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Authors: Aliya Hisam, Zia Ul Haq, Sohail Aziz, Patrick Doherty, Jill Pell

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Objective: To determine the effectiveness of Mobile health augmented Cardiac rehabilitation (MCard) on health-related quality of life (HRQoL) among post-acute coronary syndrome(post-ACS) patients. Methodology: In a randomized controlled trial, post-ACS patients were randomly allocated (1:1) to an intervention group (received MCard; counseling, empowering with self-monitoring devices, short text messages, in addition to standard post-ACS care) or control group (standard post-ACS care). HRQoL was assessed by generic Short Form-12 and MacNew quality of life myocardial infarction (QLMI) tools. Participants were followed for 24 weeks with data collection and analysis at three-time points (baseline, 12 weeks and 24 weeks). Result: At baseline, 160 patients (80 in each group; mean age 52.66+8.46 years; 126 males, 78.75%) were recruited, of which 121(75.62%) continued and were analyzed at 12-weeks and 119(74.37%) at 24-weeks. The mean SF-12 physical component score significantly improved in the MCard group at 12 weeks follow-up (48.93 vs. control 43.87, p<.001) and 24 weeks (53.52 vs. 46.82 p<.001). The mean SF-12 mental component scores also improved significantly in the MCard group at 12 weeks follow-up (44.84 vs. control 41.40, p<.001) and 24 weeks follow-up (48.95 vs 40.12, p<.001). At 12-and 24-week follow-up, all domains of MacNew QLMI (social, emotional, physical and global) were also statistically significant (p<.001) improved in the MCard group, unlike the control group. Conclusion: MCard is feasible and effective at improving all domains of HRQoL. There was an improvement in physical, mental, social, emotional and global domains among the MCard group in comparison to the control group. The addition of MCard programs to post-ACS standard care may improve patient outcomes and reduce the burden on the health care setting.

Keywords: acute coronary syndrome, mobile health augmented cardiac rehabilitation (MCard), cardiovascular diseases, cardiac rehabilitation, health-related quality of life, short form 12, MacNew QLMI

Procedia PDF Downloads 159

Authors: Tsung Chin Wu, Yu Chen Tsai, Rhay Hung Weng, Weir Sen Lin

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In recent years, nursing staff’s lower job satisfaction has led to higher turnover rates, and high turnover rates not only cause medical institution costs to increase but also the quality of medical care to decrease. From the perspective of internal marketing, institution staffs are internal customers, and institutions should focus and meet the needs of staff, so that staff will strive to meet the needs of external customers and provide them with the required care. However, few previous studies have investigated the impact of internal staff satisfaction on external customers. Therefore, this study aimed to conduct job satisfaction surveys on internal staff to investigate the relationship between job satisfaction and quality of medical care through statistical analysis of the study results. The related study results may serve as a reference for healthcare managers. This study was conducted using a questionnaire and the subjects were nursing staff from four hospitals. A total of 600 questionnaires were distributed and 577 valid questionnaires were returned with a response rate of 96.1%. After collecting the data, the reliability and validity of the study variables were confirmed by confirmatory factor analysis. The impact of internal marketing and job satisfaction on turnover intention of nursing staff was analyzed using descriptive analysis, one-way ANOVA, Pearson correlation analysis and multiple regression analysis. The study results showed that there was a significant difference between nursing staff’s job title and ‘professional participation’ and ‘shifts’. There was a significant difference between salary and ‘shifts’ and ‘turnover intention’, as well as between marriage and ‘remuneration’ and ‘turnover intention’. A significant difference was found between professional advancement and ‘professional growth’ and ‘type of leave’, as well as between division of service and ‘shifts’ and ‘turnover intention’. Pearson correlation analysis revealed a significant negative correlation between turnover intention and ‘internal marketing’, ‘interaction’, ‘professional participation’, ‘grasp of environment’, ‘remuneration’ and ‘shifts’, meaning that the higher the satisfaction, the lower the turnover intention. It is recommended that hospitals establish a comprehensive internal marketing mechanism to enhance staff satisfaction and in turn, reduce intention to resign, and the key to increasing job satisfaction is by establishing effective methods of internal communication.

Keywords: internal marketing, job satisfaction, turnover intention, nursing staff

Procedia PDF Downloads 183

Authors: Michael McMahon

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The use of media (video/animation/graphics) has long been used by athletes, coaches, and sports scientists to analyse and improve performance in technical skills and team tactics. Sports educators are increasingly open to the use of technology to support coach and learner development. However, an overreliance is a concern., This paper is part of a larger Ph.D. study looking into these new challenges for Sports Educators. Most notably, how to exploit the deep-learning potential of Digital Media among expert learners, how to instruct sports educators to create effective media content that fosters deep learning, and finally, how to make the process manageable and cost-effective. Central to the study is Richard Mayers Cognitive Theory of Multimedia Learning. Mayers Multimedia Learning Theory proposes twelve principles that shape the design and organization of multimedia presentations to improve learning and reduce cognitive load. For example, the Prior Knowledge principle suggests and highlights different learning outcomes for Novice and Non-Novice learners, respectively. Little research, however, is available to support this principle in modified domains (e.g., sports tactics and strategy). As a foundation for further research, this paper compares and contrasts a range of contemporary multimedia sports coaching content and assesses how they perform as learning tools for Strategic and Tactical Play Acquisition among elite sports practitioners. The stress tests applied are guided by Mayers's twelve Multimedia Learning Principles. The focus is on the elite athletes and whether current coaching digital media content does foster improved sports learning among this cohort. The sport of Gaelic Football was selected as it has high strategic and tactical play content, a wide range of Practitioner skill levels (Novice to Elite), and also a significant volume of Multimedia Coaching Content available for analysis. It is hoped the resulting data will help identify and inform the future instructional content design and delivery for Sports Practitioners and help promote best design practices optimal for different levels of expertise.

Keywords: multimedia learning, e-learning, design for learning, ICT

Procedia PDF Downloads 90

Authors: Elaf Ahmed, Shahid Rasul, Ohoud Alharbi, Peng Wang

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Ultra-Small Nanoparticles of metals (USNPs) have attracted the attention from the perspective of both basic and developmental science in a wide range of fields. These NPs exhibit electrical, optical, magnetic, and catalytic phenomena. In addition, they are considered effective catalysts because of their enormously large surface area. Many chemical methods of synthesising USNPs are reported. However, the drawback of these methods is the use of different capping agents and ligands in the process of the production such as Polyvinylpyrrolidone, Thiol and Ethylene Glycol. In this research ultra-small nanoparticles of gold, palladium and platinum metal have been successfully produced using electrochemically active biofilm (EAB) after optimising the pH of the media. The production of ultra-small nanoparticles has been conducted in a reactor using a simple two steps method. Initially biofilm was grown on the surface of a carbon paper for 7 days using Shewanella Loihica bacteria. Then, biofilm was employed to synthesise platinum, palladium and gold nanoparticles in water using sodium lactate as electron donor without using any toxic chemicals at mild operating conditions. Electrochemically active biofilm oxidise the electron donor and produces electrons in the solution. Since these electrons are a strong reducing agent, they can reduce metal precursors quite effectively and quickly. The As-synthesized ultra-small nanoparticles have a size range between (2-7nm) and showed excellent catalytic activity on the degradation of methyl orange. The growth of metal USNPs is strongly related to the condition of the EAB. Where using low pH for the synthesis was not successful due to the fact that it might affect and destroy the bacterial cells. However, increasing the pH to 7 and 9, led to the successful formation of USNPs. By changing the pH value, we noticed a change in the size range of the produced NPs. The EAB seems to act as a Nano factory for the synthesis of metal nanoparticles by offering a green, sustainable and toxic free synthetic route without the use of any capping agents or ligands and depending only on their respiration pathway.

