Search results for: heavy menstrual bleeding
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1802

Search results for: heavy menstrual bleeding

1322 Damage Cost for Private Property by Extreme Wind over the past 10 Years in Korea

Authors: Gou-Moon Choi, Woo-Young Jung, Chan-Young Yune

Abstract:

Recently, the natural disaster has increased worldwide. In Korea, the damage to life and property caused by a typhoon, heavy rain, heavy snow, and an extreme wind also increases every year. Among natural disasters, the frequency and the strength of wind have increased because sea surface temperature has risen due to the increase of the average temperature of the Earth. In the case of extreme wind disaster, it is impossible to control or reduce the occurrence, and the recovery cost always exceeds the damage cost. Therefore, quantitative estimation of the damage cost for extreme wind needs to be established beforehand to install proactive countermeasures. In this study, the damage cost for private properties was analyzed based on the data for the past 10 years in Korea. The damage cost curve was also suggested for the metropolitan cities and provinces. The result shows the possibility for the regional application of the damage cost curve because the damage cost of the regional area is estimated based on the cost of cities and provinces.

Keywords: damage cost, extreme wind, natural disaster, private property

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1321 Density Determination by Dilution for Extra Heavy Oil Residues Obtained Using Molecular Distillation and Supercritical Fluid Extraction as Upgrading and Refining Process

Authors: Oscar Corredor, Alexander Guzman, Adan Leon

Abstract:

Density is a bulk physical property that indicates the quality of a petroleum fraction. It is also a useful property to estimate various physicochemical properties of fraction and petroleum fluids; however, the determination of density of extra heavy residual (EHR) fractions by standard methodologies, (ASTM D70) shows limitations for samples with higher densities than 1.0879 g/cm3. For this reason, a dilution methodology was developed in order to determinate density for those particular fractions, 87 (EHR) fractions were obtained as products of the fractionation of Colombian typical Vacuum Distillation Residual Fractions using molecular distillation (MD) and extraction with Solvent N-hexane in Supercritical Conditions (SFEF) pilot plants. The proposed methodology showed reliable results that can be demonstrated with the standard deviation of repeatability and reproducibility values of 0.0031 and 0.0061 g/ml respectively. In the same way, it was possible to determine densities in fractions EHR up to 1.1647g/cm3 and °API values obtained were ten times less than the water reference value.

Keywords: API, density, vacuum residual, molecular distillation, supercritical fluid extraction

Procedia PDF Downloads 250
1320 Sustainability of Green Supply Chain for a Steel Industry Using Mixed Linear Programing Model

Authors: Ameen Alawneh

Abstract:

The cost of material management across the supply chain represents a major contributor to the overall cost of goods in many companies both manufacturing and service sectors. This fact combined with the fierce competition make supply chains more efficient and cost effective. It also requires the companies to improve the quality of the products and services, increase the effectiveness of supply chain operations, focus on customer needs, reduce wastes and costs across the supply chain. As a heavy industry, steel manufacturing companies in particular are nowadays required to be more environmentally conscious due to their contribution to air, soil, and water pollution that results from emissions and wastes across their supply chains. Steel companies are increasingly looking for methods to reduce or cost cut in the operations and provide extra value to their customers to stay competitive under the current low margins. In this research we develop a green framework model for the sustainability of a steel company supply chain using Mixed integer Linear programming.

Keywords: Supply chain, Mixed Integer linear programming, heavy industry, water pollution

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1319 Analyses of Extent of Effects of Siting Boreholes Nearby Open Landfill Dumpsite at Obosi Anambra Southeast of Nigeria

Authors: George Obinna Akuaka

Abstract:

Solid waste disposal techniques in Nigeria pose an environmental threat to the environment and to nearby resident. The presence of microbial physical and chemical concentration in boreholes samples nearby dumpsite implies that groundwater is normally contaminated by leachate infiltration from an open landfill dumpsite. In this study, the physicochemical and microbial analyses of water samples from hand dug well in the site and boreholes were carried out around the active landfill and from different distances (50 m to 200 m). leachate samples collected were used to ascertain the effect or extent of contamination on the groundwater quality. A total of 5 leachate samples and 5 samples of groundwater were collected, and all samples were analyzed for various physical and chemical parameters according to the standard methods. These include pH, Electrical conductivity, Total dissolved solid, BOD, OD, Temperature, major cations such as Mg²+ Ca²+, Fe²+ Cu²+, major anions NO³-, Cl-,SO⁴- PO⁴-, Zn, Ar, Cd, Cr, Hg, Pb, Ni are the heavy metals and metalloids. The mean values of the physical and chemical parameters obtained from both sites were compared with the established of the World Health Organization (WHO). The leachate samples were found to be higher in the concentration of the results obtained than that of the boreholes water, and the recorded mean values of heavy metals were above approved standard minimum limits. The results indicated that mercury and copper were not found in all the borehole water samples. Microbial analyses showed that total heterotrophic bacteria mean count ranged from 10.6 X10⁷ cfu/ml to 2.04x10⁷cfu/ml and 9.5 X 10⁷ cfu/ml to 18.9 X 10⁷ cfu/ml in leachate and borehole samples respectively. It also revealed that almost at the bacteria isolated in the leachate were also found in the water samples. This results indicated that heavy pollution in all the samples with most physicochemical parameters and microbes showed traceable pollution, which occurred as a result of leachate infiltration into the ground water.

Keywords: physicochemical, landfill dumpsite, microbial, leachate, groundwater

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1318 Evaluation of Humoral Immune Response Against Somatic and Excretory- Secretory Antigens of Dicrocoelium Dendriticum in Infected Sheep by Western Blot

Authors: Arash Jafari, Somaye Bahrami, Mohammad Hossein Razi Jalali

Abstract:

The aim of this study was the isolation and identification of excretory-secretory and somatic antigens from D. dendriticum by SDS-PAGE and evaluation of humeral immune response against these antigens. The sera of infected sheep with different infection degrees were collected. Somatic and ES proteins were isolated with SDS PAGE. Immunogenicity properties of the resulting proteins were determined using western blot analysis. The total extract of somatic antigens analysed by SDS-PAGE revealed 21 proteins. In mild infection, bands of 130 KDa were immune dominant. In moderate infections 48, 80 and 130 KDa and in heavy infections 48, 60, 80, 130 KDa were detected as immune dominant bands. In ES antigens, mild infection 130 KDa, in moderate infection 100, 120 and 130 KDa and in heavy infection 45, 80, 85, 100, 120 and 130 KDa were immune dominant bands. The most immunogenic protein band during different degrees of infection was 130KDa.

