Search results for: total error rate
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 16785

Search results for: total error rate

11655 Hip Resurfacing Makes for Easier Surgery with Better Functional Outcomes at Time of Revision: A Case Controlled Study

Authors: O. O. Onafowokan, K. Anderson, M. R. Norton, R. G. Middleton

Abstract:

Revision total hip arthroplasty (THA) is known to be a challenging procedure with potential for poor outcomes. Due to its lack of metaphyseal encroachment, hip resurfacing arthroplasty (HRA) is classified as a bone conserving procedure. Although the literature postulates that this is an advantage at time of revision surgery, there is no evidence to either support or refute this claim. We identified 129 hips that had undergone HRA and 129 controls undergoing first revision THA. We recorded the clinical assessment and survivorship of implants in a multi-surgeon, single centre, retrospective case control series for both arms. These were matched for age and sex. Data collected included demographics, indications for surgery, Oxford Hip Score (OHS), length of surgery, length of hospital stay, blood transfusion, implant complexity and further surgical procedures. Significance was taken as p < 0.05. Mean follow up was 7.5 years (1 to 15). There was a significant 6 point difference in postoperative OHS in favour of the revision resurfacing group (p=0.0001). The revision HRA group recorded 48 minutes less length of surgery (p<0.0001), 2 days less in length of hospital stay (p=0.018), a reduced need for blood transfusion (p=0.0001), a need for less complexity in revision implants (p=0.001) and a reduced probability of further surgery being required (P=0.003). Whilst we acknowledge the limitations of this study our results suggest that, in contrast to THA, the bone conservation element of HRA may make for a less traumatic revision procedure with better functional outcomes. Use of HRA has seen a dramatic decline as a result of concerns regarding metallosis. However, this information remains of relevance when counselling young active patients about their arthroplasty options and may become pertinent in the future if the promise of ceramic hip resurfacing is ever realized.

Keywords: hip resurfacing, metallosis, revision surgery, total hip arthroplasty

Procedia PDF Downloads 75
11654 Derivational Morphology Training Improves Spelling in School-Aged Children

Authors: Estelle Ardanouy, Helene Delage, Pascal Zesiger

Abstract:

Morphological awareness contributes to the acquisition of reading and spelling in typical learners as well as in children with learning disorders. Indeed, the acquisition of phoneme-grapheme correspondences is not sufficient to master spelling, especially in inconsistent orthographic systems such as English or French. Several meta-analyses show the benefit of explicit training in derivational morphology on reading and spelling in old children (who have already learned the main grapheme-phoneme correspondences), but highlight the lack of studies with younger children, particularly in French. In this study, we chose to focus on the efficiency of an intensive training in derivational morphology on spelling skills in French-speaking four-graders (9-10 years of age). The training consisted of 1) learning how to divide words into morphemes (ex: para/pente in French, paraglider in English), as well as 2) working on the meaning of affixes in relation to existing words (ex: para/pente: to protect against – para - the slope -pente). One group of pupils (N = 37, M age = 9.5) received this experimental group training in morphology while an alternative training group (N = 34, M age = 9.6) received a visuo-semantic training based on visual cues to memorize the spelling difficulties of complex words (such as the doubling of “r” in “verre” in French -or "glass" in English-which are represented by the drawing of two glasses). Both trainings lasted a total of 15 hours at a rate of four 45 minutes sessions per week, resulting in five weeks of training in the school setting. Our preliminary results show a significant improvement in the experimental group in the spelling of affixes on the trained (p < 0.001) and untrained word lists (p <0.001), but also in the root of words on the trained (p <0.001) and untrained word lists group (p <0.001). The training effect is also present on both trained and untrained morphologically composed words. By contrast, the alternative training group shows no progress on these previous measures (p >0.15). Further analyses testing the effects of both trainings on other measures such as morphological awareness and reading of morphologically compose words are in progress. These first results support the effectiveness of explicitly teaching derivational morphology to improve spelling in school-aged children. The study is currently extended to a group of children with developmental dyslexia because these children are known for their severe and persistent spelling difficulties.

Keywords: developmental dyslexia, derivational morphology, reading, school-aged children, spelling, training

Procedia PDF Downloads 166
11653 Parametric Appraisal of Robotic Arc Welding of Mild Steel Material by Principal Component Analysis-Fuzzy with Taguchi Technique

Authors: Amruta Rout, Golak Bihari Mahanta, Gunji Bala Murali, Bibhuti Bhusan Biswal, B. B. V. L. Deepak

Abstract:

The use of industrial robots for performing welding operation is one of the chief sign of contemporary welding in these days. The weld joint parameter and weld process parameter modeling is one of the most crucial aspects of robotic welding. As weld process parameters affect the weld joint parameters differently, a multi-objective optimization technique has to be utilized to obtain optimal setting of weld process parameter. In this paper, a hybrid optimization technique, i.e., Principal Component Analysis (PCA) combined with fuzzy logic has been proposed to get optimal setting of weld process parameters like wire feed rate, welding current. Gas flow rate, welding speed and nozzle tip to plate distance. The weld joint parameters considered for optimization are the depth of penetration, yield strength, and ultimate strength. PCA is a very efficient multi-objective technique for converting the correlated and dependent parameters into uncorrelated and independent variables like the weld joint parameters. Also in this approach, no need for checking the correlation among responses as no individual weight has been assigned to responses. Fuzzy Inference Engine can efficiently consider these aspects into an internal hierarchy of it thereby overcoming various limitations of existing optimization approaches. At last Taguchi method is used to get the optimal setting of weld process parameters. Therefore, it has been concluded the hybrid technique has its own advantages which can be used for quality improvement in industrial applications.

Keywords: robotic arc welding, weld process parameters, weld joint parameters, principal component analysis, fuzzy logic, Taguchi method

Procedia PDF Downloads 169
11652 Predictors of Glycaemic Variability and Its Association with Mortality in Critically Ill Patients with or without Diabetes

Authors: Haoming Ma, Guo Yu, Peiru Zhou

Abstract:

Background: Previous studies show that dysglycemia, mostly hyperglycemia, hypoglycemia and glycemic variability(GV), are associated with excess mortality in critically ill patients, especially those without diabetes. Glycemic variability is an increasingly important measure of glucose control in the intensive care unit (ICU) due to this association. However, there is limited data pertaining to the relationship between different clinical factors and glycemic variability and clinical outcomes categorized by their DM status. This retrospective study of 958 intensive care unit(ICU) patients was conducted to investigate the relationship between GV and outcome in critically ill patients and further to determine the significant factors that contribute to the glycemic variability. Aim: We hypothesize that the factors contributing to mortality and the glycemic variability are different from critically ill patients with or without diabetes. And the primary aim of this study was to determine which dysglycemia (hyperglycemia\hypoglycemia\glycemic variability) is independently associated with an increase in mortality among critically ill patients in different groups (DM/Non-DM). Secondary objectives were to further investigate any factors affecting the glycemic variability in two groups. Method: A total of 958 diabetic and non-diabetic patients with severe diseases in the ICU were selected for this retrospective analysis. The glycemic variability was defined as the coefficient of variation (CV) of blood glucose. The main outcome was death during hospitalization. The secondary outcome was GV. The logistic regression model was used to identify factors associated with mortality. The relationships between GV and other variables were investigated using linear regression analysis. Results: Information on age, APACHE II score, GV, gender, in-ICU treatment and nutrition was available for 958 subjects. Predictors remaining in the final logistic regression model for mortality were significantly different in DM/Non-DM groups. Glycemic variability was associated with an increase in mortality in both DM(odds ratio 1.05; 95%CI:1.03-1.08,p<0.001) or Non-DM group(odds ratio 1.07; 95%CI:1.03-1.11,p=0.002). For critically ill patients without diabetes, factors associated with glycemic variability included APACHE II score(regression coefficient, 95%CI:0.29,0.22-0.36,p<0.001), Mean BG(0.73,0.46-1.01,p<0.001), total parenteral nutrition(2.87,1.57-4.17,p<0.001), serum albumin(-0.18,-0.271 to -0.082,p<0.001), insulin treatment(2.18,0.81-3.55,p=0.002) and duration of ventilation(0.006,0.002-1.010,p=0.003).However, for diabetes patients, APACHE II score(0.203,0.096-0.310,p<0.001), mean BG(0.503,0.138-0.869,p=0.007) and duration of diabetes(0.167,0.033-0.301,p=0.015) remained as independent risk factors of GV. Conclusion: We found that the relation between dysglycemia and mortality is different in the diabetes and non-diabetes groups. And we confirm that GV was associated with excess mortality in DM or Non-DM patients. Furthermore, APACHE II score, Mean BG, total parenteral nutrition, serum albumin, insulin treatment and duration of ventilation were significantly associated with an increase in GV in Non-DM patients. While APACHE II score, mean BG and duration of diabetes (years) remained as independent risk factors of increased GV in DM patients. These findings provide important context for further prospective trials investigating the effect of different clinical factors in critically ill patients with or without diabetes.

