Suthap Jaiboon
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Supraventricular tachycardia (SVT) is an abnormally fast atrial tachycardia characterized by narrow (≤ 120 ms) and constant QRS. Adenosine was the drug of choice; the first dose was 6 mg. It can be repeated with the second and third doses of 12 mg, with greater than 90% success. The study found that patients observed at 4 hours after normal sinus rhythm was no recurrence within 24 hours. The objective of this study was to investigate the factors that influence the recurrence of SVT after adenosine in the emergency department (ED). The study was conducted retrospectively exploratory model, prognostic study at the Emergency Department (ED) in Faculty of Medicine, Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand. The study was conducted for ten years period between 2010 and 2020. The inclusion criteria were age > 15 years, visiting the ED with SVT, and treating with adenosine. Those patients were recorded with the recurrence SVT in ED. The multivariable logistic regression model developed the predictive model and prediction score for recurrence PSVT. 264 patients met the study criteria. Of those, 24 patients (10%) had recurrence PSVT. Five independent factors were predictive of recurrence PSVT. There was age>65 years, heart rate (after adenosine) > 100 per min, structural heart disease, and dose of adenosine. The clinical risk score to predict recurrence PSVT is developed accuracy 74.41%. The score of >6 had the likelihood ratio of recurrence PSVT by 5.71 times. The clinical predictive score of > 6 was associated with recurrence PSVT in ED.Keywords: supraventricular tachycardia, recurrance, emergency department, adenosine
Procedia PDF Downloads 1178304 Introducing Data-Driven Learning into Chinese Higher Education English for Academic Purposes Writing Instructional Settings
Authors: Jingwen Ou
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Writing for academic purposes in a second or foreign language is one of the most important and the most demanding skills to be mastered by non-native speakers. Traditionally, the EAP writing instruction at the tertiary level encompasses the teaching of academic genre knowledge, more specifically, the disciplinary writing conventions, the rhetorical functions, and specific linguistic features. However, one of the main sources of challenges in English academic writing for L2 students at the tertiary level can still be found in proficiency in academic discourse, especially vocabulary, academic register, and organization. Data-Driven Learning (DDL) is defined as “a pedagogical approach featuring direct learner engagement with corpus data”. In the past two decades, the rising popularity of the application of the data-driven learning (DDL) approach in the field of EAP writing teaching has been noticed. Such a combination has not only transformed traditional pedagogy aided by published DDL guidebooks in classroom use but also triggered global research on corpus use in EAP classrooms. This study endeavors to delineate a systematic review of research in the intersection of DDL and EAP writing instruction by conducting a systematic literature review on both indirect and direct DDL practice in EAP writing instructional settings in China. Furthermore, the review provides a synthesis of significant discoveries emanating from prior research investigations concerning Chinese university students’ perception of Data-Driven Learning (DDL) and the subsequent impact on their academic writing performance following corpus-based training. Research papers were selected from Scopus-indexed journals and core journals from two main Chinese academic databases (CNKI and Wanfang) published in both English and Chinese over the last ten years based on keyword searches. Results indicated an insufficiency of empirical DDL research despite a noticeable upward trend in corpus research on discourse analysis and indirect corpus applications for material design by language teachers. Research on the direct use of corpora and corpus tools in DDL, particularly in combination with genre-based EAP teaching, remains a relatively small fraction of the whole body of research in Chinese higher education settings. Such scarcity is highly related to the prevailing absence of systematic training in English academic writing registers within most Chinese universities' EAP syllabi due to the Chinese English Medium Instruction policy, where only English major students are mandated to submit English dissertations. Findings also revealed that Chinese learners still held mixed attitudes towards corpus tools influenced by learner differences, limited access to language corpora, and insufficient pre-training on corpus theoretical concepts, despite their improvements in final academic writing performance.Keywords: corpus linguistics, data-driven learning, EAP, tertiary education in China
Procedia PDF Downloads 588303 Rasagiline Improves Metabolic Function and Reduces Tissue Injury in the Substantia Nigra in Parkinson's Disease: A Longitudinal In-Vivo Advanced MRI Study
