Search results for: hospital safety

Authors: L. Kashyap, S. Jha, D. Shende, V. K. Mohan, P. Khanna, A. Aravindan, S. Kashyap, L. Singh, S. Aggarwal

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Obesity is associated with a chronic inflammatory state. During surgery, there is an interplay between anaesthetic and surgical stress vis-a-vis the already present complex immune state. Moreover, the postoperative period is dictated by inflammation, which is crucial for wound healing and regeneration. An excess of inflammatory response might hamper recovery besides increasing the risk for infection and complications. There is definite evidence of the immunosuppressive role of inhaled anaesthetic agents. This immune modulation may be brought into effect directly by influencing the innate and adaptive immunity cells. The effects of propofol on immune mechanisms in has been widely elucidated because of its popularity. It reduces superoxide generation, elastase release, and chemotaxis. However, there is no unequivocal proof of one’s superiority over the other. Hence, an anaesthetic regimen with lesser inflammatory potential and specific to the obese patient is needed. OBESITA trial protocol (2019) by Sousa and co-workers in progress aims to test the hypothesis that anaesthesia with sevoflurane results in a weaker proinflammatory response compared to propofol, as evidenced by lower IL-6 and other biomarkers and an increased macrophage differentiation into M2 phenotype in adipose tissue. IL-6 was used as the objective parameter to evaluate inflammation as it is regulated by both surgery and anesthesia. It is the most sensitive marker of the inflammatory response to tissue damage since it is released within minutes by blood leukocytes. We hypothesized that maintenance of anaesthesia with propofol would lead to less inflammation than that with desflurane. Aims: The effect of two anaesthetic techniques, total intravenous anaesthesia (TIVA) with propofol and desflurane, on surgical stress response was evaluated. The primary objective was to compare serum interleukin-6 (IL-6) levels before and after surgery. Methods: In this prospective single-blinded randomized controlled trial undertaken, 30 obese patients (BMI>30 kg/m2) undergoing laparoscopic bariatric surgery under general anaesthesia were recruited. Patients were randomized to receive desflurane or TIVA using a target-controlled infusion for maintenance of anaesthesia. As a marker of inflammation, pre-and post-surgery IL-6 levels were compared. Results: After surgery, IL-6 levels increased significantly in both groups. The rise in IL-6 was less with TIVA than with desflurane; however, it did not reach significance. IL-6 rise post-surgery correlated positively with the complexity of procedure and duration of surgery and anaesthesia, rather than anaesthetic technique. Both groups did not differ in terms of intra-operative hemodynamic and respiratory variables, time to awakening, postoperative pulmonary complications, and duration of hospital stay. The incidence of nausea was significantly higher with desflurane than with TIVA. Conclusion: Inflammatory response did not differ as a function of anaesthetic technique when propofol and desflurane were compared. Also, patient and surgical variables dictated post-operative inflammation more than the anaesthetic factors. Further, larger sample size is needed to confirm or refute these findings.

Keywords: bariatric, biomarkers, inflammation, laparoscopy

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Authors: Maki Mizogami, Hironori Tsuchiya, Yoshiroh Hayabuchi, Kenji Shigemi

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Since drugs exhibit significant structure-dependent differences in activity and toxicity, their differentiation based on the mechanism of action should have implications for comparative drug efficacy and safety. We aimed to differentiate drug stereoisomers by their stereostructure-selective membrane interactions underlying pharmacological and toxicological effects. Biomimetic lipid bilayer membranes were prepared with phospholipids and sterols (either cholesterol or epicholesterol) to mimic the lipid compositions of neuronal and cardiomyocyte membranes and to provide these membranes with the chirality. The membrane preparations were treated with different classes of stereoisomers at clinically- and pharmacologically-relevant concentrations (25-200 μM), followed by measuring fluorescence polarization to determine the membrane interactivity of drugs to change the physicochemical property of membranes. All the tested drugs acted on lipid bilayers to increase or decrease the membrane fluidity. Drug stereoisomers could not be differentiated when interacting with the membranes consisting of phospholipids alone. However, they stereostructure-selectively interacted with neuro-mimetic and cardio-mimetic membranes containing 40 mol% cholesterol ((3β)-cholest-5-en-3-ol) to show the relative potencies being local anesthetic R(+)-bupivacaine > rac-bupivacaine > S(‒)-bupivacaine, α2-adrenergic agonistic D-medetomidine > rac-medetomidine > L-medetomidine, β-adrenergic antagonistic R(+)-propranolol > rac-propranolol > S(–)-propranolol, NMDA receptor antagonistic S(+)-ketamine > rac-ketamine, analgesic monoterpenoid (+)-menthol > (‒)-menthol, non-steroidal anti-inflammatory S(+)-ibuprofen > rac-ibuprofen > R(‒)-ibuprofen, and bioactive flavonoid (+)-epicatechin > (‒)-epicatechin. All of the order of membrane interactivity were correlated to those of beneficial and adverse effects of the tested stereoisomers. In contrast, the membranes prepared with epicholesterol ((3α)-chotest-5-en-3-ol), an epimeric form of cholesterol, reversed the rank order of membrane interactivity to be S(‒)-enantiomeric > racemic > R(+)-enantiomeric bupivacaine, L-enantiomeric > racemic > D-enantiomeric medetomidine, S(–)-enantiomeric > racemic > R(+)-enantiomeric propranolol, racemic > S(+)-enantiomeric ketamine, (‒)-enantiomeric > (+)-enantiomeric menthol, R(‒)-enantiomeric > racemic > S(+)-enantiomeric ibuprofen, and (‒)-enantiomeric > (+)-enantiomeric epicatechin. The opposite configuration allows drug molecules to interact with chiral sterol membranes enantiomer-selectively. From the comparative results, it is speculated that a 3β-hydroxyl group in cholesterol is responsible for the enantioselective interactions of drugs. In conclusion, the differentiation of drug stereoisomers by their stereostructure-selective membrane interactions would be useful for designing and predicting drugs with higher activity and/or lower toxicity.

Keywords: chiral membrane, differentiation, drug stereoisomer, enantioselective membrane interaction

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Authors: Zoliana Bawitlung, P. C. Rohmingliana, L. Z. Chhangte, Remlal Siama, Hming Chungnunga, Vanram Lawma, L. Hnamte, B. K. Sahoo, B. K. Sapra, J. Malsawma

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Mizoram state has the highest lung cancer incidence rate in India due to its high-level consumption of tobacco and its products which is supplemented by the food habits. While smoking is mainly responsible for this incidence, the effect of inhalation of indoor radon gas cannot be discarded as the hazardous nature of this radioactive gas and its progenies on human population have been well-established worldwide where the radiation damage to bronchial cells eventually can be the second leading cause of lung cancer next to smoking. It is also known that the effect of radiation, however, small may be the concentration, cannot be neglected as they can bring about the risk of cancer incidence. Hence, estimation of indoor radon concentration is important to give a useful reference against radiation effects as well as establishing its safety measures and to create a baseline for further case-control studies. The indoor radon/thoron concentrations in Mizoram had been measured in 41 dwellings selected on the basis of spot gamma background radiation and construction type of the houses during 2015-2016. The dwellings were monitored for one year, in 4 months cycles to indicate seasonal variations, for the indoor concentration of radon gas and its progenies, outdoor gamma dose, and indoor gamma dose respectively. A time-integrated method using Solid State Nuclear Track Detector (SSNTD) based single entry pin-hole dosimeters were used for measurement of indoor Radon/Thoron concentration. Gamma dose measurements for indoor as well as outdoor were carried out using Geiger Muller survey meters. Seasonal variation of indoor radon/ thoron concentration was monitored. The results show that the annual average radon concentrations varied from 54.07 – 144.72 Bq/m³ with an average of 90.20 Bq/m³ and the annual average thoron concentration varied from 17.39 – 54.19 Bq/m³ with an average of 35.91 Bq/m³ which are below the permissible limit. The spot survey of gamma background radiation level varies between 9 to 24 µR/h inside and outside the dwellings throughout Mizoram which are all within acceptable limits. From the above results, there is no direct indication that radon/thoron is responsible for the high lung cancer incidence in the area. In order to find epidemiological evidence of natural radiations to high cancer incidence in the area, one may need to conduct a case-control study which is beyond this scope. However, the derived data of measurement will provide baseline data for further studies.