Keywords: diabetes, glycemic variability, predictors, severe disease

Procedia PDF Downloads 176
11651 An Infrared Inorganic Scintillating Detector Applied in Radiation Therapy

Authors: Sree Bash Chandra Debnath, Didier Tonneau, Carole Fauquet, Agnes Tallet, Julien Darreon

Abstract:

Purpose: Inorganic scintillating dosimetry is the most recent promising technique to solve several dosimetric issues and provide quality assurance in radiation therapy. Despite several advantages, the major issue of using scintillating detectors is the Cerenkov effect, typically induced in the visible emission range. In this context, the purpose of this research work is to evaluate the performance of a novel infrared inorganic scintillator detector (IR-ISD) in the radiation therapy treatment to ensure Cerenkov free signal and the best matches between the delivered and prescribed doses during treatment. Methods: A simple and small-scale infrared inorganic scintillating detector of 100 µm diameter with a sensitive scintillating volume of 2x10-6 mm3 was developed. A prototype of the dose verification system has been introduced based on PTIR1470/F (provided by Phosphor Technology®) material used in the proposed novel IR-ISD. The detector was tested on an Elekta LINAC system tuned at 6 MV/15MV and a brachytherapy source (Ir-192) used in the patient treatment protocol. The associated dose rate was measured in count rate (photons/s) using a highly sensitive photon counter (sensitivity ~20ph/s). Overall measurements were performed in IBATM water tank phantoms by following international Technical Reports series recommendations (TRS 381) for radiotherapy and TG43U1 recommendations for brachytherapy. The performance of the detector was tested through several dosimetric parameters such as PDD, beam profiling, Cerenkov measurement, dose linearity, dose rate linearity repeatability, and scintillator stability. Finally, a comparative study is also shown using a reference microdiamond dosimeter, Monte-Carlo (MC) simulation, and data from recent literature. Results: This study is highlighting the complete removal of the Cerenkov effect especially for small field radiation beam characterization. The detector provides an entire linear response with the dose in the 4cGy to 800 cGy range, independently of the field size selected from 5 x 5 cm² down to 0.5 x 0.5 cm². A perfect repeatability (0.2 % variation from average) with day-to-day reproducibility (0.3% variation) was observed. Measurements demonstrated that ISD has superlinear behavior with dose rate (R2=1) varying from 50 cGy/s to 1000 cGy/s. PDD profiles obtained in water present identical behavior with a build-up maximum depth dose at 15 mm for different small fields irradiation. A low dimension of 0.5 x 0.5 cm² field profiles have been characterized, and the field cross profile presents a Gaussian-like shape. The standard deviation (1σ) of the scintillating signal remains within 0.02% while having a very low convolution effect, thanks to lower sensitive volume. Finally, during brachytherapy, a comparison with MC simulations shows that considering energy dependency, measurement agrees within 0.8% till 0.2 cm source to detector distance. Conclusion: The proposed scintillating detector in this study shows no- Cerenkov radiation and efficient performance for several radiation therapy measurement parameters. Therefore, it is anticipated that the IR-ISD system can be promoted to validate with direct clinical investigations, such as appropriate dose verification and quality control in the Treatment Planning System (TPS).

Keywords: IR-Scintillating detector, dose measurement, micro-scintillators, Cerenkov effect

Procedia PDF Downloads 169
11650 Capability Prediction of Machining Processes Based on Uncertainty Analysis

Authors: Hamed Afrasiab, Saeed Khodaygan

Abstract:

Prediction of machining process capability in the design stage plays a key role to reach the precision design and manufacturing of mechanical products. Inaccuracies in machining process lead to errors in position and orientation of machined features on the part, and strongly affect the process capability in the final quality of the product. In this paper, an efficient systematic approach is given to investigate the machining errors to predict the manufacturing errors of the parts and capability prediction of corresponding machining processes. A mathematical formulation of fixture locators modeling is presented to establish the relationship between the part errors and the related sources. Based on this method, the final machining errors of the part can be accurately estimated by relating them to the combined dimensional and geometric tolerances of the workpiece – fixture system. This method is developed for uncertainty analysis based on the Worst Case and statistical approaches. The application of the presented method is illustrated through presenting an example and the computational results are compared with the Monte Carlo simulation results.

Keywords: process capability, machining error, dimensional and geometrical tolerances, uncertainty analysis

Procedia PDF Downloads 297
11649 Efficacy and Safety of Sublingual Sufentanil for the Management of Acute Pain

Authors: Neil Singla, Derek Muse, Karen DiDonato, Pamela Palmer

Abstract:

Introduction: Pain is the most common reason people visit emergency rooms. Studies indicate however, that Emergency Department (ED) physicians often do not provide adequate analgesia to their patients as a result of gender and age bias, opiophobia and insufficient knowledge of and formal training in acute pain management. Novel classes of analgesics have recently been introduced, but many patients suffer from acute pain in settings where the availability of intravenous (IV) access may be limited, so there remains a clinical need for rapid-acting, potent analgesics that do not require an invasive route of delivery. A sublingual sufentanil tablet (SST), dispensed using a single-dose applicator, is in development for treatment of moderate-to-severe acute pain in a medically-supervised setting. Objective: The primary objective of this study was to demonstrate the repeat-dose efficacy, safety and tolerability of sufentanil 20 mcg and 30 mcg sublingual tablets compared to placebo for the management of acute pain as determined by the time-weighted sum of pain intensity differences (SPID) to baseline over the 12-hour study period (SPID12). Key secondary efficacy variables included SPID over the first hour (SPID1), Total pain relief over the 12-hour study period (TOTPAR12), time to perceived pain relief (PR) and time to meaningful PR. Safety variables consisted of adverse events (AE), vital signs, oxygen saturation and early termination. Methods: In this Phase 2, double-blind, dose-finding study, an equal number of male and female patients were randomly assigned in a 2:2:1 ratio to SST 20 mcg, SS 30 mcg or placebo, respectively, following bunionectomy. Study drug was dosed as needed, but not more frequently than hourly. Rescue medication was available as needed. The primary endpoint was the Summed Pain Intensity Difference to baseline over 12h (SPIDI2). Safety was assessed by continuous oxygen saturation monitoring and adverse event reporting. Results: 101 patients (51 Male/50 Female) were randomized, 100 received study treatment (intent-to-treat [ITT] population), and 91 completed the study. Reasons for early discontinuation were lack of efficacy (6), adverse events (2) and drug-dosing error (1). Mean age was 42.5 years. For the ITT population, SST 30 mcg was superior to placebo (p=0.003) for the SPID12. SPID12 scores in the active groups were superior for both male (ANOVA overall p-value =0.038) and female (ANOVA overall p-value=0.005) patients. Statistically significant differences in favour of sublingual sufentanil were also observed between the SST 30mcg and placebo group for SPID1(p<0.001), TOTPAR12(p=0.002), time to perceived PR (p=0.023) and time to meaningful PR (p=0.010). Nausea, vomiting and somnolence were more frequent in the sufentanil groups but there were no significant differences between treatment arms for the proportion of patients who prematurely terminated due to AE or inadequate analgesia. Conclusions: Sufentanil tablets dispensed sublingually using a single-dose applicator is in development for treatment of patients with moderate-to-severe acute pain in a medically-supervised setting where immediate IV access is limited. When administered sublingually, sufentanil’s pharmacokinetic profile and non-invasive delivery makes it a useful alternative to IM or IV dosing.

