Search results for: duration patterns
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4322

Search results for: duration patterns

3842 Application of Compressed Sensing and Different Sampling Trajectories for Data Reduction of Small Animal Magnetic Resonance Image

Authors: Matheus Madureira Matos, Alexandre Rodrigues Farias

Abstract:

Magnetic Resonance Imaging (MRI) is a vital imaging technique used in both clinical and pre-clinical areas to obtain detailed anatomical and functional information. However, MRI scans can be expensive, time-consuming, and often require the use of anesthetics to keep animals still during the imaging process. Anesthetics are commonly administered to animals undergoing MRI scans to ensure they remain still during the imaging process. However, prolonged or repeated exposure to anesthetics can have adverse effects on animals, including physiological alterations and potential toxicity. Minimizing the duration and frequency of anesthesia is, therefore, crucial for the well-being of research animals. In recent years, various sampling trajectories have been investigated to reduce the number of MRI measurements leading to shorter scanning time and minimizing the duration of animal exposure to the effects of anesthetics. Compressed sensing (CS) and sampling trajectories, such as cartesian, spiral, and radial, have emerged as powerful tools to reduce MRI data while preserving diagnostic quality. This work aims to apply CS and cartesian, spiral, and radial sampling trajectories for the reconstruction of MRI of the abdomen of mice sub-sampled at levels below that defined by the Nyquist theorem. The methodology of this work consists of using a fully sampled reference MRI of a female model C57B1/6 mouse acquired experimentally in a 4.7 Tesla MRI scanner for small animals using Spin Echo pulse sequences. The image is down-sampled by cartesian, radial, and spiral sampling paths and then reconstructed by CS. The quality of the reconstructed images is objectively assessed by three quality assessment techniques RMSE (Root mean square error), PSNR (Peak to Signal Noise Ratio), and SSIM (Structural similarity index measure). The utilization of optimized sampling trajectories and CS technique has demonstrated the potential for a significant reduction of up to 70% of image data acquisition. This result translates into shorter scan times, minimizing the duration and frequency of anesthesia administration and reducing the potential risks associated with it.

Keywords: compressed sensing, magnetic resonance, sampling trajectories, small animals

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3841 Relationship between Physical Activity Level and Functional Movement in 16-years old Schoolchildren: A Multilevel Modelling Approach

Authors: Josip Karuc, Marjeta Mišigoj-Duraković, Goran Marković, Vedran Hadžić, Michael J. Duncan, Hrvoje Podnar, Maroje Sorić

Abstract:

As a part of the CRO-PALS longitudinal study, this investigation aimed to examine the association between different levels of physical activity (PA) and movement quality in 16-years old school children. The total number of participants in this research was 725. Movement quality was assessed via the Functional Movement Screen (FMSTM), and the PA level was estimated using the School Health Action, Planning, and Evaluation System (SHAPES) questionnaire. In addition, body fat and socioeconomic status (SES) were assessed. In order to investigate the association between total FMS score and different levels of PA, multilevel modeling was employed for boys (n=359) and girls (n=366) separately. All models were adjusted for age, body fat, and SES. Among boys, MVPA, MPA, and VPA were not significant predictors of the total FMS score (β=0.000, p=0.78; β=-0.002, p=0.455; β=0.004, p=0.158, respectively). On the contrary, among girls, VPA and MVPA showed significant effects on the total FMS score (β=0.011, p=0.001, β=0.005, p=0.006, respectively). The findings of this research provide evidence that the intensity of PA is a minor but relevant factor in describing the association between PA and movement quality in adolescent girls but not in boys. This means that the PA level does not guarantee optimal functional movement patterns. Therefore, practicing functional movement patterns in an isolated manner and at moderate to vigorous intensity could be beneficial in order to reduce the risk of injury incidence and potential orthopedic abnormalities in later life. This work was supported by the Croatian Science Foundation, grant no: IP-2016-06-9926 and grant no: DOK-2018-01-2328.

Keywords: functional movement screen, fundamental movement patterns, movement quality, pediatric

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3840 Osteitis in the Diabetic Foot in Algeria

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

— Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea.The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: diabetic foot, bone biopsy, osteitis, algeria

Procedia PDF Downloads 103
3839 Physiopathology of Osteitis in the Diabetic Foot

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

Procedia PDF Downloads 79
3838 Injury Patterns and Outcomes in Alcohol Intoxicated Trauma Patients Admitted at Level I Apex Trauma Centre of a Developing Nation

Authors: G. Kaushik, A. Gupta, S. Lalwani, K. D. Soni, S. Kumar, S. Sagar

Abstract:

Objective: Alcohol is a leading risk factor associated with the disability and death due to RTI. Present study aims to demonstrate the demographic profile, injury pattern, physiological parameters of victims of trauma following alcohol consumption arriving in the emergency department (ED) and mortality in alcohol intoxicated trauma patients admitted to Apex Trauma Center in Delhi. Design and Methods: Present study was performed in randomly selected 182 alcohol breath analyzer tested RTI patients from the emergency department of Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences, New Delhi for over a period of 3 months started from September 2013 to November 2013. Results: A total 182 RTI patients with blunt injury were selected between 30-40 years of age and equally distributed to male and female group. Of these, 93 (51%) were alcohol negative and 89 (49%) were alcohol positive. In 89 alcohol positive patients, 47 (53%) had Artificial Airway as compared to 17 (18%), (p < 0.001) in the other group. The Glasgow Coma Scale (GCS) score was lower (p < 0.001) and higher Injury Severity Score (ISS) was observed in alcohol positive group as compared to other group (p < 0.03). Increased number of patients (58%) were admitted to Intensive Care Unit (ICU), in alcohol positive group (p < 0.001) and they were in ICU for longer time compare to other group (p < 0.001). The alcohol positive patients were on ventilator support for longer duration as compared to non-alcoholic group (p < 0.001). Mortality rate was higher in alcohol intoxicated patients as compared to non-alcoholic RTI patients, however, the difference was not statistically significant. Conclusion: This study revealed that GCS, mean ISS, ICU stay, ventilation time etc. might have considerable impact on mortality in alcohol intoxicated patients as compared to non-alcoholic group.