Keywords: background gamma radiation, indoor radon/thoron, lung cancer, seasonal variation

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Authors: Emma Plante, Charles Ekwunwa, Diego Illanes

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Introduction: Serum Sickness-Like Reaction (SSLR) is an inflammatory immune response characterized by a rash, polyarthralgias, and fever. SSLR usually occurs in response to a new medication (most commonly antibiotics, anticonvulsants, or antiinflammatory agents) and is believed to involve the formation of drug-specific immune complexes. Here we present a case of a 16-year-old female patient who developed an SSLR in response to the D-mannose-containing over-the-counter supplement, Uqora, used to promote bladder health. Methodology: The methodology for this study included a thorough literature search for other cases of SSLR associated with D-Mannose containing products. Data collection was performed through a review of the patient’s medical record, including history, physical examination, relevant laboratory results, and treatment plan. Findings: A 16-year-old female with a history of overactive bladder and anemia presented with a diffuse urticarial rash, headaches, joint pain, and swelling for three days. Her medications included oral contraceptive pills, iron, mirabegron, UQora, and a probiotic. Physical examination revealed a diffuse urticarial rash, and her musculoskeletal exam revealed swelling and tenderness in her wrists. Her CBC, basic metabolic panel, liver function panel, lyme titers, and urinalysis were all within normal limits. The patient was referred to an allergist, who diagnosed her with SSLR. All medications were discontinued, and she was treated with a 7-day course of prednisone and cetirizine. Her symptoms resolved, and her medications were slowly resumed sequentially over several months. However, UQora triggered a recurrence of her symptoms, and it was identified as the culprit medication. Consequently, UQora was permanently discontinued, and the patient has remained symptom-free. Conclusion: This case report describes the first documented case of SSLR caused by UQora (active ingredient D-mannose). D-Mannose is a monosaccharide found in many plants and fruits, and it is commonly used to prevent urinary tract infections. While the clinical features and timeline, in this case, were typical of SSLR, UQora as the trigger was highly unusual. Clinicians should be aware of the diverse triggers of SSLR and the importance of prompt identification and management to enhance patient safety. It is possible D-mannose was not the trigger, and further research is necessary to better understand the potential therapeutic applications of D-mannose, as well as the potential risks and interactions.

Keywords: serum sickness-like reaction, d-mannose, hypersensitivity reaction, urticaria

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Authors: S. Arias

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New housing developments and the technological changes that this implies, adapt the styles of living of its residents, as well as new family structures and forms of work due to the particular needs of a specific group of people which involves different techniques of dealing with, organize, equip and use a particular territory. Currently, own their own space is increasingly important and the cities are faced with the challenge of providing the opportunity for such demands, as well as energy, water and waste removal necessary in the process of construction and occupation of new human settlements. Until the day of today, not has failed to give full response to these demands and needs, resulting in cities that grow without control, badly used land, avenues and congested streets. Buildings and dwellings have an important impact on the environment and on the health of the people, therefore environmental quality associated with the comfort of humans to the sustainable development of natural resources. Applied to architecture, this concept involves the incorporation of new technologies in all the constructive process of a dwelling, changing customs of developers and users, what must be a greater effort in planning energy savings and thus reducing the emissions Greenhouse Gases (GHG) depending on the geographical location where it is planned to develop. Since the techniques of occupation of the territory are not the same everywhere, must take into account that these depend on the geographical, social, political, economic and climatic-environmental circumstances of place, which in modified according to the degree of development reached. In the analysis that must be undertaken to check the degree of sustainability of the place, it is necessary to make estimates of the energy used in artificial air conditioning and lighting. In the same way is required to diagnose the availability and distribution of the water resources used for hygiene and for the cooling of artificially air-conditioned spaces, as well as the waste resulting from these technological processes. Based on the results obtained through the different stages of the analysis, it is possible to perform an energy audit in the process of proposing recommendations of sustainability in architectural spaces in search of energy saving, rational use of water and natural resources optimization. The above can be carried out through the development of a sustainable building code in develop technical recommendations to the regional characteristics of each study site. These codes would seek to build bases to promote a building regulations applicable to new human settlements looking for is generated at the same time quality, protection and safety in them. This building regulation must be consistent with other regulations both national and municipal and State, such as the laws of human settlements, urban development and zoning regulations.

Keywords: building regulations, housing, sustainability, technology

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Authors: Siva K. Bathina, Sudheer Siddapureddy

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Pool fires are formed when the flammable liquid accidentally spills on the ground or water and ignites. Pool fire is a kind of buoyancy-driven and diffusion flame. There have been many pool fire accidents caused during processing, handling and storing of liquid fuels in chemical and oil industries. Such kind of accidents causes enormous damage to property as well as the loss of lives. Pool fires are complex in nature due to the strong interaction among the combustion, heat and mass transfers and pyrolysis at the fuel surface. Moreover, the experimental study of such large complex fires involves fire safety issues and difficulties in performing experiments. In the present work, large eddy simulations are performed to study such complex fire scenarios using fire dynamic simulator. A 1 m diesel pool fire is considered for the studied cases, and diesel is chosen as it is most commonly involved fuel in fire accidents. Fire simulations are performed by specifying two different boundary conditions: one the fuel is in liquid state and pyrolysis model is invoked, and the other by assuming the fuel is initially in a vapor state and thereby prescribing the mass loss rate. A domain of size 11.2 m × 11.2 m × 7.28 m with uniform structured grid is chosen for the numerical simulations. Grid sensitivity analysis is performed, and a non-dimensional grid size of 12 corresponding to 8 cm grid size is considered. Flame properties like mass burning rate, irradiance, and time-averaged axial flame temperature profile are predicted. The predicted steady-state mass burning rate is 40 g/s and is within the uncertainty limits of the previously reported experimental data (39.4 g/s). Though the profile of the irradiance at a distance from the fire along the height is somewhat in line with the experimental data and the location of the maximum value of irradiance is shifted to a higher location. This may be due to the lack of sophisticated models for the species transportation along with combustion and radiation in the continuous zone. Furthermore, the axial temperatures are not predicted well (for any of the boundary conditions) in any of the zones. The present study shows that the existing models are not sufficient enough for modeling blended fuels like diesel. The predictions are strongly dependent on the experimental values of the soot yield. Future experiments are necessary for generalizing the soot yield for different fires.

Keywords: burning rate, fire accidents, fire dynamic simulator, pyrolysis

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Authors: Marina Gold, Yves Jackson, David Parrat

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The high predominance of Latin American migrants in Geneva from countries where Chagas disease is endemic (Bolivia, Brazil, Argentina, Colombia) is increasing the incidence of chronic Chagas-related problems, especially cardiovascular complications. The precarious migratory status of what are mostly undocumented migrants complicates access to health and affects patients’ and doctors’ health perceptions regarding screening, treatment and monitoring of Chagas-related health concerns. This project results from a 3 year collaboration between the Geneva University Hospital and the NGO Mundo Sano to understand the following questions: 1) how do Latin American migrants perceive their health? 2) What do they understand from Chagas disease? 3) Are patients’ and doctors’ health perceptions similar or do they have competing agendas? This paper aims to present the results of a long-term study that interrogates health perceptions among Latin American migrants in Geneva. The first phase consisted in completing surveys at three community screening events (2016, 2017. 2018), and the results of these surveys reveal the subordination of the importance of health to that of having met economic family obligation. That is, health is important only when it becomes an impediment to economic gain. The contradictory result emerged that people are aware of the importance of health prevention in order to ensure long-term health, but they do not always have agency over their life-style habits (healthy food, regular exercise, emotional stability). The second phase of the research collected open-ended interviews with selected participants, in order to explore in more detail how Latin American migrants deal with Chagas in a different socio-political and economic context to that of endemic countries. These interviews (5 in total) reveal mixed methods of managing health: social networks, access to health care transnationally (in Geneva, Spain and back in their home country), and different valuations of health problems in each situation. The third phase consisted in observations of doctor-patient consultations and further extended interviews with patients to determine doctor/patient health perceptions around Chagas disease. This phase is ongoing, but it has yielded preliminarily observations regarding the expectations that patients’ have of doctors, and the understanding of doctors’ to patients’ complex situations. Positive and complementary health perceptions include patients’ feeling that doctors in Geneva are more understanding, more knowledgeable and less racist than those in their home country, who do not provide detailed information about Chagas or its treatment and discriminate against them for being indigenous or from poor rural areas, enabling a better communication between doctors and patients. Possible conflicting health perceptions include patients addressing their health concerns more holistically and encountering the specialist’s limitations to only treating one health concern, given time limitations and lack of competition with their colleagues (the general practitioner that referred the patient, for example). The implications of this study extend the case of Chagas disease in Geneva and is relevant for all chronic concerns and migratory contexts of precarity.

Keywords: chagas disease, health perceptions, Latin American Migrants, non-endemic countries

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Authors: Jelena Vucicevic

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Reliability analysis represents a very important task in different areas of work. In any industry, this is crucial for maintenance, efficiency, safety and monetary costs. There are ways to calculate reliability, unreliability, failure density and failure rate. This paper will try to introduce another way of calculating reliability by using R statistical software. R is a free software environment for statistical computing and graphics. It compiles and runs on a wide variety of UNIX platforms, Windows and MacOS. The R programming environment is a widely used open source system for statistical analysis and statistical programming. It includes thousands of functions for the implementation of both standard and new statistical methods. R does not limit user only to operation related only to these functions. This program has many benefits over other similar programs: it is free and, as an open source, constantly updated; it has built-in help system; the R language is easy to extend with user-written functions. The significance of the work is calculation of time to failure or reliability in a new way, using statistic. Another advantage of this calculation is that there is no need for technical details and it can be implemented in any part for which we need to know time to fail in order to have appropriate maintenance, but also to maximize usage and minimize costs. In this case, calculations have been made on diesel generator fans but the same principle can be applied to any other part. The data for this paper came from a field engineering study of the time to failure of diesel generator fans. The ultimate goal was to decide whether or not to replace the working fans with a higher quality fan to prevent future failures. Seventy generators were studied. For each one, the number of hours of running time from its first being put into service until fan failure or until the end of the study (whichever came first) was recorded. Dataset consists of two variables: hours and status. Hours show the time of each fan working and status shows the event: 1- failed, 0- censored data. Censored data represent cases when we cannot track the specific case, so it could fail or success. Gaining the result by using R was easy and quick. The program will take into consideration censored data and include this into the results. This is not so easy in hand calculation. For the purpose of the paper results from R program have been compared to hand calculations in two different cases: censored data taken as a failure and censored data taken as a success. In all three cases, results are significantly different. If user decides to use the R for further calculations, it will give more precise results with work on censored data than the hand calculation.