Authors: Omar Khan, Shana Krstevska, Edwin George, Veronica Gorden, Fen Bao, Christina Caon, NP-C, Carla Santiago, Imad Zak, Navid Seraji-Bozorgzad
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Objective: To quantify cellular injury in the substantia nigra (SN) in patients with Parkinson's disease (PD) and to examine the effect of rasagiline of tissue injury in the SN in patients with PD. Background: N-acetylaspartate (NAA) quantified with MRS is a reliable marker of neuronal metabolic function. Fractional anisotropy (FA) and mean diffusivity (MD) obtained with DTI, characterize tissue alignment and integrity. Rasagline, has been shown to exert anti-apototic effect. We applied these advanced MRI techniques to examine: (i) the effect of rasagiline on cellular injury and metabolism in patients with early PD, and (ii) longitudinal changes seen over time in PD. Methods: We conducted a prospective longitudinal study in patients with mild PD, naive to dopaminergic treatment. The imaging protocol included multi-voxel proton-MRS and DTI of the SN, acquired on a 3T scanner. Scans were performed at baseline and month 3, during which the patient was on no treatment. At that point, rasagiline 1 mg orally daily was initiated and MRI scans are were obtained at 6 and 12 months after starting rasagiline. The primary objective was to compare changes during the 3-month period of “no treatment” to the changes observed “on treatment” with rasagiline at month 12. Age-matched healthy controls were also imaged. Image analysis was performed blinded to treatment allocation and period. Results: 25 patients were enrolled in this study. Compared to the period of “no treatment”, there was significant increase in the NAA “on treatment” period (-3.04 % vs +10.95 %, p= 0.0006). Compared to the period of “no treatment”, there was significant increase in following 12 month in the FA “on treatment” (-4.8% vs +15.3%, p<0.0001). The MD increased during “no treatment” and decreased in “on treatment” (+2.8% vs -7.5%, p=0.0056). Further analysis and clinical correlation are ongoing. Conclusions: Advanced MRI techniques quantifying cellular injury in the SN in PD is a feasible approach to investigate dopaminergic neuronal injury and could be developed as an outcome in exploratory studies. Rasagiline appears to have a stabilizing effect on dopaminergic cell loss and metabolism in the SN in PD, that warrants further investigation in long-term studies.Keywords: substantia nigra, Parkinson's disease, MRI, neuronal loss, biomarker
Procedia PDF Downloads 3158302 Development of Nursing Service System Integrated Case Manager Concept for the Patients with Epilepsy at the Tertiary Epilepsy Clinic of Thailand
Authors: C. Puangsawat, C. Limotai, P. Srikhachin
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Bio-psycho-social caring was required for promoting the quality of life of the patients with epilepsy (PWE), despite controlled seizures. Multifaceted issues emerge at the epilepsy clinic. Unpredicted seizures, antiepileptic drug compliance problems/adverse effects, psychiatric, and social problems are all needed to be explored and managed. The Nursing Service System (NSS) at the tertiary epilepsy clinic (TEC) was consequently developed for improving the clinical care for PWE. Case manager concept was integrated as the framework guiding the processes and strategies used for developing the NSS as well as the roles of the multidisciplinary team at the clinic. This study aimed to report the outcomes of the developed NSS integrated case manager concept. The processes of our developed NSS program included 1) screening for patient’s problems using questionnaire prior to seeing epileptologists i.e., assessing the patient’s risk to develop acute seizures at the clinic, issues related to medication use, and uncovered psychiatric and social problems; and 2) assigning the patients at risk to be evaluated and managed by appropriate team. Nurses specializing in epilepsy in coordination with the multidisciplinary team implemented the NSS to promote coordinated work among the team which consists of epileptologists, nurses, pharmacists, psychologists, and social workers. Determination of the role of each person and their responsibilities along with joint care plan were clearly established. One year after implementation, the rate of acute seizure occurrence at the clinic was decreased, and satisfactory feedback from the patients was received. In order to achieve an optimal goal to promote self-management behaviors in PWE, continuing the NSS and systematic assessment of its effectiveness is required.Keywords: case manager concept, nursing service system, patients with epilepsy, quality of life
Procedia PDF Downloads 1248301 Digital Self-Identity and the Role of Interactivity in Psychiatric Assessment and Treatment
Authors: Kevin William Taylor