Keywords: Dicrocoelium dendriticum excretory-secretory antigens, somatic antigens, western blot

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1317 Removal of Heavy Metal Using Continous Mode

Authors: M. Abd elfattah, M. Ossman, Nahla A. Taha

Abstract:

The present work explored the use of Egyptian rice straw, an agricultural waste that leads to global warming problem through brown cloud, as a potential feedstock for the preparation of activated carbon by physical and chemical activation. The results of this study showed that it is feasible to prepare activated carbons with relatively high surface areas and pore volumes from the Egyptian rice straw by direct chemical and physical activation. The produced activated carbon from the two methods (AC1 and AC2) could be used as potential adsorbent for the removal of Fe(III) from aqueous solution contains heavy metals and polluted water. The adsorption of Fe(III) was depended on the pH of the solution. The optimal Fe(III) removal efficiency occurs at pH 5. Based on the results, the optimum contact time is 60 minutes and adsorbent dosage is 3 g/L. The adsorption breakthrough curves obtained at different bed depths indicated increase of breakthrough time with increase in bed depths. A rise in inlet Fe(III) concentration reduces the throughput volume before the packed bed gets saturated. AC1 showed higher affinity for Fe(III) as compared to Raw rice husk.

Keywords: rice straw, activated carbon, Fe(III), fixed bed column, pyrolysis

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1316 Effect of Oxygen Ion Irradiation on the Structural, Spectral and Optical Properties of L-Arginine Acetate Single Crystals

Authors: N. Renuka, R. Ramesh Babu, N. Vijayan

Abstract:

Ion beams play a significant role in the process of tuning the properties of materials. Based on the radiation behavior, the engineering materials are categorized into two different types. The first one comprises organic solids which are sensitive to the energy deposited in their electronic system and the second one comprises metals which are insensitive to the energy deposited in their electronic system. However, exposure to swift heavy ions alters this general behavior. Depending on the mass, kinetic energy and nuclear charge, an ion can produce modifications within a thin surface layer or it can penetrate deeply to produce long and narrow distorted area along its path. When a high energetic ion beam impinges on a material, it causes two different types of changes in the material due to the columbic interaction between the target atom and the energetic ion beam: (i) inelastic collisions of the energetic ion with the atomic electrons of the material; and (ii) elastic scattering from the nuclei of the atoms of the material, which is extremely responsible for relocating the atoms of matter from their lattice position. The exposure of the heavy ions renders the material return to equilibrium state during which the material undergoes surface and bulk modifications which depends on the mass of the projectile ion, physical properties of the target material, its energy, and beam dimension. It is well established that electronic stopping power plays a major role in the defect creation mechanism provided it exceeds a threshold which strongly depends on the nature of the target material. There are reports available on heavy ion irradiation especially on crystalline materials to tune their physical and chemical properties. L-Arginine Acetate [LAA] is a potential semi-organic nonlinear optical crystal and its optical, mechanical and thermal properties have already been reported The main objective of the present work is to enhance or tune the structural and optical properties of LAA single crystals by heavy ion irradiation. In the present study, a potential nonlinear optical single crystal, L-arginine acetate (LAA) was grown by slow evaporation solution growth technique. The grown LAA single crystal was irradiated with oxygen ions at the dose rate of 600 krad and 1M rad in order to tune the structural and optical properties. The structural properties of pristine and oxygen ions irradiated LAA single crystals were studied using Powder X- ray diffraction and Fourier Transform Infrared spectral studies which reveal the structural changes that are generated due to irradiation. Optical behavior of pristine and oxygen ions irradiated crystals is studied by UV-Vis-NIR and photoluminescence analyses. From this investigation we can concluded that oxygen ions irradiation modifies the structural and optical properties of LAA single crystals.

Keywords: heavy ion irradiation, NLO single crystal, photoluminescence, X-ray diffractometer

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1315 Accumulation and Distribution of Soil Organic Carbon in Oxisols, Tshivhase Estate, Limpopo Province

Authors: M. Rose Ntsewa, P. E. Dlamini, V. E. Mbanjwa, R. Chauke

Abstract:

Land-use change from undisturbed forest to tea plantation may lead to accumulation or loss of soil organic carbon (SOC). So far, the factors controlling the vertical distribution of SOC under the long-term establishment of tea plantation remain poorly understood, especially in oxisols. In this study, we quantified the vertical distribution of SOC under tea plantation compared to adjacent undisturbed forest Oxisols sited at different topographic positions and also determined controlling edaphic factors. SOC was greater in the 30-year-old tea plantation compared to undisturbed forest oxisols and declined with depth across all topographic positions. Most of the SOC was found in the downslope position due to erosion and deposition. In the topsoil, SOC was positively correlated with heavy metals; manganese (r=0.62-0.83; P<0.05) and copper (r=0.45-0.69), effective cation exchange capacity (ECEC) (r=0.72) and mean weight diameter (MWD) (r=0.72-0.73), while in the subsoil SOC was positively correlated with copper (r=0.89-0.92) and zinc (r=0.86), ECEC (r=0.56-0.69) and MWD (r=0.48). These relationships suggest that SOC in the tea plantation, oxisols is chemically stabilized via complexation with heavy metals, and physically stabilized by soil aggregates.

Keywords: oxisols, tea plantation, topography, undisturbed forest

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1314 The Effect of Air Entraining Agents on Compressive Strength

Authors: Demet Yavuz

Abstract:

Freeze-thaw cycles are one of the greatest threats to concrete durability. Lately, protection against this threat excites scientists’ attention. Air-entraining admixtures have been widely used to produce freeze-thaw resistant at concretes. The use of air-entraining agents (AEAs) enhances not only freeze-thaw endurance but also the properties of fresh concrete such as segregation, bleeding and flow ability. This paper examines the effects of air-entraining on compressive strength of concrete. Air-entraining is used between 0.05% and 0.4% by weight of cement. One control and four fiber reinforced concrete mixes are prepared and three specimens are tested for each mix. It is concluded from the test results that when air entraining is increased the compressive strength of concrete reduces for all mixes with AEAs.