Keywords: road traffic injuries, alcohol, trauma, emergency department

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3837 A Comparative CFD Study on the Hemodynamics of Flow through an Idealized Symmetric and Asymmetric Stenosed Arteries

Authors: B. Prashantha, S. Anish

Abstract:

The aim of the present study is to computationally evaluate the hemodynamic factors which affect the formation of atherosclerosis and plaque rupture in the human artery. An increase of atherosclerosis disease in the artery causes geometry changes, which results in hemodynamic changes such as flow separation, reattachment, and adhesion of new cells (chemotactic) in the artery. Hence, geometry plays an important role in the determining the nature of hemodynamic patterns. Influence of stenosis in the non-bifurcating artery, under pulsatile flow condition, has been studied on an idealized geometry. Analysis of flow through symmetric and asymmetric stenosis in the artery revealed the significance of oscillating shear index (OSI), flow separation, low WSS zones and secondary flow patterns on plaque formation. The observed characteristic of flow in the post-stenotic region highlight the importance of plaque eccentricity on the formation of secondary stenosis on the arterial wall.

Keywords: atherosclerotic plaque, oscillatory shear index, stenosis nature, wall shear stress

Procedia PDF Downloads 350
3836 Osteitis in the Diabetic Foot and the Risk Factor on the Population

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea.The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic, biopsy, diabetic foot

Procedia PDF Downloads 99
3835 Frictional Behavior of Glass Epoxy and Aluminium Particulate Glass Epoxy Composites Sliding against Smooth Stainless Steel Counterface

Authors: Pujan Sarkar

Abstract:

Frictional behavior of glass epoxy and Al particulate glass-epoxy composites sliding against mild steel are investigated experimentally at normal atmospheric condition. Glass epoxy (0 wt% Al) and 5, 10 and 15 wt% Al particulate filled glass-epoxy composites are fabricated in conventional hand lay-up technique followed by light compression moulding process. A pin on disc type friction apparatus is used under dry sliding conditions. Experiments are carried out at a normal load of 5-50 N, and sliding speeds of 0.5-5.0 m/s for a fixed duration. Variations of friction coefficient with sliding time at different loads and speeds for all the samples are considered. Results show that the friction coefficient is influenced by sliding time, normal loads, sliding speeds, and wt% of Al content. In general, with respect to time, friction coefficient increases initially with a lot of fluctuations for a certain duration. After that, it becomes stable for the rest of the experimental time. With the increase of normal load, friction coefficient decreases at all speed levels and for all the samples whereas, friction coefficient increases with the increase of sliding speed at all normal loads for glass epoxy and 5 wt% Al content glass-epoxy composites. But for 10 and 15 wt%, Al content composites at all loads, reverse trend of friction coefficient has been recorded. Under different tribological conditions, the suitability of composites in respect of wt% of Al content is noted, and 5 wt% Al content glass-epoxy composite reports as the lowest frictional material at all loads compared to other samples.

Keywords: Al powder, composite, epoxy, friction, glass fiber

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3834 Performance of the Photovoltaic Module under Different Shading Patterns

Authors: E. T. El Shenawy, O. N. A. Esmail, Adel A. Elbaset, Hesham F. A. Hamed

Abstract:

Generation of the electrical energy based on photovoltaic (PV) technology has been increased over the world due to either the continuous reduction in the traditional energy sources in addition to the pollution problems related to their usage, or the clean nature and safe usage of the PV technology. Also, PV systems can generate clean electricity in the site of use without any transmission, which can be considered cost effective than other generation systems. The performance of the PV system is highly affected by the amount of solar radiation incident on it. Completely or partially shaded PV systems can affect its output. The PV system can be shaded by trees, buildings, dust, incorrect system configuration, or other obstacles. The present paper studies the effect of the partial shading on the performance of a thin film PV module under climatic conditions of Cairo, Egypt. This effect was measured and evaluated according to practical measurement of the characteristic curves such as current-voltage and power-voltage for two identical PV modules (with and without shading) placed at the same time on one mechanical structure for comparison. The measurements have been carried out for the following shading patterns; half cell (bottom, middle, and top of the PV module); complete cell; and two adjacent cells. The results showed that partially shading the PV module changes the shapes of the I-V and P-V curves and produces more than one maximum power point, that can disturb the traditional maximum power point trackers. Also, the output power from the module decreased according to the incomplete solar radiation reaching the PV module due to shadow patterns. The power loss due shading was 7%, 22%, and 41% for shading of half-cell, one cell, and two adjacent cells of the PV module, respectively.

