Search results for: patient safety incidents

Authors: Rolland Epafras Fanggidae

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The impact of climate change such as natural disasters, crop failures, increasing crop pests, bad gisi on children and other impacts, will indirectly affect education, health, food safety, as well as the economy. The impact of climate change has put a man in a situation of vulnerability, which was powerless to meet the minimum requirements, it is in close contact with poverty. When talking about poverty, the most plausible is female. The role of women in Indonesia, particularly in East Nusa Tenggara in Domestic aktifity very central and dominant. This makes Indonesian woman can say "outstanding actor in the face of climate change mitigation and adaptation and applying local knowledge", but still ignored when women based on gender division of work entrusted role in domestic activities. Similarly, in public activity is an extension of the Domestic example, trading activity in the market lele / mama. Although men are also affected by climate change, but most feel is female. From the above problems, it can be said that Indonesia's commitment has not been followed by optimal empowerment of women's role in addressing climate change, it is necessary to learn to know how the role of women in the face of climate change impacts that hit on her role as a woman, a housewife or head of the family and will be input in order to determine how women find a solution to tackle the problem of climate change. This study focuses on the efforts made by women cope with the impacts of climate change, efforts by the government, empowerment model used in Playing the impact of climate change. The container with the formulation of the title "The Role of Women in Climate Change Impact in Kupang district". Where the assessment in use types Research mix Methods combination of quantitative research and qualitative research. While the location of the research conducted in Kupang regency, East Nusa Tenggara, namely: District of East Kupang is a district granary in Kupang district. Subdistrict West Kupang, especially Tablolong Village is the center of seaweed cultivation in Kupang district.

Keywords: climate change, women, women's roles, gender, family

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Authors: Samuel Odumu Ogana John, Stephen Friday Olukotun, Manny Mathuthu

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Radon-222 (²²²Rn), a naturally occurring radioactive gas, poses potential health risks due to its inhalation and ingestion, especially through drinking water. This study investigates the activity concentration levels of ²²²Rn in 21 brands of bottled water samples collected from the open market in South Africa. The samples were analyzed using a highly sensitive system consisting of the Ionization Chamber AlphaGUARD (PQ 2000), an AquaKIT set, and an AlphaPUMP, ensuring precise measurement of radon activity. The results revealed significant variations in radon concentrations across different brands, with values ranging from 0.062 ± 0.046 Bq/m³ to 0.198 ± 0.286 Bq/mv³, with a mean of 0.118 ± 0.034 Bq/m³. These measurements were then used to estimate the annual effective ingestion dose of radiation for consumers across various age groups based on the guidelines provided by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). The mean effective doses were found to be 4.057 × 10⁻⁴ ± 1.188 × 10⁻⁴ mSv/y for infants (1–2 years), 2.428 × 10⁻⁴ ± 7.111 × 10⁻⁵ mSv/y for children (7–12 years), and 2.058 × 10⁻⁴ ± 6.026 × 10⁻⁵ mSv/y for adults, all of which are below the recommended international safety limits and are comparable to other published studies. These findings suggest that bottled drinking water in South Africa is safe for consumption and does not pose a significant health hazard from ²²²Rn radiation. The study underscores the importance of monitoring radon levels in bottled water to assess the associated radiological health risks, particularly in South Africa, where access to safe drinking water is essential. This research provides baseline data for future regulatory frameworks and policy development and can serve as a valuable reference for bottled water producers. Furthermore, it highlights the need for continued investigation into the regulation and mitigation of radon exposure in drinking water sources throughout the country.

Keywords: Radon-222, activity concentration levels, annual effective ingestion dose, bottled drinking water, South Africa

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Authors: Rui Li, Min Wen, Kim Bang Salling

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For the modern railways, maintenance is critical for ensuring safety, train punctuality and overall capacity utilization. The cost of railway maintenance in Europe is high, on average between 30,000 – 100,000 Euros per kilometer per year. In order to reduce such maintenance expenditures, this paper presents a mixed 0-1 linear mathematical model designed to optimize the predictive railway tamping activities for ballast track in the planning horizon of three to four years. The objective function is to minimize the tamping machine actual costs. The approach of the research is using the simple dynamic model for modelling condition-based tamping process and the solution method for finding optimal condition-based tamping schedule. Seven technical and practical aspects are taken into account to schedule tamping: (1) track degradation of the standard deviation of the longitudinal level over time; (2) track geometrical alignment; (3) track quality thresholds based on the train speed limits; (4) the dependency of the track quality recovery on the track quality after tamping operation; (5) Tamping machine operation practices (6) tamping budgets and (7) differentiating the open track from the station sections. A Danish railway track between Odense and Fredericia with 42.6 km of length is applied for a time period of three and four years in the proposed maintenance model. The generated tamping schedule is reasonable and robust. Based on the result from the Danish railway corridor, the total costs can be reduced significantly (50%) than the previous model which is based on optimizing the number of tamping. The different maintenance strategies have been discussed in the paper. The analysis from the results obtained from the model also shows a longer period of predictive tamping planning has more optimal scheduling of maintenance actions than continuous short term preventive maintenance, namely yearly condition-based planning.

Keywords: integer programming, railway tamping, predictive maintenance model, preventive condition-based maintenance

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Authors: Eimar Yadir Quintero Tapias

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Background: Science is not generally self-correcting; many clinical studies end with the same conclusion "more research is needed." This study hypothesizes that first, we need a better appraisal of the available (and unavailable) evidence instead of creating more of the same false inquiries. Methods: Systematic review of ClinicalTrials.gov study records using the following Boolean operators: (food OR nut OR milk OR egg OR shellfish OR wheat OR peanuts) AND (allergy OR allergies OR hypersensitivity OR hypersensitivities). Variables included the status of the study (e g., active and completed), availability of results, sponsor type, sample size, among others. To determine the rates of non-publication in journals indexed by PubMed, an advanced search query using the specific Number of Clinical Trials (e.g., NCT000001 OR NCT000002 OR...) was performed. As a prophylactic measure to prevent P-hacking, data analyses only included descriptive statistics and not inferential approaches. Results: A total of 2092 study records matched the search query described above (date: September 13, 2019). Most studies were interventional (n = 1770; 84.6%) and the remainder observational (n = 322; 15.4%). Universities, hospitals, and research centers sponsored over half of these investigations (n = 1208; 57.7%), 308 studies (14.7%) were industry-funded, and 147 received NIH grants; the remaining studies got mixed sponsorship. Regarding completed studies (n = 1156; 55.2%), 248 (21.5%) have results available at the registry site, and 417 (36.1%) matched NCT numbers of journal papers indexed by PubMed. Conclusions: The internal and external validity of human research is critical for the appraisal of medical evidence. It is imperative to analyze the entire dataset of clinical studies, preferably at a patient-level anonymized raw data, before rushing to conclusions with insufficient and inadequate information. Publication bias and non-registration of clinical trials limit the evaluation of the evidence concerning therapeutic interventions for food allergy, such as oral and sublingual immunotherapy, as well as any other medical condition. Over half of the food allergy human research remains unpublished.