Keywords: concrete, air-entraining, compressive strength, mechanical properties

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1313 Potential Ecological Risk Assessment of Selected Heavy Metals in Sediments of Tidal Flat Marsh, the Case Study: Shuangtai Estuary, China

Authors: Chang-Fa Liu, Yi-Ting Wang, Yuan Liu, Hai-Feng Wei, Lei Fang, Jin Li

Abstract:

Heavy metals in sediments can cause adverse ecological effects while it exceeds a given criteria. The present study investigated sediment environmental quality, pollutant enrichment, ecological risk, and source identification for copper, cadmium, lead, zinc, mercury, and arsenic in the sediments collected from tidal flat marsh of Shuangtai estuary, China. The arithmetic mean integrated pollution index, geometric mean integrated pollution index, fuzzy integrated pollution index, and principal component score were used to characterize sediment environmental quality; fuzzy similarity and geo-accumulation Index were used to evaluate pollutant enrichment; correlation matrix, principal component analysis, and cluster analysis were used to identify source of pollution; environmental risk index and potential ecological risk index were used to assess ecological risk. The environmental qualities of sediment are classified to very low degree of contamination or low contamination. The similar order to element background of soil in the Liaohe plain is region of Sanjiaozhou, Honghaitan, Sandaogou, Xiaohe by pollutant enrichment analysis. The source identification indicates that correlations are significantly among metals except between copper and cadmium. Cadmium, lead, zinc, mercury, and arsenic will be clustered in the same clustering as the first principal component. Copper will be clustered as second principal component. The environmental risk assessment level will be scaled to no risk in the studied area. The order of potential ecological risk is As > Cd > Hg > Cu > Pb > Zn.

Keywords: ecological risk assessment, heavy metals, sediment, marsh, Shuangtai estuary

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1312 The Gravitational Impact of the Sun and the Moon on Heavy Mineral Deposits and Dust Particles in Low Gravity Regions of the Earth

Authors: T. B. Karu Jayasundara

Abstract:

The Earth’s gravity is not uniform. The satellite imageries of the Earth’s surface from NASA reveal a number of different gravity anomaly regions all over the globe. When the moon rotates around the earth, its gravity has a major physical influence on a number of regions on the earth. This physical change can be seen by the tides. The tides make sea levels high and low in coastal regions. During high tide, the gravitational force of the Moon pulls the Earth’s gravity so that the total gravitational intensity of Earth is reduced; it is further reduced in the low gravity regions of Earth. This reduction in gravity helps keep the suspended particles such as dust in the atmosphere, sand grains in the sea water for longer. Dramatic differences can be seen from the floating dust in the low gravity regions when compared with other regions. The above phenomena can be demonstrated from experiments. The experiments have to be done in high and low gravity regions of the earth during high and low tide, which will assist in comparing the final results. One of the experiments that can be done is by using a water filled cylinder about 80 cm tall, a few particles, which have the same density and same diameter (about 1 mm) and a stop watch. The selected particles were dropped from the surface of the water in the cylinder and the time taken for the particles to reach the bottom of the cylinder was measured using the stop watch. The times of high and low tide charts can be obtained from the regional government authorities. This concept is demonstrated by the particle drop times taken at high and low tides. The result of the experiment shows that the particle settlement time is less in low tide and high in high tide. The experiment for dust particles in air can be collected on filters, which are cellulose ester membranes and using a vacuum pump. The dust on filters can be used to make slides according to the NOHSC method. Counting the dust particles on the slides can be done using a phase contrast microscope. The results show that the concentration of dust is high at high tide and low in low tide. As a result of the high tides, a high concentration of heavy minerals deposit on placer deposits and dust particles retain in the atmosphere for longer in low gravity regions. These conditions are remarkably exhibited in the lowest low gravity region of the earth, mainly in the regions of India, Sri Lanka and in the middle part of the Indian Ocean. The biggest heavy mineral placer deposits are found in coastal regions of India and Sri Lanka and heavy dust particles are found in the atmosphere of India, particularly in the Delhi region.

Keywords: gravity, minerals, tides, moon, costal, atmosphere

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1311 Determination of Iodine and Heavy Metals in Two Brands of Iodised Salt

Authors: Z. O. Apotiola, J. F. Fashakin

Abstract:

A study was conducted to investigate the storage stability of Mr Chef and Annapurna salts. The salts were bought from Mile 12 market in Lagos State and were stored for a period of six months. The stability of the iodine content was then investigated by storing some at ambient temperature (24-30oC) and some at atmospheric temperature (21-35 oC), and from each storage condition, a sample each was taken every month to analyze for the iodine and moisture contents. The result shows that there was a significant difference between Mr Chef and the standard and Annapurna and the standard. The iodine content of Mr Chef stored at ambient and atmospheric temperature decreases progressively from 48.70±0.00-37.00±0.00 and 47.60±0.00-11.60±0.00 respectively. And that of Annapurna at both ambient and atmospheric temperature also decreases progressively from 47.60±0.00-36.60±0.00 and 47.60±0.00-10.60±0.00 respectively. Also, the moisture content of both salts at the zero month to the sixth month both at room temperature and atmospheric temperature increases from 1.11±0.00-1.70±0.00 and 1.11±0.00-2.40±0.00 respectively. The results of the heavy metals shows that only Copper, Zinc and Cobalt were detected at the first and the sixth month in both Mr Chef and Annapurna which ranges from 0.15±0.00-0.38±0.00 and 0.18±0.00 - 3.50±0.00 respectively. Hence, the stability of iodine in salt is influenced by the storage conditions it is subjected to and the length of time it is been stored.

Keywords: salt, iodine, stability, ambient, atmospheric temperature

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1310 The Effect of Aromatherapy with Citrus aurantium Blossom Essential Oil on Premenstrual Syndrome in University Students: A Clinical Trial Study

Authors: Neda Jamalimoghadam, Naval Heydari, Maliheh Abootalebi, Maryam Kasraeian, M. Emamghoreishi , Akbarzadeh Marzieh

Abstract:

Background: The aim was to investigate the effect of aromatherapy using Citrus aurantium blossom essential oil on premenstrual syndrome in university students. Methods: In this double-blind clinical trial was controlled on 62 students from March 2016 to February 2017. The intervention with 0.5% of C. Aurantium blossom essential oil and control was inhalation of odorless sweet almond oil in the luteal phase of the menstrual cycle. The screening questionnaire (PSST) for PMSwas filled out before and also one and two months after the intervention. Results: Mean score of overall symptoms of PMS between the Bitter orange and control groups In the first (p < 0.003) and second months (p < 0.001) of the intervention was significant. Besides, decreased the mean score of psychological symptoms in the intervention group (p < 0.001), but on physical symptoms and social function were not significant (p > 0.05). Conclusion: The aromatherapy with Citrus aurantium blossom improved the symptoms of premenstrual syndrome.