Keywords: censored data, R statistical software, reliability analysis, time to failure

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Authors: Beom-Seok Ko, Yoo-Seok Kim, Woo-Sung Lim, Ku-Sang Kim, Hyun-Ah Kim, Jin-Sun Lee, An-Bok Lee, Jin-Gu Bong, Tae-Hyun Kim, Sei-Hyun Ahn

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Background: Breast conserving surgery (BCS) followed by radiation therapy is today standard therapy for early breast cancer. It is safe therapeutic procedure in early breast cancers, because it provides the same level of overall survival as mastectomy. There are a number of different types of incisions used to BCS. Avoiding scars on the breast is women’s desire. Numerous minimal approaches have evolved due to this concern. Periareolar incision is often used when the small tumor relatively close to the nipple. But periareolar incision has a disadvantages include limited exposure of the surgical field. In plastic surgery, various methods such as zigzag incisions have been recommended to achieve satisfactory esthetic results. Periareolar zigzag incision has the advantage of not only good surgical field but also contributed to better surgical scars. The purpose of this study was to evaluate the oncological safety of procedures by studying the status of the surgical margins of the excised tumor specimen and reduces the need for further surgery. Methods: Between January 2016 and September 2016, 148 women with breast cancer underwent BCS or mastectomy by the same surgeon in ASAN medical center. Patients with exclusion criteria were excluded from this study if they had a bilateral breast cancer or underwent resection of the other tumors or taken axillary dissection or performed other incision methods. Periareolar zigzag incision was performed and excision margins of the specimen were identified frozen sections and paraffin-embedded or permanent sections in all patients in this study. We retrospectively analyzed tumor characteristics, the operative time, size of specimen, the distance from the tumor to nipple. Results: A total of 148 patients were reviewed, 72 included in the final analysis, 76 excluded. The mean age of the patients was 52.6 (range 25-19 years), median tumor size was 1.6 cm (range, 0.2-8.8), median tumor distance from the nipple was 4.0 cm (range, 1.0-9.0), median excised specimen sized was 5.1 cm (range, 2.8-15.0), median operation time was 70.0 minute (range, 39-138). All patients were discharged with no sign of infection or skin necrosis. Free resection margin was confirmed by frozen biopsy and permanent biopsy in all samples. There were no patients underwent reoperation. Conclusions: We suggest that periareolar zigzag incision can provide a good surgical field to remove a relatively large tumor and may provide cosmetically good outcomes.

Keywords: periareolar zigzag incision, breast conserving surgery, breast cancer, resection margin

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Authors: Anudeep Appe, Bhanu Poluparthi, Lakshmi Kasivajjula, Udai Mv, Sobha Bagadi, Punya Modi, Aditya Singh, Hemanth Gunupudi, Spenser Troiano, Jeff Paul, Justin Stovall, Justin Yamamoto

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The necessity of data-driven decisions in healthcare strategy formulation is rapidly increasing. A reliable framework which helps identify factors impacting a healthcare provider facility or a hospital (from here on termed as facility) market share is of key importance. This pilot study aims at developing a data-driven machine learning-regression framework which aids strategists in formulating key decisions to improve the facility’s market share which in turn impacts in improving the quality of healthcare services. The US (United States) healthcare business is chosen for the study, and the data spanning 60 key facilities in Washington State and about 3 years of historical data is considered. In the current analysis, market share is termed as the ratio of the facility’s encounters to the total encounters among the group of potential competitor facilities. The current study proposes a two-pronged approach of competitor identification and regression approach to evaluate and predict market share, respectively. Leveraged model agnostic technique, SHAP, to quantify the relative importance of features impacting the market share. Typical techniques in literature to quantify the degree of competitiveness among facilities use an empirical method to calculate a competitive factor to interpret the severity of competition. The proposed method identifies a pool of competitors, develops Directed Acyclic Graphs (DAGs) and feature level word vectors, and evaluates the key connected components at the facility level. This technique is robust since its data-driven, which minimizes the bias from empirical techniques. The DAGs factor in partial correlations at various segregations and key demographics of facilities along with a placeholder to factor in various business rules (for ex. quantifying the patient exchanges, provider references, and sister facilities). Identified are the multiple groups of competitors among facilities. Leveraging the competitors' identified developed and fine-tuned Random Forest Regression model to predict the market share. To identify key drivers of market share at an overall level, permutation feature importance of the attributes was calculated. For relative quantification of features at a facility level, incorporated SHAP (SHapley Additive exPlanations), a model agnostic explainer. This helped to identify and rank the attributes at each facility which impacts the market share. This approach proposes an amalgamation of the two popular and efficient modeling practices, viz., machine learning with graphs and tree-based regression techniques to reduce the bias. With these, we helped to drive strategic business decisions.

Keywords: competition, DAGs, facility, healthcare, machine learning, market share, random forest, SHAP

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Authors: Ahmed Mohamed Elnady Mohamed Elsafty

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This paper explains a developed applied objective model to measure the culture qualitatively and quantitatively, whether in individuals or in teams, in order to be able to use culture correctly or modify it efficiently. This model provides precise measurements and consistent interpretations by being comprehensive, updateable, and protected from being misled by imitations. Methodically, the provided model divides the culture into seven dimensions (total 43 cultural factors): First dimension is outcome-orientation which consists of five factors and should be highest in leaders. Second dimension is details-orientation which consists of eight factors and should be in highest intelligence members. Third dimension is team-orientation which consists of five factors and should be highest in instructors or coaches. Fourth dimension is change-orientation which consists of five factors and should be highest in soldiers. Fifth dimension is people-orientation which consists of eight factors and should be highest in media members. Sixth dimension is masculinity which consists of seven factors and should be highest in hard workers. Last dimension is stability which consists of seven factors and should be highest in soft workers. In this paper, the details of all cultural factors are explained. Practically, information collection about each cultural factor in the targeted person or team is essential in order to calculate the degrees of all cultural factors using the suggested equation of multiplying 'the score of factor presence' by 'the score of factor strength'. In this paper, the details of how to build each score are explained. Based on the highest degrees - to identify which cultural dimension is the prominent - choosing the tested individual or team in the supposedly right position at the right time will provide a chance to use minimal efforts to make everyone aligned to the organization’s objectives. In other words, making everyone self-motivated by setting him/her at the right source of motivation is the most effective and efficient method to achieve high levels of competency, commitment, and sustainability. Modifying a team culture can be achieved by excluding or including new members with relatively high or low degrees in specific cultural factors. For conclusion, culture is considered as the software of the human beings and it is one of the major compression factors on the managerial discretion. It represents the behaviors, attitudes, and motivations of the human resources which are vital to enhance quality and safety, expanding the market share, and defending against attacks from external environments. Thus, it is tremendously essential and useful to use such a comprehensive model to measure, use, and modify culture.

Keywords: culture dimensions, culture factors, culture measurement, cultural analysis, cultural modification, self-motivation, alignment to objectives, competency, sustainability

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Authors: Wan-Yu Liu, Tiffany April Lin, Yu-Chieh Tang, Yi-Lin Wang, Chieh-Hui Li

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As the national income in Taiwan has been raised, the life style of the public has also been changed, so that the tourism industry gradually moves from a service industry to an experience economy. The Lihpaoland is one of the most popular theme parks in Taiwan. However, the related works on performance of service quality of the park have been lacking since its re-operation in 2012. Therefore, this study investigates the quality of software/hardware facilities and services of the Lihpaoland, and aims to achieve the following three goals: 1) analyzing how various sample data of tourists leads to different results for service quality of LihpaoLand; 2) analyzing how tourists respond to the service tangibility, service reliability, service responsiveness, service guarantee, and service empathy of LihpaoLand; 3) according to the theoretical and empirical results, proposing how to improve the overall facilities and services of LihpaoLand, and hoping to provide suggestions to the LihpaoLand or other related businesses to make decision. The survey was conducted on the tourists to the LihpaoLand using convenience sampling, and 400 questionnaires were collected successfully. Analysis results show that tourists paid much attention to maintenance of amusement facilities and safety of the park, and were satisfied with them, which are great advantages of the park. However, transportation around the LihpaoLand was inadequate, and the price of the Fullon hotel (which is the hotel closest to the LihpaoLand) were not accepted by tourists – more promotion events are recommended. Additionally, the shows are not diversified, and should be improved with the highest priority. Tourists did not pay attention to service personnel’s clothing and the ticket price, but they were not satisfied with them. Hence, this study recommends to design more distinctive costumes and conduct ticket promotions. Accordingly, the suggestions made in this study for LihpaoLand are stated as follows: 1) Diversified amusement facilities should be provided to satisfy the needs at different ages. 2) Cheep but tasty catering and more distinctive souvenirs should be offered. 3) Diversified propaganda schemes should be strengthened to increase number of tourists. 4) Quality and professional of the service staff should be enhanced to acquire public praise and tourists revisiting. 5) Ticket promotions in peak seasons, low seasons, and special events should be conducted. 6) Proper traffic flows should be planned and combined with technologies to reduce waiting time of tourists. 7) The features of theme landscape in LihpaoLand should be strengthened to increase willingness of the tourists with special preferences to visit the park. 8) Ticket discounts or premier points card promotions should be adopted to reward the tourists with high loyalty.