Keywords: allergy, clinical trials, immunology, systematic reviews

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Authors: Hadeer E. Eliwa, Naglaa S. Bazan, Ebtissam A. Darweesh, Nagwa A. Sabri

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Background: Generic substitution of brand ivabradine prescriptions can reduce drug expenditures and improve adherence. However, the distrust of generic medicines by practitioners and patients due to doubts regarding their quality and fear of counterfeiting compromise the acceptance of this practice. Aim: The goal of this study is to compare the therapeutic equivalence of brand product versus the generic product of ivabradine in adult patients with chronic heart failure with reduced ejection fraction (≤ 40%) (HFrEF). Methodology: Thirty-two Egyptian patients with chronic heart failure with reduced ejection fraction (HFrEF) were treated with branded ivabradine (Procrolan ©) and generic (Bradipect ©) during 24 (2x12) weeks. Primary outcomes were resting heart rate (HR), NYHA FC, Quality of life (QoL) using Minnesota Living with Heart Failure (MLWHF) and EF. Secondary outcomes were the number of hospitalizations for worsening HFrEF and adverse effects. The washout period was not allowed. Findings: At the 12th week, the reduction in HR was comparable in the two groups (90.13±7.11 to 69±11.41 vs 96.13±17.58 to 67.31±8.68 bpm in brand and generic groups, respectively). Also, the increase in EF was comparable in the two groups (27.44 ±4.59 to 33.38±5.62 vs 32±5.96 to 39.31±8.95 in brand and generic groups, respectively). The improvement in NYHA FC was comparable in both groups (87.5% in brand group vs 93.8% in the generic group). The mean value of the QOL improved from 31.63±15.8 to 19.6±14.7 vs 35.68±17.63 to 22.9±15.1 for the brand and generic groups, respectively. Similarly, at end of 24 weeks, no significant changes were observed from data observed at 12th week regarding HR, EF, QoL and NYHA FC. Only minor side effects, mainly phosphenes, and a comparable number of hospitalizations were observed in both groups. Conclusion: The study revealed no statistically significant differences in the therapeutic effect and safety between generic and branded ivabradine. We assume that practitioners can safely interchange between them for economic reasons.

Keywords: bradipect©, heart failure, ivabradine, Procrolan ©, therapeutic equivalence

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Authors: Andrew R. Beatty

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The exploitation of Australia’s vast mineral wealth is regulated by a matrix of planning, environment and heritage legislation, and despite the desire for a ‘balance’ between economic, environmental and heritage values, Aboriginal objects and places are often detrimentally impacted by mining approvals. The Australian experience is not novel. There are other cases of clashes between the rights of traditional landowners and businesses seeking to exploit mineral or other resources on or beneath those lands, including in the United States, Canada, and Brazil. How one reconciles the rights of traditional owners with those of resource companies is an ongoing legal problem of general interest. In Australia, planning and environmental approvals for resource projects are ordinarily issued by State or Territory governments. Federal legislation such as the Aboriginal and Torres Strait Islander Heritage Protection Act 1984 (Cth) is intended to act as a safety net when State or Territory legislation is incapable of protecting Indigenous objects or places in the context of approvals for resource projects. This paper will analyse the context and effectiveness of legislation enacted to protect Indigenous heritage in the planning process. In particular, the paper will analyse how the statutory objects of such legislation need to be weighed against the statutory objects of competing legislation designed to facilitate and control resource exploitation. Using a current claim in the Federal Court of Australia for the protection of a culturally significant landscape as a case study, this paper will examine the challenges faced in ascribing value to cultural heritage within the wider context of environmental and planning laws. Our findings will reveal that there is an inherent difficulty in defining and weighing competing economic, environmental and heritage considerations. An alternative framework will be proposed to guide regulators towards making decisions that result in better protection of Indigenous heritage in the context of resource management.

Keywords: environmental law, heritage law, indigenous rights, mining

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Authors: Zyrah Lou R. Samar, Genecarlo Liwanag

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Type 2 Diabetes Mellitus is the more prevalent type, caused by a combination of insulin resistance and inadequate insulin response to hyperglycemia1. Aside from pharmacologic interventions, medical nutrition therapy is an integral part of the management of patients with Type 2 Diabetes Mellitus. Whey protein, which is one of the best protein sources, has been investigated for its applicability in improving glycemic control in patients with Type 2 Diabetes Mellitus. This systematic review and meta-analysis was conducted to measure the magnitude of the effect of whey protein on glycemic control in type 2 diabetes mellitus. The aim of this review is to evaluate the efficacy and safety of whey protein in patients with type 2 diabetes mellitus. Methods: A systematic electronic search for studies in the PubMed and Cochrane Collaboration database was done. Included in this review were randomized controlled trials of whey protein enrolling patients with type 2 diabetes mellitus. Three reviewers independently searched, assessed, and extracted data from the individual studies. Results: A systematic literature search on online databases such as Cochrane Central Registry, PubMed, and Herdin Plus was conducted in April to September 2021 to identify eligible studies. The search yielded 21 randomized controlled trials after removing duplicates. Only 5 articles were included after reviewing the full text, which met the criteria for selection. Conclusion: Whey protein supplementation significantly reduced fasting blood glucose. However, it did not reduce post-prandial blood glucose, HbA1c level, and weight when compared with the placebo. There has been a considerate heterogeneity across all studies, which may have contributed/confounded its effects. A larger sample size and better inclusion, and a more specific study may be included in the future reviews.