Keywords: aromatherapy, Citrus Aurantium, premenstrual syndrome, oil, students

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1309 Preparation of IPNs and Effect of Swift Heavy Ions Irradiation on their Physico-Chemical Properties

Authors: B. S Kaith, K. Sharma, V. Kumar, S. Kalia

Abstract:

Superabsorbent are three-dimensional networks of linear or branched polymeric chains which can uptake large volume of biological fluids. The ability is due to the presence of functional groups like –NH2, -COOH and –OH. Such cross-linked products based on natural materials, such as cellulose, starch, dextran, gum and chitosan, because of their easy availability, low production cost, non-toxicity and biodegradability have attracted the attention of Scientists and Technologists all over the world. Since natural polymers have better biocompatibility and are non-toxic than most synthetic one, therefore, such materials can be applied in the preparation of controlled drug delivery devices, biosensors, tissue engineering, contact lenses, soil conditioning, removal of heavy metal ions and dyes. Gums are natural potential antioxidants and are used as food additives. They have excellent properties like high solubility, pH stability, non-toxicity and gelling characteristics. Till date lot of methods have been applied for the synthesis and modifications of cross-linked materials with improved properties suitable for different applications. It is well known that ion beam irradiation can play a crucial role to synthesize, modify, crosslink or degrade polymeric materials. High energetic heavy ions irradiation on polymer film induces significant changes like chain scission, cross-linking, structural changes, amorphization and degradation in bulk. Various researchers reported the effects of low and heavy ion irradiation on the properties of polymeric materials and observed significant improvement in optical, electrical, chemical, thermal and dielectric properties. Moreover, modifications induced in the materials mainly depend on the structure, the ion beam parameters like energy, linear energy transfer, fluence, mass, charge and the nature of the target material. Ion-beam irradiation is a useful technique for improving the surface properties of biodegradable polymers without missing the bulk properties. Therefore, a considerable interest has been grown to study the effects of SHIs irradiation on the properties of synthesized semi-IPNs and IPNs. The present work deals with the preparation of semi-IPNs and IPNs and impact of SHI like O7+ and Ni9+ irradiation on optical, chemical, structural, morphological and thermal properties along with impact on different applications. The results have been discussed on the basis of Linear Energy Transfer (LET) of the ions.

Keywords: adsorbent, gel, IPNs, semi-IPNs

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1308 Effect of Smoking on Tear Break-Up Time and Basal Tear Secretion

Authors: Kalsoom Rani

Abstract:

Tobacco contains nicotine, which causes addiction to many toxic chemicals. In the world, people consume it in the form of smoke, chew, and sniffing, smoke of it is composed of almost 7000 active chemicals, which are very harmful to human health as well as for eye health, inhalation of tobacco smoke and fumes can accelerate and cause many blinding eye diseases. Dry eye and smoking have not been covered extensively in researches; more studies are required to unveil the relationship between smoking and dry eye. This study was conducted to determine the quantity and quality of tears in smokers. 60 subjects participated in the study, which was divided into two groups on the basis of consumption of cigarettes per day with age matched non smokers of 15-50 years. All participants have gone through a study based questioner, eye examination, and diagnostic 'Dry Eye Tests' for evaporative tears evaluation and measurement of basal tear secretion. Subjects were included in the criteria of 10 cigarettes per day with a minimum duration of 1 year; passive smokers for control groups were excluded. The study was carried out in a Medina Teaching Hospital, Faisalabad, Pakistan, ophthalmology department for the duration of 8 months. Mean values for tear break up time (TBUT), was reported 10sec with SD of +3.74 in controlled group, 5sec with SD + 2.32 in smokers and 4sec SD +3.77 heavy smokers in right eye (RE) and left eye (LE) 10.35sec with SD of +3.88 in controlled 5sec with SD + 2.3 in smokers and much reduced TBUT in heavy smokers was 3.85sec SD+2.20. Smoking has a very strong association with TRUT with a significance of P=.00 both eyes. Mean Schirmer-I value of the subjects was reported 12.6mm with SD + 8.37 in RE and 12.59mm with SD + 8.96 LE. The mean Schirmer-II test value was reported in the right, and left eye with a mean value for control was 20.23mm with SD + 8.93, 20.75mm with SD + 8.84 respectively, and in Smokers 9.90mm with SD + 5.74, and 10.07mm with SD + 6.98, and in heavy smokers 7.7mm, SD + 3.22 and 6.9, SD + 3.50 mm, association with smoking showed p=.001 in RE and .003 in LE. Smoking has deteriorated effect on both evaporative tear and aqueous tear secretion and causing symptoms of dry eye burning, itching, redness, and watering with epithelial cell damage.

Keywords: tear break-up time, basal tear secretion, smokers, dry eye

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1307 Left Atrial Appendage Occlusion vs Oral Anticoagulants in Atrial Fibrillation and Coronary Stenting. The DESAFIO Registry

Authors: José Ramón López-Mínguez, Estrella Suárez-Corchuelo, Sergio López-Tejero, Luis Nombela-Franco, Xavier Freixa-Rofastes, Guillermo Bastos-Fernández, Xavier Millán-Álvarez, Raúl Moreno-Gómez, José Antonio Fernández-Díaz, Ignacio Amat-Santos, Tomás Benito-González, Fernando Alfonso-Manterola, Pablo Salinas-Sanguino, Pedro Cepas-Guillén, Dabit Arzamendi, Ignacio Cruz-González, Juan Manuel Nogales-Asensio

Abstract:

Background and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To this end, we studied the impact of LAAO plus antiplatelet drugs vs oral anticoagulants (OAC) (including direct OAC) plus antiplatelet drugs in these patients’ long-term outcomes. Methods: The results of 207 consecutive patients with NVAF who underwent coronary stenting were analyzed. A total of 146 patients were treated with OAC (75 with acenocoumarol, 71 with direct OAC) while 61 underwent LAAO. The median follow-up was 35 months. Patients also received antiplatelet therapy as prescribed by their cardiologist. The study received the proper ethical oversight. Results: Age (mean 75.7 years), and the past medical history of stroke were similar in both groups. However, the LAAO group had more unfavorable characteristics (history of coronary artery disease [CHA2DS2-VASc], and significant bleeding [BARC ≥ 2] and HAS-BLED). The occurrence of major adverse events (death, stroke/transient ischemic events, major bleeding) and major cardiovascular events (cardiac death, stroke/transient ischemic attack, and myocardial infarction) were significantly higher in the OAC group compared to the LAAO group: 19.75% vs 9.06% (HR, 2.18; P = .008) and 6.37% vs 1.91% (HR, 3.34; P = .037), respectively. Conclusions: In patients with NVAF undergoing coronary stenting, LAAO plus antiplatelet therapy produced better long-term outcomes compared to treatment with OAC plus antiplatelet therapy despite the unfavorable baseline characteristics of the LAAO group.