Keywords: service quality, customers’ satisfaction, theme park, Taiwan

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Authors: Zachary Muthii Rukenya, James Mbaria, Peter Mbaabu, Kiama Stephen Gitahi, Ronald Onzago

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Aloe turkanensis is one of the widely used medicinal shrub and in Kenya the plant is mainly found in Baringo, Isiolo, Laikipia, Turkana and West Pokot Counties where it is used in ethno-medicine and ethno-veterinary medicine. The Turkana community uses the plant products to manage malaria, wounds, stomach ache, constipation, pain, skin infection, poultry diseases and retained afterbirth in cows. This evaluated the efficacy and safety of the plant obtained from Turkana County, Kenya. Preliminary data on the use of the plant in the county was collected through observation, photographing and interviews. A sample of the whole plant was harvested in Natira sublocation, in ex-Turkana west district in February 2012 after identification by Aloe-working group herbalists who voluntarily provided information on its medicinal uses. Botanical identification was done at Kenya Forest Research Centre in Karura where voucher specimen was deposited. Cold maceration using 70% methanol and distilled water was used for extraction. Bioassays were to determine the effects of the plant extracts on brine shrimp and selected bacterial and fungal cultures. The extracts were tested in-vitro activity against standard cultures of B. cereus (ATCC 11778), S. aureus (ATCC25923), P. aeroginosa (ATCC 27853), E. coli (ATCC 25922) and a human infections clinical isolate of C. albicans. The extracts of Aloe turkanensis inhibited the growth B. cereus (100-200 mg/ml), S. aureus (50-100 mg/ml), P. aeroginosa (200mg/ml), E. coli (400mg/ml) while C. albicans was not affected. The extracts also inhibited the growth of S. aureus and B. cereus with mean diameters of inhibition zones being 19.75±1 mm and 18.5±05 mm reapectively. Phytochemical screening showed the presence of alkaloids, tarpenoids, steroids, quinones, saponins and tannins in the plant extracts. The extract was found to be non-toxic at a concentration of 1000µg/ml with a 100% survival of Brine Shrimp larva. It was concluded that Aloe turkanensis growing the study area has metabolites that inhibit the growth of microorganisms and is however, there is need for further studies to validate the in-vivo bioactivity of the plant and more generate adequate toxicological data.to support conservation, value chain addition of its products and widespread use as a herbal remedy.

Keywords: Aloe turkanensis, bioactivity, cultivated, human infections

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Authors: Pampita Chakraborty, Sukumar Mukherjee

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This study was done to determine the bacteriological profile and antibiotic resistance of the isolates and to find out the potential risk factors for infection with multidrug-resistant organisms. Diabetic foot ulcer is a major medical, social, economic problem and a leading cause of morbidity and mortality, especially in the developing countries like India. 25 percent of all diabetic patients develop a foot ulcer at some point in their lives which is highly susceptible to infections and that spreads rapidly, leading to overwhelming tissue destruction and subsequent amputation. Infection with multidrug resistant organisms (MDRO) may increase the cost of management and may cause additional morbidity and mortality. Proper management of these infections requires appropriate antibiotic selection based on culture and antimicrobial susceptibility testing. Early diagnosis of microbial infections is aimed to institute the appropriate antibacterial therapy initiative to avoid further complications. A total of 200 Type 2 Diabetic Mellitus patients with infection were admitted at GD Hospital and Diabetes Institute, Kolkata. 60 of them who developed ulcer during the year 2013 were included in this study. A detailed clinical history and physical examination were carried out for every subject. Specimens for microbiological studies were obtained from ulcer region. Gram-negative bacilli were tested for extended spectrum Beta-lactamase (ESBL) production by double disc diffusion method. Staphylococcal isolates were tested for susceptibility to oxacillin by screen agar method and disc diffusion. Potential risk factors for MDRO-positive samples were explored. Gram-negative aerobes were most frequently isolated, followed by gram-positive aerobes. Males were predominant in the study and majority of the patients were in the age group of 41-60 years. The presence of neuropathy was observed in 80% cases followed by peripheral vascular disease (73%). Proteus spp. (22) was the most common pathogen isolated, followed by E.coli (17). Staphylococcus aureus was predominant amongst the gram-positive isolates. S.aureus showed a high rate of resistance to antibiotic tested (63.6%). Other gram-positive isolates were found to be highly resistant to erythromycin, tetracycline and ciprofloxacin, 40% each. All isolates were found to be sensitive to Vancomycin and Linezolid. ESBL production was noted in Proteus spp and E.coli. Approximately 70 % of the patients were positive for MDRO. MDRO-infected patients had poor glycemic control (HbA1c 11± 2). Infection with MDROs is common in diabetic foot ulcers and is associated with risk factors like inadequate glycemic control, the presence of neuropathy, osteomyelitis, ulcer size and increased the requirement for surgical treatment. There is a need for continuous surveillance of resistant bacteria to provide the basis for empirical therapy and reduce the risk of complications.

Keywords: diabetic foot ulcer, bacterial infection, multidrug-resistant organism, extended spectrum beta-lactamase

Procedia PDF Downloads 319

Authors: Neerja Gupta

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Objective-Reconstruction of large cavities of the breast without contralateral symmetrisation Background- Reconstruction of breast includes a wide spectrum of procedures from displacement to regional and distant flaps. The pedicled Perforator flaps cover a wide spectrum of reconstruction surgery for all quadrants of the breast, especially in patients with comorbidities. These axial flaps singly or adjunct are based on a near constant perforator vessel, a ratio of 2:1 at its entry in a flap is good to maintain vascularity. The perforators of lateral chest wall viz LICAP, LTAP have overlapping perfurosomes without clear demarcation. LTAP is localized in the narrow zone between the lateral breast fold and anterior axillary line,2.5-3.8cm from the fold. MICAP are localized at 1-2 cm from sternum. Being 1-2mm in diameter, a Single perforator is good to maintain the flap. LICAP has a dominant perforator in 6th-11th spaces, while LTAP has higher placed dominant perforators in 4th and 5th spaces. Methodology-Six consecutive patients who underwent reconstruction of the breast with pedicled perforator flaps were retrospectively analysed. Selections of the flap was done based on the size and locations of the tumour, anticipated volume loss, willingness to undergo contralateral symmetrisation, cosmetic expectations, and finances available.3 patients underwent vertical LTAP, the distal limit of the flap being the inframammary crease. 3 patients underwent MICAP, oriented along the axis of rib, the distal limit being the anterior axillary line. Preoperative identification was done using a unidirectional hand held doppler. The flap was raised caudal to cranial, the pivot point of rotation being the vessel entry into the skin. The donor area is determined by the skin pinch. Flap harvest time was 20-25 minutes. Intra operative vascularity was assessed with dermal bleed. The patient immediate pre, post-operative and follow up pics were compared independently by two breast surgeons. Patients were given a breast Q questionnaire (licensed) for scoring. Results-The median age of six patients was 46. Each patient had a hospital stay of 24 hours. None of the patients was willing for contralateral symmetrisation. The specimen dimensions were from 8x6.8x4 cm to 19x16x9 cm. The breast volume reconstructed range was 30 percent to 45 percent. All wide excision had free margins on frozen. The mean flap dimensions were 12x5x4.5 cm. One LTAP underwent marginal necrosis and delayed wound healing due to seroma. Three patients were phyllodes, of which one was borderline, and 2 were benign on final histopathology. All other 3 patients were invasive ductal cancer and have completed their radiation. The median follow up is 7 months the satisfaction scores at median follow of 7 months are 90 for physical wellbeing and 85 for surgical results. Surgeons scored fair to good in Harvard score. Conclusion- Pedicled perforator flaps are a valuable option for 3/8th volume of breast defects. LTAP is preferred for tumours at the Central, upper, and outer quadrants of the breast and MICAP for the inner and lower quadrant. The vascularity of the flap is dependent on the angiosomalterritories; adequate venous and cavity drainage.