Keywords: whey protein, diabetes, nutrition, fasting blood sugar, postprandial glucose, HbA1c, weight reduction

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Authors: Hassan Alhoujeiri, Angele Matrat, Sandra Beaufort, Claire joaniss Cassan, Jerome Silvester

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Aquaponics is a sustainable food production technology, and its transition to industrial-scale systems has created several challenges that require further investigation in order to make it a robust process. One of the critical concerns is the potential accumulation of compounds from veterinary treatments, phytosanitary agents, fish feed, or simply from contaminated water sources. The accumulation of these substances could negatively impact fish health, microbial biofilters, and plant growth, thereby disrupting the system’s overall balance and functionality. The lack of legislation and knowledge regarding the presence of such compounds in aquaponic systems raises concerns about their potential impact on both system balance and food safety. In this study, we focused on the effects of oxytetracycline (OTC), an antibiotic commonly used in aquaculture, on both the microbial biofilter and plant growth. Although OTC is rarely applied in aquaponics today, the fish compartment may need to be isolated from the system during treatment, as it inhibits specific bacterial populations, which could affect the microbial biofilter's efficiency. However, questions remain about the aquaponic system's tolerance threshold, particularly in cases of treatment or residual OTC traces post-treatment. This study results indicated a decline in microbial biofilter activity to 20% compared to the control, potentially corresponding to treatments of 41 mg/L of OTC. Analysis of microbial populations in the biofilter, using flow cytometry and microscopy (confocal and scanning electron microscopy), revealed an increase in bacterial mortality without disrupting the microbial biofilm. Additionally, OTC exposure led to noticeable changes in plant morphology (e.g., color) and growth, though it did not fully inhibit development. However, no significant effects were observed on seed germination at the tested concentrations despite a measurable impact on subsequent plant growth.

Keywords: aquaponic, oxytetracycline, nitrifying biofilter, plant, micropollutants, sustainability

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Authors: Murat Demir Aydin, Elanur Celebi

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Adhesively bonded joints are used as an alternative to traditional joining methods due to the important advantages they provide. The most important consideration in the use of adhesively bonded joints is that these joints have appropriate requirements for their use in terms of safety. In order to ensure control of this condition, damage analysis of the adhesively bonded joints should be performed by determining the mechanical properties of the adhesives. When the literature is investigated; it is generally seen that the mechanical properties of adhesives are determined by traditional measurement methods. In this study, to determine the mechanical properties of adhesives, the Digital Image Correlation (DIC) method, which can be an alternative to traditional measurement methods, has been used. The DIC method is a new optical measurement method which is used to determine the parameters of displacement and strain in an appropriate and correct way. In this study, tensile tests of Thick Adherent Shear Test (TAST) samples formed using DP410 liquid structural adhesive and steel materials and bulk tensile specimens formed using and DP410 liquid structural adhesive was performed. The displacement and strain values of the samples were determined by DIC method and the shear stress-strain curves of the adhesive for TAST specimens and the tensile strain curves of the bulk adhesive specimens were obtained. Various methods such as numerical methods are required as conventional measurement methods (strain gauge, mechanic extensometer, etc.) are not sufficient in determining the strain and displacement values of the very thin adhesive layer such as TAST samples. As a result, the DIC method removes these requirements and easily achieves displacement measurements with sufficient accuracy.

Keywords: structural adhesive, adhesively bonded joints, digital image correlation, thick adhered shear test (TAST)

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Authors: Suresh Hettiarachchi, Conrad Wasko, Ashish Sharma

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The ever changing and expanding urban landscape increases the stress on urban systems to support and maintain safe and functional living spaces. Flooding presents one of the more serious threats to this safety, putting a larger number of people in harm’s way in congested urban settings. Climate change is adding to this stress by creating a dichotomy in the urban flood response. On the one hand, climate change is causing storms to intensify, resulting in more destructive, rarer floods, while on the other hand, longer dry periods are decreasing the severity of more frequent, less intense floods. This variability is creating a need to be more agile and innovative in how we design for and manage urban flooding. Here, we argue that to cope with this challenge climate change brings, we need to move towards urban flood management through resilience rather than flood prevention. We also argue that dealing with the larger variation in flood response to climate change means that we need to look at flooding from all aspects rather than the single-dimensional focus of flood depths and extents. In essence, we need to rethink how we manage flooding in the urban space. This change in our thought process and approach to flood management requires a practical way to assess and quantify resilience that is built into the urban landscape so that informed decision-making can support the required changes in planning and infrastructure design. Towards that end, we propose a Simple Urban Flood Resilience Index (SUFRI) based on a robust definition of resilience as a tool to assess flood resilience. The application of a simple resilience index such as the SUFRI can provide a practical tool that considers urban flood management in a multi-dimensional way and can present solutions that were not previously considered. When such an index is grounded on a clear and relevant definition of resilience, it can be a reliable and defensible way to assess and assist the process of adapting to the increasing challenges in urban flood management with climate change.

Keywords: urban flood resilience, climate change, flood management, flood modelling

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Authors: Naima Bouslah, Leila Bounabi, Farid Ouazib, Nabila Haddadine

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Conventional release dosage forms are known to provide an immediate release of the drug. Controlling the rate of drug release from polymeric matrices is very important for a number of applications, particularly in the pharmaceutical area. Hydrogels are polymers in three-dimensional network arrangement, which can absorb and retain large amounts of water without dissolution. They have been frequently used to develop controlled released formulations for oral administration because they can extend the duration of drug release and thus reduce dose to be administrated improving patient compliance. Tramadol is an opioid pain medication used to treat moderate to moderately severe pain. When taken as an immediate-release oral formulation, the onset of pain relief usually occurs within about an hour. In the present work, we synthesized pH-responsive hydrogels of (hydroxyl ethyl methacrylate-co-acrylic acid), (HEMA-AA) for control drug delivery of tramadol in the gastro-intestinal tractus. The hydrogels with different acrylic acid content, were synthesized by free radical polymerization and characterized by FTIR spectroscopy, X ray diffraction analysis (XRD), differential scanning calorimetry (DSC) and thermo gravimetric analysis (TGA). FTIR spectroscopy has shown specific hydrogen bonding interactions between the carbonyl groups of the hydrogels and hydroxyl groups of tramadol. Both the XRD and DSC studies revealed that the introduction of tramadol in the hydrogel network induced the amorphization of the drug. The swelling behaviour, absorptive kinetics and the release kinetics of tramadol in simulated gastric fluid (pH 1.2) and in simulated intestinal fluid (pH 7.4) were also investigated. The hydrogels exhibited pH-responsive behavior in the swelling study. The (HEMA-AA) hydrogel swelling was much higher in pH =7.4 medium. The tramadol release was significantly increased when pH of the medium was changed from simulated gastric fluid (pH 1.2) to simulated intestinal fluid (pH 7.4). Using suitable mathematical models, the apparent diffusional coefficients and the corresponding kinetic parameters have been calculated.

