Search results for: early mobilisation in intensive care (ICU)

Authors: Racheal Ayanga, Nancy Katumba Muwangala, Jane Babirye, Harriet Kivumbi

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Background: Deaf adolescents are vulnerable. Deafness limits their access to resources that are accessed by their hearing peers. There is minimal attention placed on the SRH needs of persons with disabilities, especially in developing countries. We sought to assess barriers to access of SRH education and services for deaf adolescents in Uganda. Methods: We performed a cross sectional study using a questionnaire on knowledge of and access to SRH education and services from a selected sample of deaf adolescents aged 13-19 years at Wakiso Secondary school for the deaf. A consecutive sample of eligible participants was asked to join the study after obtaining informed consent until the target sample size was reached. Results: From 01 Jul 2022 to 30 Jan 2023, 70 quantitative interviews were conducted. Participants’ mean age was 17 years, and 66% were female. 89% had heard about several components of SRH. 99% reported a need for education and services but had challenges with access 85% of the time. 54% reported receipt of education and services from government or private facilities, and the rest from friends, parents, siblings, teachers and the internet. Conclusion: Government needs to look into availing tailored, sustainable SRH education/services to deaf adolescents at health facilities and teach health workers sign language. SRH education to parents, teachers and communities of deaf adolescents improves access in hard-to-reach areas. Integration of services into routine health care is key in creating and improving models of access to wider communities of persons with disabilities to improve their mental health.

Keywords: sexual and reproductive health, deaf, adolescents, education, services, disabilities, mental health, hard-to-reach areas

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Authors: Jose G. Tshikuka, Goabaone Rankgoane-Pono, Mgaywa G. M. D. Magafu, Julius C. Mwita, Tiny Masupe, Fortunat M. Kandanda, Shimeles G. Hamda, Roy Tapera, Mooketsi Molefi, John T. Tlhakanelo

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Background: Factors associated with overweight and obesity among antiretroviral therapy (ART) recipients have not been sufficiently studied in Botswana. We aimed to study (i) the prevalence and trends in overweight/obesity by duration of exposure to ART among recipients, (ii) changes in body mass index (BMI) categories among recipients before ART initiation (BMI-1) and after ART initiation (BMI-2), (iii) associations between ART and overweight/obesity and (iv) factors associated with BMI changes among ART recipients. Methods: A 12 years retrospective record-based review was conducted. Factors potentially associated with BMI change among patients after at least three years of ART exposure were examined using multiple regression model. Adjusted odds ratios (AOR) and their 95% confidence intervals (CIs) were computed. ART regimens, duration of exposure to ART, and recipients’ demographic and biomedical characteristics including the presence or absence of diabetes mellitus related comorbidities (DRC) were investigated as potential factors associated with overweight/obesity. Results: Twenty-nine percent of recipients were overweight, 16.6% had obesity of whom 2.4% were morbidly-obese at the last clinic visit. Overweight/obesity recipients were more likely to be female, to have DRC and less likely to have nadir CD4 count or CD4 count between 201 – 249 cells/mm³. Neither the first-line nor the second-, third-line ART regimens predicted overweight/obesity more than the other and neither did the duration of exposure to ART. No significant linear trends were observed in the prevalence of overweight/obesity by the duration of exposure to ART. Conclusions: These results indicate that overweight/obesity seen among ART recipients is not directly induced by ART. ART used CD4 and/or DRC pathway to induce overweight/obesity seen among recipients; suggesting that, weight gain documented herein is likely a reflection of improved health status that mirrors trends in the general population or a DRC related effect. Weight management programs may be important components of HIV care.

Keywords: overweight/obesity, recipients of antiretroviral therapy, HIV/AIDS, Botswana

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Authors: Qing Wu, Xuchun Ye, Qiuchen Wang, Kirsten Corazzini