Keywords: stents, atrial fibrillation, anticoagulants, left atrial appendage occlusion

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1306 The Contribution of Shell Correction of Targets ²⁷₁₃Al,⁶³₂₉Cu,¹⁹⁷₇₉Au in the Calculation of Stopping Power of Charged Particles ¹H,⁴He,⁷Li,¹²C,¹⁶O for Speeds V≥V₀Z₁²/³

Authors: Foul Sihem, Chekirine Mamoun, Sidoumou Mohamed

Abstract:

The modified Bethe-Bloch formula depends on several corrective terms; the most important of these is undoubtedly the shell correction, especially for energies of a few MeV/u and whose contribution can exceed 10% of the stopping power. The charge state of the incident ions also influences this latter, particularly heavy ions at intermediates speeds 2Z₁V₀≥V≥V₀Z₁²/³. In the present work, we calculated the shell corrections of the targets ²⁷₁₃Al,⁶³₂₉Cu,¹⁹⁷₇₉Au, the effective charge and the stopping power of the ¹H,⁴He, ⁷Li,¹²C,¹⁶O ions by using the Bethe-Bloch formula at energies ranging from 1 to 100 MeV/ u. The stopping power values of the ¹H,⁴He, ⁷Li,¹²C,¹⁶O ions in the targets ²⁷₁₃Al,⁶³₂₉Cu,¹⁹⁷₇₉Au were compared to those generated by the SRIM- 2013, PSTAR, ASTAR, and MSTAR calculation codes. In this study, we found that the contribution of the shell corrections could reach 13% of stopping power, especially for medium and heavy targets at energies of a few MeV/u.

Keywords: shell correction, stopping power, modified Bethe-Bloch formula, V≥V₀Z₁²/³, ¹H, ⁴He, ⁷Li, ¹²C, ¹⁶O, ²⁷₁₃Al, ⁶³₂₉Cu, ¹⁹⁷₇₉Au

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1305 Prediction of Extreme Precipitation in East Asia Using Complex Network

Authors: Feng Guolin, Gong Zhiqiang

Abstract:

In order to study the spatial structure and dynamical mechanism of extreme precipitation in East Asia, a corresponding climate network is constructed by employing the method of event synchronization. It is found that the area of East Asian summer extreme precipitation can be separated into two regions: one with high area weighted connectivity receiving heavy precipitation mostly during the active phase of the East Asian Summer Monsoon (EASM), and another one with low area weighted connectivity receiving heavy precipitation during both the active and the retreat phase of the EASM. Besides,a way for the prediction of extreme precipitation is also developed by constructing a directed climate networks. The simulation accuracy in East Asia is 58% with a 0-day lead, and the prediction accuracy is 21% and average 12% with a 1-day and an n-day (2≤n≤10) lead, respectively. Compare to the normal EASM year, the prediction accuracy is lower in a weak year and higher in a strong year, which is relevant to the differences in correlations and extreme precipitation rates in different EASM situations. Recognizing and identifying these effects is good for understanding and predicting extreme precipitation in East Asia.

Keywords: synchronization, climate network, prediction, rainfall

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1304 The Effect of Solid Wastes Disposal at Amokpala Dump Site in Orumba North Local Government Area, Anambra State

Authors: Nwanneka Mmonwuba

Abstract:

Solid waste disposal to the environment was investigated by analyzing the quality characteristics of waste, air quality, and heavy metal concentration in the soil. The characteristics of waste were analyzed by enumerating the number of houses, hostels, hotels, markets, schools, and industries with the type of waste being discharged or deposited into the dump site. The percentage of waste was estimated with organic ranking first for both wet and dry seasons, 54% and 44%, respectively. The ambient air quality was analyzed using the crown gas monitor analyzer. The analysis showed that the mean concentration of NO₂, SO₂, and Co is 0.74, 0.37, and 47.35 ppm for the wet season and 0.47, 0.35, and 37.65 ppm for the dry season, respectively, and do not conform with the USEPA standard. The chemical analysis of the groundwater sample indicates alkalinity ranging from 7.38 to 9.11. the heavy metals concentration in the soil of cadmium, iron, copper, calcium, and potassium with 0.053, 0.722, 0227, 21.3, and 9.019, respectively, obtained from 0.3 m at the subsurface failed to conform to the NRC (2013) standard. Iron consent in the soil can be corrected using ascorbic acid and soda ash. The permanent reduction of effects is to try relocating people who live very close to the dumpsite, or the dumpsite should be sited elsewhere and replaced with a sanitary landfill.

Keywords: solid waste, groundwater, disposal, dumpsite

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1303 Antibacterial Studies on Cellulolytic Bacteria for Termite Control

Authors: Essam A. Makky, Chan Cai Wen, Muna Jalal, Mashitah M. Yusoff

Abstract:

Termites are considered as important pests that could cause severe wood damage and economic losses in urban, agriculture and forest of Malaysia. The ability of termites to degrade cellulose depends on association of gut cellulolytic microflora or better known as mutual symbionts. With the idea of disrupting the mutual symbiotic association, better pest control practices can be attained. This study is aimed to isolate cellulolytic bacteria from the gut of termites and carry out antibacterial studies for the termite. Confirmation of cellulase activity is done by qualitative and quantitative methods. Impacts of antibiotics and their combinations, as well as heavy metals and disinfectants, are conducted by using disc diffusion method. Effective antibacterial agents are then subjected for termite treatment to study the effectiveness of the agents as termiticides. 24 cellulolytic bacteria are isolated, purified and screened from the gut of termites. All isolates were identified as Gram-negative with either rod or cocci in shape. For antibacterial studies result, isolates were found to be 100% sensitive to 4 antibiotics (rifampicin, tetracycline, gentamycin, and neomycin), 2 heavy metals (cadmium and mercury) and 3 disinfectants (lactic acid, formalin, and hydrogen peroxide). 22 out of 36 antibiotic combinations showed synergistic effect while 15 antibiotic combinations showed an antagonistic effect on isolates. The 2 heavy metals and 3 disinfectants that showed 100% effectiveness, as well as 22 antibiotic combinations, that showed synergistic effect were used for termite control. Among the 27 selected antibacterial agents, 12 of them were found to be effective to kill all the termites within 1 to 6 days. Mercury, lactic acid, formalin and hydrogen peroxide were found to be the most effective termiticides in which all termites were killed within 1 day only. These effective antibacterial agents possess a great potential to be a new application to control the termite pest species in the future.