Keywords: I-V measurements, PV module characteristics, PV module power loss, PV module shading

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3833 Investigation and Analysis of Residential Building Energy End-Use Profile in Hot and Humid Area with Reference to Zhuhai City in China

Authors: Qingqing Feng, S. Thomas Ng, Frank Xu

Abstract:

Energy consumption in domestic sector has been increasing rapidly in China all along these years. Confronted with environmental challenges, the international society has made a concerted effort by setting the Paris Agreement, the Sustainable Development Goals, and the New Urban Agenda. Thus it’s very important for China to put forward reasonable countermeasures to boost building energy conservation which necessitates looking into the actuality of residential energy end-use profile and its influence factors. In this study, questionnaire surveys have been conducted in Zhuhai city in China, a typical city in hot summer warm winter climate zone. The data solicited mainly include the occupancy schedule, building’s information, residents’ information, household energy uses, the type, quantity and use patterns of appliances and occupants’ satisfaction. Over 200 valid samples have been collected through face-to-face interviews. Descriptive analysis, clustering analysis, correlation analysis and sensitivity analysis were then conducted on the dataset to understand the energy end-use profile. The findings identify: 1) several typical clusters of occupancy patterns and appliances utilization patterns; 2) the top three sensitive factors influencing energy consumption; 3) the correlations between satisfaction and energy consumption. For China with many different climates zones, it’s difficult to find a silver bullet on energy conservation. The aim of this paper is to provide a theoretical basis for multi-stakeholders including policy makers, residents, and academic communities to formulate reasonable energy saving blueprints for hot and humid urban residential buildings in China.

Keywords: residential building, energy end-use profile, questionnaire survey, sustainability

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3832 Patterns of Self-Medication with Over-the-Counter Pain Relievers (Acetaminophen, Ibuprofen, and Aspirin) among the Kuwaiti Population

Authors: Nabil Ahmed Kamal Badawy, Ali Falah Alhajraf, Mawaheb Falah Alsamdan

Abstract:

Objectives: To estimate the prevalence of self-medication with over-the-counter pain relievers (acetaminophen, ibuprofen, and aspirin) among Kuwaiti citizens above the age of 16 years old and describe their patterns of use, perceived awareness of, and concerns about the drugs’ potential side effects. Design: A descriptive cross-sectional questionnaire-based survey. Setting: Samples were selected from the six Kuwaiti governorates. Subjects: The data were collected over a four-month period in 2012, from 850 subjects who identified as Kuwaiti citizens. These subjects were recruited using stratified random sampling. Results: Overall, a 67% response rate was obtained. In total, 68% (573) of the respondents reported the use of over-the-counter pain relievers. Women, middle-aged or single individuals, and those who had completed higher education used these drugs more than any other subgroup (p<0.05). We found evidence of inappropriate use of these drugs, with 15% (88) of the consumers using them almost daily. Further, 19% (111) of the consumers exceeded the recommended dosage at least once. Not only were 81% of the consumers unaware of the potential side effects, but also more than 61% were not concerned about them. Women were more knowledgeable than men regarding the maximum dose (p=0.036, OR 1.49, CI 1.03–2.17). Consumers with higher levels of education did not show distinct knowledge regarding the maximum allowed dose of the drugs (p=0.252, OR 1.71, CI 0.68-4.25). Conclusion: The results showed a high prevalence of self-medication with over-the-counter pain relievers among Kuwaiti citizens. The subjects showed marked unawareness and a lack of concern regarding the potential complications resulting from the inappropriate use of these analgesics. This demonstrates the need for educational interventions directed toward both patients and health care workers.

Keywords: awareness of side effects, concern, patterns of use, prevalence

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3831 Guiding Urban Development in a Traditional Neighbourhood: Case Application of Kolkata

Authors: Nabamita Nath, Sanghamitra Sarkar

Abstract:

Urban development in traditional neighbourhoods of cities is undergoing a sea change due to imposition of irregular development patterns on a predominantly inclusive urban fabric. In recent times, traditional neighbourhoods of Kolkata have experienced irregular urban development which has resulted in transformation of its immediate urban character. The goal is to study and analyse impact of new urban developments within traditional neighbourhoods of Kolkata and establish development guidelines to balance the old with the new. Various cities predominantly in third world countries are also experiencing similar development patterns in their traditional neighbourhoods. Existing literature surveys of development patterns in such neighbourhoods have established 9 major parameters viz. edge, movement, node, landmark, size-density, pattern-grain-texture, open spaces, urban spaces, urban form and views-vistas of the neighbourhood. To evaluate impact of urban development in traditional neighbourhoods of Kolkata, 3 different areas have been chronologically selected based on their settlement patterns. Parameters established through literature surveys have been applied to the selected areas to study and analyse the existing patterns of development. The main sources of this study included extensive on-site surveys, academic archive, census data, organisational records and informational websites. Applying the established parameters, 5 major conclusions were derived. Firstly, it was found that pedestrian friendly neighbourhoods of the city were becoming more car-centric. This has resulted in loss of interactive and social spaces which defined the cultural heritage of Kolkata. Secondly, the urban pattern which was composed of dense and compact fabric is gradually losing its character due to incorporation of new building typologies. Thirdly, the new building typologies include gated communities with private open spaces which is a stark departure from the existing built typology. However, these open spaces have not contributed in creation of inclusive public places for the community which are a significant part of such heritage neighbourhood precincts. Fourthly, commercial zones that primarily developed along major access routes have now infiltrated within these neighbourhoods. Gated communities do not favour formation of on-street commercial activities generating haphazard development patterns. Lastly, individual residential buildings that reflected Indo-saracenic and Neo-gothic architectural styles are converting into multi-storeyed residential apartments. As a result, the axis that created a definite visual identity for a neighbourhood is progressively following an irregular pattern. Thus, uniformity of the old skyline is gradually becoming inconsistent. The major issue currently is threat caused by irregular urban development to heritage zones and buildings of traditional neighbourhoods. Streets, lanes, courtyards, open spaces and buildings of old neighbourhoods imparted a unique cultural identity to the city that is disappearing with emerging urban development patterns. It has been concluded that specific guidelines for urban development should be regulated primarily based on existing urban form of traditional neighbourhoods. Such neighbourhood development strategies should be formulated for various cities of third world countries to control irregular developments thereby balancing heritage and development.