Keywords: breast, oncoplasty, pedicled, perforator

Procedia PDF Downloads 167

Authors: Ramoshweu Melvin Sethobya, Emmanuel Chirenje, Mihlali Hobo, Simon Sebothoma

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The recent surge in residential infrastructure development around the metropolitan areas of South Africa has necessitated conditions for thorough geotechnical assessments to be conducted prior to site developments to ensure human and infrastructure safety. This paper appraises the success in the application of multi-method geophysical techniques for the delineation of sinkhole vulnerability in a residential landscape. Geophysical techniques ERT, MASW, VES, Magnetics and gravity surveys were conducted to assist in mapping sinkhole vulnerability, using an existing sinkhole as a constraint at Venterspost town, West of Johannesburg city. A combination of different geophysical techniques and results integration from those proved to be useful in the delineation of the lithologic succession around sinkhole locality, and determining the geotechnical characteristics of each layer for its contribution to the development of sinkholes, subsidence and cavities at the vicinity of the site. Study results have also assisted in the determination of the possible depth extension of the currently existing sinkhole and the location of sites where other similar karstic features and sinkholes could form. Results of the ERT, VES and MASW surveys have uncovered dolomitic bedrock at varying depths around the sites, which exhibits high resistivity values in the range 2500-8000ohm.m and corresponding high velocities in the range 1000-2400 m/s. The dolomite layer was found to be overlain by a weathered chert-poor dolomite layer, which has resistivities between the range 250-2400ohm.m, and velocities ranging from 500-600m/s, from which the large sinkhole has been found to collapse/ cave in. A compiled 2.5D high resolution Shear Wave Velocity (Vs) map of the study area was created using 2D profiles of MASW data, offering insights into the prevailing lithological setup conducive for formation various types of karstic features around the site. 3D magnetic models of the site highlighted the regions of possible subsurface interconnections between the currently existing large sinkhole and the other subsidence feature at the site. A number of depth slices were used to detail the conditions near the sinkhole as depth increases. Gravity surveys results mapped the possible formational pathways for development of new karstic features around the site. Combination and correlation of different geophysical techniques proved useful in delineation of the site geotechnical characteristics and mapping the possible depth extend of the currently existing sinkhole.

Keywords: resistivity, magnetics, sinkhole, gravity, karst, delineation, VES

Procedia PDF Downloads 49

Authors: Gabriel Fernando Talero Rojas, Vladimir Silva Leal, Camilo Bayona-Roa, Juan Pava, Mauricio Lopez Gomez

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The substitution of conventional aviation fuels with biomass-derived alternative fuels is an emerging field of study in the aviation transport, mainly due to its energy consumption, the contribution to the global Greenhouse Gas - GHG emissions and the fossil fuel price fluctuations. Nevertheless, several challenges remain as the biofuel production cost and its degradative effect over the fuel systems that alter the operating safety. Moreover, experimentation on full-scale aeronautic turbines are expensive and complex, leading to most of the research to the testing of small-size turbojets with a major absence of information regarding the effects in the energy performance and the emissions. The main purpose of the current study is to present the results of experimentation in a full-scale military turbojet engine J69-T-25A (presented in Fig. 1) with 640 kW of power rating and using blends of Jet A1 with oil palm biodiesel. The main findings are related to the thrust specific fuel consumption – TSFC, the engine global efficiency – η, the air/fuel ratio – AFR and the volume fractions of O2, CO2, CO, and HC. Two fuels are used in the present study: a commercial Jet A1 and a Colombian palm oil biodiesel. The experimental plan is conducted using the biodiesel volume contents - w_BD from 0 % (B0) to 50 % (B50). The engine operating regimes are set to Idle, Cruise, and Take-off conditions. The turbojet engine J69 is used by the Colombian Air Force and it is installed in a testing bench with the instrumentation that corresponds to the technical manual of the engine. The increment of w_BD from 0 % to 50 % reduces the η near 3,3 % and the thrust force in a 26,6 % at Idle regime. These variations are related to the reduction of the 〖HHV〗_ad of the fuel blend. The evolved CO and HC tend to be reduced in all the operating conditions when increasing w_BD. Furthermore, a reduction of the atomization angle is presented in Fig. 2, indicating a poor atomization in the fuel nozzle injectors when using a higher biodiesel content as the viscosity of fuel blend increases. An evolution of cloudiness is also observed during the shutdown procedure as presented in Fig. 3a, particularly after 20 % of biodiesel content in the fuel blend. This promotes the contamination of some components of the combustion chamber of the J69 engine with soot and unburned matter (Fig. 3). Thus, the substitution of biodiesel content above 20 % is not recommended in order to avoid a significant decrease of η and the thrust force. A more detail examination of the mechanical wearing of the main components of the engine is advised in further studies.

Keywords: aviation, air to fuel ratio, biodiesel, energy performance, fuel atomization, gas turbine

Procedia PDF Downloads 90

Authors: Sachin Mulmi Shrestha, Xin Fang, Hui Ye, Lihua Ren, Qinghua Ji, Ruihua Shi

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Background: Esophageal squamous cell carcinoma (ESCC) is a tumor arising from esophageal epithelial cells and is one of the major disease subtype in Asian countries, including China. Esophageal cancer is the 7th highest incidence based on the 2020 data of GLOBOCAN. The pathogenesis of cancer is still not well understood as many molecular and genetic basis of esophageal carcinogenesis has yet to be clearly elucidated. Circular RNAs are RNA molecules that are formed by back-splicing covalently joined 3′- and 5′-endsrather than canonical splicing, and recent data suggest circular RNAs could sponge miRNAs and are enriched with functional miRNA binding sites. Hence, we studied the mechanism of circular RNA, its biological function, and the relationship between microRNA in the carcinogenesis of ESCC. Methods: 4 pairs of normal and esophageal cancer tissues were collected in Zhongda hospital, affiliated to Southeast University, and high-throughput RNA sequencing was done. The result revealed that circ_0032746 was upregulated, and thus we selected circ_0032746 for further study. The backsplice junction of circRNA was validated by sanger sequence, and stability was determined by RNASE R assay. The binding site of circRNA and microRNA was predicted by circinteractome,mirandaand RNAhybrid database. Furthermore, circRNA was silenced by siRNA and then by lentivirus. The regulatory axis of circ0032746/miR4270 was validated by shRNA, mimic, and inhibitor transfection. Then, in vitro experiments were performed to assess the role of circ0032746 on proliferation (CCK-8 assay and colon formation assay), migration and invasion (Transewell assay), and apoptosis of ESCC. Results: The upregulated circ0032746 was validated in 9 pairs of tissues and 5 types of cell lines by qPCR, which showed high expression and was statistically significant (P<0.005) ). Upregulated circ0032746 was silenced by shRNA, which showed significant knockdown in KYSE 30 and TE-1 cell lines expression compared to control. Nuclear and cytoplasmic mRNA fraction experiment displayed the cytoplasmic location of circ0032746. The sponging of miR4270 was validated by co-transfection of sh-circ0032746 and mimic or inhibitor. Transfection with mimic showed the decreased expression of circ_0032746, whereas inhibitor inhibited the result. In vitro experiments showed that silencing of circ_0032746 inhibited the proliferation, migration, and invasion compared to the negative control group. The apoptosis was seen higher in a knockdown group than in the control group. Furthermore, 11 common mircoRNA target mRNAs were predicted by Targetscan, MirTarbase, and miRanda database, which may further play role in the pathogenesis. Conclusion: Our results showed that novel circ_0032746 is upregulated in ESCC and plays role in itsoncogenicity. Silencing of circ_0032746 inhibits the proliferation and migration of ESCC whereas increases the apoptosis of cancer cells. Hence, circ0032746 acts as an oncogene in ESCC by sponging with miR4270 and could be a potential biomarker in the diagnosis of ESCC in the future.

Keywords: circRNA, esophageal squamous cell carcinoma, microRNA, upregulated

Procedia PDF Downloads 88

Authors: Oseyemi Omowunmi Olubomehin, Olufemi Michael Denton

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Diabetes mellitus is a disease that is related to the digestion of carbohydrates, proteins and fats and how this affects the blood glucose levels. Various synthetic drugs employed in the management of the disease work through different mechanisms. Keeping postprandial blood glucose levels within acceptable range is a major factor in the management of type 2 diabetes and its complications. Thus, the inhibition of carbohydrate-hydrolyzing enzymes such as α-amylase is an important strategy in lowering postprandial blood glucose levels, but synthetic inhibitors have undesirable side effects like flatulence, diarrhea, gastrointestinal disorders to mention a few. Therefore, it is necessary to identify and explore the α-amylase inhibitors from plants due to their availability, safety, and low costs. In the present study, extracts from the leaves of Rauvolfia vomitoria and seeds of Picralima nitida which are used in the Nigeria traditional system of medicine to treat diabetes were tested for their α-amylase inhibitory effect. The powdered plant samples were subjected to phytochemical screening using standard procedures. The leaves and seeds macerated successively using n-hexane, ethyl acetate and methanol resulted in the crude extracts which at different concentrations (0.1, 0.5 and 1 mg/mL) alongside the standard drug acarbose, were subjected to α-amylase inhibitory assay using the Benfield and Miller methods, with slight modification. Statistical analysis was done using ANOVA, SPSS version 2.0. The phytochemical screening results of the leaves of Rauvolfia vomitoria and the seeds of Picralima nitida showed the presence of alkaloids, tannins, saponins and cardiac glycosides while in addition Rauvolfia vomitoria had phenols and Picralima nitida had terpenoids. The α-amylase assay results revealed that at 1 mg/mL the methanol, hexane, and ethyl acetate extracts of the leaves of Rauvolfia vomitoria gave (15.74, 23.13 and 26.36 %) α-amylase inhibitions respectively, the seeds of Picralima nitida gave (15.50, 30.68, 36.72 %) inhibitions which were not significantly different from the control at p < 0.05, while acarbose gave a significant 56 % inhibition at p < 0.05. The presence of alkaloids, phenols, tannins, steroids, saponins, cardiac glycosides and terpenoids in these plants are responsible for the observed anti-diabetic activity. However, the low percentages of α-amylase inhibition by these plant samples shows that α-amylase inhibition is not the major way by which both plants exhibit their anti-diabetic effect.