Keywords: electrochemically active biofilm, electron donor, shewanella loihica, ultra-small nanoparticles

Procedia PDF Downloads 185

Authors: Aditi Taunk, George Iskander, Kitty Ka Kit Ho, Mark Willcox, Naresh Kumar

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Bacterial infections on biomaterial implants and medical devices accounts for 60-70% of all hospital acquired infections (HAIs). Treatment or removal of these infected devices results in high patient mortality and morbidity along with increased hospital expenses. In addition, with no effective strategies currently available and rapid development of antibacterial resistance has made device-related infections extremely difficult to treat. Therefore, in this project we have developed biomaterial surfaces using antibacterial compounds that inhibit biofilm formation by interfering with the bacterial communication mechanism known as quorum sensing (QS). This study focuses on covalent attachment of potent quorum sensing (QS) inhibiting compounds, halogenated furanones (FUs) and dihydropyrrol-2-ones (DHPs), onto glass surfaces. The FUs were attached by photoactivating the azide groups on the surface, and the acid functionalized DHPs were immobilized on amine surface via EDC/NHS coupling. The modified surfaces were tested in vitro against pathogenic organisms such as Staphylococcus aureus and Pseudomonas aeruginosa using confocal laser scanning microscopy (CLSM). Successful attachment of compounds on the substrates was confirmed by X-ray photoelectron spectroscopy (XPS) and contact angle measurements. The antibacterial efficacy was assessed, and significant reduction in bacterial adhesion and biofilm formation was observed on the FU and DHP coated surfaces. The activity of the coating was dependent upon the type of substituent present on the phenyl group of the DHP compound. For example, the ortho-fluorophenyl DHP (DHP-2) exhibited 79% reduction in bacterial adhesion against S. aureus and para-fluorophenyl DHP (DHP-3) exhibited 70% reduction against P. aeruginosa. The results were found to be comparable to DHP coated surfaces prepared in earlier study via Michael addition reaction. FUs and DHPs were able to retain their in vitro antibacterial efficacy after covalent attachment via azide chemistry. This approach is a promising strategy to develop efficient antibacterial biomaterials to reduce device related infections.

Keywords: antibacterial biomaterials, biomedical device-related infections, quorum sensing, surface functionalization

Procedia PDF Downloads 256

Authors: Abhay Asthana, Shally Toshkhani, Gyati Shilakari

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The objective of the present research work is to develop a topical biodegradable dermal patch based formulation to aid accelerated wound healing. It is always better for patient compliance to be able to reduce the frequency of dressings with improved drug delivery and overall therapeutic efficacy. In present study optimized formulation using biodegradable components was obtained evaluating polymers and excipients (HPMC K4M, Ethylcellulose, Povidone, Polyethylene glycol and Gelatin) to impart significant folding endurance, elasticity, and strength. Molten gelatin was used to get a mixture using ethylene glycol. Chitosan dissolved in acidic medium was mixed with stirring to Gelatin mixture. With continued stirring to the mixture Curcumin was added with the aid of DCM and Methanol in an optimized ratio of 60:40 to get homogenous dispersion. Polymers were dispersed with stirring in the final formulation. The mixture was sonicated casted to get the film form. All steps were carried out under strict aseptic conditions. The final formulation was a thin uniformly smooth textured film with dark brown-yellow color. The film was found to have folding endurance was around 20 to 21 times without a crack in an optimized formulation at RT (23°C). The drug content was in range 96 to 102% and it passed the content uniform test. The final moisture content of the optimized formulation film was NMT 9.0%. The films passed stability study conducted at refrigerated conditions (4±0.2°C) and at room temperature (23 ± 2°C) for 30 days. Further, the drug content and texture remained undisturbed with stability study conducted at RT 23±2°C for 45 and 90 days. Percentage cumulative drug release was found to be 80% in 12h and matched the biodegradation rate as tested in vivo with correlation factor R2>0.9. In in vivo study administration of one dose in equivalent quantity per 2 days was applied topically. The data demonstrated a significant improvement with percentage wound contraction in contrast to control and plain drug respectively in given period. The film based formulation developed shows promising results in terms of stability and in vivo performance.

Keywords: wound healing, biodegradable, polymers, patch

Procedia PDF Downloads 467

Authors: Abram Zoltan

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Over the past hundred years, human activities, particularly the burning of fossil fuels, have released enough carbon dioxide and other greenhouse gases to dissipate additional heat into the lower atmosphere and affect the global climate. Climate change affects many social and environmental determinants of health: clean air, safe drinking water, and adequate food. Our aim is to draw attention to the effects of climate change on the health and health care system. Improving climate awareness and the knowledge related to climate change's health impacts are essential among medical students and practicing medical doctors. Therefore, in their everyday practice, they also need some assistance and up-to-date knowledge of how climate change can endanger human health and deal with these novel health problems. Our activity, based on the cooperation of more universities, aims to develop new curriculum outlines and learning materials on climate change's health impacts for medical schools. Special attention is intended to pay to the possible preventative measures against these impacts. For all of this, the project plans to create new curriculum outlines and learning materials for medical students, elaborate methodological guidelines and create training materials for medical doctors' postgraduate learning programs. The target groups of the project are medical students, educational staff of medical schools and universities, practicing medical doctors with special attention to the general practitioners and family doctors. We had searched various surveys, domestic and international studies about the effects of climate change and statistical estimation of the possible consequences. The health effects of climate change can be measured only approximately by considering only a fraction of the potential health effects and assuming continued economic growth and health progress. We can estimate that climate change is expected to cause about 250,000 more deaths. We conclude that climate change is one of the most serious problems of the 21st century, affecting all populations. In the short- to medium-term, the health effects of climate change will be determined mainly by human vulnerability. In the longer term, the effects depend increasingly on the extent to which transformational action is taken now to reduce emissions. We can contribute to reducing environmental pollution by raising awareness and by educating the population.

Keywords: climate change, health impacts, medical students, education

Procedia PDF Downloads 118

Authors: D. Avila

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The tourism industry is a phenomenon that has become a growing presence in international socio-economic dynamics, which in most cases exceeds the control parameters in the various environmental regulations and sustainability of existing resources. Because of this, the effects on the natural environment at the regional and national levels represent a challenge, for which a number of strategies are necessary to minimize the environmental impact generated by the occupation of the territory. The hotel tourist building and sustainable development in the coastal zone, have an important impact on the environment and on the physical and psychological health of the inhabitants. Environmental quality associated with the comfort of humans to the sustainable development of natural resources; applied to the hotel architecture this concept involves the incorporation of new demands on all of the constructive process of a building, changing customs of developers and users. The methodology developed provides an initial analysis to determine and rank the different tourist buildings, with the above it will be feasible to establish methods of study and environmental impact assessment. Finally, it is necessary to establish an overview regarding the best way to implement tourism development on the coast, containing guidelines to improve and protect the natural environment. This paper analyzes the parameters and strategies to reduce environmental impacts derived from deployments tourism on the coast, through a series of recommendations towards sustainability, in the context of the Bahia de Banderas, Puerto Vallarta, Jalisco. The environmental impact caused by the implementation of tourism development, perceived in a coastal environment, forcing a series of processes, ranging from the identification of impacts, prediction and evaluation of them. For this purpose are described below, different techniques and valuation procedures: Identification of impacts. Methods for the identification of damage caused to the environment pursue general purpose to obtain a group of negative indicators that are subsequently used in the study of environmental impact. There are several systematic methods to identify the impacts caused by human activities. In the present work, develops a procedure based and adapted from the Ministry of works public urban reference in studies of environmental impacts, the representative methods are: list of contrast, arrays, and networks, method of transparencies and superposition of maps.