Keywords: heritage, Kolkata, traditional neighbourhood, urban development

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3830 Diagnostic Physiopathology of Osteitis in the Diabetic Foot

Authors: Adaour Mohamed Amine, Bachene Mohamed Sadek, Fortassi Mosaab, Siouda Wafaa

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73% and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

Procedia PDF Downloads 103
3829 Adherence of Trauma and Orthopaedics Surgery Operative Notes to the RCS Good Surgical Practice Guidelines in Ashford and St. Peter's Hospital

Authors: Maryam Risla Shahul Hameed, Tharsiga Yogarajah, Fritzy Mathew, Tayyaba Syed, Shalin Shaunak

Abstract:

Aim: Auditing the adherence of Trauma and Orthopaedics Operative notes to the RCS Good Surgical Practice Guidelines. Method: Clinical audit conducted on 150 operative notes over a period of 2 months April- May 2023, including emergency and elective surgeries performed in Ashford and St. Peter’s Hospital. The RCS Good Practice Surgical Guidelines for an ideal operative note were used to compare.Results: Date of the procedure and signature of the surgeon were mentioned in all the notes by default in the electronic template being used. Title of the operation performed and whether elective or emergency were mentioned by 92% and 45%, respectively. Name of theatre anaesthetist and operating surgeons were mentioned by 73% and 93% respectively. Time of surgery mentioned by 26%. Operative findings and operative diagnosis mentioned by 83% and 53% respectively. Incision and complications of surgery mentioned in 80% and 53%, respectively. Details of tissue added/ altered/ removed mentioned by 46%. Information on prosthesis or implant used is mentioned by 54%. Details of closure and anticipated blood loss mentioned in 91% and 45% respectively. Antibiotic prophylaxis was mentioned by 63%, out of which only 23% mentioned the name and duration of the antibiotic. VTE prophylaxis was mentioned by 84%, out of which only 23% and 29% mentioned the name and duration of the prophylaxis, respectively. Conclusion: There is more for improvement in the operative notes for better continuity of care between the operating surgeons and other doctors in the wards taking care of the patients post operatively. We recommend to follow a standardized guidelines by all the nationwide and a standard template to be followed by all.

Keywords: surgery, notes, RCS, guidelines

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3828 Mechanical Properties of Enset Fibers Obtained from Different Breeds of Enset Plant

Authors: Diriba T. Balcha, Boris Kulig, Oliver Hensel, Eyassu Woldesenbet

Abstract:

Enset fiber is agricultural waste and available in a surplus amount in Ethiopia. However, the hypothesized variation in properties of this fiber due to diversity of its plant source breed, fiber position within plant stem and chemical treatment duration had not proven that its application for the development of composite products is problematic. Currently, limited data are known on the functional properties of the fiber as a potential functional fiber. Thus, an effort is made in this study to narrow the knowledge gaps by characterizing it. The experimental design was conducted using Design-Expert software and the tensile test was conducted on Enset fiber from 10 breeds: Dego, Dirbo, Gishera, Itine, Siskela, Neciho, Yesherkinke, Tuzuma, Ankogena, and Kucharkia. The effects of 5% Na-OH surface treatment duration and fiber location along and across the plant pseudostem was also investigated. The test result shows that the rupture stress variation is not significant among the fibers from 10 Enset breeds. However, strain variation is significant among the fibers from 10 Enset breeds that breed Dego fiber has the highest strain before failure. Surface treated fibers showed improved rupture strength and elastic modulus per 24 hours of treatment duration. Also, the result showed that chemical treatment can deteriorate the load-bearing capacity of the fiber. The raw fiber has the higher load-bearing capacity than the treated fiber. And, it was noted that both the rupture stress and strain increase in the top to bottom gradient, whereas there is no significant variation across the stem. Elastic modulus variation both along and across the stem was insignificant. The rupture stress, elastic modulus, and strain result of Enset fiber are 360.11 ± 181.86 MPa, 12.80 ± 6.85 GPa and 0.04 ± 0.02 mm/mm, respectively. These results show that Enset fiber is comparable to other natural fibers such as abaca, banana, and sisal fibers and can be used as alternatives natural fiber for composites application. Besides, the insignificant variation of properties among breeds and across stem is essential for all breeds and all leaf sheath of the Enset fiber plant for fiber extraction. The use of short natural fiber over the long is preferable to reduce the significant variation of properties along the stem or fiber direction. In conclusion, Enset fiber application for composite product design and development is mechanically feasible.

Keywords: Agricultural waste, Chemical treatment, Fiber characteristics, Natural fiber

Procedia PDF Downloads 236
3827 Using Emerging Hot Spot Analysis to Analyze Overall Effectiveness of Policing Policy and Strategy in Chicago

Authors: Tyler Gill, Sophia Daniels

Abstract:

The paper examines how accessing the spatial-temporal constrains of data will help inform policymakers and law enforcement officials. The authors utilize Chicago crime data from 2006-2016 to demonstrate how the Emerging Hot Spot Tool is an ideal hot spot clustering approach to analyze crime data. Traditional approaches include density maps or creating a spatial weights matrix to include the spatial-temporal constrains. This new approach utilizes a space-time implementation of the Getis-Ord Gi* statistic to visualize the data more quickly to make better decisions. The research will help complement socio-cultural research to find key patterns to help frame future policies and evaluate the implementation of prior strategies. Through this analysis, homicide trends and patterns are found more effectively and recommendations for use by non-traditional users of GIS are offered for real life implementation.