Keywords: biopolymres, drug delivery, hydrogels, tramadol

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Authors: Borhan Marzougui

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Road and Transport Authority (RTA) is moving ahead with the implementation of the leader’s vision in exploring all avenues that may bring better security and safety services to the community. Smart transport means using smart technologies such as IoT (Internet of Things). This technology continues to affirm its important role in the context of Information and Transportation Systems. In fact, IoT is a network of Internet-connected objects able to collect and exchange different data using embedded sensors. With the growth of IoT, Distributed Denial of Service (DDoS) attacks is also growing exponentially. DDoS attacks are the major and a real threat to various transportation services. Currently, the defense mechanisms are mainly passive in nature, and there is a need to develop a smart technique to handle them. In fact, new IoT devices are being used into a botnet for DDoS attackers to accumulate for attacker purposes. The aim of this paper is to provide a relevant understanding of dangerous types of DDoS attack related to IoT and to provide valuable guidance for the future IoT security method. Our methodology is based on development of the distributed algorithm. This algorithm manipulates dedicated intelligent and cooperative agents to prevent and to mitigate DDOS attacks. The proposed technique ensure a preventive action when a malicious packets start to be distributed through the connected node (Network of IoT devices). In addition, the devices such as camera and radio frequency identification (RFID) are connected within the secured network, and the data generated by it are analyzed in real time by intelligent and cooperative agents. The proposed security system is based on a multi-agent system. The obtained result has shown a significant reduction of a number of infected devices and enhanced the capabilities of different security dispositives.

Keywords: IoT, DDoS, attacks, botnet, security, agents

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Authors: Ali Fuad Ashour

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Introduction: Multiple sclerosis (MS) is a chronic, progressive and degenerative disease that affects the central nervous system (CNS). MS has been described to result in the debilitating symptom of the disease. It is reported to have a negative impact on the patient’s mental activities, brings a lower quality of life, leads to unemployment, causes distress and psychological disorders, generates low levels of motivation and self-esteem, and result in disability and neurological impairment. The aim of this study was to compare the effects of MS on patients from Britain and Kuwait. Methodology: A questionnaire was distributed to 200 individuals with MS (100 Kuwaiti and 100 British). The questionnaire consists of three parts; 1. General demographics, 2. Disease-specific data (symptoms, severity levels, relapse frequency, and support system), and 3. Attitudes towards physical exercise. Results: A response rate of 62% from the British sample and 50% from the Kuwaiti sample was achieved. 84% of the sample (n=52) were 41 years old or over. The duration of the disease was less than 10 years in 43.4% of British and 68% of Kuwaiti respondents. The majority of British respondents (56.5%) reported the disease severity to be moderate, while the majority of Kuwaitis was mild (72%). The annual relapse rates in Kuwait were relatively low, with 82% of the Kuwaiti sample had one relapse per year, compared to the 64.5% of British. The most common symptoms reported by British respondents were balance (75.8%), fatigue (74.2%), and weakness (71%), and by Kuwaiti respondents were fatigue (86%), balance (76%), and weakness (66%). The help and support for MS were by far more diverse for the British than Kuwaiti respondents. Discussion: The results unveiled marked differences between two groups of British and Kuwaiti MS patients in terms of patients’ age and disease duration, and severity. The overwhelming majority of Kuwaiti patients are young individuals who have been with the disease for a relatively short period of time, and their MS in most cases was mild. On the other hand, British patients were relatively older, many have been with the disease for a long period of time, and their average MS condition was more serious than that of their Kuwaiti counterparts. The main support in Kuwait comes from the neurologist, who primarily prescribe medications and advise patients to try to be active. The Kuwaiti respondents thought that lack of encouragement was the main reason for them not to engage in social activities.

Keywords: multiple sclerosis, Kuwait, exercise, demographic

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Authors: Shohoni Mahabub

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Health Information Systems (HIS) are essential to contemporary healthcare; nonetheless, they frequently encounter challenges such as data fragmentation, inefficiencies, and an absence of real-time analytics. The advent of machine learning (ML) and artificial intelligence (AI) provides a revolutionary potential to address these difficulties via AI-driven data fusion ecosystems. These ecosystems integrate many health data sources, including electronic health records (EHRs), wearable devices, and genetic data, with sophisticated machine learning techniques such as natural language processing (NLP) and predictive analytics to produce actionable insights. Through the integration of strong data intake layers, secure interoperability protocols, and privacy-preserving models, these ecosystems provide individualized treatment, early illness diagnosis, and enhanced operational efficiency. This paradigm change enhances clinical decision-making and rectifies systemic inefficiencies in healthcare delivery. Nonetheless, adoption presents problems such as data privacy concerns, ethical considerations, and scalability constraints. The study examines options such as federated learning for safe, decentralized data sharing, explainable AI for transparency, and cloud-based infrastructure for scalability to address these issues. These ecosystems aim to address health equity disparities, particularly in resource-limited environments, and improve public health surveillance, notably in pandemic response initiatives. This article emphasizes the revolutionary potential of AI-driven data fusion ecosystems in redefining Health Information Systems by providing an implementation roadmap and showcasing successful deployment case studies. The suggested method promotes a cooperative initiative among legislators, healthcare professionals, and technology to establish a cohesive, efficient, and patient-centric healthcare model.

Keywords: AI-powered healthcare systems, data fusion ecosystem, predictive analytics, digital health interoperability

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Authors: Kevin Moustapha

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Psychopathy is perceived today as being «the most important concept in the criminal justice system» and as «the most important legal notion of the early 21 th century». The explosion of research related to psychopathy seems to perfectly illustrate this trend. Traditionally, many studies tend to focus on links between insanity defense and psychopathy. That is why our purpose in this article is to analyze psychopathic disorders in the scope of judges sentencing in Canada. Indeed, in every Canadian case related to dangerous offenders, judges must balance between fairness and protection of the individuals rights of the accused and protection of society from dangerous predators who may commit future acts of physical or sexual violence. Increasingly, psychopathic disorders are taking an important part in judge sentencing, especially in Canada. This phenomenon can be illustrated by the high proportion of psychopath offenders incarcerated in North American prisons. Many decisions in Canadians courtrooms seem to point out that psychopathy is often used as a strong argument by the judges to preserve public safety. The fact that psychopathy is often associated with violence, recklessness and recidivism, it could explain why many judges consider psychopathic disorders as an aggravating factor. Generally, the judge reasoning is based on article 753 of Canadian Criminal Code related to dangerous offenders, which is used for individuals who show a pattern of repetitive and persistent aggressive behaviour. However, with cognitive neurosciences, the psychopath’s situation in courtrooms would probably change. Cerebral imaging and news data provided by the neurosciences show that emotional and volitional functions in psychopath’s brains are impaired. Understanding these new issues could enable some judges to recognize psychopathic disorders as a mitigating factor. Two important questions ought to be raised in this article: can exploring psychopaths ‘brains really change the judge sentencing in Canadian courtrooms? If yes, can judges consider psychopathy more as a mitigating factor than an aggravating factor?