Keywords: alpha-amylase, Picralima nitida, postprandial hyperglycemia, Rauvolfia vomitoria

Procedia PDF Downloads 166

Authors: Hyuk Sung Yoon, In-Lee Choi, Mohammad Zahirul Islam, Jun Pill Baek, Ho-Min Kang

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The strawberry ‘Maehyang’ cultivated in South Korea has been increased to export to Southeast Asia. The degradation of quality often occurs in strawberries during short export period. Botrytis cinerea has been known to cause major damage to the export strawberries and the disease was caused during shipping and distribution. This study was conducted to find out the sterilized effect of chlorine dioxide(ClO2) gas and high concentration of CO2 gas injection for ‘Maehyang’ strawberry and it was packaged with oxygen transmission rate (OTR) films. The strawberry was harvested at 80% color changed stage and packaged with OTR film and perforated film (control). The treatments were a MAP used by with 20,000 cc·m-2·day·atm OTR film and gas injection in packages. The gas type of ClO2 and CO2 were injected into OTR film packages, and treatments were 6 mg/L ClO2, 15% CO2, and they were combined. The treated strawberries were stored at 3℃ for 30 days. Fresh weight loss rate was less than 1% in all OTR film packages but it was more than 15% in a perforated film treatment that showed severe deterioration of visual quality during storage. Carbon dioxide concentration within a package showed approximately 15% of the maximum CO2 concentration in all treatments except control until the 21st day, it was the tolerated range of maximum CO2 concentration of strawberry in recommended CA or MA conditions. But, it increased to almost 50% on the 30th day. Oxygen concentration showed a decrease down to approximately 0% in all treatments except control for 25 days. Ethylene concentration was shown to be steady until the 17th day, but it quickly increased on the 17th day and dropped down on the final storage day (30th day). All treatments did not show any significant differences in gas treatments. Firmness increased in CO2 (15%) and ClO2 (6mg/L) + CO2 (15%) treatments during storage. It might be the effect of high concentration CO2 known by reducing decay and cell wall degradation. The soluble solid decreased in all treatments during storage. These results were caused to use up the sugar by the increase of respiration during storage. The titratable acidity showed a similarity in all treatments. Incidence of fungi was 0% in CO2 (15%) and ClO2 (6mg/L)+ CO2 (15%), but was more than 20% in a perforated film treatment. Consequently, The result indicates that Chloride Dioxide(ClO2) and high concentration of CO2 inhibited fungi growth. Due to the fact that fresh weight loss rate and incidence of fungi were lower, the ClO2(6mg/L)+ CO2(15%) prove to be most efficient in sterilization. These results suggest that Chloride Dioxide (ClO2) and high concentration of CO2 gas injection treatments were an effective decontamination technique for improving the safety of strawberries.

Keywords: chloride dioxide, high concentration of CO2, modified atmosphere condition, oxygen transmission rate films

Procedia PDF Downloads 325

Authors: Viviane P. Romani, Bradley D. Olsen, Vilásia G. Martins

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Biodegradable films for food packaging have gained growing attention due to environmental pollution caused by synthetic films and the interest in the better use of resources from nature. Important research advances were made in the development of materials from proteins, polysaccharides, and lipids. However, the commercial use of these new generation of sustainable materials for food packaging is still limited due to their low mechanical and barrier properties that could compromise the food quality and safety. Thus, strategies to improve the performance of these materials have been tested, such as chemical modifications, incorporation of reinforcing structures and others. Cold plasma is a versatile, fast and environmentally friendly technology. It consists of a partially ionized gas containing free electrons, ions, and radicals and neutral particles able to react with polymers and start different reactions, leading to the polymer degradation, functionalization, etching and/or cross-linking. In the present study, biodegradable films from fish protein prepared through the casting technique were plasma treated using an AC glow discharge equipment. The reactor was preliminary evacuated to ~7 Pa and the films were exposed to air plasma for 2, 5 and 8 min. The films were evaluated by their mechanical and water vapor permeability (WVP) properties and changes in the protein structure were observed using Scanning Electron Microscopy (SEM) and X-ray diffraction (XRD). Potential cross-links and elimination of surface defects by etching might be the reason for the increase in tensile strength and decrease in the elongation at break observed. Among the times of plasma application tested, no differences were observed when higher times of exposure were used. The X-ray pattern showed a broad peak at 2θ = 19.51º that corresponds to the distance of 4.6Å by applying the Bragg’s law. This distance corresponds to the average backbone distance within the α-helix. Thus, the changes observed in the films might indicate that the helical configuration of fish protein was disturbed by plasma treatment. SEM images showed surface damage in the films with 5 and 8 min of plasma treatment, indicating that 2 min was the most adequate time of treatment. It was verified that plasma removes water from the films once weight loss of 4.45% was registered for films treated during 2 min. However, after 24 h in 50% of relative humidity, the water lost was recovered. WVP increased from 0.53 to 0.65 g.mm/h.m².kPa after plasma treatment during 2 min, that is desired for some foods applications which require water passage through the packaging. In general, the plasma technology affects the properties and structure of fish protein films. Since this technology changes the surface of polymers, these films might be used to develop multilayer materials, as well as to incorporate active substances in the surface to obtain active packaging.

Keywords: fish protein films, food packaging, improvement of properties, plasma treatment

Procedia PDF Downloads 144

Authors: Javier E. García-Gallo, Nelson J. Fonseca-Ruiz, John F. Duitama-Munoz

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Sepsis is a syndrome that occurs with physiological and biochemical abnormalities induced by severe infection and carries a high mortality and morbidity, therefore the severity of its condition must be interpreted quickly. After patient admission in an intensive care unit (ICU), it is necessary to synthesize the large volume of information that is collected from patients in a value that represents the severity of their condition. Traditional severity of illness scores seeks to be applicable to all patient populations, and usually assess in-hospital mortality. However, the use of machine learning techniques and the data of a population that shares a common characteristic could lead to the development of customized mortality prediction scores with better performance. This study presents the development of a score for the one-year mortality prediction of the patients that are admitted to an ICU with a sepsis diagnosis. 5650 ICU admissions extracted from the MIMICIII database were evaluated, divided into two groups: 70% to develop the score and 30% to validate it. Comorbidities, demographics and clinical information of the first 24 hours after the ICU admission were used to develop a mortality prediction score. LASSO (least absolute shrinkage and selection operator) and SGB (Stochastic Gradient Boosting) variable importance methodologies were used to select the set of variables that make up the developed score; each of this variables was dichotomized and a cut-off point that divides the population into two groups with different mean mortalities was found; if the patient is in the group that presents a higher mortality a one is assigned to the particular variable, otherwise a zero is assigned. These binary variables are used in a logistic regression (LR) model, and its coefficients were rounded to the nearest integer. The resulting integers are the point values that make up the score when multiplied with each binary variables and summed. The one-year mortality probability was estimated using the score as the only variable in a LR model. Predictive power of the score, was evaluated using the 1695 admissions of the validation subset obtaining an area under the receiver operating characteristic curve of 0.7528, which outperforms the results obtained with Sequential Organ Failure Assessment (SOFA), Oxford Acute Severity of Illness Score (OASIS) and Simplified Acute Physiology Score II (SAPSII) scores on the same validation subset. Observed and predicted mortality rates within estimated probabilities deciles were compared graphically and found to be similar, indicating that the risk estimate obtained with the score is close to the observed mortality, it is also observed that the number of events (deaths) is indeed increasing as the outcome go from the decile with the lowest probabilities to the decile with the highest probabilities. Sepsis is a syndrome that carries a high mortality, 43.3% for the patients included in this study; therefore, tools that help clinicians to quickly and accurately predict a worse prognosis are needed. This work demonstrates the importance of customization of mortality prediction scores since the developed score provides better performance than traditional scoring systems.