Keywords: acute pain, pain management, sublingual, sufentanil

Procedia PDF Downloads 346
11648 Trends in Use of Millings in Pavement Maintenance

Authors: Rafiqul Tarefder, Mohiuddin Ahmad, Mohammad Hossain

Abstract:

While milling materials from old pavement surface can be an important component of cost effective maintenance operation, their use in maintenance projects are not uniform and well documented. This study documents the different maintenance practices followed by four transportation districts of New Mexico Department of Transportation (NMDOT) in an attempt to find whether millings are being used in maintenance projects by those districts. Based on existing literature, a questionnaire was developed related to six common maintenance practices. NMDOT district personal were interviewed face to face to discuss and get answers to that questionnaire. It revealed that NMDOT districts mainly use chip seal and patching. Other maintenance procedures such as sand seal, scrub seal, slurry seal, and thin overlay have limited use. Two out of four participating districts do not have any documents on chip sealing; rather they employ the experiences of the chip seal crew. All districts use polymer modified high float emulsion (HFE100P) for chip seal with an application rate ranging from 0.4 to 0.56 gallons per square yard. Chip application rate varies from 15 to 40 lb/ square yard. State wide, the thickness of chip seal varies from 3/8" to 1" and life varies from 3 to 10 years. NMDOT districts mainly use three type of patching: pothole, dig-out and blade patch. Pothole patches are used for small potholes and during emergency, dig-out patches are used for all type of potholes sometimes after pothole patching, and blade patch is used when a significant portion of the pavement is damaged. Pothole patches last as low as three days whereas, blade patch lasts as long as 3 years. It was observed that all participating districts use millings in maintenance projects.

Keywords: chip seal, sand seal, scrub seal, slurry seal, overlay, patching, millings

Procedia PDF Downloads 329
11647 Pregnancy Rate and Outcomes after Uterine Fibroid Embolization Single Centre Experience in the Middle East from the United Arab Emirates at Alain Hospital

Authors: Jamal Alkoteesh, Mohammed Zeki, Mouza Alnaqbi

Abstract:

Objective: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. Design: Retrospective study. In this study, most women opted for UFE as a fertility treatment after failure of myomectomy or in vitro fertilization, or because hysterectomy was the only suggested option. Background. Myomectomy is the standard approach in patients with fibroids desiring a future pregnancy. However, myomectomy may be difficult in cases of numerous interstitial and/or submucous fibroids.In these cases, UFE has the advantage of embolizing all fibroids in one procedure. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids. Study Methods: A retrospective study of 210 patients treated with UFE for symptomatic uterine fibroids between 2011-2016 was performed. UFE was performed using ((PVA; Embozen, Beadblock) (500-900 µm in diameter). Pregnancies were identified using screening questionnaires and the study database. Of the 210 patients who received UFE treatment, 35 women younger than the age of 40 wanted to conceive and had been unable. All women in our study were advised to wait six months or more after UFE before attempting to become pregnant, of which the reported time range before attempting to conceive was seven to 33 months (average 20 months). RESULTS: In a retrospective chart review of patients younger than the age of 40 (35 patients,18 patients reported 23 pregnancies, of which five were miscarriages. Two more pregnancies were complicated by premature labor. Of the 23 pregnancies, 16 were normal full-term pregnancies, 15 women had conceived once, and four had become pregnant twice. The remaining patients did not conceive. In the study, there was no reported intrauterine growth retardation in the prenatal period, fetal distress during labor, or problems related to uterine integrity. Two patients reported minor problems during pregnancy that were borderline oligohydramnios and low-lying placenta. In the cohort of women who did conceive, overall, 16 out of 18 births proceeded normally without any complications (86%). Eight women delivered by cesarean section, and 10 women had normal vaginal delivery. In this study of 210 women, UFE had a fertility rate of 47%. Our group of 23 pregnancies was small, but did confirm successful pregnancy after UFE. The 45.7% pregnancy rate in women below the age of 40 years old who completed a term pregnancy compares favorably with women who underwent myomectomy via other method. Of the women in the cohort who did conceive, subsequent birth proceeded normally (86%). Conclusion: Pregnancy after UFE is well-documented. The risks of infertility following embolization, premature menopause, and hysterectomy are small, as is the radiation exposure during embolization. Fertility rates appear similar to patients undergoing myomectomy.UFE should not be contraindicated in patients who want to conceive and they should be able to choose between surgical options and UFE.

Keywords: fibroid, pregnancy, therapeutic embolization, uterine artery

Procedia PDF Downloads 218
11646 Numerical Assessment of Fire Characteristics with Bodies Engulfed in Hydrocarbon Pool Fire

Authors: Siva Kumar Bathina, Sudheer Siddapureddy

Abstract:

Fires accident becomes even worse when the hazardous equipment like reactors or radioactive waste packages are engulfed in fire. In this work, large-eddy numerical fire simulations are performed using fire dynamic simulator to predict the thermal behavior of such bodies engulfed in hydrocarbon pool fires. A radiatively dominated 0.3 m circular burner with n-heptane as the fuel is considered in this work. The fire numerical simulation results without anybody inside the fire are validated with the reported experimental data. The comparison is in good agreement for different flame properties like predicted mass burning rate, flame height, time-averaged center-line temperature, time-averaged center-line velocity, puffing frequency, the irradiance at the surroundings, and the radiative heat feedback to the pool surface. Cask of different sizes is simulated with SS304L material. The results are independent of the material of the cask simulated as the adiabatic surface temperature concept is employed in this study. It is observed that the mass burning rate increases with the blockage ratio (3% ≤ B ≤ 32%). However, the change in this increment is reduced at higher blockage ratios (B > 14%). This is because the radiative heat feedback to the fuel surface is not only from the flame but also from the cask volume. As B increases, the volume of the cask increases and thereby increases the radiative contribution to the fuel surface. The radiative heat feedback in the case of the cask engulfed in the fire is increased by 2.5% to 31% compared to the fire without cask.

Keywords: adiabatic surface temperature, fire accidents, fire dynamic simulator, radiative heat feedback

Procedia PDF Downloads 114
11645 Techno Commercial Aspects of Using LPG as an Alternative Energy Solution for Transport and Industrial Sector in Bangladesh: Case Studies in Industrial Sector

Authors: Mahadehe Hassan

Abstract:

Transport system and industries which are the main basis of industrial and socio-economic development of any country. It is mainly dependent on fossil fuels. Bangladesh has fossil fuel reserves of 9.51 TCF as of July 2023, and if no new gas fields are discovered in the next 7-9 years and if the existing gas consumption rate continues, the fossil fuel reserves will be exhausted. The demand for petroleum products in Bangladesh is increasing steadily, with 63% imported by BPC and 37% imported by private companies. 61.61% of BPC imported products are used in the transport sector and 5.49% in the industrial sector, which is expensive and harmful to the environment. Liquefied Petroleum Gas (LPG) should be considered as an alternative energy for Bangladesh based on Sustainable Development Goals (SDGs) criteria for sustainable, clean and affordable energy. This will not only lead to the much desired mitigation of energy famine in the country but also contribute favorably to the macroeconomic indicators. Considering the environmental and economic issues, the government has referred to CNG (compressed natural gas) as the fuel carrier since 2000, but currently due to the decline mode of gas reserves, the government of Bangladesh is thinking of new energy sources for transport and industrial sectors which will be sustainable, environmentally friendly and economically viable. Liquefied Petroleum Gas (LPG) is the best choice for fueling transport and industrial sectors in Bangladesh. At present, a total of 1.54 million metric tons of liquefied petroleum gas (LPG) is marketed in Bangladesh by the public and private sectors. 83% of it is used by households, 12% by industry and commerce and 5% by transportation. Industrial and transport sector consumption is negligible compared to household consumption. So the purpose of the research is to find out the challenges of LPG market development in transport and industrial sectors in Bangladesh and make recommendations to reduce the challenges. Secure supply chain, inadequate infrastructure, insufficient investment, lack of government monitoring and consumer awareness in the transport sector and industrial sector are major challenges for LPG market development in Bangladesh. Bangladesh government as well as private owners should come forward in the development of liquefied petroleum gas (LPG) industry to reduce the challenges of secure energy sector for sustainable development. Furthermore, ensuring adequate Liquefied Petroleum Gas (LPG) supply in Bangladesh requires government regulations, infrastructure improvements in port areas, awareness raising and most importantly proper pricing of Liquefied Petroleum Gas (LPG) to address the energy crisis in Bangladesh.