Keywords: criminal law, judges sentencing, neurosciences, psychopathy

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Authors: Yea-Pyng Lin

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Dignity is a core element of nursing care. Maintaining the dignity of patients is an important issue because the health and recovery of patients can be adversely affected by a lack of dignity in their care. The aim of this study was to explore the effects of a nursing dignity care program upon patients’ dignity in care. A quasi-experimental research design was implemented. Nurses were recruited by purposive sampling, and their patients were recruited by simple random sampling. Nurses in the experimental group received the nursing educational program on dignity care, while nurses in the control group received in-service education as usual. Data were collected via two instruments: the dignity in care scale for nurses and the dignity in care scale to patients, both of which were developed by the researcher. Both questionnaires consisted of three domains: agreement, importance, and frequencies of providing dignity care. A total of 178 nurses in the experimental group and 193 nurses in the control group completed the pretest and the follow-up evaluations at the first month, the third month, and the sixth month. The number of patients who were cared for by the nurses in the experimental group was 94 in the pretest. The number of patients in the post-test at the first, third, and sixth months were 91, 85, and 77, respectively. In the control group, 88 patients completed the II pretest, and 80 filled out the post-test at the first month, 77 at the third, and 74 at the sixth month. The major findings revealed the scores of agreement domain among nurses in the experimental group were found significantly different from those who in the control group at each point of time. The scores of importance domain between these two groups also displayed significant differences at pretest and the first month of post-test. Moreover, the frequencies of proving dignity care to patients were significant at pretest, the third month and sixth month of post-test. However, the experimental group had only significantly different from those who in the control group on the frequencies of receiving dignity care especially in the items of ‘privacy care,’ ‘communication care,’ and ‘emotional care’ for the patients. The results show that the nursing program on dignity care could increase nurses’ dignity care for patients in three domains of agreement, importance, and frequencies of providing dignity care. For patients, only the frequencies of receiving dignity care were significantly increased. Therefore, the nursing program on dignity care could be applicable for nurses’ in-service education and practice to enhance the ability of nurses to care for patient’s dignity.

Keywords: nurses, patients, dignity care, quasi-experimental, nursing education

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Authors: Godwin Ojochogu Adejo, Evelyn UnekwuOjo Adejo, Sunday UnenwOjo Adejo

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The mainstream contemporary approach to controlling the impact of diseases among poultry birds rely largely on curative measures through the administration of drugs to infected birds. Most times as observed in the deep liter poultry farming system, entire flocks including uninfected birds receive the treatment they do not need. As such, unguarded use of chemical drugs and antibiotics has led to wastage and accumulation of chemical residues in poultry products with associated health hazards to humans. However, wanton and frequent drug usage in poultry is avoidable if feeding and drinking equipment are designed to curb infection transmission among birds. Using toxicological assays as guide and with efficiency and simplicity in view, two newly field-tested and recently patented equipments called 'healthy liquid drinking trough (HDT)' and 'healthy feeding trough (HFT)' that systematically eliminate contamination of the feeding and drinking channels, thereby, curbing wide-spread infection and transmission of diseases in the (intensive) deep litter poultry farming system were designed. Upon combined usage, they automatically and drastically reduced both the amount and frequency of antibiotics use in poultry by over > 50%. Additionally, they conferred optimization of feed and water utilization/elimination of wastage by > 80%, reduced labour by > 70%, reduced production cost by about 15%, and reduced chemical residues in poultry meat or eggs by > 85%. These new and cheap technologies which require no energy input are likely to elevate safety of poultry products for consumers' health, increase marketability locally and for export, and increase output and profit especially among poultry farmers and poor people who keep poultry or inevitably utilize poultry products in developing countries.

Keywords: healthy, trough, toxicological, assay-guided, poultry

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Authors: S. Sadhu, M. Ramgopal, S. Bhattacharyya

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Natural circulation loops (NCLs) are buoyancy driven flow systems without any moving components. NCLs have vast applications in geothermal, solar and nuclear power industry where reliability and safety are of foremost concern. Due to certain favorable thermophysical properties, especially near supercritical regions, carbon dioxide can be considered as an ideal loop fluid in many applications. In the present work, a high temperature NCL that uses supercritical carbon dioxide as loop fluid is analysed. The effects of relevant design and operating variables on loop performance are studied. The system operating under steady state is modelled taking into account the axial conduction through loop fluid and loop wall, and heat transfer with surroundings. The heat source is considered to be a heater with controlled heat flux and heat sink is modelled as an end heat exchanger with water as the external cold fluid. The governing equations for mass, momentum and energy conservation are normalized and are solved numerically using finite volume method. Results are obtained for a loop pressure of 90 bar with the power input varying from 0.5 kW to 6.0 kW. The numerical results are validated against the experimental results reported in the literature in terms of the modified Grashof number (Gr_m) and Reynolds number (Re). Based on the results, buoyancy and friction dominated regions are identified for a given loop. Parametric analysis has been done to show the effect of loop diameter, loop height, ambient temperature and insulation. The results show that for the high temperature loop, heat loss to surroundings affects the loop performance significantly. Hence this conjugate heat transfer between the loop and surroundings has to be considered in the analysis of high temperature NCLs.

Keywords: conjugate heat transfer, heat loss, natural circulation loop, supercritical carbon dioxide

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Authors: Ph. Fauquet-Alekhine

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Decision-making occurs several times an hour when working in high risk industry and an erroneous choice might have undesirable outcomes for people and the environment surrounding the industrial plant. Industrial decisions are very often made in a context of acute stress. Time pressure is a crucial stressor leading decision makers sometimes to boost up the decision-making process and if it is not possible then shift to the simplest strategy. We thus found it interesting to update the characterization of the stress factors impairing decision-making at Chinon Nuclear Power Plant (France) in order to optimize decision making contexts and/or associated processes. The investigation was based on the analysis of reports addressing safety events over the last 3 years. Among 93 reports, those explicitly addressing decision-making issues were identified. Characterization of each event was undertaken in terms of three criteria: stressors, biases impairing decision making and weaknesses of the decision-making process. The statistical analysis showed that biases were distributed over 10 possibilities among which the hypothesis confirmation bias was clearly salient. No significant correlation was found between criteria. The analysis indicated that the main stressor was time pressure and highlights an unexpected form of stressor: the trust asymmetry principle of the expert. The analysis led to the conclusion that this stressor impaired decision-making from a psychological angle rather than from a physiological angle: it induces defensive bias of self-esteem, self-protection associated with a bias of confirmation. This leads to the hypothesis that this stressor can intervene in some cases without being detected, and to the hypothesis that other stressors of the same kind might occur without being detected too. Further investigations addressing these hypotheses are considered. The analysis also led to the conclusion that dealing with these issues implied i) decision-making methods being well known to the workers and automated and ii) the decision-making tools being well known and strictly applied. Training was thus adjusted.