Keywords: antibacterial, cellulase, termicide, termites

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1302 Renal Angiomyolipoma Rupture Following COVID-19 Infection: A Case Report

Authors: Mohammed Abdurabu, Akram Al-Warqi, Ebrahim M. A. Ebrahim, Jouhar Kollari, Salman Mirza

Abstract:

The novel coronavirus (COVID-19) is one of the most recent pandemics that invaded earth that left and still leaving hundreds of thousands of patients and ended with high morbidity and mortality rates with no clear cure till this moment. COVID-19 has been proven to be associated with pathologic changes in coagulation, characterized by either thromboembolic or bleeding events. We present this case of a 44-year-old male patient that presented to our Emergency Department with flank pain that later was found to have renal angiomyolipoma (AML) rupture during his COVID-19 infection, ultimately requiring admission for hemorrhage control via Interventional Radiology (IR) drainage. Here, we discuss the role of the front-line physicians and how they should keep a low threshold for the different presentations that could be associated with COVID-19 infection.

Keywords: angiomyolipoma, COVID-19, renal, rupture

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1301 Risks of Traditional Practices: Chemical and Health Assessment of Bakhour

Authors: Yehya Elsayed, Sarah Dalibalta, Fareedah Alqtaishat, Ioline Gomes, Nagelle Fernandes

Abstract:

Bakhour or Arabian incense is traditionally used to perfume houses, shops and clothing as part of cultural or religious practices in several Middle Eastern countries. Conventionally, Bakhour consists of a mixture of natural ingredients such as chips of agarwood (oud), musk and sandalwoods that are soaked in scented oil. Bakhour is usually burned by charcoal or by using gas or electric burners to produce the scented smoke. It is necessary to evaluate the impact of such practice on human health and environment especially that the burning of Bakhour is usually done on a regular basis and in closed areas without proper ventilation. Although significant amount of research has been reported in scientific literature on the chemical analysis of various types of incense smoke, unfortunately only very few of them focused specifically on the health impacts of Bakhour. Raw Bakhour samples, their smoke emissions and the ash residue were analyzed to assess the existence of toxic ingredients and their possible influence on health and the environment. Three brands of Bakhour samples were analyzed for the presence of harmful heavy metals and organic compounds. Thermal Desorption Gas Chromatography-Mass Spectrometry (TD-GC-MS) was used to identify organic compounds while Inductively Coupled Plasma (ICP) and Scanning Electron Microscope-Energy Dispersive X-Ray Spectrometer (SEM-EDS) were used to analyze the presence of toxic and heavy metals. Organic compounds from the smoke were collected on specific tenax and activated carbon adsorption tubes. More than 850 chemical compounds were identified. The presence of 19 carcinogens, 23 toxins and 173 irritants were confirmed. Additionally, heavy metals were detected in amounts similar to those present in cigarettes. However, it was noticed that many of the detected compounds in the smoke lacked clinical studies on their health effects which shows the need for further clinical studies to be devoted to this area of study.

Keywords: Bakhour, incense smoke, pollution, indoor environment, health risk, chemical analysis

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1300 Chemical and Health Assessment of Bakhour: Risks of Traditional Practices

Authors: Yehya Elsayed, Sarah Dalibalta, Fareedah Alqtaishat, Ioline Gomes, Nagelle Fernandes

Abstract:

Bakhour, or Arabian incense, is traditionally used to perfume houses, shops and clothing as part of cultural or religious practices in several Middle Eastern countries. Conventionally, Bakhour consists of a mixture of natural ingredients such as chips of agarwood (oud), musk and sandalwoods that are soaked in scented oil. Bakhour is usually burned by charcoal or by using gas or electric burners to produce the scented smoke. It is necessary to evaluate the impact of such practice on human health and environment especially that the burning of Bakhour is usually done on a regular basis and in closed areas without proper ventilation. Although significant amount of research has been reported in scientific literature on the chemical analysis of various types of incense smoke, unfortunately, only very few of them focused specifically on the health impacts of Bakhour. Raw Bakhour samples, their smoke emissions and the ash residue were analyzed to assess the existence of toxic ingredients and their possible influence on health and the environment. Three brands of Bakhour samples were analyzed for the presence of harmful heavy metals and organic compounds. Thermal Desorption Gas Chromatography-Mass Spectrometry (TD-GC-MS) was used to identify organic compounds while Inductively Coupled Plasma (ICP) and Scanning Electron Microscope-Energy Dispersive X-Ray Spectrometer (SEM-EDS) were used to analyze the presence of toxic and heavy metals.. Organic compounds from the smoke were collected on specific tenax and activated carbon adsorption tubes. More than 850 chemical compounds were identified. The presence of 19 carcinogens, 23 toxins, and 173 irritants were confirmed. Additionally, heavy metals were detected in amounts similar to those present in cigarettes. However, it was noticed that many of the detected compounds in the smoke lacked clinical studies on their health effects which shows the need for further clinical studies to be devoted to this area of study.

Keywords: bakhour, incense smoke, pollution, indoor environment, health risk, chemical analysis

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1299 Pulmonary Complications of Dengue Infection

Authors: Shilpa Avarebeel

Abstract:

Background: India is one of the seven identified countries in South-East Asia region, regularly reporting dengue infection and may soon transform into a major niche for dengue epidemics. Objective: To study the clinical profile of dengue in our setting with special reference to respiratory complication. Study design: Descriptive and exploratory study, for one year in 2014. All patients confirmed as dengue infection were followed and their clinical profile, along with outcome was determined. Study proforma was designed based on the objective of the study and it was pretested and used after modification. Data was analyzed using statistical software SPSS-Version 16. Data were expressed as mean ±S .D for parametric variables and actual frequencies or percentage for non-parametric data. Comparison between groups was done using students’ t-test for independent groups, Chie square test, one-way ANOVA test, Karl Pearson’s correlation test. Statistical significance is taken at P < 0.05. Results: Study included 134 dengue positive cases. 81% had dengue fever, 18% had dengue hemorrhagic fever, and one had dengue shock syndrome. Most of the cases reported were during the month of June. Maximum number of cases was in the age group of 26-35 years. Average duration of hospital stay was less than seven days. Fever and myalgia was present in all the 134 patients, 16 had bleeding manifestation. 38 had respiratory symptoms, 24 had breathlessness, and 14 had breathlessness and dry cough. On clinical examination of patients with respiratory symptoms, all twenty-eight had hypoxia features, twenty-four had signs of pleural effusion, and four had ARDS features. Chest x-ray confirmed the same. Among the patients with respiratory symptoms, the mean platelet count was 26,537 c/cmm. There was no statistical significant difference in the platelet count in those with ARDS and other dengue complications. Average four units of platelets were transfused to all those who had ARDS in view of bleeding tendency. Mechanical ventilator support was provided for ARDS patients. Those with pleural effusion and pulmonary oedema were given NIV (non-invasive ventilation) support along with supportive care. However, steroids were given to patients with ARDS and 10 patients with signs of respiratory distress. 100%. Mortality was seen in patients with ARDS. Conclusion: Dengue has to be checked for those presenting with fever and breathlessness. Supportive treatments remain the cornerstone of treatment. Platelet transfusion has to be given only by clinical judgment. Steroids have no role except in early ARDS, which is controversial. Early NIV support helps in speedy recovery of dengue patients with respiratory distress.