Keywords: transportand industries fuel, LPG consumption, challenges, economical sustainability

Procedia PDF Downloads 70
11644 Association of Antibiotics Resistance with Efflux Pumps Genes among Multidrug-Resistant Klebsiella pneumonia Recovered from Hospital Waste Water Effluents in Eastern Cape, South Africa

Authors: Okafor Joan, Nwodo Uchechukwu

Abstract:

Klebsiella pneumoniae (K. pneumoniae) is a significant pathogen responsible for opportunistic and nosocomial infection. One of the most significant antibiotic resistance mechanisms in K. pneumoniae isolates is efflux pumps. Our current study identified efflux genes (AcrAB, OqxAB, MacAB, and TolC) and regulatory genes (RamR and RarA) in multidrug-resistant (MDR) K. pneumoniae isolated from hospital effluents and investigated their relationship with antibiotic resistance. The sum of 145 K. pneumoniae isolates was established by PCR and screened for antibiotic susceptibility. PCR detected efflux pump genes, and their link with antibiotic resistance was statistically examined. However, 120 (83%) of the confirmed isolated were multidrug-resistant, with the largest percentage of resistance to ampicillin (88.3%) and the weakest rate of resistance to imipenem (5.5%). Resistance to the other antibiotics ranged from 11% to 76.6%. Molecular distribution tests show that AcrA, AcrB, MacA, oqxB oqxA, TolC, MacB were detected in 96.7%, 85%, 76.7%, 70.8%, 55.8%, 39.1%, and 29.1% respectively. However, 14.3% of the isolates harboured all seven genes screened. Efflux pump system AcrAB (83.2%) was the most commonly detected in K. pneumonia isolated across all the antibiotics class-tested. In addition, the frequencies of RamR and RarA were 46.2% and 31.4%, respectively. AcrAB and OqxAB efflux pump genes were significantly associated with fluoroquinolone, beta-lactam, carbapenem, and tetracycline resistance (p<0.05). The high rate of efflux genes in this study demonstrated that this resistance mechanism is the dominant way in K. pneumoniae isolates. Appropriate treatment must be used to reduce and tackle the burden of resistant Klebsiella pneumonia in hospital wastewater effluents.

Keywords: Klebsiella pneumonia, efflux pumps, regulatory genes, multidrug-resistant, hospital, PCR

Procedia PDF Downloads 69
11643 Harmonic Assessment and Mitigation in Medical Diagonesis Equipment

Authors: S. S. Adamu, H. S. Muhammad, D. S. Shuaibu

Abstract:

Poor power quality in electrical power systems can lead to medical equipment at healthcare centres to malfunction and present wrong medical diagnosis. Equipment such as X-rays, computerized axial tomography, etc. can pollute the system due to their high level of harmonics production, which may cause a number of undesirable effects like heating, equipment damages and electromagnetic interferences. The conventional approach of mitigation uses passive inductor/capacitor (LC) filters, which has some drawbacks such as, large sizes, resonance problems and fixed compensation behaviours. The current trends of solutions generally employ active power filters using suitable control algorithms. This work focuses on assessing the level of Total Harmonic Distortion (THD) on medical facilities and various ways of mitigation, using radiology unit of an existing hospital as a case study. The measurement of the harmonics is conducted with a power quality analyzer at the point of common coupling (PCC). The levels of measured THD are found to be higher than the IEEE 519-1992 standard limits. The system is then modelled as a harmonic current source using MATLAB/SIMULINK. To mitigate the unwanted harmonic currents a shunt active filter is developed using synchronous detection algorithm to extract the fundamental component of the source currents. Fuzzy logic controller is then developed to control the filter. The THD without the active power filter are validated using the measured values. The THD with the developed filter show that the harmonics are now within the recommended limits.

Keywords: power quality, total harmonics distortion, shunt active filters, fuzzy logic

Procedia PDF Downloads 466
11642 Cognitive Impairment in Chronic Renal Patients on Hemodialysis

Authors: Fabiana Souza Orlandi, Juliana Gomes Duarte, Gabriela Dutra Gesualdo

Abstract:

Chronic renal disease (CKD), accompanied by hemodialysis, causes chronic renal failure in a number of situations that compromises not only physical, personal and environmental aspects, but also psychological, social and family aspects. Objective: To verify the level of cognitive impairment of chronic renal patients on hemodialysis. Methodology: This is a descriptive, cross-sectional study. The present study was performed in a Dialysis Center of a city in the interior of the State of São Paulo. The inclusion criteria were: being 18 years or older; have a medical diagnosis of CKD; being in hemodialysis treatment in this unit; and agree to participate in the research, with the signature of the Informed Consent (TCLE). A total of 115 participants were evaluated through the Participant Characterization Instrument and the Addenbrooke Cognitive Exam - Revised Version (ACE-R), being scored from 0 to 100, stipulating the cut-off note for the complete battery <78 and subdivided into five domains: attention and guidance; memory; fluency; language; (66.9%) and caucasian (54.7%), 53.7 (±14.8) years old. Most of the participants were retired (74.7%), with incomplete elementary schooling (36.5%) and the average time of treatment was 46 months. Most of the participants (61.3%) presented impairment in the area of attention and orientation, 80.4% in the spatial visual domain. Regarding the total ACE-R score, 75.7% of the participants presented scores below the established cut grade. Conclusion: There was a high percentage (75.7%) below the cut-off score established for ACE-R, suggesting that there may be some cognitive impairment among these participants, since the instrument only performs a screening on cognitive health. The results of the study are extremely important so that possible interventions can be traced in order to minimize impairment, thus improving the quality of life of chronic renal patients.

Keywords: cognition, chronic renal insufficiency, adult health, dialysis

Procedia PDF Downloads 348
11641 Numerical Investigation of Phase Change Materials (PCM) Solidification in a Finned Rectangular Heat Exchanger

Authors: Mounir Baccar, Imen Jmal

Abstract:

Because of the rise in energy costs, thermal storage systems designed for the heating and cooling of buildings are becoming increasingly important. Energy storage can not only reduce the time or rate mismatch between energy supply and demand but also plays an important role in energy conservation. One of the most preferable storage techniques is the Latent Heat Thermal Energy Storage (LHTES) by Phase Change Materials (PCM) due to its important energy storage density and isothermal storage process. This paper presents a numerical study of the solidification of a PCM (paraffin RT27) in a rectangular thermal storage exchanger for air conditioning systems taking into account the presence of natural convection. Resolution of continuity, momentum and thermal energy equations are treated by the finite volume method. The main objective of this numerical approach is to study the effect of natural convection on the PCM solidification time and the impact of fins number on heat transfer enhancement. It also aims at investigating the temporal evolution of PCM solidification, as well as the longitudinal profiles of the HTF circling in the duct. The present research undertakes the study of two cases: the first one treats the solidification of PCM in a PCM-air heat exchanger without fins, while the second focuses on the solidification of PCM in a heat exchanger of the same type with the addition of fins (3 fins, 5 fins, and 9 fins). Without fins, the stratification of the PCM from colder to hotter during the heat transfer process has been noted. This behavior prevents the formation of thermo-convective cells in PCM area and then makes transferring almost conductive. In the presence of fins, energy extraction from PCM to airflow occurs at a faster rate, which contributes to the reduction of the discharging time and the increase of the outlet air temperature (HTF). However, for a great number of fins (9 fins), the enhancement of the solidification process is not significant because of the effect of confinement of PCM liquid spaces for the development of thermo-convective flow. Hence, it can be concluded that the effect of natural convection is not very significant for a high number of fins. In the optimum case, using 3 fins, the increasing temperature of the HTF exceeds approximately 10°C during the first 30 minutes. When solidification progresses from the surfaces of the PCM-container and propagates to the central liquid phase, an insulating layer will be created in the vicinity of the container surfaces and the fins, causing a low heat exchange rate between PCM and air. As the solid PCM layer gets thicker, a progressive regression of the field of movements is induced in the liquid phase, thus leading to the inhibition of heat extraction process. After about 2 hours, 68% of the PCM became solid, and heat transfer was almost dominated by conduction mechanism.