Keywords: bias, expert, high risk industry, stress.

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Authors: S. M. C. Kelly, M. Goulden

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Introduction: Chronic Pancreatitis is an increasing problem worldwide. Pain is the main symptom and the main reason for hospital readmission following diagnosis, despite the use of strong analgesics including opioids. Ketamine infusions reduce pain in complex regional pain syndrome and other neuropathic pain conditions. Our centre has trialed the use of ketamine infusions in patients with chronic pancreatitis. We have evaluated this service to assess whether ketamine reduces emergency department admissions and analgesia requirements. Methods: This study collected retrospective data from 2010 in all patients who received a ketamine infusion for chronic pain secondary to a diagnosis of chronic pancreatitis. The day-case ketamine infusions were initiated in theatre by an anaesthetist, with standard monitoring and the assistance of an anaesthetic practitioner. A bolus dose of 0.5milligrams/kilogram was given in theatre. The infusion of 0.5 milligrams/kilogram per hour was then administered over a 6 hour period in the theatre recovery area. A study proforma detailed the medical history, analgesic use and admissions to hospital. Patients received a telephone follow up consultation. Results: Over the last eight years, a total of 30 patients have received intravenous ketamine infusions, with a total of 92 ketamine infusions being administered. 53% of the patients were male with the average age of 47. A total of 27 patients participated with the telephone consultation. A third of patients reported a reduction in hospital admissions with pain following the ketamine infusion. Analgesia requirements were reduced by an average of 48.3% (range 0-100%) for an average duration of 69.6 days (range 0-180 days.) Discussion: This service evaluation illustrates that ketamine infusions can reduce analgesic requirements and the number of hospital admissions in patients with chronic pancreatitis. In the light of increasing pressures on Emergency departments and the increasing evidence of the dangers of long-term opioid use, this is clearly a useful finding. We are now performing a prospective study to assess the long-term effectiveness of ketamine infusions in reducing analgesia requirements and improving patient’s quality of life.

Keywords: acute-on-chronic pain, intravenous analgesia infusion, ketamine, pancreatitis

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Authors: Tambe Daniel Atem

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Background: Clinical Research is an organized research on human beings intended to provide adequate information on the drug use as a therapeutic agent on its safety and efficacy. The significance of the study is to educate the global health and life science graduates in Clinical Research in depth to perform better as it involves testing drugs on human beings. Objectives: to provide an overall understanding of the scientific approach to the evaluation of new and existing medical interventions and to apply ethical and regulatory principles appropriate to any individual research. Methodology: It is based on – Primary data analysis and Secondary data analysis. Primary data analysis: means the collection of data from journals, the internet, and other online sources. Secondary data analysis: a survey was conducted with a questionnaire to interview the Clinical Research Professionals to understand the need of training to perform clinical trials globally. The questionnaire consisted details of the professionals working with the expertise. It also included the areas of clinical research which needed intense training before entering into hardcore clinical research domain. Results: The Clinical Trials market worldwide worth over USD 26 billion and the industry has employed an estimated 2,10,000 people in the US and over 70,000 in the U.K, and they form one-third of the total research and development staff. There are more than 2,50,000 vacant positions globally with salary variations in the regions for a Clinical Research Coordinator. R&D cost on new drug development is estimated at US$ 70-85 billion. The cost of doing clinical trials for a new drug is US$ 200-250 million. Due to an increase trained Clinical Research Professionals India has emerged as a global hub for clinical research. The Global Clinical Trial outsourcing opportunity in India in the pharmaceutical industry increased to more than $2 billion in 2014 due to increased outsourcing from U.S and Europe to India. Conclusion: Assessment of training need is recommended for newer Clinical Research Professionals and trial sites, especially prior the conduct of larger confirmatory clinical trials.

Keywords: clinical research, clinical trials, clinical research professionals

Procedia PDF Downloads 454

Authors: Gary Pattemore, Michael Edgar, Andrew Job, Marina Auad, Kathryn Job

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As critical commodities become more scarce, significant time and resources have been used to better understand complicated ore bodies and extract their full potential. These challenging ore bodies provide several pain points for geologists and engineers to overcome, poor handling of these issues flows downs stream to the processing plant affecting throughput rates and recovery. Many open cut mines utilise blast hole drilling to extract additional information to feed back into the modelling process. This method requires samples to be collected during or after blast hole drilling. Samples are then sent for assay with turnaround times varying from 1 to 12 days. This method is time consuming, costly, requires human exposure on the bench and collects elemental data only. To address this challenge, research has been undertaken to utilise hyperspectral imaging across a broad spectrum to scan samples, collars or take down hole measurements for minerals and moisture content and grade abundances. Automation of this process using unmanned vehicles and on-board processing reduces human in pit exposure to ensure ongoing safety. On-board processing allows data to be integrated into modelling workflows with immediacy. The preliminary results demonstrate numerous direct and indirect benefits from this new technology, including rapid and accurate grade estimates, moisture content and mineralogy. These benefits allow for faster geo modelling updates, better informed mine scheduling and improved downstream blending and processing practices. The paper presents recommendations for implementation of the technology in open cut mining environments.

Keywords: grade control, hyperspectral scanning, artificial intelligence, autonomous mining, machine learning

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Authors: R. Alramyan, S. Alsalamah, R. Alrashed, R. Alakel, F. Altheyeb, M. Alessa

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Background: Nutritional support with total parenteral nutrition (TPN) is usually commenced with hematopoietic stem cell transplantation (HSCT) patients. However, it has its benefits and risks. Complications related to central venous catheter such as infections, and metabolic disturbances, including abnormal liver function, is usually of concern in such patients. Methods: A retrospective charts review of all pediatric patients who underwent HSCT between the period 2015-2018 in a tertiary hospital in Riyadh, Saudi Arabia. Patients' demographics, types of conditioning, type of nutrition, and patients' outcomes were collected. Statistical analysis was conducted using SPSS version 22. Frequencies and percentages were used to describe categorical variables. Mean, and standard deviation were used for continuous variables. A P value of less than 0.05 was considered as statically significant. Results: a total of 162 HSCTs were identified during the period mentioned. Indication of allogenic transplant included hemoglobinopathy in 50 patients (31%), acute lymphoblastic leukemia in 21 patients (13%). TPN was used in 96 patients (59.30%) for a median of 14 days, nasogastric tube feeding (NGT) in 16 (9.90%) patients for a median of 11 days, and 71 of patients (43.80%) were able to tolerate oral feeding. Out of the 96 patients (59.30%) who were dependent on TPN, 64 patients (66.7%) had severe mucositis in comparison to 17 patients (25.8%) who were either on NGT or tolerated oral intake. (P-value= 0.00). Sinusoidal obstruction syndrome (SOS) was seen in 14 patients (14.6%) who were receiving TPN compared to none in non-TPN patients (P=value 0.001). Moreover, majority of patients who had SOS received myeloablative conditioning therapy for non-malignant disease (hemoglobinopathy). However, there were no statistically significant differences in Graft-vs-Host Disease (both acute and chronic), bacteremia, and patient outcome between both groups. Conclusions: Nutritional support using TPN is used in majority of patients, especially post-myeloablative conditioning associated with severe mucositis. TPN was associated with VOD, especially in hemoglobinopathy patients who received myeloablative therapy. This may emphasize on use of preventative measures such as fluid restriction, use of diuretics, or defibrotide in high-risk patients.