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Objective: It’s increasing acknowledged that patient engagement in healthcare and health literacy both have positive impact on patient outcome. Health literacy emphasizes the ability of individuals to understand and apply health information and manage health. Patients' health literacy affected their willingness to participate in decision-making, but its impact on the behavior and willingness of patient engagement in healthcare is not clear, especially in China. Therefore, this study aimed to explore the correlation between the behavior and willingness of patient engagement and health literacy. Methods: A cross-sectional survey was employed using the behavior and willingness of patient engagement in healthcare questionnaire, Chinese version All Aspects of Health Literacy Scale (AAHLS). A convenient sample of 443 patients was recruited from 8 general hospitals in Shanghai, Jiangsu Province and Zhejiang Province, from September 2016 to January 2017. Results: The mean score for the willingness was (4.41±0.45), and the mean score for the patient engagement behavior was (4.17±0.49); the mean score for the patient's health literacy was (2.36±0.29)，the average score of its three dimensions- the functional literacy, the Communicative/interactive literacy and the Critical literacy, was (2.26±0.38), (2.28±0.42), and (2.61±0.43), respectively. Patients' health literacy was positively correlated with their willingness of engagement (r = 0.367, P < 0.01), and positively correlated with patient engagement behavior (r = 0.357, P < 0.01). All dimensions of health literacy were positively correlated with the behavior and willingness of patient engagement in healthcare; the dimension of Communicative/interactive literacy (r = 0.312, P < 0.01; r = 0.357, P < 0.01) and the Critical literacy (r = 0.357, P < 0.01; r = 0.357, P < 0.01) are more relevant to the behavior and willingness than the dimension of basic/functional literacy (r=0.150, P < 0.01; r = 0.150, P < 0.01). Conclusions: The behavior and willingness of patient engagement in healthcare are positively correlated with health literacy and its dimensions. In clinical work, medical staff should pay attention to patients’ health literacy, especially the situation that low literacy leads to low participation and provide health information to patients through health education or communication to improve their health literacy as well as guide them to actively and rationally participate in their own health care.

Keywords: patient engagement, health literacy, healthcare, correlation

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Authors: Abbas Al-Refaie, Ruba Najdawi, Nour Bata, Mohammad D. AL-Tahat

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The pharmaceutical industry is an important component of health care systems throughout the world. Measurement of a production unit-performance is crucial in determining whether it has achieved its objectives or not. This paper applies data envelopment (DEA) window analysis to assess the efficiencies of two packaging lines; Allfill (new) and DP6, in the Penicillin plant in a Jordanian Medical Company in 2010. The CCR and BCC models are used to estimate the technical efficiency, pure technical efficiency, and scale efficiency. Further, the Malmquist productivity index is computed to measure then employed to assess productivity growth relative to a reference technology. Two primary issues are addressed in computation of Malmquist indices of productivity growth. The first issue is the measurement of productivity change over the period, while the second is to decompose changes in productivity into what are generally referred to as a ‘catching-up’ effect (efficiency change) and a ‘frontier shift’ effect (technological change). Results showed that DP6 line outperforms the Allfill in technical and pure technical efficiency. However, the Allfill line outperforms DP6 line in scale efficiency. The obtained efficiency values can guide production managers in taking effective decisions related to operation, management, and plant size. Moreover, both machines exhibit a clear fluctuations in technological change, which is the main reason for the positive total factor productivity change. That is, installing a new Allfill production line can be of great benefit to increasing productivity. In conclusions, the DEA window analysis combined with the Malmquist index are supportive measures in assessing efficiency and productivity in pharmaceutical industry.

Keywords: window analysis, malmquist index, efficiency, productivity

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Authors: Ash Ahmed, Fraser Hyndman, Heni Fitriani, John Kamau

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The highway pavement is the biggest structural asset a government can construct and maintain. Concrete rigid pavements are used to carry traffic in large volumes across countries safely and efficiently. Pavement quality concrete mixes have high levels of cement which contribute to up to 10% of global CO₂ emissions. Currently the UK specifies (ground granulated blastfurnace slag) GGBS and (pulverised fuel ash) PFA to reduce the quantity of cement used in pavement construction. GGBS and PFA come from heavy industry that should not be relied upon to improve the sustainability of construction materials. This report shows that cement in pavement quality concrete can be replaced with rice husk ash (RHA) without causing adverse effects to the mechanical properties required for highways. RHA comes from the food production industry and is vital for the growing global population. It is thus a socially responsible objective to use a pozzolan in highway pavement construction that is sourced from an environmentally friendly industry. The report investigates the properties of RHA mixes and compares them to existing pavement quality mixes already used and specified. The report found that sieving RHA and not grinding it gives the best performance. Due to the low density of RHA the investigation found that replacing cement by volume rather than weight provided the best results. Findings showed that CEM II mixed with 20% RHA meets the required specification for pavement quality concrete and mitigates using the comparative CEM I. The investigation also notes that RHA is observed to be more reactive with CEM II rather than CEM I and suits early strength gains required for pavement construction. The report concludes that RHA is a sustainable material that reduces the embodied CO₂ of pavement quality concrete, which is well suited for UK highway specifications and has the potential to improve the lives of people living in the developing countries.