Keywords: heat transfer enhancement, front solidification, PCM, natural convection

Procedia PDF Downloads 173
11640 Review of Hydrologic Applications of Conceptual Models for Precipitation-Runoff Process

Authors: Oluwatosin Olofintoye, Josiah Adeyemo, Gbemileke Shomade

Abstract:

The relationship between rainfall and runoff is an important issue in surface water hydrology therefore the understanding and development of accurate rainfall-runoff models and their applications in water resources planning, management and operation are of paramount importance in hydrological studies. This paper reviews some of the previous works on the rainfall-runoff process modeling. The hydrologic applications of conceptual models and artificial neural networks (ANNs) for the precipitation-runoff process modeling were studied. Gradient training methods such as error back-propagation (BP) and evolutionary algorithms (EAs) are discussed in relation to the training of artificial neural networks and it is shown that application of EAs to artificial neural networks training could be an alternative to other training methods. Therefore, further research interest to exploit the abundant expert knowledge in the area of artificial intelligence for the solution of hydrologic and water resources planning and management problems is needed.

Keywords: artificial intelligence, artificial neural networks, evolutionary algorithms, gradient training method, rainfall-runoff model

Procedia PDF Downloads 432
11639 3-D Numerical Simulation of Scraped Surface Heat Exchanger with Helical Screw

Authors: Rabeb Triki, Hassene Djemel, Mounir Baccar

Abstract:

Surface scraping is a passive heat transfer enhancement technique that is directly used in scraped surface heat exchanger (SSHE). The scraping action prevents the accumulation of the product on the inner wall, which intensifies the heat transfer and avoids the formation of dead zones. SSHEs are widely used in industry for several applications such as crystallization, sterilization, freezing, gelatinization, and many other continuous processes. They are designed to deal with products that are viscous, sticky or that contain particulate matter. This research work presents a three-dimensional numerical simulation of the coupled thermal and hydrodynamic behavior within a SSHE which includes Archimedes’ screw instead of scraper blades. The finite volume Fluent 15.0 was used to solve continuity, momentum and energy equations using multiple reference frame formulation. The process fluid investigated under this study is the pure glycerin. Different geometrical parameters were studied in the case of steady, non-isothermal, laminar flow. In particular, attention is focused on the effect of the conicity of the rotor and the pitch of Archimedes’ screw on temperature and velocity distribution and heat transfer rate. Numerical investigations show that the increase of the number of turns in the screw from five to seven turns leads to amelioration of heat transfer coefficient, and the increase of the conicity of the rotor from 0.1 to 0.15 leads to an increase in the rate of heat transfer. Further studies should investigate the effect of different operating parameters (axial and rotational Reynolds number) on the hydrodynamic and thermal behavior of the SSHE.

Keywords: ANSYS-Fluent, hydrodynamic behavior, scraped surface heat exchange, thermal behavior

Procedia PDF Downloads 148
11638 The Association between Gene Polymorphisms of GPX, SEPP1, and SEP15, Plasma Selenium Levels, Urinary Total Arsenic Concentrations, and Prostate Cancer

Authors: Yu-Mei Hsueh, Wei-Jen Chen, Yung-Kai Huang, Cheng-Shiuan Tsai, Kuo-Cheng Yeh

Abstract:

Prostate cancer occurs in men over the age of 50, and rank sixth of the top ten cancers in Taiwan, and the incidence increased gradually over the past decade in Taiwan. Arsenic is confirmed as a carcinogen by International Agency for Research on (IARC). Arsenic induces oxidative stress may be a risk factor for prostate cancer, but the mechanism is not clear. Selenium is an important antioxidant element. Whether the association between plasma selenium levels and risk of prostate cancer are modified by different genotype of selenoprotein is still unknown. Glutathione peroxidase, selenoprotein P (SEPP1) and 15 kDa selenoprotein (SEP 15) are selenoprotein and regulates selenium transport and the oxidation and reduction reaction. However, the association between gene polymorphisms of selenoprotein and prostate cancer is not yet clear. The aim of this study is to determine the relationship between plasma selenium, polymorphism of selenoprotein, urinary total arsenic concentration and prostate cancer. This study is a hospital-based case-control study. Three hundred twenty-two cases of prostate cancer and age (±5 years) 1:1 matched 322 control group were recruited from National Taiwan University Hospital, Taipei Medical University Hospital, and Wan Fang Hospital. Well-trained personnel carried out standardized personal interviews based on a structured questionnaire. Information collected included demographic and socioeconomic characteristics, lifestyle and disease history. Blood and urine samples were also collected at the same time. The Research Ethics Committee of National Taiwan University Hospital, Taipei, Taiwan, approved the study. All patients provided informed consent forms before sample and data collection. Buffy coat was to extract DNA, and the polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) was used to measure the genotypes of SEPP1 rs3797310, SEP15 rs5859, GPX1 rs1050450, GPX2 rs4902346, GPX3 rs4958872, and GPX4 rs2075710. Plasma concentrations of selenium were determined by inductively coupled plasma mass spectrometry (ICP-MS).Urinary arsenic species concentrations were measured by high-performance liquid chromatography links hydride generator and atomic absorption spectrometer (HPLC-HG-AAS). Subject with high education level compared to those with low educational level had a lower prostate cancer odds ratio (OR) Mainland Chinese and aboriginal people had a lower OR of prostate cancer compared to Fukien Taiwanese. After adjustment for age, educational level, subjects with GPX1 rs1050450 CT and TT genotype compared to the CC genotype have lower, OR of prostate cancer, the OR and 95% confidence interval (Cl) was 0.53 (0.31-0.90). SEPP1 rs3797310 CT+TT genotype compared to those with CC genotype had a marginally significantly lower OR of PC. The low levels of plasma selenium and the high urinary total arsenic concentrations had the high OR of prostate cancer in a significant dose-response manner, and SEPP1 rs3797310 genotype modified this joint association.

Keywords: prostate cancer, plasma selenium concentration, urinary total arsenic concentrations, glutathione peroxidase, selenoprotein P, selenoprotein 15, gene polymorphism

Procedia PDF Downloads 255
11637 A Pilot Study on Integration of Simulation in the Nursing Educational Program: Hybrid Simulation

Authors: Vesile Unver, Tulay Basak, Hatice Ayhan, Ilknur Cinar, Emine Iyigun, Nuran Tosun

Abstract:

The aim of this study is to analyze the effects of the hybrid simulation. In this simulation, types standardized patients and task trainers are employed simultaneously. For instance, in order to teach the IV activities standardized patients and IV arm models are used. The study was designed as a quasi-experimental research. Before the implementation an ethical permission was taken from the local ethical commission and administrative permission was granted from the nursing school. The universe of the study included second-grade nursing students (n=77). The participants were selected through simple random sample technique and total of 39 nursing students were included. The views of the participants were collected through a feedback form with 12 items. The form was developed by the authors and “Patient intervention self-confidence/competence scale”. Participants reported advantages of the hybrid simulation practice. Such advantages include the following: developing connections between the simulated scenario and real life situations in clinical conditions; recognition of the need for learning more about clinical practice. They all stated that the implementation was very useful for them. They also added three major gains; improvement of critical thinking skills (94.7%) and the skill of making decisions (97.3%); and feeling as if a nurse (92.1%). In regard to the mean scores of the participants in the patient intervention self-confidence/competence scale, it was found that the total mean score for the scale was 75.23±7.76. The findings obtained in the study suggest that the hybrid simulation has positive effects on the integration of theoretical and practical activities before clinical activities for the nursing students.