Keywords: hematopoeitic stem cell transplant, HSCT, stem cell transplant, sinusoidal obstruction syndrome, total parenteral nutrition

Procedia PDF Downloads 159

Authors: N. A. D. P. Niwunhella, W. G. R. C. K. Sirisena

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Appendicitis is one of the most encountered abdominal emergencies worldwide. Proper clinical diagnosis and appendicectomy with minimal post operative complications are therefore priorities. Aim of this study was to ascertain the overall management of acute appendicitis in Sri Lanka in special preference to delayed primary suturing of the surgical site, comparing other local and international treatment outcomes. Data were collected prospectively from 155 patients who underwent appendicectomy following clinical and radiological diagnosis with ultrasonography. Histological assessment was done for all the specimens. All perforated appendices were managed with delayed primary closure. Patients were followed up for 28 days to assess complications. Mean age of patient presentation was 27 years; mean pre-operative waiting time following admission was 24 hours; average hospital stay was 72 hours; accuracy of clinical diagnosis of appendicitis as confirmed by histology was 87.1%; post operative wound infection rate was 8.3%, and among them 5% had perforated appendices; 4 patients had post operative complications managed without re-opening. There was no fistula formation or mortality reported. Current study was compared with previously published data: a comparison on management of acute appendicitis in Sri Lanka vs. United Kingdom (UK). The diagnosis of current study was equally accurate, but post operative complications were significantly reduced - (current study-9.6%, compared Sri Lankan study-16.4%; compared UK study-14.1%). During the recent years, there has been an exponential rise in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. Even though, the diagnostic accuracy without using CT, and treatment outcome of acute appendicitis in this study match other local studies as well as with data compared to UK. Therefore CT usage has not increased the diagnostic accuracy of acute appendicitis significantly. Especially, delayed primary closure may have reduced post operative wound infection rate for ruptured appendices, therefore suggest this approach for further evaluation as a safer and an effective practice in other hospitals worldwide as well.

Keywords: acute appendicitis, computerised tomography, diagnostic accuracy, delayed primary closure

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Authors: Gichun Cha, Changgil Lee, Seunghee Park

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The objective of the study is to construct the shape management method contributing to the safety of the large structure. In Korea, the research of the shape management is lack because of the new attempted technology. Terrestrial Laser Scanning (TLS) is used for measurements of large structures. TLS provides an efficient way to actively acquire accurate the point clouds of object surfaces or environments. The point clouds provide a basis for rapid modeling in the industrial automation, architecture, construction or maintenance of the civil infrastructures. TLS produce a huge amount of point clouds. Registration, Extraction and Visualization of data require the processing of a massive amount of scan data. The octree can be applied to the shape management of the large structure because the scan data is reduced in the size but, the data attributes are maintained. The octree space partitioning generates the voxel of 3D space, and the voxel is recursively subdivided into eight sub-voxels. The point cloud of scan data was converted to voxel and sampled. The experimental site is located at Sungkyunkwan University. The scanned structure is the steel-frame bridge. The used TLS is Leica ScanStation C10/C5. The scan data was condensed 92%, and the octree model was constructed with 2 millimeter in resolution. This study presents octree space partitioning for handling the point clouds. The basis is created by shape management of the large structures such as double-deck tunnel, building and bridge. The research will be expected to improve the efficiency of structural health monitoring and maintenance. "This work is financially supported by 'U-City Master and Doctor Course Grant Program' and the National Research Foundation of Korea(NRF) grant funded by the Korea government (MSIP) (NRF- 2015R1D1A1A01059291)."

Keywords: 3D scan data, octree space partitioning, shape management, structural health monitoring, terrestrial laser scanning

Procedia PDF Downloads 297

Authors: Salma H. Abu Hafsa, A. Mendonca, B. Brehm-Stecher, A. A. Hassan, S. A. Ibrahim

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Enterococci are important inhabitants of the animal intestine and are widely used in probiotic products. A probiotic strain is expected to possess several desirable properties in order to exert beneficial effects. Therefore, the objective of this study was to isolate and characterize strains of Enterococcus sp. from chicken cecal and fecal samples to determine potential probiotic properties. Enterococci were isolated from thirty one chicken cecal and fecal samples collected from a local farm. In vitro studies were performed to assess antibacterial activity (using agar well diffusion and cell free supernatant broth technique against Salmonella enterica serotype Enteritidis), susceptibility to antibiotics (amoxycillin, cotrimoxazole, chloramphenicol, cefuroxime, ceftriaxone, ciprofloxacin, and nalidixic acid), survival in acidic conditions, resistance to bile salts, and their survival during simulated gastric juice conditions at pH 2.5. Isolates were identified using biochemical and molecular assays (API 50 CHL, and API ZYM kits followed by 16S rDNA gene sequence analysis). Two strains were identified, of which, Enteroccocus faecium was capable of inhibiting the growth of S. enteritidis and was susceptible to a wide range of antibiotics. In addition, the isolated strain exhibited significant resistance under highly acidic conditions (pH=2.5) for 8 hours and survived well in bile salt at 0.2% for 24 hours and showing ability to survive in the presence of simulated gastric juice at pH 2.5. Based on these results, the E. faecium isolate fulfills some of the criteria to be considered as a probiotic strain and therefore, could be used as a feed additive with good potential for controlling S. enteritidis in chickens. However, in vivo studies are needed to determine the safety of the strain.