Keywords: pavement, pozzolan, rice husk ash, sustainable concrete

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Authors: Abeer K. Jameel, Harry Evdorides

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The Assessment of the road safety performance is a challengeable issue. This is not only because of the ineffective and unreliability of road and traffic crash data system but also because of its systematic character. Recent strategic plans and interventions implemented in some of the developed countries where a significant decline in the rate of traffic and road crashes considers that the road safety is a system. This system consists of four main elements which are: road user, road infrastructure, vehicles and speed in addition to other supporting elements such as the institutional framework and post-crash care system. To assess the performance of a system, it is required to assess all its elements. To present an understandable results of the assessment, it is required to present a unique term representing the performance of the overall system. This paper aims to develop an overall performance indicator which may be used to assess the road safety system. The variables of this indicators are the main elements of the road safety system. The data regarding these variables will be collected from the World Health Organization report. Multi-criteria analysis method is used to aggregate the four sub-indicators for the four variables. Two weighting methods will be assumed, equal weights and different weights. For the different weights method, the factor analysis method is used. The weights then will be converting to scores. The total score will be the overall indicator for the road safety performance in a national scale. This indicator will be used to compare and rank countries according to their road safety performance indicator. The country with the higher score is the country which provides most sustainable and effective interventions for successful road safety system. These indicator will be tested by comparing them with the aggregate real crash rate for each country.

Keywords: factor analysis, Multi-criteria analysis, road safety assessment, safe system indicator

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Authors: M. M. S. Prahastomi, M. Muhajir Saputra, Axel Derian

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Lapindo mud (LUSI ) phenomenon which occurred in Sidoarjo 2006 is a national scale of the geological phenomenon. This mudflow forms a mud volcano that spreads by time is in the need of serious treatment. Some further research has been conducted either by the application method of geodesy, geophysics, and subsurface geology, but still remains a mystery to this phenomenon. Sidoarjo Physiographic regions are included in the Kendeng zone flanked by Rembang zones in northern and Solo zones in southern. In this region revealed Kabuh formation, Jombang formation, and alluvium. In general, in the northern part of the area is composed of sedimentary rocks Sidoarjo klastika, epiklastic, pyroclastics, and older alluvium of the Early Pleistocene to Resen. The study was conducted with the literature study of the stratigraphy and regional geology as well as secondary data from observations coupled gravity method (Anomaly Bouger). The aim of the study is to reveal the subsurface geology structure pattern and the changes in mass flow. Gravity anomaly data were obtained from the calculation of the value of gravity and altitude, then processed into gravity anomaly contours which reflect changes in density of each group observed gravity. The gravity data could indicate a bottom surface which deformation occur the stronger or more intense to the south. Deformation in the form of gravity impairment was associated with a decrease in future density which is indicated by the presence of gas, water and gas bursts. Sectional analysis of changes in the measured value of gravity at different times indicates a change in the value of gravity caused by the presence of subsurface subsidence. While the gravity anomaly section describes the fault zone causes the zone to be unstable.

Keywords: mud volcano, Lumpur Sidoarjo, Bouger anomaly, Indonesia

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Authors: Alexander S. Burnasov, Anatoly V. Stepanov, Maria Y. Ilyushkina

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In the conditions of transition to the digital economy, the digital environment of the city becomes one of the key factors of its tourism attractiveness. Modern digital environment makes travelling more accessible, improves the quality of travel services and the attractiveness of many tourist destinations. The digitalization of the industry allows to use resources more efficiently, to simplify business processes, to minimize risks, and to improve travel safety. The city promotion as a tourist destination in the foreign market becomes decisive in the digital environment. Information technologies are extremely important for the functioning of not only any tourist enterprise but also the city as a whole. In addition to solving traditional problems, it is also possible to implement some innovations from the tourism industry, such as the availability of city services in international systems of booking tickets and booking rooms in hotels, the possibility of early booking of theater and museum tickets, the possibility of non-cash payment by cards of international payment systems, Internet access in the urban environment for travelers. The availability of the city's digital services makes it possible to reduce ordering costs, contributes to the optimal selection of tourist products that meet the requirements of the tourist, provides increased transparency of transactions. The users can compare prices, features, services, and reviews of the travel service. The ability to share impressions with friends thousands of miles away directly affects the image of the city. It is possible to promote the image of the city in the digital environment not only through world-scale events (such as World Cup 2018, international summits, etc.) but also through the creation and management of services in the digital environment aimed at supporting tourism services, which will help to improve the positioning of the city in the global tourism market.