Keywords: intensive care, logistic regression model, mortality prediction, sepsis, severity of illness, stochastic gradient boosting

Procedia PDF Downloads 194

Authors: Daniel Manaye Kabtamu, Anteneh Wodaje Bayeh

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With the development and utilization of new energy technology, people’s demand for large-scale energy storage system has become increasingly urgent. Vanadium redox flow battery (VRFB) is one of the most promising technologies for grid-scale energy storage applications because of numerous attractive features, such as long cycle life, high safety, and flexible design. However, the relatively low energy efficiency and high production cost of the VRFB still limit its practical implementations. It is of great attention to enhance its energy efficiency and reduce its cost. One of the main components of VRFB that can impressively impact the efficiency and final cost is the electrode materials, which provide the reactions sites for redox couples (V₂₊/V³⁺ and VO²⁺/VO₂⁺). Graphite felt (GF) is a typical carbon-based material commonly employed as electrode for VRFB due to low-cost, good chemical and mechanical stability. However, pristine GF exhibits insufficient wettability, low specific surface area, and poor kinetics reversibility, leading to low energy efficiency of the battery. Therefore, it is crucial to further modify the GF electrode to improve its electrochemical performance towards VRFB by employing active electrocatalysts, such as less expensive metal oxides. This study successfully fabricates low-cost plate-like bismuth vanadate (BiVO₄) material through a simple one-step hydrothermal route, employed as an electrocatalyst to adorn the GF for use as the negative electrode in VRFB. The experimental results show that BiVO₄-3h exhibits the optimal electrocatalytic activity and reversibility for the vanadium redox couples among all samples. The energy efficiency of the VRFB cell assembled with BiVO₄-decorated GF as the negative electrode is found to be 75.42% at 100 mA cm−2, which is about 10.24% more efficient than that of the cell assembled with heat-treated graphite felt (HT-GF) electrode. The possible reasons for the activity enhancement can be ascribed to the existence of oxygen vacancies in the BiVO₄ lattice structure and the relatively high surface area of BiVO₄, which provide more active sites for facilitating the vanadium redox reactions. Furthermore, the BiVO₄-GF electrode obstructs the competitive irreversible hydrogen evolution reaction on the negative side of the cell, and it also has better wettability. Impressively, BiVO₄-GF as the negative electrode shows good stability over 100 cycles. Thus, BiVO₄-GF is a promising negative electrode candidate for practical VRFB applications.

Keywords: BiVO₄ electrocatalyst, electrochemical energy storage, graphite felt, vanadium redox flow battery

Procedia PDF Downloads 1548

Authors: Muhammad Yasir Tarar

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Background: Intraarticular steroid injections are an effective option in alleviating the symptoms of conditions like osteoarthritis, rheumatoid arthritis, crystal arthropathy, and rotator cuff tendinopathy. Most of these injections are conducted in the elderly who are on polypharmacy, including anticoagulants at times. Up to 6% of patients aged 80-84 years have been reported to be taking Warfarin. The literature availability on safety quotient for patients undergoing intraarticular injections on Warfarin is scarce. It has remained debatable over the years which approach is safe for these patients. Continuing warfarin has a theoretical bleeding risk, and stopping it can lead to even severe life-threatening thromboembolic events in high-risk patients. Objectives: To evaluate the risk of bleeding complications in patients on warfarin undergoing intraarticular injections or arthrocentesis. Study Design & Methods: A literature search of MEDLINE (1946 to present), EMBASE (1974 to present), and Cochrane CENTRAL (1988 to present) databases were conducted using any combination of the keywords, Injection, Knee, Shoulder, Joint, Intraarticular, arthrocentesis, Warfarin, and Anticoagulation in November 2020 for articles published in any language with no publication year limit. The study inclusion criteria included reporting on the rate of bleeding complications following injection of the knee or shoulder in patients on warfarin treatment. Randomized control trials and prospective and retrospective study designs were included. An electronic standardized Performa for data extraction was made. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) the methodology was used. The articles were appraised using the methodological index for nonrandomized studies. The Cochrane Risk of Bias Tool used to assess the risk of bias in included RCTs and the MINORS tool for assessment of bias in observational studies. Results: The search of databases resulted in a total of 852 articles. Relevant articles as per the inclusion criteria were shortlisted, 7 articles deemed suitable to be include. A total of 1033 joints sample size was undertaken with specified knee and shoulder joints of a total of 820. Only 6 joints had bleeding complications, 5 early bleeding at the time of injection or aspiration, and one late bleeding complication with INR of 5, additionally, 2 patients complained of bruising, 3 of pain, and 1 managed for infection. Conclusions: The results of the metanalysis show that it is relatively safe to perform intraarticular injections in patients on Warfarin regardless of the INR range.

Keywords: arthrocentesis, warfarin, bleeding, injection

Procedia PDF Downloads 62

Authors: Nursultan Turdakyn, Alisher Medeubayev, Didar Meiramov, Zhibek Bekezhankyzy, Desmond Adair, Gulnur Kalimuldina

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In recent years the development of sustainable energy sources is getting extensive research interest due to the ever-growing demand for energy. As an alternative energy source to power small electronic devices, ambient energy harvesting from vibration or human body motion is considered a potential candidate. Despite the enormous progress in the field of battery research in terms of safety, lifecycle and energy density in about three decades, it has not reached the level to conveniently power wearable electronic devices such as smartwatches, bands, hearing aids, etc. For this reason, the development of self-charging power units with excellent flexibility and integrated energy harvesting and storage is crucial. Self-powering is a key idea that makes it possible for the system to operate sustainably, which is now getting more acceptance in many fields in the area of sensor networks, the internet of things (IoT) and implantable in-vivo medical devices. For solving this energy harvesting issue, the self-powering nanogenerators (NGS) were proposed and proved their high effectiveness. Usually, sustainable power is delivered through energy harvesting and storage devices by connecting them to the power management circuit; as for energy storage, the Li-ion battery (LIB) is one of the most effective technologies. Through the movement of Li ions under the driving of an externally applied voltage source, the electrochemical reactions generate the anode and cathode, storing the electrical energy as the chemical energy. In this paper, we present a simultaneous process of converting the mechanical energy into chemical energy in a way that NG and LIB are combined as an all-in-one power system. The electrospinning method was used as an initial step for the development of such a system with a β-PVDF separator. The obtained film showed promising voltage output at different stress frequencies. X-ray diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FT-IR) analysis showed a high percentage of β phase of PVDF polymer material. Moreover, it was found that the addition of 1 wt.% of BTO (Barium Titanate) results in higher quality fibers. When comparing pure PVDF solution with 20 wt.% content and the one with BTO added the latter was more viscous. Hence, the sample was electrospun uniformly without any beads. Lastly, to test the sensor application of such film, a particular testing device has been developed. With this device, the force of a finger tap can be applied at different frequencies so that electrical signal generation is validated.

Keywords: electrospinning, nanogenerators, piezoelectric PVDF, self-charging li-ion batteries

Procedia PDF Downloads 142

Authors: Heli Makkonen, Eini Hyppönen

Abstract:

The ageing of employees, the availability of workforce, and employees’ engagement in work are today’s challenges in the field of health care and social services, and particularly in the care of older people. Therefore, it is important to enhance both the attractiveness of the work in the field of older people’s care and the retention of employees in the field, and also to pay attention to the length of careers. The length of careers can be affected, for example, by developing an age-friendly organisational culture. Changing the organisational culture in a workplace is, however, a slow process which requires engagement from employees and enhanced dialogue between employees. This article presents an example of age-friendly organisational culture in an older people’s care unit and presents the results of the development of this organisational culture to meet the identified development challenges. In this research-based development process, cycles used in action research were applied. Three workshops were arranged for employees in a service home for older people. The workshops worked as interventions, and the employees and their manager were given several consecutive assignments to be completed between them. In addition to workshops, the employees benchmarked two other service homes. In the workshops, data was collected by observing and documenting the conversations. After that, thematic analysis was used to identify the factors connected to an age-friendly organisational culture. By analysing the data and comparing it to previous studies, some dilemmas we recognised that were hindering or enhancing the attractiveness of work and the retention of employees in this nursing home. After each intervention, the process was reflected and evaluated, and the next steps were planned. The areas of development identified in the study were related to, for example, the flexibility of work, holistic ergonomics, the physical environment at the workplace, and the workplace culture. Some of the areas of development were taken over by the work community and carried out in cooperation with e.g. occupational health care. We encouraged the work community, and the employees provided us with information about their progress. In this research project, the focus was on the development of the workplace culture and, in particular, on the development of the culture of interaction. The workshops showed employees’ attitudes and strong opinions, which can be a challenge from the point of view of the attractiveness of work and the retention of employees in the field. On the other hand, the data revealed that the work community has an interest in developing the dialogue in the work community. Enhancing the dialogue gave the employees the opportunity and resources to face even challenging dilemmas related to the attractiveness of work and the retention of employees in the field. The psychological safety was also enhanced at the same time. The results of this study are part of a broader study that aims at building a model for extending older employees’ careers.