Keywords: environmental impact, physical health, sustainability, tourist building

Procedia PDF Downloads 322

Authors: Chi-Wai Kan, Kam-Hong Chau, Ho-Shing Law

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Wicking property is important for textile finishing and wears comfort. Good wicking properties can ensure uniformity and efficiency of the textiles treatment. In view of wear comfort, quick wicking fabrics facilitate the evaporation of sweat. Therefore, the wetness sensation of the skin is minimised to prevent discomfort. The testing method for vertical wicking was standardised by the American Association of Textile Chemists and Colorists (AATCC) in 2011. The traditional vertical wicking test involves human error to observe fast changing and/or unclear wicking height. This study introduces optoelectronic devices to achieve an automatic Vertical Wicking Tester (VWT) and reduce human error. The VWT can record the wicking time and wicking height of samples. By reducing the difficulties of manual judgment, the reliability of the vertical wicking experiment is highly increased. Furthermore, labour is greatly decreased by using the VWT. The automatic measurement of the VWT has optoelectronic devices to trace the liquid wicking with a simple operation procedure. The optoelectronic devices detect the colour difference between dry and wet samples. This allows high sensitivity to a difference in irradiance down to 10 μW/cm². Therefore, the VWT is capable of testing dark fabric. The VWT gives a wicking distance (wicking height) of 1 mm resolution and a wicking time of one-second resolution. Acknowledgment: This is a research project of HKRITA funded by Innovation and Technology Fund (ITF) with title “Development of an Automatic Measuring System for Vertical Wicking” (ITP/055/20TP). Author would like to thank the financial support by ITF. Any opinions, findings, conclusions or recommendations expressed in this material/event (or by members of the project team) do not reflect the views of the Government of the Hong Kong Special Administrative Region, the Innovation and Technology Commission or the Panel of Assessors for the Innovation and Technology Support Programme of the Innovation and Technology Fund and the Hong Kong Research Institute of Textiles and Apparel. Also, we would like to thank the support and sponsorship from Lai Tak Enterprises Limited, Kingis Development Limited and Wing Yue Textile Company Limited.

Keywords: AATCC method, comfort, textile measurement, wetness sensation

Procedia PDF Downloads 90

Authors: Burcu Uçan

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The certification approach differs in civil and military projects in aviation. Sets of criteria and standards created by airworthiness authorities for the determination of certification basis are distinct. While the civil standards are more understandable and clear because of not only include detailed specifications but also the help of guidance materials such as Advisory Circular, military criteria do not provide this level of guidance. Therefore, specifications that are more negotiable and sometimes more difficult to reconcile arise for the certification basis of a military aircraft. This study investigates a method of how to develop a military specification set by taking advantage of civil standards, regarding the European Military Airworthiness Criteria (EMACC) that establishes the airworthiness criteria for aircraft systems. Airworthiness Certification Criteria (MIL-HDBK-516C) is a handbook published for guidance that contains qualitative evaluation for military aircrafts meanwhile Certification Specifications (CS-29) is published for civil aircrafts by European Union Aviation Safety Agency (EASA). This method intends to compare and contrast specifications that MIL-HDBK-516C and CS-29 contain within the scope of Human Factors. Human Factors supports human performance and aims to improve system performance by encompassing knowledge from a range of scientific disciplines. Human Factors focuses on how people perform their tasks and reduce the risk of an accident occurring due to human physical and cognitive limitations. Hence, regardless of whether the project is civil or military, the specifications must be guided at a certain level by taking into account human limits. This study presents an advisory method for this purpose. The method in this study develops a solution for the military certification process by identifying the CS requirement corresponding to the criteria in the MIL-HDBK-516C by means of EMACC. Thus, it eases understanding the expectations of the criteria and establishing derived requirements. As a result of this method, it may not always be preferred to derive new requirements. Instead, it is possible to add remarks to make the expectancy of the criteria and required verification methods more comprehensible for all stakeholders. This study contributes to creating a certification basis for military aircraft, which is difficult and takes plenty of time for stakeholders to agree due to gray areas in the certification process for military aircrafts.

Keywords: human factors, certification, aerospace, requirement

Procedia PDF Downloads 67

Authors: Bahareh Sarmadi, Paul A. Kilmartin, Leandro D. Araújo, Brandt P. Bastow

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Aim: Sauvignon blanc is the most substantial variety cultivated in almost 62% of all producing vineyards of New Zealand. The popularity of New Zealand Sauvignon blanc is due to its unique taste. It is the most famous wine characterized by its aroma profile derived from mercaptans. 3-mercaptohexan-1-ol (3MH) and 3-mercaptohexyl acetate (3MHA) are two of the most important volatile mercaptans found in Sauvignon blanc wines. “Viticultural” and “Enological” factors such as machine-harvesting, the most common harvesting practice used in New Zealand, can be among the reasons for this distinct flavor. Elemental sulfur is commonly sprayed in the fields to protect berries against powdery mildew. Although it is not the only source of sulfur, this practice creates a source of elemental sulfur that can be transferred into the must and eventually into wines. Despite the clear effects of residual elemental sulfur present in the must on the quality and aroma of the final wines, its measurement before harvest or fermentation is not a regular practice in the wineries. This can be due to the lack of accessible and applicable methods for the equipment at most commercial wineries. This study aims to establish a relationship between the number and frequency of elemental sulfur applications and the concentration of polyfunctional mercaptans in the final wines. Methods: An apparatus was designed to reduce elemental sulfur to sulfide, then an ion-selective electrode to measure sulfide concentration. During harvest 2022, we explored a wider range of residual elemental sulfur levels than what typically applies in the vineyards. This has been done through later manual elemental sulfur applications in the vineyard. Additional sulfur applications were made 20, 10 and 5 days prior to harvesting the treated grapes, covering long and short pre-harvest intervals (PHI). The grapes were processed into juice and fermented into wine; then, they were analyzed to find the correlation between polyfunctional mercaptans concentrations in the wines and residual elemental sulfur in the juice samples. Results: The research showed that higher 3MH/3MHA was formed when elemental sulfur was applied more frequent in the vineyards and supported the proposed pathway in which elemental sulfur is a source of 3MH formation in wines.

Keywords: sauvignon blanc, elemental sulfur, polyfunctional mercaptans, varietal thiols

Procedia PDF Downloads 94

Authors: Yi Fung Lin, Pei Chen Tsai

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Purpose: Many breast cancer survivors actively seek information about diet, exercise, and nutritional supplements to expedite recovery, reduce the risk of recurrence, and enhance their quality of life. While weight loss is not a primary concern for overweight or obese patients during the active treatment phase, they continue to face the additional burden and risks associated with excess weight post-treatment. This group has complex views on weight loss: they are concerned that exercise or dietary control might exacerbate symptoms, yet they also believe that obesity could negatively impact health. These perceptions can have both positive and negative effects on weight management. Therefore, this qualitative study aimed to explore the factors that influence overweight or obese breast cancer survivors' ability to manage their weight. Method: Eight women participated in in-depth interviews in 2022. Data was extracted based on the verbatim transcripts of the audio files, and the analysis was conducted through careful reading of the text. This qualitative research collected data until data saturation was reached. Results: A total of 22 codes were identified and subsequently integrated into three main themes: (1) Facilitators, including support systems, others' successful weight loss experiences, education, responsibility to others, and motivation; (2) Barriers, encompassing physical limitations, the stigma associated with weight loss, the cost of weight loss, antiestrogen medication, and cancer symptoms; (3) Variable Factors, which comprise perspectives on cancer, perspectives on obesity, and past experiences with weight loss. Conclusions: These findings are similar to previous research on barriers and motivators, highlighting variable factors that exist and can lead to either positive or negative effects on weight loss. The results can inform the development of weight management programs tailored to the needs of overweight or obese breast cancer survivors. Additionally, the identified factors represent vital variables for future studies, serving as valuable references for further research in this area.