Keywords: crime mapping, emerging hot spot analysis, Getis-Ord Gi*, spatial-temporal analysis

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3826 Investigating Homicide Offender Typologies Based on Their Clinical Histories and Crime Scene Behaviour Patterns

Authors: Valeria Abreu Minero, Edward Barker, Hannah Dickson, Francois Husson, Sandra Flynn, Jennifer Shaw

Abstract:

Purpose – The purpose of this paper is to identify offender typologies based on aspects of the offenders’ psychopathology and their associations with crime scene behaviours using data derived from the National Confidential Enquiry into Suicide and Safety in Mental Health concerning homicides in England and Wales committed by offenders in contact with mental health services in the year preceding the offence (n=759). Design/methodology/approach – The authors used multiple correspondence analysis to investigate the interrelationships between the variables and hierarchical agglomerative clustering to identify offender typologies. Variables describing: the offender’s mental health history; the offenders’ mental state at the time of offence; characteristics useful for police investigations; and patterns of crime scene behaviours were included. Findings – Results showed differences in the offender’s histories in relation to their crime scene behaviours. Further, analyses revealed three homicide typologies: externalising, psychosis and depression. Analyses revealed three homicide typologies: externalising, psychotic and depressive. Practical implications – These typologies may assist the police during homicide investigations by: furthering their understanding of the crime or likely suspect; offering insights into crime patterns; provide advice as to what an offender’s offence behaviour might signify about his/her mental health background; findings suggest information concerning offender psychopathology may be useful for offender profiling purposes in cases of homicide offenders with schizophrenia, depression and comorbid diagnosis of personality disorder and alcohol/drug dependence. Originality/value – Empirical studies with an emphasis on offender profiling have almost exclusively focussed on the inference of offender demographic characteristics. This study provides a first step in the exploration of offender psychopathology and its integration to the multivariate analysis of offence information for the purposes of investigative profiling of homicide by identifying the dominant patterns of mental illness within homicidal behaviour.

Keywords: offender profiling, mental illness, psychopathology, multivariate analysis, homicide, crime scene analysis, crime scene behviours, investigative advice

Procedia PDF Downloads 129
3825 An Intercontinental Comparison of Delay Discounting for Real and Hypothetical Money and Cigarettes among Cigarette Smokers

Authors: Steven R. Lawyer, Tereza Prihodova, Katerina Prihodova

Abstract:

Delay discounting (DD) is one of the most frequently used behavioral-economic measures of impulsive choice, but there are few cross-cultural comparisons of discounting, and to the best of our knowledge, none compare patterns of DD across different commodities or compare real and hypothetical rewards across cultures. The purpose of this study was to compare patterns of DD for both real and hypothetical money and cigarettes among participants in the USA and the Czech Republic. Adult smokers from the United States and the Czech Republic completed standard measures of DD for hypothetical and real money (~$10USD) and cigarettes (1 pack, or 20 cigarettes). Contrary to data from the USA sample, Czech Republic participants discounted the value of real money steeper than hypothetical money, though this could be related to the relatively poor fit of the hyperbolic decay function to DD for hypothetical money in the Czech sample. These findings suggest that there might be cultural differences in delay discounting that warrant further attention.

Keywords: delay discounting, temporal discounting, cigarette smoking, real rewards, hypothetical rewards

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3824 A Multi-Stage Learning Framework for Reliable and Cost-Effective Estimation of Vehicle Yaw Angle

Authors: Zhiyong Zheng, Xu Li, Liang Huang, Zhengliang Sun, Jianhua Xu

Abstract:

Yaw angle plays a significant role in many vehicle safety applications, such as collision avoidance and lane-keeping system. Although the estimation of the yaw angle has been extensively studied in existing literature, it is still the main challenge to simultaneously achieve a reliable and cost-effective solution in complex urban environments. This paper proposes a multi-stage learning framework to estimate the yaw angle with a monocular camera, which can deal with the challenge in a more reliable manner. In the first stage, an efficient road detection network is designed to extract the road region, providing a highly reliable reference for the estimation. In the second stage, a variational auto-encoder (VAE) is proposed to learn the distribution patterns of road regions, which is particularly suitable for modeling the changing patterns of yaw angle under different driving maneuvers, and it can inherently enhance the generalization ability. In the last stage, a gated recurrent unit (GRU) network is used to capture the temporal correlations of the learned patterns, which is capable to further improve the estimation accuracy due to the fact that the changes of deflection angle are relatively easier to recognize among continuous frames. Afterward, the yaw angle can be obtained by combining the estimated deflection angle and the road direction stored in a roadway map. Through effective multi-stage learning, the proposed framework presents high reliability while it maintains better accuracy. Road-test experiments with different driving maneuvers were performed in complex urban environments, and the results validate the effectiveness of the proposed framework.