Keywords: hybrid simulation, clinical practice, nursing education, nursing students

Procedia PDF Downloads 269
11636 First Documented Anesthesia with Use of Low Doses of Tiletamine-Zolazepam Combination in Ovoviparous Amazon Tree Boa Undergoing Emergency Coeliotomy-Case Report

Authors: Krzysztof Buczak, Sonia Lachowska, Pawel Kucharski, Agnieszka Antonczyk

Abstract:

Tiletamine - zolazepam combination is increasingly used in veterinary anaesthesiology in wild animals, including snakes. The available literature shows a lack of information about anesthesia in this mixture in ovoviviparous snakes. The studies show the possibility of using the combination at a dose of 20 mg/kg or more for snake immobilization. This paper presents an anesthetic protocol with the use of a combination of tiletamine - zolazepam at the dose of 10 mg/kg intramuscularly and maintenance with inhalant anesthesia with isoflurane in pure oxygen. The objective of this study was to evaluate the usefulness of the anesthetic protocol to proceed with coeliotomy in Amazon Tree Boa. The patient was a five years old bicolor female Amazon Tree Boa (Corallus hortulanus) with dystocia. The clinical examination reveals significant emaciation (bodyweight 520g), high degree of dehydration, heart rate (HR = 60 / min), pale mucous membranes and poor reactivity. Meloxicam (1 mg/kg) and tramadol (10 mg/kg) were administered subcutaneously and the patient was placed in an incubator with access to fresh oxygen. Four hours later, the combination of tiletamine - zolazepam (10 mg/kg) was administered intramuscularly for induction of anesthesia. The snake was intubated and connected to inhalant anesthesia equipment. For maintenance, the anesthesia isoflurane in pure oxygen was used due to apnea, which occurs 30 minutes after the induction semi-closed system was attached and the ventilator was turned on (PCV system, four breaths per minute, 8 cm of H2O). Cardiopulmonary parameters (HR, RR, SPO2, ETCO2, ETISO) were assessed throughout the procedure. During the entire procedure, the operating room was heated to a temperature of 26 degrees Celsius. Additionally, the hose was placed on a heating mat, which maintained a temperature of 30 degrees Celsius. For 15 minutes after induction, the loss of muscle tone was observed from the head to the tail. Induction of general anesthesia was scored as good because of the possibility of intubation. During the whole procedure, the heart rate was at the rate of 58 beats per minute (bpm). Ventilation parameters were stable throughout the procedure. The recovery period lasts for about 4 hours after the end of general anesthesia. The muscle tension returned from tail to head. The snake started to breathe spontaneously within 1,5 hours after the end of general anesthesia. The protocol of general anesthesia with the combination of tiletamine- zolazepam with a dose of 10 mg/kg is useful for proceeding with the emergency coeliotomy in maintenance with isoflurane in oxygen. Further study about the impact of the combination of tiletamine- zolazepam for the recovery period is needed.

Keywords: anesthesia, corallus hortulanus, ovoviparous, snake, tiletamine, zolazepam

Procedia PDF Downloads 225
11635 The Knowledge-Behavior Gap in the Online Information Seeking Process

Authors: Yen-Mei Lee

Abstract:

The concept of a knowledge-behavior gap has been discussed for several years. It is addressed that an individual’s knowledge does not sufficiently transfer to his or her actual actions. This concept is mostly focused on fields related to medicine or applied to health care issues to explain how people or patients connect their personal knowledge to actual health care behaviors. To our knowledge, seldomly has this research been applied to discuss people’s online information seeking behavior. In the current study, the main purpose is to investigate the relationship between web users’ personal values and their actual performances when seeking information on the Internet. The total number of twenty-eight participants, divided into one experienced group (n=14) and one novice group (n=14), were recruited and asked to complete a self-report questionnaire of fifty items related to information seeking actions and behaviors. During the execution, participants needed to rate the importance level (how important each item is) and the performance level (how often they actually do each item) from 1 to 10 points on each item. In this paper, the mean scores of the importance and the performance level are analyzed and discussed. The results show that there is a gap between web user’s knowledge and their actual online seeking behaviors. Both experienced group and novice group have higher average scores of the importance level (experienced group = 7.57, novice group = 6.01) than the actual performance level (experienced group = 6.89, novice group = 5.00) in terms of the fifty online information seeking actions. On the other hand, the experienced group perceives more importance of the fifty online seeking actions and performs actual behaviors better than the novice group. Moreover, experienced participants express a consistent result between their concept knowledge and actual behaviors. For instance, they feel extending a seeking strategy is important and frequently perform this action when seeking online. However, novice participants do not have a consistency between their knowledge and behaviors. For example, though they perceive browsing and judging information are less important than they get lost in the online information seeking process. However, in the actual behavior rating, the scores show that novices do browsing and judge information more often than they get lost when seeking information online. These results, therefore, help scholars and educators have a better understanding of the difference between experienced and novice web users regarding their concept knowledge and actual behaviors. In future study, figuring out how to narrow down the knowledge-behavior gap and create practical guidance for novice users to increase their online seeking efficiency is crucial. Not only could it help experienced users be aware of their actual information seeking behaviors, but also help the novice become mastery to concisely obtain information on the Internet.

Keywords: experienced web user, information seeking behavior, knowledge-behavior gap, novice, online seeking efficiency

Procedia PDF Downloads 110
11634 A Comparison of Caesarean Section Indications and Characteristics in 2009 and 2020 in a Saudi Tertiary Hospital

Authors: Sarah K. Basudan, Ragad I. Al Jazzar, Zeinah Sulaihim, Hanan M. Al-Kadri

Abstract:

Background: Cesarean section has been increasing in recent years, with a wide range of etiologies contributing to this rise. This study aimed to assess the indications, outcomes, and complications in Riyadh, Saudi Arabia. Methods: A Retrospective Cohort study was conducted at King Abdulaziz medical city. The study includes two cohorts: G1 (2009) and G2 (2020) groups who met the inclusion criteria. The data was transferred to the SPSS (statistical package for social sciences) version 24 for analysis. The initial descriptive statistics were run for all variables, including numerical and categorical data. The numerical data were reported as median, and standard deviation and categorical data were reported as frequencies and percentages. Results: The data were collected from 399 women who were divided into two groups, G1(199) and G2(200). The mean age of all participants is 32+-6​; G1 and G2 had significant differences in age means with 30+-6 and 34+-5, respectively, with a p-value of <0.001, which indicates delayed fertility by four years. Moreover, a breech presentation was less likely to occur in G2 (OR 0.64, CI: 0.21-0.62. P<0.001). Nonetheless, maternal causes such as repeated C-sections and maternal medical conditions were more likely to happen in G2 (OR 1.5, CI: 1.04-2.38, p=0.03) and (OR 5.4, CI: 1.12-23.9, P=0.01), respectively. Furthermore, postpartum hemorrhage showed an increase of 12% in G2 (OR 5.4, CI: 2.2-13.4, p<0.001). G2 was more likely to be admitted to the neonatal intensive care unit (NICU) (OR 16, CI: 7.4-38.7) and to special care baby (SCB) (OR 7.2, CI: 3.9-13.1), both with a p-value<0.001 compared to regular nursery admission. Conclusion: There are multiple factors that are contributing to the increase in c section rate in a Saudi tertiary hospitals. The factors were suggested to be previous c-sections, abnormal fetal heart rate, malpresentation, and maternal or fetal medical conditions.