Keywords: weight management, breast cancer, overweight, obese, cancer survivors

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Authors: Sharadha G., Suresh Kanakkanavar

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Background: Placenta previa is a condition characterized by partial or complete implantation of the placenta in the lower uterine segment. It is one of the main causes of vaginal bleeding in the third trimester and a significant cause of maternal and perinatal morbidity and mortality. Materials and Methods: This is an observational study involving 130 patients diagnosed with placenta previa and satisfying inclusion criteria. The demographic data, clinical, surgical, and treatment, along with maternal and neonatal outcome parameters, were noted in proforma. Results: The incidence of placenta previa among scarred uterus was 1.32%, and in unscarred uterus was 0.67%. The mean age of the study population was 27.12±4.426years. High parity, high abortion rate, multigravida status, and less gestational age at delivery were commonly seen in scarred uterus compared to unscarred uterus. Complete placenta previa, anterior placental position, and adherent placenta were significantly associated with a scarred uterus compared to an unscarred uterus. The rate of caesarean hysterectomy was higher in the scarred uterus, along with statistical association to previous lower-segment caesarean sections. Intraoperative procedures like uterine artery ligation, bakri balloon insertion, and iliac artery ligation were higher in the scarred group. The maternal intensive care unit admission rate was higher in the scarred group and also showed its statistical association with previous lower segment caesarean section. Neonatal outcomes in terms of pre-term birth, still birth, neonatal intensive care unit admission, and neonatal death, though higher in the scarred group, did not differ statistically among the groups. Conclusion: Advancing maternal age, multiparity, prior uterine surgeries, and abortions are independent risk factors for placenta previa. Maternal morbidity is higher in the scarred uterus group compared to the unscarred group. Neonatal outcomes did not differ statistically among the groups. This knowledge would help the obstetricians to take measures to reduce the incidence of placenta previa and scarred uterus which would improve the fetomaternal outcome of placenta previa.

Keywords: placenta previa, scarred uterus, unscarred uterus, adherent placenta

Procedia PDF Downloads 46

Authors: Moujib Bahri, Rahim Kallel, Ouafa Sakka

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Corruption is a phenomenon that increases uncertainty and risk of SMEs as it undermines the quality of the business environment and the easy access to public services. Our research builds on existing research on corruption's effects on economic growth at the firm level. Several papers have analyzed the effect of firms’ payments of bribes on their performance; however, only limited research has investigated the link between corruption, innovation, and exports. Drawing on principal-agent theory, we explore how corruption weakens the institutional context and makes the business environment unsound and not conducive to innovation and exports. This study employs data from The Enterprise Surveys conducted in Tunisia between March 2013 and July 2014 by the World Bank, the European Bank for Reconstruction and Development (EBRD) and the European Investment Bank (EIB). The main objective of this survey was to gain a better understanding of Tunisian firms’ perception of the environment in which they operate. Since 2011, the country's political situation has become fragile and unstable, and public services are perceived as inefficient and corrupt. We test our hypotheses on a sample of 537 Tunisian manufacturing SMEs using structural equation modeling and path analysis. We find that political instability leads to higher level of corruption, and that excessive business licensing regulations create a fertile ground for bribery. Our findings do not support the greasing hypothesis suggesting that corruption can reduce the negative effect of bureaucratic delays and the hard access of companies to public services related to innovation and exports. Instead, our results support the sanding hypothesis according to which corruption hinders innovation activities and exports. Furthermore, corruption is found to, negatively and significantly, impact firms’ ownership of quality certificates. Our results suggest that, in an environment with a high level of corruption, governments and policymakers interested in assisting SMEs with their innovation and export activities should have a better control on corruption to allow them developing those activities without being forced to bribe government officers.

Keywords: corruption, innovation, exports, SMEs

Procedia PDF Downloads 172

Authors: Sreto Boljevic

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Heating systems based on geothermal energy sources are becoming increasingly popular among commercial/community buildings as management of these buildings looks for a more efficient and environmentally friendly way to manage the heating system. The thermal energy supply of most European commercial/community buildings at present is provided mainly by energy extracted from natural gas. In order to reduce greenhouse gas emissions and achieve climate change targets set by the EU, restructuring in the area of thermal energy supply is essential. At present, heating and cooling account for approx... 50% of the EU primary energy supply. Due to its physical characteristics, thermal energy cannot be distributed or exchange over long distances, contrary to electricity and gas energy carriers. Compared to electricity and the gas sectors, heating remains a generally black box, with large unknowns to a researcher and policymaker. Ain literature number of documents address policies for promoting renewable energy technology to facilitate heating for residential/community/commercial buildings and assess the balance between heat supply and heat savings. Ground source heat pump (GSHP) technology has been an extremely attractive alternative to traditional electric and fossil fuel space heating equipment used to supply thermal energy for residential/community/commercial buildings. The main purpose of this paper is to create an algorithm using an analytical approach that could enable a feasibility study regarding the implementation of GSHP technology in community building with existing fossil-fueled heating systems. The main results obtained by the algorithm will enable building management and GSHP system designers to define the optimal size of the system regarding technical, environmental, and economic impacts of the system implementation, including payback period time. In addition, an algorithm is created to be utilized for a feasibility study for many different types of buildings. The algorithm is tested on a building that was built in 1930 and is used as a church located in Cork city. The heating of the building is currently provided by a 105kW gas boiler.

Keywords: GSHP, greenhouse gas emission, low-enthalpy, renewable energy

Procedia PDF Downloads 209

Authors: Md. Ashikur Rahman

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Optimal breastfeeding practice is essential to reducing childhood morbidity and mortality and helps to achieve Millennium Development Goal (MDG). A cross-sectional study was conducted in a rural area in Dhaka district to explore the barrier to optimal breastfeeding practices. The population of this study constitutes all nursing mothers having children aged 0-6 months, and they were selected purposively. The study adopted a structured and in-depth interview procedure consisting of open and closed-ended questions. Four hundred rural nursing mothers constituted the sample of the structured interview, while 15 were involved in the in-depth interview. Among the respondent's majority (67%) were in the age group 17-25 years, with a mean age of 24.44 years. Most (39.5%) of the mothers were housewives with a secondary level of education (46.5%). About 32% of mothers started breastfeeding within one hour after birth. But delayed initiation was reported in 31.5% of mothers, whereas 36.8% of mothers forgot the exact time of initiation of breastfeeding. The main reason not to practice colostrum was mothers tried to breastfeed, but there was no milk, stated 13.8% of mothers. In addition, about one-third (34.3%) of the respondents practiced pre-lacteal feeding, and among them, 12.8% introduced sugar with water. Reasons given by the mothers for bottle-feeding was that baby was not satisfied with breast milk only; 22.0% of mothers indicated this cause. The main influence to take formula milk by their mother and mothers-in-law was stated by 18.8% of mothers. Some mothers stated that major constraints to EBF were the perception of not having enough milk (25.5 %) and babies crying seems to be hungry (8.8%). One-third of the mothers (31.5%) felt uncomfortable during breastfeeding. Access to antenatal and postnatal counseling in the study area also was a key obstacle to optimal breastfeeding practices. In a qualitative survey, some mothers believed that there was no difference between breast milk and formula milk. Colostrum feeding, pre-lacteal feeding, early initiation of breastfeeding, and exclusive breastfeeding were strongly associated with family type, family member, birth order, religion, husbands' occupation, delivery attendants and delivery type, postnatal care, and health care facilities. To reduce the barriers to the successful practice of exclusive breastfeeding, there is a need for a grass-roots approach to educating and counseling nursing mothers with identifying factors influencing or discouraging the optimal practice.