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This work draws upon research in the fields of games development and mental health treatments to assess the influence that interactive entertainment has on the populous, and the potential of technology to affect areas of psychiatric assessment and treatment. It will use studies to establish the evolving direction of interactive media in the development of ‘digital self-identity,’ and how this can be incorporated into treatment to the benefit of psychiatry. It will determine that this approach will require collaborative production between developers and psychiatrists in order to ensure precise goals are met, improving the success of serious gaming for psychiatric assessment and treatment. Analysis documents the reach of video games across a growing global community of gamers, highlighting cases of the positives and negatives of video game usage. The games industry is largely oblivious to the psychological negatives, with psychiatrists encountering new conditions such as gaming addiction, which is now recognized by the World Health Organization. With an increasing amount of gamers worldwide, and an additional time per day invested in online gaming and character development, the concept of virtual identity as a means of expressing the id needs further study to ensure successful treatment. In conclusion, the assessment and treatment of game-related conditions are currently reactionary, and while some mental health professionals have begun utilizing interactive technologies to assist with the assessment and treatment of conditions, this study will determine how the success of these products can be enhanced. This will include collaboration between software developers and psychiatrists, allowing new avenues of skill-sharing in interactive design and development. Outlining how to innovate approaches to engagement will reap greater rewards in future interactive products developed for psychiatric assessment and treatment.Keywords: virtual reality, virtual identity, interactivity, psychiatry
Procedia PDF Downloads 1468300 The Effect of Electrical Discharge Plasma on Inactivation of Escherichia Coli MG 1655 in Pure Culture
Authors: Zoran Herceg, Višnja Stulić, Anet Režek Jambrak, Tomislava Vukušić
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Electrical discharge plasma is a new non-thermal processing technique which is used for the inactivation of contaminating and hazardous microbes in liquids. Plasma is a source of different antimicrobial species including UV photons, charged particles, and reactive species such as superoxide, hydroxyl radicals, nitric oxide and ozone. Escherichia coli was studied as foodborne pathogen. The aim of this work was to examine inactivation effects of electrical discharge plasma treatment on the Escherichia coli MG 1655 in pure culture. Two types of plasma configuration and polarity were used. First configuration was with titanium wire as high voltage needle and another with medical stainless steel needle used to form bubbles in treated volume and titanium wire as high voltage needle. Model solution samples were inoculated with Escerichia coli MG 1655 and treated by electrical discharge plasma at treatment time of 5 and 10 min, and frequency of 60, 90 and 120 Hz. With the first configuration after 5 minutes of treatment at frequency of 120 Hz the inactivation rate was 1.3 log₁₀ reduction and after 10 minutes of treatment the inactivation rate was 3.0 log₁₀ reduction. At the frequency of 90 Hz after 10 minutes inactivation rate was 1.3 log₁₀ reduction. With the second configuration after 5 minutes of treatment at frequency of 120 Hz the inactivation rate was 1.2 log₁₀ reduction and after 10 minutes of treatment the inactivation rate was also 3.0 log₁₀ reduction. In this work it was also examined the formation of biofilm, nucleotide and protein leakage at 260/280 nm, before and after treatment and recuperation of treated samples. Further optimization of method is needed to understand mechanism of inactivation.Keywords: electrical discharge plasma, escherichia coli MG 1655, inactivation, point-to-plate electrode configuration
Procedia PDF Downloads 4328299 The Effectiveness of Pretreatment Methods on COD and Ammonia Removal from Landfill Leachate
Authors: M. Poveda, S. Lozecznik, J. Oleszkiewicz, Q. Yuan
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The goal of this experiment is to evaluate the effectiveness of different leachate pre-treatment options in terms of COD and ammonia removal. This research focused on the evaluation of physical-chemical methods for pre-treatment of leachate that would be effective and rapid in order to satisfy the requirements of the sewer discharge by-laws. The four pre-treatment options evaluated were: air stripping, chemical coagulation, electro-coagulation and advanced oxidation with sodium ferrate. Chemical coagulation reported the best COD removal rate at 43%, compared to 18 % for both air stripping and electro-coagulation, and 20 % for oxidation with sodium ferrate. On the other hand, air stripping was far superior to the other treatment options in terms of ammonia removal with 86 %. Oxidation with sodium ferrate reached only 16 %, while chemical coagulation and electro-coagulation removed less than 10 %. When combined, air stripping and chemical coagulation removed up to 50 % COD and 85 % ammonia.Keywords: leachate pretreatment, air stripping, chemical coagulation, electro-coagulation, oxidation