Keywords: adult respiratory distress syndrome, dengue fever, non-invasive ventilation, pulmonary complication

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1298 Toxicological Effects of Heavy Metals; Copper, Lead and Chromium on Brain and Liver Tissue of Grass Carp (Ctenopharyngodon idella)

Authors: Ahsan Khan, Nazish Shah, Muhammad Salman

Abstract:

The present study deals with the toxicological effects of copper, lead and chromium on brain and liver tissues of grass carp (Ctenopharyngodon idella). The average length of experimental fish was 8.5 ± 5.5 cm and weighed 9.5 ± 6.5 g. Grass carp was exposed to lethal concentration (LC₁₅) of copper, lead and chromium for 24, 48, 72 and 96 hours respectively. (LC₁₅) for copper was 1.5, 1.4, 1.2 and 1mgL⁻¹. Similarly, LC₁₅ of lead was 250, 235, 225 and 216mgL⁻¹ while (LC₁₅) for chromium was 25.5, 22.5, 20 and 18mgL⁻¹ respectively. During the time of exposure against various doses of heavy metals the grass carp showed some behavioral changes. In the initial stages of experiment, the rapid movements and gulping of air were observed. Several times the fish tried to jump to scat from the toxic median. In addition, the accumulation of heavy metals in different tissues of grass carp particularly in liver and brain tissues were observed. Lead was highly accumulated in brain tissue after the exposure of fish for 24 and 48 hours, while highly accumulated in liver tissues after the exposure of fish for 72 and 96 hours. Chromium was highly accumulated in the liver tissues after the exposure of fish for 24 hours while its accumulation was found highly in the brain tissues after the exposure of fish for 48, 72 and 96 hours. Similarly, accumulation of copper concentration was found highly in brain tissues after the exposure of 48 and 96 hours while its accumulation was high in liver tissues after the exposure of 24 and 72 hours. Comparatively maximum accumulation of lead was found in brain and liver tissues of grass carp followed by chromium and copper. Furthermore, accumulation of these metals caused many abnormalities like gliosis, destruction of cell, change in cell shape and shrinkage of cells in brain tissue while in liver tissues aggregation in hepatocytes, widen space between cells and also destruction of cell was observed. These experiments and observations can be useful to monitor the aquatic pollution and quality of aquatic environment system.

Keywords: brain, grass carp, liver, lethal concentration, toxicity

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1297 The Ballistics Case Study of the Enrica Lexie Incident

Authors: Diego Abbo

Abstract:

On February 15, 2012 off the Indian coast of Kerala, in position 091702N-0760180E by the oil tanker Enrica Lexie, flying the Italian flag, bursts of 5.56 x45 caliber shots were fired from assault rifles AR/70 Italian-made Beretta towards the Indian fisher boat St. Anthony. The shots that hit the St. Anthony fishing boat were six, of which two killed the Indian fishermen Ajesh Pink and Valentine Jelestine. From the analysis concerning the kinematic engagement of the two ships and from the autopsy and ballistic results of the Indian judicial authorities it is possible to reconstruct the trajectories of the six aforementioned shots. This essay reconstructs the trajectories of the six shots that cannot be of direct shooting but have undergone a rebound on the water. The investigation carried out scientifically demonstrates the rebound of the blows on the water, the gyrostatic deviation due to the rebound and the tumbling effect always due to the rebound as regards intermediate ballistics. In consideration of the four shots that directly impacted the fishing vessel, the current examination proves, with scientific value, that the trajectories could not be downwards but upwards. Also, the trajectory of two shots that hit to death the two fishermen could not be downwards but only upwards. In fact, this paper demonstrates, with scientific value: The loss of speed of the projectiles due to the rebound on the water; The tumbling effect in the ballistic medium within the two victims; The permanent cavities subject to the injury ballistics and the related ballistic trauma that prevented homeostasis causing bleeding in one case; The thermo-hardening deformation of the bullet found in Valentine Jelestine's skull; The upward and non-downward trajectories. The paper constitutes a tool in forensic ballistics in that it manages to reconstruct, from the final spot of the projectiles fired, all phases of ballistics like the internal one of the weapons that fired, the intermediate one, the terminal one and the penetrative structural one. In general terms the ballistics reconstruction is based on measurable parameters whose entity is contained with certainty within a lower and upper limit. Therefore, quantities that refer to angles, speed, impact energy and firing position of the shooter can be identified within the aforementioned limits. Finally, the investigation into the internal bullet track, obtained from any autopsy examination, offers a significant “lesson learned” but overall a starting point to contain or mitigate bleeding as a rescue from future gunshot wounds.

Keywords: impact physics, intermediate ballistics, terminal ballistics, tumbling effect

Procedia PDF Downloads 142
1296 Comparative Evaluation of Kinetic Model of Chromium and Lead Uptake from Aqueous Solution by Activated Balanitesaegyptiaca Seeds

Authors: Mohammed Umar Manko

Abstract:

A series of batch experiments were conducted in order to investigate the feasibility of Balanitesaegyptiaca seeds based activated carbon as compared with industrial activated carbon for the removal of chromium and lead ions from aqueous solution by the adsorption process within 30 to 150 minutes contact time. The activated samples were prepared using zinc chloride and tetraoxophophate(VI) acid. The results obtained showed that the activated carbon of Balanitesaegyptiaca seeds studied had relatively high adsorption capacities for these heavy metal ions compared with industrial Activated Carbon. The percentage removal of Cr (VI) and lead (II) ions by the three activated carbon samples were 64%, 70% and 71%; 60%, 66% and 60% respectively. Adsorption equilibrium was established in 90 minutes for the heavy metal ions. The equilibrium data fitted the pseudo second order out of the pseudo first, pseudo second, Elovich ,Natarajan and Khalaf models tested. The investigation also showed that the adsorbents can effectively remove metal ions from similar wastewater and aqueous media.