Keywords: cesarean sections, maternal indications, maternal complications, neonatal condition

Procedia PDF Downloads 65
11633 Survival Pattern of Under-five Mortality in High Focus States in India

Authors: Rahul Kumar

Abstract:

Background: Under-FiveMortality Rate(U5MR)ofanationiswidelyacceptedandlong-standing indicators of well-beingofherchildren.They measuredtheprobability of dying before theageoffive(expressedper1000livebirths).TheU5MRisanappropriate indicator of the cumulative exposure totheriskofdeathduringthefirstfiveyearsoflife, and accepted globalindicator ofthehealthandsocioeconomicstatusofagiven population.Itisalsousefulforassessing theimpactofvariousintervention programmes aimed at improving child survival.Under-fivemortalitytrendsconstitutealeadingindicatorofthelevel ofchildhealthandoveralldevelopmentincountries. Objectives: The first aim of our research is to study the level, trends, and Pattern of Under-five mortality using different sources of data. The second objective is to examine the survival pattern of Under-five mortality by different background characteristics. Data Source and Methodology: SRS and NFHS data have been used forobservingthelevelandtrendofUnder-Five mortality rate. Kaplan Meier Estimate has been used to understand the survival Pattern of Under-five mortality. Result: WefindthatallmostallthestatesmadesomeprogressbyreducingU5MRin recent decades.During1992-93highestU5MR(per thousand live birth) was observed in Assam(142)followed by up(141),Odisha(131),MP(130),andBihar(127.5).While the least U5MR(perthousandlive birth)wasobservedinRajasthan(102). The highestU5MR(per thousandlive birth)isobservedinUP(78.1), followed by MP(64.9)and Chhattisgarh(63.7)which are far away from the national level(50). Among them, Uttarakhand(46.7)hadleastU5MR(perthousandlivebirth), followed by Odisha(48.6). TheU5MR(perthousandlivebirth)ofcombinedhighfocusstateis63.7whichisfar away fromthenationallevel(50). Weidentified thatthesurvivalprobability ofunder-fivechildrenfromadolescentmotherislessin comparisontootherchildrenbornby differentagegroupofmothers. thatduringneonatalperiodusually male mortality exceedsthefemale mortality butthisdifferentialreversedinthepostneonatalperiod. Astheirageincreasesand approachingtofiveyears,weidentifiedthatthesurvivalprobability ofbothsexdecreasesbut female’s survival probabilitydecrement is more than male as their ageincreases. The poorer children’s survival probability is minimum. Children using improved toilet facility has more survival probability throughout thefiveyearsthan who uses unimproved. The survival probability of children under five who got Full ANCis more than the survival probability of children under five who doesn’t get any ANC. Conclusions: Improvement of maternal education is an urgent need to improve their health seeking behavior and thus the health of their children. Awareness on reproductive health and environmental sanitation should be strengthened.

Keywords: under-five mortality, survival pattern, ANC, trend

Procedia PDF Downloads 116
11632 Differences in Patient Satisfaction Observed between Female Japanese Breast Cancer Patients Who Receive Breast-Conserving Surgery or Total Mastectomy

Authors: Keiko Yamauchi, Motoyuki Nakao, Yoko Ishihara

Abstract:

The increase in the number of women with breast cancer in Japan has required hospitals to provide a higher quality of medicine so that patients are satisfied with the treatment they receive. However, patients’ satisfaction following breast cancer treatment has not been sufficiently studied. Hence, we investigated the factors influencing patient satisfaction following breast cancer treatment among Japanese women. These women underwent either breast-conserving surgery (BCS) (n = 380) or total mastectomy (TM) (n = 247). In March 2016, we conducted a cross-sectional internet survey of Japanese women with breast cancer in Japan. We assessed the following factors: socioeconomic status, cancer-related information, the role of medical decision-making, the degree of satisfaction regarding the treatments received, and the regret arising from the medical decision-making processes. We performed logistic regression analyses with the following dependent variables: extreme satisfaction with the treatments received, and regret regarding the medical decision-making process. For both types of surgery, the odds ratio (OR) of being extremely satisfied with the cancer treatment was significantly higher among patients who did not have any regrets compared to patients who had. Also, the OR tended to be higher among patients who chose to play a wanted role in the medical decision-making process, compared with patients who did not. In the BCS group, the OR of being extremely satisfied with the treatment was higher if, at diagnosis, the patient’s youngest child was older than 19 years, compared with patients with no children. The OR was also higher if patient considered the stage and characteristics of their cancer significant. The OR of being extremely satisfied with the treatments was lower among patients who were not employed on full-time basis, and among patients who considered the second medical opinions and medical expenses to be significant. These associations were not observed in the TM group. The OR of having regrets regarding the medical decision-making process was higher among patients who chose to play a role in the decision-making process as they preferred, and was also higher in patients who were employed on either a part-time or contractual basis. For both types of surgery, the OR was higher among patients who considered a second medical opinion to be significant. Regardless of surgical type, regret regarding the medical decision-making process decreases treatment satisfaction. Patients who received breast-conserving surgery were more likely to have regrets concerning the medical decision-making process if they could not play a role in the process as they preferred. In addition, factors associated with the satisfaction with treatment in BCS group but not TM group included the second medical opinion, medical expenses, employment status, and age of the youngest child at diagnosis.

Keywords: medical decision making, breast-conserving surgery, total mastectomy, Japanese

Procedia PDF Downloads 134
11631 Cointegration Dynamics in Asian Stock Markets: Implications for Long-Term Portfolio Management

Authors: Xinyi Xu

Abstract:

This study conducts a detailed examination of Asian stock markets over the period from 2008 to 2023, with a focus on the dynamics of cointegration and their relevance for long-term investment strategies. Specifically, we assess the co-movement and potential for pairs trading—a strategy where investors take opposing positions on two stocks, indices, or financial instruments that historically move together. For example, we explore the relationship between the Nikkei 225 (N225), Japan’s benchmark stock index, and the Straits Times Index (STI) of Singapore, as well as the relationship between the Korea Composite Stock Price Index (KS11) and the STI. The methodology includes tests for normality, stationarity, cointegration, and the application of Vector Error Correction Modeling (VECM). Our findings reveal significant long-term relationships between these pairs, indicating opportunities for pairs trading strategies. Furthermore, the research underscores the challenges posed by model instability and the influence of major global incidents, which are identified as structural breaks. These findings pave the way for further exploration into the intricacies of financial market dynamics.

Keywords: normality tests, stationarity, cointegration, VECM, pairs trading

Procedia PDF Downloads 37
11630 Morphological Comparison of the Total Skeletal of (Common Bottlenose Dolphin) Tursiops truncatus and (Harbour Porpoise) Phocoena phocoena

Authors: Onur Yaşar, Okan Bilge, Ortaç Onmuş

Abstract:

The aim of this study is to investigate and compare the locomotion structures, especially the bone structures, of two different dolphin species, the Common bottlenose dolphin Tursiops truncatus and the Harbor porpoise Phocoena phocoena, and to provide a more detailed and descriptive comparison. To compare the structures of bones of two study species; first, the Spinous Process (SP), Inferior Articular Process (IAP), Laminae Vertebrae (LA), Foramen Vertebrae (FV), Corpus Vertebrae (CV), Transverse Process (TP) were determined and then the length of the Spinous Process (LSP), length of the Foramen Vertebrae (LFV), area of the Corpus Vertebrae (ACV), and length of the Transverse Process (LTP) were measured from the caudal view. The spine consists of a total of 61 vertebrae (7 cervical, 13 thoracic, 14 lumbar, and 27 caudal vertebrae) in the Common bottlenose dolphin, while the Harbor Porpoise has 63 vertebrae (7 cervical, 12 thoracic, 14 lumbar, 30 caudal. In the Common bottlenose dolphin, epiphyseal ossification was between the 21st caudal vertebra and the 27th caudal vertebra, while in the Harbor porpoise, it was observed in all vertebrae. Ankylosing spondylitis was observed in the C1 and C2 vertebrae in the Common bottlenose dolphin and in all cervical vertebrae between C1 and C6 in the Harbor porpoise. We argue that this difference in fused cervical vertebrae between the two species may be due to the fact that the neck movements of the Harbor porpoise in the vertical and horizontal axes are more limited than those of the Common bottlenose dolphin. We also think that as the number of fused cervical vertebrae increases, underwater maneuvers are performed at a wider angle, but to test this idea, we think that different species of dolphins should be compared and the different age groups should be investigated.