Keywords: exclusive, breast feeding, practices, Bangladesh

Procedia PDF Downloads 83

Authors: Yuanxiaoyue Yang

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Emissions trading, or ‘cap-and-trade', has been long promoted by economists as a more cost-effective pollution control approach than traditional performance standard approaches. While there is a large body of empirical evidence for the overall effectiveness of emissions trading, relatively little attention has been paid to other unintended consequences brought by emissions trading. One important consequence is that cap-and-trade could introduce the risk of creating high-level emission concentrations in areas where emitting facilities purchase a large number of emission allowances, which may cause an unequal distribution of environmental benefits. This study will contribute to the current environmental policy literature by linking trading activity with environmental injustice concerns and empirically analyzing the causal relationship between trading activity and emissions reduction under a cap-and-trade program for the first time. To investigate the potential environmental injustice concern in cap-and-trade, this paper uses a differences-in-differences (DID) with instrumental variable method to identify the causal effect of allowance trading behaviors on emission reduction levels under the clean air interstate rule (CAIR), a cap-and-trade program targeting on the power sector in the eastern US. The major data source is the facility-year level emissions and allowance transaction data collected from US EPA air market databases. While polluting facilities from CAIR are the treatment group under our DID identification, we use non-CAIR facilities from the Acid Rain Program - another NOx control program without a trading scheme – as the control group. To isolate the causal effects of trading behaviors on emissions reduction, we also use eligibility for CAIR participation as the instrumental variable. The DID results indicate that the CAIR program was able to reduce NOx emissions from affected facilities by about 10% more than facilities who did not participate in the CAIR program. Therefore, CAIR achieves excellent overall performance in emissions reduction. The IV regression results also indicate that compared with non-CAIR facilities, purchasing emission permits still decreases a CAIR participating facility’s emissions level significantly. This result implies that even buyers under the cap-and-trade program have achieved a great amount of emissions reduction. Therefore, we conclude little evidence of environmental injustice from the CAIR program.

Keywords: air pollution, cap-and-trade, emissions trading, environmental justice

Procedia PDF Downloads 136

Authors: Leila H. Khiabani, Mohammadreza Vafaee, Farshad Hashemzadeh

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Industrial waste management regulates different stages of production, storage, transfer, recycling and waste disposal. There are several common practices for industrial waste management. However, due to various local health, economic, social, environmental and aesthetic considerations, the most optimal principles and measures often vary at each specific industrial zone. In addition, waste management strategies are heavily impacted by local administrative, legal, and financial regulations. In this study, a hybrid qualitative and quantitative research methodology has been designed for waste management planning in an industrial city. Firstly, following a qualitative research methodology, the most relevant waste management strategies for the specific industrial city were identified through interviews with environmental planning and waste management experts. Forty experts participated in this study. Alborz industrial city in Iran, which hosts more than one thousand industrial units in nine hundred acres, was chosen as the sample industrial city in this study. The findings from the expert interviews at the first phase were then used to design a quantitative questionnaire for the second phase of the study. The aim of the questionnaire was to quantify the relative impact of different waste management strategies in the sample industrial city. Eight waste management strategies and three implementation policies were included in the questionnaire. The experts were asked to rank the relative effectiveness of each strategy for environmental planning of the sample industrial city. They were also asked to rank the relative effectiveness of each planning policy on each of the waste management strategies. In the end, the weighted average of all the responses was calculated to identify the most effective waste management strategy and planning policies for the sample industrial city. The results suggested that among the eight suggested waste management strategies, industrial composting is the most effective (31%) strategy based on the collective evaluation of the local expert. Additionally, the results suggested that the most effective policy (58%) in the city’s environmental planning is to reduce waste generation by prolonging the effective life of industrial products using higher quality and recyclable materials. These findings can provide useful expert guidelines for prioritization between different waste management strategies in the city’s overall environmental planning roadmap. The findings may also be applicable to similar industrial cities. In addition, a similar methodology can be utilized in the environmental planning of other industrial cities.

Keywords: environmental planning, industrial city, quantitative research, waste management

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Authors: Mohammad Reza Esmaili

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One of the most important parts of the restoration process of a power network is the synchronizing of its subsystems. In this situation, the biggest concern of the system operators will be the reduction of the standing phase angle (SPA) between the endpoints of the two islands. In this regard, the system operators perform various actions and maneuvers so that the synchronization operation of the subsystems is successfully carried out and the system finally reaches acceptable stability. The most common of these actions include load control, generation control and, in some cases, changing the network topology. Although these maneuvers are simple and common, due to the weak network and extreme load changes, the restoration will be associated with low speed. One of the best ways to control the SPA is to use FACTS devices. By applying a soft control signal, these tools can reduce the SPA between two subsystems with more speed and accuracy, and the synchronization process can be done in less time. Meanwhile, the unified power controller (UPFC), a series-parallel compensator device with the change of transmission line power and proper adjustment of the phase angle, will be the proposed option in order to realize the subject of this research. Therefore, with the optimal placement of UPFC in a power system, in addition to improving the normal conditions of the system, it is expected to be effective in reducing the SPA during power system restoration. Therefore, the presented paper provides an optimal structure to coordinate the three problems of improving the division of subsystems, reducing the SPA and optimal power flow with the aim of determining the optimal location of UPFC and optimal subsystems. The proposed objective functions in this paper include maximizing the quality of the subsystems, reducing the SPA at the endpoints of the subsystems, and reducing the losses of the power system. Since there will be a possibility of creating contradictions in the simultaneous optimization of the proposed objective functions, the structure of the proposed optimization problem is introduced as a non-linear multi-objective problem, and the Pareto optimization method is used to solve it. The innovative technique proposed to implement the optimization process of the mentioned problem is an optimization algorithm called the water cycle (WCA). To evaluate the proposed method, the IEEE 39 bus power system will be used.

Keywords: UPFC, SPA, water cycle algorithm, multi-objective problem, pareto

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Authors: Christian Neunzig, Simon Fahle, Jürgen Schulz, Matthias Möller, Bernd Kuhlenkötter

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Manufacturing companies are facing global competition and enormous cost pressure. The use of machine learning applications can help reduce production costs and create added value. Predictive quality enables the securing of product quality through data-supported predictions using machine learning models as a basis for decisions on test results. Furthermore, machine learning methods are able to process large amounts of data, deal with unfavourable row-column ratios and detect dependencies between the covariates and the given target as well as assess the multidimensional influence of all input variables on the target. Real production data are often subject to highly fluctuating boundary conditions and unbalanced data sets. Changes in production data manifest themselves in trends, systematic shifts, and seasonal effects. Thus, Machine learning applications require intensive pre-processing and feature selection. Data preprocessing includes rule-based data cleaning, the application of dimensionality reduction techniques, and the identification of comparable data subsets. Within the used real data set of Bosch hydraulic valves, the comparability of the same production conditions in the production of hydraulic valves within certain time periods can be identified by applying the concept drift method. Furthermore, a classification model is developed to evaluate the feature importance in different subsets within the identified time periods. By selecting comparable and stable features, the number of features used can be significantly reduced without a strong decrease in predictive power. The use of cross-process production data along the value chain of hydraulic valves is a promising approach to predict the quality characteristics of workpieces. In this research, the ada boosting classifier is used to predict the leakage of hydraulic valves based on geometric gauge blocks from machining, mating data from the assembly, and hydraulic measurement data from end-of-line testing. In addition, the most suitable methods are selected and accurate quality predictions are achieved.