Keywords: age-friendliness, attractiveness of work, dialogue, older people, organisational culture, workplace culture

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Authors: Rangrong Yoksan, Amporn Sane, Nattaporn Khanoonkon, Chanakorn Yokesahachart, Narumol Noivoil, Khanh Minh Dang

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Polylactic acid (PLA) is the most commercially available bio-based and biodegradable plastic at present. PLA has been used in plastic related industries including single-used containers, disposable and environmentally friendly packaging owing to its renewability, compostability, biodegradability, and safety. Although PLA demonstrates reasonably good optical, physical, mechanical, and barrier properties comparable to the existing petroleum-based plastics, its brittleness and mold shrinkage as well as its price are the points to be concerned for the production of rigid and semi-rigid packaging. Blending PLA with other bio-based polymers including thermoplastic starch (TPS) is an alternative not only to achieve a complete bio-based plastic, but also to reduce the brittleness, shrinkage during molding and production cost of the PLA-based products. TPS is a material produced mainly from starch which is cheap, renewable, biodegradable, compostable, and non-toxic. It is commonly prepared by a plasticization of starch under applying heat and shear force. Although glycerol has been reported as one of the most plasticizers used for preparing TPS, its migration caused the surface stickiness of the TPS products. In some cases, mixed plasticizers or natural fibers have been applied to impede the retrogradation of starch or reduce the migration of glycerol. The introduction of fibers into TPS-based materials could reinforce the polymer matrix as well. Therefore, the objective of the present research is to study the effect of starch type (i.e. native starch and phosphate starch), plasticizer type (i.e. glycerol and xylitol with a weight ratio of glycerol to xylitol of 100:0, 75:25, 50:50, 25:75, and 0:100), and fiber content (i.e. in the range of 1-25 % wt) on properties of PLA/TPS blend and composite. PLA/TPS blends and composites were prepared using a twin-screw extruder and then converted into dumbbell-shaped specimens using an injection molding machine. The PLA/TPS blends prepared by using phosphate starch showed higher tensile strength and stiffness than the blends prepared by using the native one. In contrast, the blends from native starch exhibited higher extensibility and heat distortion temperature (HDT) than those from the modified starch. Increasing xylitol content resulted in enhanced tensile strength, stiffness, and water resistance, but decreased extensibility and HDT of the PLA/TPS blend. Tensile properties and hydrophobicity of the blend could be improved by incorporating silane treated-jute fibers.

Keywords: polylactic acid, thermoplastic starch, Jute fiber, composite, blend

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Authors: P. Kavuma, J. Mukasa, M. Lusunku

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Background and Problem: The widespread poverty in Africa- together with the negative impacts of climate change-are two great global challenges that call for everyone’s involvement including Architects. This in particular places serious challenges on architects to have additional skills in both Entrepreneurship and Environmental Design (SEED). Regrettably, while Architectural Training in most African Universities including those from Uganda lack comprehensive implementation of SEED in their curricula, regulatory bodies have not contributed towards the effective integration of SEED in their professional practice. In response to these challenges, Nkumba University (NU) under Architect Kavuma Paul supported by the Uganda Chambers of Architects– initiated the SEED integration in the undergraduate Architectural curricula to cultivate SEED know-how and examples of best practices. Main activities: Initiated in 2007, going beyond the traditional Architectural degree curriculum, the NU Architect department offers SEED courses including provoking passions for creating desirable positive changes in communities. Learning outcomes are assessed theoretically and practically through field projects. The first set of SEED graduates came out in 2012. As part of the NU post-graduation and alumni survey, in October 2014, the pioneer SEED graduates were contacted through automated reminder emails followed by individual, repeated personal follow-ups via email and phone. Out of the 36 graduates who responded to the survey, 24 have formed four (4) private consortium agencies of 5-7 graduates all of whom have pioneered Ugandan-own-cultivated Architectural social projects that include: fishing farming in shipping containers; solar powered mobile homes in shipping containers, solar powered retail kiosks in rural and fishing communities, and floating homes in the flood-prone areas. Primary outcomes: include being business self –reliant in creating the social change the architects desired in the communities. Examples of the SEED project returns to communities reported by the graduates include; employment creation via fabrication, retail business, marketing, improved diets, safety of life and property, decent shelter in the remote mining and oil exploration areas. Negative outcomes-though not yet evaluated include the disposal of used-up materials. Conclusion: The integration of SEED in Architectural Training has established a baseline benchmark and a replicable model based on best practice projects.

Keywords: architectural training, entrepreneurship, environment, integration

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Authors: Lubna M. Al-Otaibi

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Mucocele is a common benign neoplasm of the oral cavity and the most common after fibroma. The lesion develops as a result of retention or extravasation of mucous material from minor salivary glands. Extravasation type of mucocele results from trauma and mostly occurs in the lower lip of young patients. The various treatment options available for the treatment of mucocele are associated with a relatively high incidence of recurrence making surgical intervention necessary for a permanent cure. The conventional surgical procedure, however, arouses apprehension in the patient and is associated with bleeding and postoperative pain. Recently, treatment of mucocele with lasers has become a viable treatment option. Various types of lasers are being used and are preferable over the conventional surgical procedure as they provide good hemostasis, reduced postoperative swelling and pain, reduced bacterial population, lesser need for suturing, faster healing and low recurrence rates. Er,Cr:YSGG is a solid-state laser with great affinity to water molecule. Its hydrokinetic cutting action allows it to work effectively on hydrated tissues without any thermal damage. However, up to date, only a few studies have reported its use in the removal of lip mucocele, especially in children. In this case, a 6 year old female patient with history of trauma to the lower lip presented with a soft, sessile, whitish-bluish 4 mm papule. The lesion was present for approximately four months and was fluctuant in size. The child developed a habit of biting the lesion causing injury, bleeding and discomfort. Surgical excision under local anaesthesia was performed using 2780 nm Er,Cr:YSGG Laser (WaterLase iPlus, Irvine, CA) with a Gold handpiece and MZ6 tip (3.5w, 50 Hz, 20% H2O, 20% Air, S mode). The tip was first applied in contact mode with focused beam using the Circumferential Incision Technique (CIT) to excise the tissue followed by the removal of the underlying causative minor salivary gland. Bleeding was stopped using Laser Dry Bandage setting (0.5w, 50 Hz, 1% H2O, 20% Air, S mode) and no suturing was needed. Safety goggles were worn and high-speed suction was used for smoke evacuation. Mucocele excision using 2780 nm Er,Cr:YSGG laser was rapid, easy to perform with excellent precision and allowed for histopathological examination of the excised tissue. The patient was comfortable and there were minimum bleeding and no sutures, postoperative pain, scarring or recurrence. Laser assisted mucocele excision appears to have efficient and reliable benefits in young patients and should be considered as an alternative to conventional surgical and non-surgical techniques.

Keywords: Erbium, excision, laser, lip, mucocele

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Authors: Vilas Warudkar, Dinkar Janghel, Siraj Ahmed

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Rapid development experienced by India requires huge amount of energy. Actual supply capacity additions have been consistently lower than the targets set by the government. According to World Bank 40% of residences are without electricity. In 12th five year plan 30 GW grid interactive renewable capacity is planned in which 17 GW is Wind, 10 GW is from solar and 2.1 GW from small hydro project, and rest is compensated by bio gas. Renewable energy (RE) and energy efficiency (EE) meet not only the environmental and energy security objectives, but also can play a crucial role in reducing chronic power shortages. In remote areas or areas with a weak grid, wind energy can be used for charging batteries or can be combined with a diesel engine to save fuel whenever wind is available. India according to IEC 61400-1 belongs to class IV Wind Condition; it is not possible to set up wind turbine in large scale at every place. So, the best choice is to go for small scale wind turbine at lower height which will have good annual energy production (AEP). Based on the wind characteristic available at MANIT Bhopal, rotor for small scale wind turbine is designed. Various Aero foil data is reviewed for selection of airfoil in the Blade Profile. Airfoil suited of Low wind conditions i.e. at low Reynold’s number is selected based on Coefficient of Lift, Drag and angle of attack. For designing of the rotor blade, standard Blade Element Momentum (BEM) Theory is implanted. Performance of the Blade is estimated using BEM theory in which axial induction factor and angular induction factor is optimized using iterative technique. Rotor performance is estimated for particular designed blade specifically for low wind Conditions. Power production of rotor is determined at different wind speeds for particular pitch angle of the blade. At pitch 15o and velocity 5 m/sec gives good cut in speed of 2 m/sec and power produced is around 350 Watts. Tip speed of the Blade is considered as 6.5 for which Coefficient of Performance of the rotor is calculated 0.35, which is good acceptable value for Small scale Wind turbine. Simple Load Model (SLM, IEC 61400-2) is also discussed to improve the structural strength of the rotor. In SLM, Edge wise Moment and Flap Wise moment is considered which cause bending stress at the root of the blade. Various Load case mentioned in the IEC 61400-2 is calculated and checked for the partial safety factor of the wind turbine blade.

Keywords: annual energy production, Blade Element Momentum Theory, low wind Conditions, selection of airfoil

Procedia PDF Downloads 319