Keywords: acid tolerance, antimicrobial activity, Enterococcus faecium, probiotic

Procedia PDF Downloads 397

Authors: Basavaraj R. Endigeri, S. G. Sarganachari

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Steel is widely used in machine parts, structural equipment and many other applications. In many steel structural elements, holes of different shapes and orientations are made with a view to satisfy the design requirements. The presence of holes in steel elements creates stress concentration, which eventually reduce the mechanical strength of the structure. Therefore, it is of great importance to investigate the state of stress around the holes for the safety and properties design of such elements. By literature survey, it is known that till date, there is no analytical solution to reduce the stress concentration by providing auxiliary holes at a definite location and radii in a steel plate. The numerical method can be used to determine the optimum location and radii of auxiliary holes. In the present work plate with an elliptical hole, for a steel material subjected to uniaxial load is analyzed and the effect of stress concentration is graphically represented .The introduction of auxiliary holes at a optimum location and radii with its effect on stress concentration is also represented graphically. The finite element analysis package ANSYS 11.0 is used to analyse the steel plate. The analysis is carried out using a plane 42 element. Further the ANSYS optimization model is used to determine the location and radii for optimum values of auxiliary hole to reduce stress concentration. All the results for different diameter to plate width ratio are presented graphically. The results of this study are in the form of the graphs for determining the locations and diameter of optimal auxiliary holes. The graph of stress concentration v/s central hole diameter to plate width ratio. The Finite Elements results of the study indicates that the stress concentration effect of central elliptical hole in an uniaxial loaded plate can be reduced by introducing auxiliary holes on either side of the central circular hole.

Keywords: finite element method, optimization, stress concentration factor, auxiliary holes

Procedia PDF Downloads 453

Authors: Selim M. Khan, Aaron A. Goodarzi, Joshua M. Taron, Tryggve Rönnqvist

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Indoor air quality, a prime determinant of health, is strongly influenced by the presence of hazardous radon gas within the built environment. As a health issue, dangerously high indoor radon arose within the 20th century to become the 2nd leading cause of lung cancer. While the 21st century building metrics and human behaviors have captured, contained, and concentrated radon to yet higher and more hazardous levels, the issue is rapidly worsening in Canada. It is established that Canadians in the Prairies are the 2nd highest radon-exposed population in the world, with 1 in 6 residences experiencing 0.2-6.5 millisieverts (mSv) radiation per week, whereas the Canadian Nuclear Safety Commission sets maximum 5-year occupational limits for atomic workplace exposure at only 20 mSv. This situation is also deteriorating over time within newer housing stocks containing higher levels of radon. Deep machine learning (LSTM) algorithms were applied to analyze multiple quantitative and qualitative features, determine the most important contributory factors, and predicted radon levels in the known past (1990-2020) and projected future (2021-2050). The findings showed gradual downwards patterns in Sweden, whereas it would continue to go from high to higher levels in Canada over time. The contributory factors found to be the basement porosity, roof insulation depthness, R-factor, and air dynamics of the indoor environment related to human window opening behaviour. Building codes must consider including these factors to ensure adequate indoor ventilation and healthy living that can prevent lung cancer in non-smokers.

Keywords: radon, building metrics, deep learning, LSTM prediction model, lung cancer, canada, sweden

Procedia PDF Downloads 112

Authors: Ghadeer Mohammad Said El-Sheikh, Samer Mohamad Shalhoob

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Medical equipment operation state is a valid reflection of health care organizations' performance, where such equipment highly contributes to the quality of healthcare services on several levels in which quality improvement has become an intrinsic part of the discourse and activities of health care services. In healthcare organizations, clinical and biomedical engineering departments play an essential role in maintaining the safety and efficiency of such equipment. One of the most challenging topics when it comes to such sophisticated equipment is the lifespan of medical equipment, where many factors will impact such characteristics of medical equipment through its life cycle. So far, many attempts have been made in order to address this issue where most of the approaches are kind of arbitrary approaches and one of the criticisms of existing approaches trying to estimate and understand the lifetime of a medical equipment lies under the inquiry of what are the environmental factors that can play into such a critical characteristic of a medical equipment. In an attempt to address this shortcoming, the purpose of our study rises where in addition to the standard technical factors taken into consideration through the decision-making process by a clinical engineer in case of medical equipment failure, the dimension of environmental factors shall be added. The investigations, researches and studies applied for the purpose of supporting the decision making process by a clinical engineers and assessing the lifespan of healthcare equipment’s in the Lebanese society was highly dependent on the identification of technical criteria’s that impacts the lifespan of a medical equipment where the affecting environmental factors didn’t receive the proper attention. The objective of our study is based on the need for introducing a new well-designed plan for evaluating medical equipment depending on two dimensions. According to this approach, the equipment that should be replaced or repaired will be classified based on a systematic method taking into account two essential criteria; the standard identified technical criteria and the added environmental criteria.

Keywords: technical, environmental, healthcare, characteristic of medical equipment

Procedia PDF Downloads 156

Authors: Krishna Dahiya, Esha Charaya

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Induction of labour is a common obstetrical intervention. Around 1 in every 4 patient undergo induction of labour for different indications Purpose: To study the efficacy of the combination of Foley bulb and vaginal misoprostol in comparison to vaginal misoprostol alone for cervical ripening and induction of labour. Methods: A prospective randomised study was conducted on 150 patients with term singleton pregnancy admitted for induction of labour. Seventy-five patients were induced with both Foley bulb, and vaginal misoprostol and another 75 were given vaginal misoprostol alone for induction of labour. Both groups were then compared with respect to change in Bishop score, induction to the active phase of labour interval, induction delivery interval, duration of labour, maternal complications and neonatal outcomes. Data was analysed using statistical software SPSS version 11.5. Tests with P,.05 were considered significant. Results: The two groups were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (2.99 ± 1.72 and 2.17 ± 1.48 respectively with statistically significant difference (p=0.001 S, 95% C.I. -0.1978 to 0.8378). Mean induction to delivery interval was significantly lower in the combination group (11.76 ± 5.89 hours) than misoprostol group (14.54 ± 7.32 hours). Difference was of 2.78 hours (p=0.018,S, 95% CI -5.1042 to -0.4558). Induction to delivery interval was significantly lower in nulliparous women of combination group (13.64 ± 5.75 hours) than misoprostol group (18.4±7.09 hours), and the difference was of 4.76 hours (p=0.002, S, 95% CI 1.0465 to 14.7335). There was no difference between the groups in the mode of delivery, infant weight, Apgar score and intrapartum complications. Conclusion: From the present study it was concluded that addition of Foley catheter to vaginal misoprostol have the synergistic effect and results in early cervical ripening and delivery. These results suggest that the combination may be used to achieve timely and safe delivery in the presence of an unfavorable cervix. A combination of the Foley bulb and vaginal misoprostol resulted in a shorter induction-to-delivery time when compared with vaginal misoprostol alone without increasing labor complications.

Keywords: Bishop score, Foley catheter, induction of labor, misoprostol

Procedia PDF Downloads 306