Keywords: classification, achine learning, predictive quality, feature selection

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Authors: Mohanad Al-Behadili, Xiang Song, Djamila Ouelhadj, Alex Fraess-Ehrfeld

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In off-shore wind farms, turbine blade inspection accessibility under various sea states is very challenging and greatly affects the downtime of wind turbines. Maintenance of any offshore system is not an easy task due to the restricted logistics and accessibility. The multirotor unmanned helicopter is of increasing interest in inspection applications due to its manoeuvrability and payload capacity. These advantages increase when many of them are deployed simultaneously in a swarm. Hence this paper proposes a drone swarm framework for inspecting offshore wind turbine blades and nacelles so as to reduce downtime. One of the big challenges of this task is that when operating a drone swarm, an individual drone may not have enough power to fly and communicate during missions and it has no capability of refueling due to its small size. Once the drone power is drained, there are no signals transmitted and the links become intermittent. Vessels equipped with 5G masts and small power units are utilised as platforms for drones to recharge/swap batteries. The research work aims at designing a smart energy management system, which provides automated vessel and drone routing and recharging plans. To achieve this goal, a novel mathematical optimisation model is developed with the main objective of minimising the number of drones and vessels, which carry the charging stations, and the downtime of the wind turbines. There are a number of constraints to be considered, such as each wind turbine must be inspected once and only once by one drone; each drone can inspect at most one wind turbine after recharging, then fly back to the charging station; collision should be avoided during the drone flying; all wind turbines in the wind farm should be inspected within the given time window. We have developed a real-time Ant Colony Optimisation (ACO) algorithm to generate real-time and near-optimal solutions to the drone swarm routing problem. The schedule will generate efficient and real-time solutions to indicate the inspection tasks, time windows, and the optimal routes of the drones to access the turbines. Experiments are conducted to evaluate the quality of the solutions generated by ACO.

Keywords: drone swarm, routing, scheduling, optimisation model, ant colony optimisation

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Authors: Mostafa Sarabzadeh, Masoumeh Helalizadeh, Seyyed Mahmoud Hejazi

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Multiple Sclerosis is considered as diseases related to central nerve system, the chronic and progressive disease impress on sensory and motor function of people. Due to equilibrium problems in this patients that related to disorder of nerve conduction transmission from central nerve system to organs and the nature of elastic bands that can make changes in neuromuscular junctions and momentary actions, the aim of this research is evaluate elastic training effect by reactionary ropes on nerve conduction velocity (in lower and upper limb) and functional balance in female patients with Multiple Sclerosis. The study was a semi-experimental study that was performed based on pre and post-test method, The statistical community consisted of 16 women with MS in the age mean 25-40yrs, at low and intermediate levels of disease EDSS 1-4 (Expanded Disability Status Scale) that were divided randomly into elastic and control groups, so the training program of experimental group lasted six weeks, 3 sessions per week of elastic exercises with reactionary ropes. Electroneurography parameters (nerve conduction velocity- latency) of Upper and lower nerves (Median, Tibial, Sural, Peroneal) along with balance were investigated respectively by the Electroneurography system (ENG) and Timed up and go (TUG) functional test two times in before and after the training period. After that, To analyze the data were used of Dependent and Independent T-test (with sig level p<0.05). The results showed significant increase in nerve conduction velocity of Sural (p=0.001), Peroneal (p=0.01), Median (p=0.03) except Tibial and also development Latency Time of Tibial (p= 0), Peroneal (p=0), Median (p=0) except Sural. The TUG test showed significant decreases in execution time too (p=0.001). Generally, based on what the obtained data can indicate, modern training with elastic bands can contribute to enhanced nerve conduction velocity and balance in neurosis patients (MS) so lead to reduce problems, promotion of mobility and finally more life expectancy in these patients.

Keywords: balance, elastic bands, multiple sclerosis, nerve conduction, velocity

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Authors: Juan C. Sanchez, Jose L. Endrino, Alejandro Toro, Hugo A. Estupinan, Glenn Leighton

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For years, the reduction of friction and wear has been a matter of interest in the engineering field. Several solutions have been proposed to address this issue, including the use of lubricants and coatings to reduce the frictional forces and to increase the surface wear resistance. Alternatively, texturing processes have been used in a wide variety of materials, in many cases inspired in natural surfaces. Nature has shown how species adapt to the environment and the engineers try to understand natural surfaces for particular applications by analyzing outstanding species such as gecko for high adhesion, lotus leaves for hydrophobicity, sharks for reduced flow resistance and snakes for optimized frictional response. Texturized surfaces have shown a superior performance in terms of the frictional response in many situations, and the control of its behavior greatly depends on the manufacturing process. The focus of this work is to evaluate the tribological behavior of AISI 52100 steel samples texturized by Photochemical Machining (PCM). The surface texture was inspired by several features of the snakeskin such as aspect ratio of fibrils and mean fibril spacing. Two coatings were applied on the texturized surface, namely Diamond-like Carbon (DLC) and Molybdenum Disulphide (MoS₂), and their tribological behavior after pin-on-disk tests were compared with that of the non-texturized and uncovered surfaces. The samples were characterised through Stereoscopic Microscope (SM), Scanning Electron Microscope (SEM), Optical Microscope (OM), Profilometer, Raman Spectrometer (RS) and X-Ray Diffractometer (XRD). The Coefficient of Friction (COF) measured in pin-on-disk tests showed correlations with the sliding direction (relative to the texture features) and the aspect ratio of the texture features. Regarding the coated surfaces, the DLC and MoS₂ coating had a good performance in terms of wear rate and coefficient of friction compared with the uncoated and non-texturized surfaces. On the other hand, for the uncoated surfaces, the texture showed an influence in the tribological performance with respect to the non-texturized surface.

Keywords: coating, coefficient of friction, deterministic surface, photochemical machining

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Authors: Pampita Chakraborty, Sukumar Mukherjee

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People with diabetes mellitus are more susceptible to developing infections, as high blood sugar levels can weaken the patient's immune system defences. People with diabetes are more adversely affected when they get an infection than someone without the disease, because you have weakened immune defences in diabetes. People who have minimally elevated blood sugar levels experience worse outcomes with infections. Diabetic patients in hospitals do not necessarily have a higher mortality rate due to infections, but they do face longer hospitalisation and recovery times. A study was done in a tertiary care unit in eastern India. Patients with type 2 diabetes mellitus infection were recruited in the study. A total of 520 cases of Type 2 Diabetes Mellitus were recorded out of which 200 infectious cases was included in the study. All subjects underwent detailed history & clinical examination. Microbiological samples were collected from respective site of the infection for microbial culture and antibiotic sensitivity test. Out of the 200 infectious cases urinary tract infection(UTI) was found in majority of the cases followed by diabetic foot ulcer (DFU), respiratory tract infection(RTI) and sepsis. It was observed that Escherichia coli was the most commonest pathogen isolated from UTI cases and Staphylococcus aureus was predominant in foot ulcers followed by other organisms. Klebsiella pneumonia was the major organism isolated from RTI and Enterobacter aerogenes was commonly observed in patients with sepsis. Isolated bacteria showed differential sensitivity pattern against commonly used antibiotics. The majority of the isolates were resistant to several antibiotics that are usually prescribed on an empirical basis. These observations are important, especially for patient management and the development of antibiotic treatment guidelines. It is recommended that diabetic patients receive pneumococcal and influenza vaccine annually to reduce morbidity and mortality. Appropriate usage of antibiotics based on local antibiogram pattern can certainly help the clinician in reducing the burden of infections.