Keywords: anatomy, morphometry, vertebrae, common bottlenose dolphin, Tursiops truncatus, harbour porpoise, Phocoena phocoena

Procedia PDF Downloads 22
11629 Intensive Multidisciplinary Feeding Intervention for a Toddler with In-Utero Drug Exposure

Authors: Leandra Prempeh, Emily Malugen

Abstract:

Prenatal drug exposure can have a molecular impact on the hypothalamic and reward genes that regulate feeding behavior. This can impact feeding regulation, resulting in feeding difficulties and growth failure. This was potentially seen in “McKayla,” a 19- month old girl with a history of in-utero drug exposure, patent ductus arteriosus, and gastroesophageal reflux disease who presented for intensive day treatment feeding therapy. She was diagnosed with Avoidant Restrictive Food Intake Disorder, described as total food refusal and meeting 100% of her caloric needs from a gastrostomy tube. The primary goals during intensive feeding therapy were to increase her oral intake and decrease her reliance on supplementation with formula. Several behavioral antecedent manipulations were implemented to establish consistent responding and make progress towards treatment goals. This included multiple modified bolus placements (using underloaded and Nuk brush), reinforcement contingencies, and variety fading before stability was finally achieved. Following, increasing retention of bites then increasing volume and variety were goals targeted. From treatment onset to the last 3 days of treatment, McKayla's rate of rapid acceptance of bite presentations increased significantly from 33.33% to 93.13%, rapid swallowing went from 0.00% to 92.32%, and her percentage of inappropriate mealtime behavior and expels decreased from 58.33% and 100% to 2.31% and 7.68%, respectively. Overall, the treatment team successfully introduced and increased the bite size of 7 pureed foods, generalize the treatment to caregivers with high integrity, and began facilitating tube weaning. She was receiving about 33.42% of her needs by mouth at the time of discharge. Other nutritional concerns addressed during treatment included drinking a nutritionally complete drink out of an open cup and age appropriate growth. McKayla continued to have emesis almost daily, as was her baseline before starting treatment; however, the frequency during mealtime decreased. Overall, McKayla responded well to treatment. She had a very slow response to treatment and required a lot of antecedent manipulations to establish consistent responding. As the literature suggests, [drug]-exposed neonates, like McKayla, may be at increased risk for nutritional and growth challenges that may persist throughout development. This supports the need for longterm follow-up of infant growth.

Keywords: behavioral intervention, feeding problems, in-utero drug exposure, intensive multidisciplinary intervention

Procedia PDF Downloads 50
11628 Coupled Hydro-Geomechanical Modeling of Oil Reservoir Considering Non-Newtonian Fluid through a Fracture

Authors: Juan Huang, Hugo Ninanya

Abstract:

Oil has been used as a source of energy and supply to make materials, such as asphalt or rubber for many years. This is the reason why new technologies have been implemented through time. However, research still needs to continue increasing due to new challenges engineers face every day, just like unconventional reservoirs. Various numerical methodologies have been applied in petroleum engineering as tools in order to optimize the production of reservoirs before drilling a wellbore, although not all of these have the same efficiency when talking about studying fracture propagation. Analytical methods like those based on linear elastic fractures mechanics fail to give a reasonable prediction when simulating fracture propagation in ductile materials whereas numerical methods based on the cohesive zone method (CZM) allow to represent the elastoplastic behavior in a reservoir based on a constitutive model; therefore, predictions in terms of displacements and pressure will be more reliable. In this work, a hydro-geomechanical coupled model of horizontal wells in fractured rock was developed using ABAQUS; both extended element method and cohesive elements were used to represent predefined fractures in a model (2-D). A power law for representing the rheological behavior of fluid (shear-thinning, power index <1) through fractures and leak-off rate permeating to the matrix was considered. Results have been showed in terms of aperture and length of the fracture, pressure within fracture and fluid loss. It was showed a high infiltration rate to the matrix as power index decreases. A sensitivity analysis is conclusively performed to identify the most influential factor of fluid loss.

Keywords: fracture, hydro-geomechanical model, non-Newtonian fluid, numerical analysis, sensitivity analysis

Procedia PDF Downloads 190
11627 Development and Evaluation of a Psychological Adjustment and Adaptation Status Scale for Breast Cancer Survivors

Authors: Jing Chen, Jun-E Liu, Peng Yue

Abstract:

Objective: The objective of this study was to develop a psychological adjustment and adaptation status scale for breast cancer survivors, and to examine the reliability and validity of the scale. Method: 37 breast cancer survivors were recruited in qualitative research; a five-subject theoretical framework and an item pool of 150 items of the scale were derived from the interview data. In order to evaluate and select items and reach a preliminary validity and reliability for the original scale, the suggestions of study group members, experts and breast cancer survivors were taken, and statistical methods were used step by step in a sample of 457 breast cancer survivors. Results: An original 24-item scale was developed. The five dimensions “domestic affections”, “interpersonal relationship”, “attitude of life”, “health awareness”, “self-control/self-efficacy” explained 58.053% of the total variance. The content validity was assessed by experts, the CVI was 0.92. The construct validity was examined in a sample of 264 breast cancer survivors. The fitting indexes of confirmatory factor analysis (CFA) showed good fitting of the five dimensions model. The criterion-related validity of the total scale with PTGI was satisfactory (r=0.564, p<0.001). The internal consistency reliability and test-retest reliability were tested. Cronbach’s alpha value (0.911) showed a good internal consistency reliability, and the intraclass correlation coefficient (ICC=0.925, p<0.001) showed a satisfactory test-retest reliability. Conclusions: The scale was brief and easy to understand, was suitable for breast cancer patients whose physical strength and energy were limited.

Keywords: breast cancer survivors, rehabilitation, psychological adaption and adjustment, development of scale

Procedia PDF Downloads 502
11626 Ultrasound-Assisted Extraction of Bioactive Compounds from Cocoa Shell and Their Encapsulation in Gum Arabic and Maltodextrin: A Technology to Produce Functional Food Ingredients

Authors: Saeid Jafari, Khursheed Ahmad Sheikh, Randy W. Worobo, Kitipong Assatarakul

Abstract:

In this study, the extraction of cocoa shell powder (CSP) was optimized, and the optimized extracts were spray-dried for encapsulation purposes. Temperature (45-65 ◦C), extraction time (30–60 min), and ethanol concentration (60–100%) were the extraction parameters. The response surface methodology analysis revealed that the model was significant (p ≤ 0.05) in interactions between all variables (total phenolic compound, total flavonoid content, and antioxidant activity as measured by 2,2-Diphenyl-1-picrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP assays), with a lack of fit test for the model being insignificant (p > 0.05). Temperature (55 ◦C), time (45 min), and ethanol concentration (60%) were found to be the optimal extraction conditions. For spray-drying encapsulation, some quality metrics (e.g., water solubility, water activity) were insignificant (p > 0.05). The microcapsules were found to be spherical in shape using a scanning electron microscope. Thermogravimetric and differential thermogravimetric measurements of the microcapsules revealed nearly identical results. The gum arabic + maltodextrin microcapsule (GMM) showed potential antibacterial (zone of inhibition: 11.50 mm; lower minimum inhibitory concentration: 1.50 mg/mL) and antioxidant (DPPH: 1063 mM trolox/100g dry wt.) activities (p ≤ 0.05). In conclusion, the microcapsules in this study, particularly GMM, are promising antioxidant and antibacterial agents to be fortified as functional food ingredients for the production of nutraceutical foods with health-promoting properties.

Keywords: functional foods, coco shell powder, antioxidant activity, encapsulation, extraction

Procedia PDF Downloads 44