Procedia PDF Downloads 8438298 Optimisation of Wastewater Treatment for Yeast Processing Effluent Using Response Surface Methodology
Authors: Shepherd Manhokwe, Sheron Shoko, Cuthbert Zvidzai
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In the present study, the interactive effects of temperature and cultured bacteria on the performance of a biological treatment system of yeast processing wastewater were investigated. The main objective of this study was to investigate and optimize the operating parameters that reduce organic load and colour. Experiments were conducted based on a Central Composite Design (CCD) and analysed using Response Surface Methodology (RSM). Three dependent parameters were either directly measured or calculated as response. These parameters were total Chemical Oxygen Demand (COD) removal, colour reduction and total solids. COD removal efficiency of 26 % and decolourization efficiency of 44 % were recorded for the wastewater treatment. The optimized conditions for the biological treatment were found to be at 20 g/l cultured bacteria and 25 °C for COD reduction. For colour reduction optimum conditions were temperature of 30.35°C and bacterial formulation of 20g/l. Biological treatment of baker’s yeast processing effluent is a suitable process for the removal of organic load and colour from wastewater, especially when the operating parameters are optimized.Keywords: COD reduction, optimisation, response surface methodology, yeast processing wastewater
Procedia PDF Downloads 3448297 Influence of UV/Ozone Treatment on the Electrical Performance of Polystyrene Buffered Pentacene-Based OFETs
Authors: Lin Gong, Holger Göbel
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In the present study, we have investigated the influence of UV/ozone treatment on pentacene-based organic field effect transistors (OFETs) with a bilayer gate dielectric. The OFETs for this study were fabricated on heavily n-doped Si substrates with a thermally deposited SiO2 dielectric layer (300nm). On the SiO2 dielectric a very thin (≈ 15nm) buffer layer of polystyrene (PS) was first spin-coated and then treated by UV/ozone to modify the surface prior to the deposition of pentacene. We found out that by extending the UV/ozone treatment time the threshold voltage of the OFETs was monotonically shifted towards positive values, whereas the field effect mobility first decreased but eventually reached a stable value after a treatment time of approximately thirty seconds. Since the field effect mobility of the UV/ozone treated bilayer OFETs was found to be higher than the value of a comparable transistor with a single layer dielectric, we propose that the bilayer (SiO2/PS) structure can be used to shift the threshold voltage to a desired value without sacrificing field effect mobility.Keywords: buffer layer, organic field effect transistors, threshold voltage, UV/ozone treatment
Procedia PDF Downloads 3368296 Role of Preoperative and Postoperative Endovaginal Ultrasound and 24-Hour Pad Test in Evaluation of Efficacy of Various Treatment Modalities for Stress Urinary Incontinence
Authors: J. B. Sharma, Vivek Kakkar, Sunesh Kumar, K. K. Roy, Rajesh Kumari, Kavita Pandey, Smriti Hari
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Background: Stress urinary incontinence (SUI) is a common problem affecting the quality of life of women. Methods: It is a prospective study conducted over 40 women of SUI by endovaginal ultrasound on rest and Valsalva preoperatively and six months postoperatively for levator hiatus, pubovisceral thickness, urethral length, and bladder neck position. A 24-hour pad test was also performed on all women at the same time for grading of SUI. Treatment given was medical in 4 (10%), Burch colposuspension in 18 (45%), and tension-free obturator tape in 18 (45%). Results: Mean age, parity, and body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m², respectively. All 40 (100%) patients had SUI, with the mean duration of symptoms being 4.04 years. On the 24-hour pad test, mild SUI was in 4 (10%), moderate SUI in 33 (82.5%), and severe SUI in 3 (7.5%), with mean preoperative 24-hour pad test being 36.69 gm which significantly reduced to 9.79 gm postoperatively (p 0.001). There was a significant change in levator hiatus and pubovisceral thickness with the treatment of SUI. Overall urethral length increased, but there was a significant decrease in urethral length on Valsalva after the treatment (0.40 versus 0.28 cm, p 0.04) and a significant reduction in bladder neck descent after Valsalva after treatment (0.41 cm versus 0.27 cm, p 0.001). Conclusion: Endovaginal ultrasound and 24-hour pad test are useful diagnostic modalities for SUI diagnosis and to see the impact of treatment.Keywords: stress urinary incontinence, endovaginal ultrasound, 24-hours pad test, pubovisceral muscle thickness
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