Keywords: antimicrobial resistance, diabetic foot ulcer, respiratory tract infection, urinary tract infection

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Authors: Maria Miranda-Medina, Sara Salopek, Andras Vernes, Martin Jech

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Sliding lubricated surfaces induce the formation of tribofilms that reduce friction, wear and prevent large-scale damage of contact parts. Engine oils and lubricants use antiwear and antioxidant additives such as zinc dialkyldithiophosphate (ZDDP) from where protective tribofilms are formed by degradation. The ZDDP tribofilms are described as a two-layer structure composed of inorganic polymer material. On the top surface, the long chain polyphosphate is a zinc phosphate and in the bulk, the short chain polyphosphate is a mixed Fe/Zn phosphate with a gradient concentration. The polyphosphate chains are partially adherent to steel surface through a sulfide and work as anti-wear pads. In this contribution, ZDDP tribofilms formed on gray cast iron surfaces are studied. The tribofilms were generated in a reciprocating sliding tribometer with a piston ring-cylinder liner configuration. Fully formulated oil of SAE grade 5W-30 was used as lubricant during two tests at 40Hz and 50Hz. For the estimation of the tribofilm thicknesses, spectroscopic ellipsometry was used due to its high accuracy and non-destructive nature. Ellipsometry works under an optical principle where the change in polarisation of light reflected by the surface, is associated with the refractive index of the surface material or to the thickness of the layer deposited on top. Ellipsometrical responses derived from tribofilms are modelled by effective medium approximation (EMA), which includes the refractive index of involved materials, homogeneity of the film and thickness. The materials composition was obtained from x-ray photoelectron spectroscopic studies, where the presence of ZDDP, O and C was confirmed. From EMA models it was concluded that tribofilms formed at 40 Hz are thicker and more homogeneous than the ones formed at 50 Hz. In addition, the refractive index of each material is mixed to derive an effective refractive index that describes the optical composition of the tribofilm and exhibits a maximum response in the UV range, being a characteristic of glassy semitransparent films.

Keywords: effective medium approximation, reciprocating sliding tribometer, spectroscopic ellipsometry, zinc dialkyldithiophosphate

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Authors: Joana Gato, Ahmed Abotabekh, Panayoti Bachkangi

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Introduction: Oestrogen is an essential gonadal hormone that plays a vital role in the reproductive system of women1. The average age of menopause in the UK is 512. Women who go through premature menopause should be offered Hormone replacement therapy (HRT). Similarly, women who undergo surgical menopause should be offered HRT, unless contraindicated, depending on the indication of their surgery2,3. Aim: To assess if the patients in our department are counselled regarding HRT after surgical treatment and if HRT was prescribed. Methodology: A retrospective audit in a busy district hospital, examining all the patients who had a hysterectomy. The audit examined if HRT was discussed pre-operatively, prescribed on discharge and if a follow up was arranged. For women with contraindication to HRT, the audit assessed if the reasons were discussed pre-operatively and communicated to the Inclusion criteria: woman having a total or subtotal hysterectomy, with or without bilateral salpingo-ophorectomy (BSO), between April and September 2022. Exclusion criteria: woman having a vaginal hysterectomy. Results: 40 patients in total had hysterectomy; 27 (68%) were under the age of 51. 15 out of 27 patients bad BSO. 9 women were prescribed HRT, but 8 were offered HRT immediately, and 1 of them were offered a follow up. Of women who underwent surgical menopause, 7 were not given any HRT. The HRT choice was diverse, however, the majority was prescribed oral HRT. 40% of women undergoing surgical menopause did not have a discussion about HRT prior to their surgery. In postmenopausal women (n=13; 33%), still two were given HRT for preexisting menopausal symptoms. Discussion: Only 59% of the pre-menopausal patients had oophorectomy, therefore undergoing surgical menopause. Of these, 44% were not given any HRT, and 40% had no discussion about HRT prior to surgery. Interestingly, the majority of these women have no obvious contraindication to HRT. The choice of HRT was diverse, but the majority was commenced on oral HRT. Our unit is still working towards meeting all the NICE guidance standards of offering HRT and information prior to surgery to women planning to undergo surgical menopause. Conclusion: Starting HRT at the onset of menopause has been shown to improve quality of life and reduce the risk of cardiovascular disease and osteoporotic fractures4. Our unit still has scope for improvement to comply with the current NICE guidance. All pre-menopausal women undergoing surgical menopause should have a discussion regarding HRT prior to surgery and be offered it if there are no contraindications. This discussion should be clearly documented in the notes. At the time of this report, some of the patients have not yet had a follow up, which we recognize as a limitation to our audit.

Keywords: hormone replacement therapy, menopause, premature ovarian insufficiency, surgical management

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Authors: Haoyu Zhao, Qianshu Ma, Min Xie, Yunqi Huang, Yunjia Liu, Huan Song, Hongsheng Gui, Mingli Li, Qiang Wang

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Rationale: Bipolar disorder (BD) and major depressive disorder (MDD), as severe chronic illnesses that restrict patients’ psychosocial functioning and reduce their quality of life, are both categorized into mood disorders. Emerging evidence has suggested that the reliability of self-rated health (SRH) was wellvalidated and that the risk of various health outcomes, including mortality and health care costs, could be predicted by SRH. Compared with other lengthy multi-item patient-reported outcomes (PRO) measures, SRH was proven to have a comparable predictive ability to predict mortality and healthcare utilization. However, to our knowledge, no study has been conducted to assess the association between SRH and hospitalization among people with mental disorders. Therefore, our study aims to determine the association between SRH and subsequent all-cause hospitalizations in patients with BD and MDD. Methods: We conducted a prospective cohort study on people with BD or MDD in the UK from 2006 to 2010 using UK Biobank touchscreen questionnaire data and linked administrative health databases. The association between SRH and 2-year all-cause hospitalizations was assessed using proportional hazard regression after adjustment for sociodemographics, lifestyle behaviors, previous hospitalization use, the Elixhauser comorbidity index, and environmental factors. Results: A total of 29,966 participants were identified, experiencing 10,279 hospitalization events. Among the cohort, the average age was 55.88 (SD 8.01) years, 64.02% were female, and 3,029 (10.11%), 15,972 (53.30%), 8,313 (27.74%), and 2,652 (8.85%) reported excellent, good, fair, and poor SRH, respectively. Among patients reporting poor SRH, 54.19% had a hospitalization event within 2 years compared with 22.65% for those having excellent SRH. In the adjusted analysis, patients with good, fair, and poor SRH had 1.31 (95% CI 1.21-1.42), 1.82 (95% CI 1.68-1.98), and 2.45 (95% CI 2.22, 2.70) higher hazards of hospitalization, respectively, than those with excellent SRH. Conclusion: SRH was independently associated with subsequent all-cause hospitalizations in patients with BD or MDD. This large study facilitates rapid interpretation of SRH values and underscores the need for proactive SRH screening in this population, which might inform resource allocation and enhance high-risk population detection.