Keywords: gated recurrent unit, multi-stage learning, reliable estimation, variational auto-encoder, yaw angle

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3823 The Social Structuring of Mate Selection: Assortative Marriage Patterns in the Israeli Jewish Population

Authors: Naava Dihi, Jon Anson

Abstract:

Love, so it appears, is not socially blind. We show that partner selection is socially constrained, and the freedom to choose is limited by at least two major factors or capitals: on the one hand, material resources and education, locating the partners on a scale of personal achievement and economic independence. On the other, the partners' ascriptive belonging to particular ethnic, or origin, groups, differentiated by the groups' social prestige, as well as by their culture, history and even physical characteristics. However, the relative importance of achievement and ascriptive factors, as well as the overlap between them, varies from society to society, depending on the society's structure and the factors shaping it. Israeli social structure has been shaped by the waves of new immigrants who arrived over the years. The timing of their arrival, their patterns of physical settlement and their occupational inclusion or exclusion have together created a mosaic of social groups whose principal common feature has been the country of origin from which they arrived. The analysis of marriage patterns helps illuminate the social meanings of the groups and their borders. To the extent that ethnic group membership has meaning for individuals and influences their life choices, the ascriptive factor will gain in importance relative to the achievement factor in their choice of marriage partner. In this research, we examine Jewish Israeli marriage patterns by looking at the marriage choices of 5,041 women aged 15 to 49 who were single at the census in 1983, and who were married at the time of the 1995 census, 12 years later. The database for this study was a file linking respondents from the 1983 and the 1995 censuses. In both cases, 5 percent of household were randomly chosen, so that our sample includes about 4 percent of women in Israel in 1983. We present three basic analyses: (1) Who was still single in 1983, using personal and household data from the 1983 census (binomial model), (2) Who married between 1983 and a1995, using personal and household data from the 1983 census (binomial model), (3) What were the personal characteristics of the womens’ partners in 1995, using data from the 1995 census (loglinear model). We show (i) that material and cultural capital both operate to delay marriage and to increase the probability of remaining single; and (ii) while there is a clear association between ethnic group membership and education, endogamy and homogamy both operate as separate forces which constraint (but do not determine) the choice of marriage partner, and thus both serve to reproduce the current pattern of relationships, as well as identifying patterns of proximity and distance between the different groups.

Keywords: Israel, nuptiality, ascription, achievement

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3822 The Influence of the Types of Smoke Powder and Storage Duration on Sensory Quality of Balinese Beef and Buffalo Meatballs

Authors: E. Abustam, M. I. Said, M. Yusuf, H. M. Ali

Abstract:

This study aims to examine the sensory quality of meatballs made from Balinese beef and buffalo meat after the addition of smoke powder prior to storage at the temperatures of 2-5°C for 7 days. This study used meat from Longissimus dorsi muscle of male Balinese cattle aged 3 years and of male buffalo aged 5 years as the main raw materials, and smoke powder as a binder and preservative in making meatballs. The study was based on completely randomized design (CRD) of factorial pattern of 2 x 3 x 2 where factors 1, 2 and 3 included the types of meat (cattle and buffalo), types of smoke powder (oven dried, freeze dried and spray dried) with a level of 2% of the weight of the meat (b/b), and storage duration (0 and 7 days) with three replications respectively. The parameters measured were the meatball sensory quality (scores of tenderness, firmness, chewing residue, and intensity of flavor). The results of this study show that each type of meat has produced different sensory characteristics. The meatballs made from buffalo meat have higher tenderness and elasticity scores than the Balinese beef. Meanwhile, the buffalo meatballs have a lower residue mastication score than the Balinese beef. Each type of smoke powders has produced a relatively similar sensory quality of meatballs. It can be concluded that the smoke powder of 2% of the weight of the meat (w/w) could maintain the sensory quality of the meatballs for 7 days of storage.

Keywords: Balinese beef meatballs, buffalo meatballs, sensory quality, smoke powder

Procedia PDF Downloads 337
3821 Prevalence, Median Time, and Associated Factors with the Likelihood of Initial Antidepressant Change: A Cross-Sectional Study

Authors: Nervana Elbakary, Sami Ouanes, Sadaf Riaz, Oraib Abdallah, Islam Mahran, Noriya Al-Khuzaei, Yassin Eltorki

Abstract:

Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Most patients with MDD in the mental health setting have been labeled incorrectly as treatment-resistant where in fact they have not been subjected to an adequate trial of guideline-recommended therapy. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. Avoiding irrational practices such as subtherapeutic doses of IAD, premature switching between the ADs, and refraining from unjustified polypharmacy can help the disease to go into a remission phase We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. This was a retrospective cross- sectional study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using two unadjusted and adjusted cox regression models. A total of 487 patients met the inclusion criteria of the study. The average age for participants was 39.1 ± 12.3 years. Patients with first experience MDD episode 255 (52%) constituted a major part of our sample comparing to the relapse group 206(42%). About 431 (88%) of the patients had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. Switching was consistently more common than combination or augmentation at any timepoint. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. Five independent variables (age, bothersome side effects, un-optimization of the dose before any change, comorbid anxiety, first onset episode) were significantly associated with the likelihood of IAD change in the unadjusted analysis. The factors statistically associated with higher hazard of IAD change in the adjusted analysis were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. The findings of this study can have direct clinical guidance for health care professionals since an optimized, evidence-based use of AD medication can improve the clinical outcomes of patients with MDD; and also, to identify high-risk factors that could worsen the survival time on IAD such as young age and comorbid anxiety

Keywords: initial antidepressant, dose optimization, major depressive disorder, comorbid anxiety, combination, augmentation, switching, premature discontinuation

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3820 Renewable Energy Storage Capacity Rating: A Forecast of Selected Load and Resource Scenario in Nigeria

Authors: Yakubu Adamu, Baba Alfa, Salahudeen Adamu Gene

Abstract:

As the drive towards clean, renewable and sustainable energy generation is gradually been reshaped by renewable penetration over time, energy storage has thus, become an optimal solution for utilities looking to reduce transmission and capacity cost, therefore the need for capacity resources to be adjusted accordingly such that renewable energy storage may have the opportunity to substitute for retiring conventional energy systems with higher capacity factors. Considering the Nigeria scenario, where Over 80% of the current Nigerian primary energy consumption is met by petroleum, electricity demand is set to more than double by mid-century, relative to 2025 levels. With renewable energy penetration rapidly increasing, in particular biomass, hydro power, solar and wind energy, it is expected to account for the largest share of power output in the coming decades. Despite this rapid growth, the imbalance between load and resources has created a hindrance to the development of energy storage capacity, load and resources, hence forecasting energy storage capacity will therefore play an important role in maintaining the balance between load and resources including supply and demand. Therefore, the degree to which this might occur, its timing and more importantly its sustainability, is the subject matter of the current research. Here, we forecast the future energy storage capacity rating and thus, evaluate the load and resource scenario in Nigeria. In doing so, We used the scenario-based International Energy Agency models, the projected energy demand and supply structure of the country through 2030 are presented and analysed. Overall, this shows that in high renewable (solar) penetration scenarios in Nigeria, energy storage with 4-6h duration can obtain over 86% capacity rating with storage comprising about 24% of peak load capacity. Therefore, the general takeaway from the current study is that most power systems currently used has the potential to support fairly large penetrations of 4-6 hour storage as capacity resources prior to a substantial reduction in capacity ratings. The data presented in this paper is a crucial eye-opener for relevant government agencies towards developing these energy resources in tackling the present energy crisis in Nigeria. However, if the transformation of the Nigeria. power system continues primarily through expansion of renewable generation, then longer duration energy storage will be needed to qualify as capacity resources. Hence, the analytical task from the current survey will help to determine whether and when long-duration storage becomes an integral component of the capacity mix that is expected in Nigeria by 2030.

Keywords: capacity, energy, power system, storage

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3819 Flow Boiling Heat Transfer at Low Mass and Heat Fluxes: Heat Transfer Coefficient, Flow Pattern Analysis and Correlation Assessment

Authors: Ernest Gyan Bediako, Petra Dancova, Tomas Vit

Abstract:

Flow boiling heat transfer remains an important area of research due to its relevance in thermal management systems and other applications. Despite the enormous work done in the field of flow boiling heat transfer over the years to understand how flow parameters such as mass flux, heat flux, saturation conditions and tube geometries influence the characteristics of flow boiling heat transfer, there are still many contradictions and lack of agreement on the actual mechanisms controlling heat transfer and how flow parameters impact the heat transfer. This work thus seeks to experimentally investigate the heat transfer characteristics and flow patterns at low mass fluxes, low heat fluxes and low saturation pressure conditions which are of less attention in literature but prevalent in refrigeration, air-conditioning and heat pump applications. In this study, flow boiling experiment was conducted for R134a working fluid in a 5 mm internal diameter stainless steel horizontal smooth tube with mass flux ranging from 80- 100 kg/m2 s, heat fluxes ranging from 3.55kW/m2 - 25.23 kW/m2 and saturation pressure of 460 kPa. Vapor quality ranged from 0 to 1. A well-known flow pattern map created by Wojtan et al. was used to predict the flow patterns noticed during the study. The experimental results were correlated with well-known flow boiling heat transfer correlations in literature. The findings show that, heat transfer coefficient was influenced by both mass flux and heat fluxes. However, for an increasing heat flux, nucleate boiling was observed to be the dominant mechanism controlling the heat transfer especially at low vapor quality region. For an increasing mass flux, convective boiling was the dominant mechanism controlling the heat transfer especially in the high vapor quality region. Also, the study observed an unusual high heat transfer coefficient at low vapor qualities which could be due to periodic wetting of the walls of the tube due to slug flow pattern and stratified wavy flow patterns. The flow patterns predicted by Wojtan et al. flow pattern map were mixture of slug and stratified wavy, purely stratified wavy and dry out. Statistical assessment of the experimental data with various well-known correlations from literature showed that, none of the correlations reported in literature could predicted the experimental data with enough accuracy.

Keywords: flow boiling, heat transfer coefficient, mass flux, heat flux.

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3818 Aspects of Tone in the Educated Nigeria Accent of English

Authors: Nkereke Essien

Abstract:

The study seeks to analyze tone in the Educated Nigerian accent of English (ENAE) using the three tones: Low (L), High (H) and Low-High (LH). The aim is to find out whether there are any differences or similarities in the performance of the experimental group and the control. To achieve this, twenty educated Nigerian speakers of English who are educated in the language were selected by a Stratified Random Sampling (SRS) technique from two federal universities in Nigeria. They were given a passage to read and their intonation patterns were compared with that of a native speaker (control). The data were analyzed using Pierrehumbert’s (1980) intonation system of analysis. Three different approaches were employed in the analysis of the intonation Phrase (IP) as used by Pierrehumbert: perceptual, statistical and acoustic. We first analyzed our data from the passage and utterances using Willcoxon Matched Pairs Signs Ranks Test to establish the differences between the performance of the experimental group and the control. Then, the one-way Analysis of variance (ANOVA) statistical and Tukey-Krammar Post Hoc Tests were used to test for any significant difference in the performances of the twenty subjects. The acoustic data were presented to corroborate both the perceptual and statistical findings. Finally, the tonal patterns of the selected subjects in the three categories - A, B, C, were compared with those of the control. Our findings revealed that the tonal pattern of the Educated Nigerian Accent of English (ENAE) is significantly different from the tonal pattern of the Standard British Accent of English (SBAE) as represented by the control. A high preference for unidirectional tones, especially, the high tones was observed in the performance of the experimental group. Also, high tones do not necessarily correspond to stressed syllables and low tones to unstressed syllables.