Keywords: activated carbon, pseudo second order, chromium, lead, Elovich model

Procedia PDF Downloads 299
1295 Collaborative Implementation of Master Plans in Afghanistan's Context Considering Land Readjustment as Case Study

Authors: Ahmad Javid Habib, Tetsuo Kidokoro

Abstract:

There is an increasing demand for developing urban land to provide better living conditions for all citizens in Afghanistan. Most of the development will involve the acquisition of land. And the current land acquisition method practiced by central government is expropriation, which is a cash-based transaction method that imposes heavy fiscal burden on local municipalities and central government, and it does not protect ownership rights and social equity of landowners besides it relocates the urban poor to remote areas with limited access to jobs and public services. The questionnaire analysis, backed by observations of different case studies in countries where land readjustment is used as a collaborative land development tool indicates that the method plays a key role in valuing landowners’ rights, giving other community members and stakeholders the opportunity to collaboratively implement urban development projects. The practice of the method is reducing the heavy fiscal burden on the local and central governments and is a better option to deal with the current development challenges in Afghanistan.

Keywords: collaboration, land readjustment, master plan, expropriation

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1294 The Role of EDTA and EDDS in Reducing Metal Toxicity for Aquaculture Shellfish Perna canaliculus

Authors: Daniel R. McDougall, Martin D. de Jonge, Gordon M. Miskelly, Duncan J. McGillivray, Andrew G. Jeffs

Abstract:

The chelating agent ethylenediaminetetraacetic acid (EDTA) is commonly added as a cure-all to seawater in aquaculture hatcheries around the world to reduce heavy metal toxicity, significantly improve the survival of larval shellfish, and to therefore improve the overall production efficiency of the aquaculture industry. However, EDTA is not a biodegradable chemical and is considered to be a persistent organic pollutant, which will accumulate in the environment over time. This makes the use of EDTA unsustainable environmentally, and therefore alternatives should be considered. Ethylenediaminedisuccinic acid (EDDS) is a biodegradable alternative to EDTA with very similar metal chelation properties. This study investigates the effect of EDTA and EDDS at two different concentrations, on metal concentrations found within developing New Zealand green-lipped mussel (Perna canaliculus) larvae. P. canaliculus is New Zealand’s main shellfish aquaculture species, providing a major export for New Zealand’s economy, with excellent potential for increased production in the near future. It is well known that the early stages of bivalve development are the most vulnerable to metal toxicity and P. canaliculus is no exception. The commercially used concentration (12 µmol L⁻¹) of EDTA added to P. canaliculus larval rearing tanks often increases the yield of D-larvae by over 80%. This concentration of EDTA and EDDS will be tested in this study, along with a lower concentration (3 µmol L⁻¹). After 48 hours of larval development, the D-larvae will be analyzed for heavy metal content with Inductively Coupled Plasma Mass Spectrometry (ICP-MS) and heavy metal distribution with synchrotron X-ray Fluorescence Microscopy (XFM). In this study, we found that EDDS also improves the yield of P. canaliculus larvae and could be a viable alternative to EDTA in aquaculture. Furthermore, results suggest a higher concentration of chelating agent is more effective for improving the yield of developing P. canaliculus larvae. Metals with significant differences in concentration with the addition of EDTA were Cr, Cu, Zn, Cd and Pb (P < 0.05). We observed for the first time to the author’s best knowledge, metal distribution within 100 µm P. canaliculus D-larvae using synchrotron XFM and found changes in the distribution of metals with the addition of EDTA. XFM also has the potential to provide information about the chemical state of the metals within mussel larvae. This research provides greater insight into the reasons for the effectiveness of adding the chelating agent to aquaculture culture water, and a more environmentally conscious alternative to the currently used EDTA, which could be extremely valuable for the aquaculture industry.

Keywords: EDDS, EDTA, heavy metals, P. canaliculus, toxicity, water treatment

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1293 Incidence of Vulval, Vaginal and Cervical Disease in Rapid Access Clinic in a London Tertiary Hospital Setting

Authors: Kieren Wilson, Gulnaz Majeed

Abstract:

NHS constitution gives rights to the patient with suspected cancer to be seen by a cancer specialist within 2 weeks of referral. Guys and St Thomas Hospital (GSTT) is one of the largest cancer centres in London. NICE guidelines have provided guidance for health professionals to refer patients appropriately to RAC. In GSTT suspected gynae cancer referrals are mostly by NHS e-Referral Service with some fax, emails as well as paper referrals. The objective of this study was to evaluate compliance with 2-week referral pathway with emphasis on one stop diagnostic service with supporting efficient pathways. A prospective evaluation over 3 months (1 Jan 2017 to 31 Mar 2017) was undertaken. There were 26 clinics, 761 patients were booked in the clinics with a DNA rate of 13% (n=101) hence 606 patients were seen. Majority of referrals were for post menopausal bleeding (PMB) 25% (n=194) followed by cervical, vaginal, vulval reasons 23% (n=179) (abnormal cytology excluded as patients directly referred to colposcopy unit in GSTT), ovarian 7% (n=54) and endometrial 5% (n=41). Women with new or previous established diagnosis of cancer were 24, cervical (n=17), vulva (n=6) and vagina (n=1). Multifocal preinvasive disease vulva (VIN), vagina (VAIN) and cervix (CIN) was confirmed in twenty-six patients 4% (high prevalence in HIV patients). Majority of cervical referrals: PCB (n=14), cervical erosion (n=7), polyps (n=9) and cervical cyst were benign. However, two women with PMB had cervical cancer. Only 2 out of 13 referrals with vaginal concerns had VAIN. One case with non-cervical glandular cytology was confirmed to have endometrial cancer. One stop service based on the diagnostic support of ultrasound, colposcopy and hysteroscopy was achieved in 54% (n=359). Patients were discharged to GP, benign gynaecology, endometriosis, combined vulval/dermatology clinic or gynae oncology. 33% (n=202) required a second visit, 12% (n=70) third visit, 3% (n=19) fourth visit, 1% (n=4) fifth visit and 1% (n=6) sixth visit. Main reasons for follow ups were the unavailability of diagnostic slots, patient choice, need for interpreters, the discussion following gynae MDM review for triage to benign gynae, delay in availability of diagnostic results like histology/MRI/CT. Recommendations following this study are multi disciplinary review of pathways with the availability of additional diagnostic procedure slots to aim for one stop service. Furthermore, establishment of virtual and telephone consultations to reduce follow ups.

Keywords: multifocal disease, post menopausal bleeding, preinvasive disease, rapid access clinic

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