Keywords: severe mental illnesses, hospitalization, risk prediction, patient-reported outcomes

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Authors: Holm Zerbe, Laura Macias, Hans-Joachim Schuberth, Wolfram Petzl

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Mastitis is among the most important production diseases in cows. It accounts for large parts of antimicrobial drug use in the dairy industry worldwide. Due to the imminent normative to reduce the use of antimicrobial drugs in livestock, new ways for therapy and prophylaxis of mastitis are needed. Recently epigenetic regulation of inflammation by chromatin modifications has increasingly drawn attention. Currently, some epigenetic modifiers have already been approved for the use in humans, however little is known about their actions in the bovine system. The aim of our study was to investigate whether three selected epigenetic modifiers (Vitamin D3, SAHA and S2101) influence the initial immune response towards mastitis pathogens in bovine udder tissue in vitro. Tissue explants of the teat cistern and udder parenchyma were collected from 21 cows and were incubated for 36 hours in the absence and presence of epigenetic modifiers. Additionally, the tissue was stimulated with heat-inactivated particles of Escherichia coli and Staphylococcus aureus, which are regarded as two of the most important mastitis pathogens. After incubation, the explants were tested by RT-qPCR for transcript abundances of immune-related candidate genes. Gene expression was validated in culture supernatants by an AlphaLISA assay. Furthermore, the culture supernatants were analyzed for their chemotactic capacity through a chemotaxis assay. Statistical analysis of data was performed with the program ‘R’ version 3.2.3. Vitamin D3 had no effect on the immune response of udder tissue in vitro after stimulation with mastitis pathogens. The epigenetic modifiers SAHA and S2101 however significantly blocked the pathogen-induced upregulation of CXCL8, TNFα, S100A9 and LAP (P < 0.05). The regulation of IL10 was not affected by treatment with SAHA and S2101. Transcript abundances for CXCL8 were reflected by IL8 contents and chemotactic activity in culture supernatants. In conclusion, these data show the potential of epigenetic modifiers (SAHA and S2101) to block overshooting inflammation in the udder. Thus epigenetic modifiers may serve in future as immune modulators for the treatment and/or prophylaxis of clinical mastitis. (Funded by Deutsche Forschungsgemeinschaft PE 1495/2-1).

Keywords: mastitis, cattle, epigenetics, immunomodulation

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Authors: Christos Lampropoulos, Maria Konsta, Ifigenia Apostolou, Vicky Dradaki, Tamta Sirbilatze, Irini Dri, Christina Kordali, Vaggelis Lambas, Kostas Argyros, Georgios Mavras

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Objectives: Mediterranean diet has been associated with lower incidence of cardiovascular disease and cancer. The purpose of our study was to examine the hypothesis that Mediterranean diet may protect against mortality and reduce admission duration in elderly, hospitalized patients. Methods: Sample population included 150 patients (78 men, 72 women, mean age 80±8.2). The following data were taken into account in analysis: anthropometric and laboratory data, dietary habits (MedDiet score), patients’ nutritional status [Mini Nutritional Assessment (MNA) score], physical activity (International Physical Activity Questionnaires, IPAQ), smoking status, cause and duration of current admission, medical history (co-morbidities, previous admissions). Primary endpoints were mortality (from admission until 6 months afterwards) and duration of admission, compared to national guidelines for closed consolidated medical expenses. Logistic regression and linear regression analysis were performed in order to identify independent predictors for mortality and admission duration difference respectively. Results: According to MNA, nutrition was normal in 54/150 (36%) of patients, 46/150 (30.7%) of them were at risk of malnutrition and the rest 50/150 (33.3%) were malnourished. After performing multivariate logistic regression analysis we found that the odds of death decreased 30% per each unit increase of MedDiet score (OR=0.7, 95% CI:0.6-0.8, p < 0.0001). Patients with cancer-related admission were 37.7 times more likely to die, compared to those with infection (OR=37.7, 95% CI:4.4-325, p=0.001). According to multivariate linear regression analysis, admission duration was inversely related to Mediterranean diet, since it is decreased 0.18 days on average for each unit increase of MedDiet score (b:-0.18, 95% CI:-0.33 - -0.035, p=0.02). Additionally, the duration of current admission increased on average 0.83 days for each previous hospital admission (b:0.83, 95% CI:0.5-1.16, p<0.0001). The admission duration of patients with cancer was on average 4.5 days higher than the patients who admitted due to infection (b:4.5, 95% CI:0.9-8, p=0.015). Conclusion: Mediterranean diet adequately protects elderly, hospitalized patients against mortality and reduces the duration of hospitalization.

Keywords: Mediterranean diet, malnutrition, nutritional status, prognostic factors for mortality

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Authors: V. Ibujes, A. Guevara, P. Barreto

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Concentration of arsenic represents a serious threat to human health. It is a bioaccumulable toxic element and is transferred through the food chain. In Ecuador, values of 0.0423 mg/kg As are registered in potatoes of the skirts of the Tungurahua volcano. The increase of arsenic contamination in Ecuador is mainly due to mining activity, since the process of gold extraction generates toxic tailings with mercury. In the Province of Azuay, due to the mining activity, the soil reaches concentrations of 2,500 to 6,420 mg/kg As whereas in the province of Tungurahua it can be found arsenic concentrations of 6.9 to 198.7 mg/kg due to volcanic eruptions. Since the contamination by arsenic, the present investigation is directed to the remediation of the soils in the provinces of Azuay and Tungurahua by phytoremediation technique and the definition of a methodology of extraction by means of analysis of arsenic in the system soil-plant. The methodology consists in selection of two types of plants that have the best arsenic removal capacity in synthetic solutions 60 μM As, a lower percentage of mortality and hydroponics resistance. The arsenic concentrations in each plant were obtained from taking 10 ml aliquots and the subsequent analysis of the ICP-OES (inductively coupled plasma-optical emission spectrometry) equipment. Soils were contaminated with synthetic solutions of arsenic with the capillarity method to achieve arsenic concentration of 13 and 15 mg/kg. Subsequently, two types of plants were evaluated to reduce the concentration of arsenic in soils for 7 weeks. The global variance for soil types was obtained with the InfoStat program. To measure the changes in arsenic concentration in the soil-plant system, the Rhizo and Wenzel arsenic extraction methodology was used and subsequently analyzed with the ICP-OES (optima 8000 Pekin Elmer). As a result, the selected plants were bluegrass and llanten, due to the high percentages of arsenic removal of 55% and 67% and low mortality rates of 9% and 8% respectively. In conclusion, Azuay soil with an initial concentration of 13 mg/kg As reached the concentrations of 11.49 and 11.04 mg/kg As for bluegrass and llanten respectively, and for the initial concentration of 15 mg/kg As reached 11.79 and 11.10 mg/kg As for blue grass and llanten after 7 weeks. For the Tungurahua soil with an initial concentration of 13 mg/kg As it reached the concentrations of 11.56 and 12.16 mg/kg As for the bluegrass and llanten respectively, and for the initial concentration of 15 mg/kg As reached 11.97 and 12.27 mg/kg Ace for bluegrass and llanten after 7 weeks. The best arsenic extraction methodology of soil-plant system is Wenzel.

Keywords: blue grass, llanten, phytoremediation, soil of Azuay, soil of Tungurahua, synthetic arsenic solution

Procedia PDF Downloads 93