Keywords: accent, intonation phrase (IP), tonal patterns, tone

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3817 The Design Inspired by Phra Maha Chedi of King Rama I-IV at Wat Phra Chetuphon Vimolmangklaram Rajwaramahaviharn

Authors: Taechit Cheuypoung

Abstract:

The research will focus on creating pattern designs that are inspired by the pagodas, Phra Maha Chedi of King Rama I-IV, that are located in the temple, Wat Phra Chetuphon Vimolmangklararm Rajwaramahaviharn. Different aspects of the temple were studied, including the history, architecture, significance of the temple, and techniques used to decorate the pagodas, Phra Maha Chedi of King Rama I-IV. Moreover, composition of arts and the form of pattern designs which all led to the outcome of four Thai application pattern. The four patterns combine Thai traditional design with international scheme, however, maintaining the distinctiveness of the glaze mosaic tiles of each Phra Maha Chedi. The patterns consist of rounded and notched petal flowers, leaves and vine, and various square shapes, and original colors which are updated for modernity. These elements are then grouped and combined with new techniques, resulting in pattern designs with modern aspects and simultaneously reflecting the charm and the aesthetic of Thai craftsmanship which are eternally embedded in the designs.

Keywords: Chedi, Pagoda, pattern, Wat

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3816 Subspace Rotation Algorithm for Implementing Restricted Hopfield Network as an Auto-Associative Memory

Authors: Ci Lin, Tet Yeap, Iluju Kiringa

Abstract:

This paper introduces the subspace rotation algorithm (SRA) to train the Restricted Hopfield Network (RHN) as an auto-associative memory. Subspace rotation algorithm is a gradient-free subspace tracking approach based on the singular value decomposition (SVD). In comparison with Backpropagation Through Time (BPTT) on training RHN, it is observed that SRA could always converge to the optimal solution and BPTT could not achieve the same performance when the model becomes complex, and the number of patterns is large. The AUTS case study showed that the RHN model trained by SRA could achieve a better structure of attraction basin with larger radius(in general) than the Hopfield Network(HNN) model trained by Hebbian learning rule. Through learning 10000 patterns from MNIST dataset with RHN models with different number of hidden nodes, it is observed that an several components could be adjusted to achieve a balance between recovery accuracy and noise resistance.

Keywords: hopfield neural network, restricted hopfield network, subspace rotation algorithm, hebbian learning rule

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3815 The Analysis on the Renewal Strategy of Public Space in Old Communities with an Example of GeDa Community in Xi'An

Authors: Xiyue Wen

Abstract:

With the rapid development of the city, old communities in the city are facing a series of problems. On one hand, aging facilities, obsolete spatial patterns, aging populations arouse in the aging of the community. On the other hand, public space is reduced and is taking up by cars parking or facilities setting, which lead to the collapse of traditional life in the old communities. That is to say, modern amenities haven’t helped to reform the old community, but have leading to tedious and inefficient, when it is not accommodated in the traditional space. Exploring a way is imminent to the east the contradiction between modern living facilities and spatial patterns of traditional. We select a typical site-GeDa Community in Xi’an, built in 70-80s,and carry out a concept calling 'Raising Landscape', which enables a convenient and efficient space for parking, as well as a high-quality yard for activities. In addition, the design implements low cost, simple construction, resident participation, so that it can be spread in the same texture of urban space.

Keywords: old communities, renewal strategy, raising landscape, public space, parking space

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3814 Comparison of Corneal Curvature Measurements Conducted with Tomey AO-2000® and the Current Standard Biometer IOL Master®

Authors: Mohd Radzi Hilmi, Khairidzan Mohd Kamal, Che Azemin Mohd Zulfaezal, Ariffin Azrin Esmady

Abstract:

Purpose: Corneal curvature (CC) is an important anterior segment parameter. This study compared CC measurements conducted with two optical devices in phakic eyes. Methods: Sixty phakic eyes of 30 patients were enrolled in this study. CC was measured three times with the optical biometer and topography-keratometer Tomey AO-2000 (Tomey Corporation, Nagoya, Japan), then with the standard partial optical coherence interferometry (PCI) IOL Master (Carl Zeiss Meditec, Dublin, CA) and data were statistically analysed. Results: The measurements resulted in a mean CC of 43.86 ± 1.57 D with Tomey AO-2000 and 43.84 ± 1.55 D with IOL Master. Distribution of data is normal, and no significance difference in CC values was detected (P = 0.952) between the two devices. Correlation between CC measurements was highly significant (r = 0. 99; P < 0.0001). The mean difference of CC values between devices was 0.017 D and 95% limit of agreement was -0.088 to 0.12. Duration taken for measurements with the standard biometer IOL Master was longer (55.17 ± 2.24 seconds) than with Tomey AO-2000 (39.88 ± 2.38 seconds) in automatic mode. Duration of manual measurement with Tomey AO-2000 in manual mode was the shortest (28.57 ± 2.71 seconds). Conclusion: In phakic eyes, CC measured with Tomey AO-2000 and IOL Master showed similar values, and high correlation was observed between these two devices. This shows that both devices can be used interchangeably. Tomey AO-2000 is better in terms of faster to operate and has its own topography systems.

Keywords: corneal topography, corneal curvature, IOL Master, Tomey AO2000

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3813 Carbapenem Usage in Medical Wards: An Antibiotic Stewardship Feedback Project

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

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

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

Procedia PDF Downloads 204