Keywords: competitiveness, digital environment, travelling, Yekaterinburg

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Authors: Larissa Burruano, Sergey Grabovyj, Irina Nguen

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The study aimed to assess the level of adherence to anti retroviral therapy (ART) and to examine the relationship between adherence and risk behavior factor (drug use) among patients infected with HIV. The patients with newly diagnosed or established HIV infection under follow-up at the Sumskij Regional Centre for AIDS Prevention in Ukraine were eligible for this study. Medical records were used to measure the patient’s adherence to medication. Measurements were obtained at month 6 and at month 12 to calculate the number of medication omission during the past 30 days: (on a 2-point scale – once until three in a month – were considered adherent, three and more in a month – were considered non-adherent). Of the 50 study participants, 27 (54.0%) were men and 23 (46.0%) women. The mean age is 35.2 years (SD= 5.1). A majority of the patients (82.0%) is in the age group of 25-30 years. The main level of adherence was 74.0% and 66.0% at 6 and 12 months, respectively. The main routes of HIV transmission were drug injection among men 12 (44.4%) and sexual contact among women 11 (47.8%). Univariate analyses indicated that patients who had lower level of education were more likely to have been non-adherent at month 6- (X2 =5.1, n=50, p < .05) and at month 12 (X2 = 4.34, n=50, p < .05). Multivariate tests showed that only age (OR= 1.163 [95% CI 0.98–1.370]) was significant independent predictor of treatment adherence, while gender, education, employment status were not predictive for the risk of developing non-compliance. There was not a significant interaction between non-adherence and intravenous drug use. Consistent with these findings, younger people were more likely to have missed a dose of their medication because they had a greater sense of invulnerability than older patients. The study indicates that the socio demographic characteristic should be taken into an account in the future research regarding adherence in the case of HIV infection. If the patient anti retroviral adherence can be improved by qualitatively better medical care in all regions of the Ukraine, behavioral changes in the population can to be expected in the long term.

Keywords: HIV, antiretroviral therapy, adherence, Ukraine, Eastern Europe

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Authors: Kristiina Teiss

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Estonians and children having Estonian as a one of their languages have lately become the fastest growing minority or bilingual group in Finland which underlines the importance of studying this target group. The acquisition of bilingualism by an infant is affected by many different issues like the child’s personal traits, language differences, and different environmental factors such as people´s attitudes towards languages and bilingualism. In the early years the most important factor is the children’s interaction with their parents and siblings. This poster gives an overview to the material and some preliminary findings of ongoing PhD study concerning code-mixing, code-switching and language attitudes of two bilingual 10-11 year old children. Data was collected from two different bilingual families, one of them living in Tampere, Finland and one of them moved during the study to Tallinn, Estonia. The data includes audio recordings of the families’ interactions with their children when they were aged 2-3 years old and then when they were 10-11 years old. The data also includes recorded semi-structured queries of the parents, as well as recorded semi-structured queries of the children when they were in the age of 10-11 years. The features of code-mixing can vary depending on norms or models in the families, or even according to its use by two parents in same family. The practices studied in the ongoing longitudinal case study, based on a framework of ethnography, contain parental conversational strategies and family attitudes as well as CS (code-switching and code-mixing) cases occurring both in children and adult language. The aim of this paper is to find out whether there is a connection between children’s attitudes and their daily language use. It would be also interesting to find some evidence, as to whether living in different countries has different impacts on using two languages. The results of dissertation maid give some directional suggestions on how language maintenance of Estonian-Finnish bilinguals could be supported, although generalizations on the base of case study could not be done.

Keywords: code switching, Estonian, Finnish, language attitudes

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Authors: Nisar Ahmad, Xuyi, Ali Akbar

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As healthcare systems worldwide strive for improvement, the integration of advanced health information systems (HIS) has emerged as a pivotal strategy. This study aims to investigate the critical role of leadership in the implementation and enhancement of HIS in Chinese hospitals and how such leadership can drive improvements in patient outcomes and overall healthcare satisfaction. We propose a comprehensive study to be conducted across various hospitals in China, targeting healthcare professionals as the primary population. The research will leverage established theories of transformational leadership and technology acceptance to underpin the analysis. In our approach, data will be meticulously gathered through surveys and interviews, focusing on the experiences and perceptions of healthcare professionals regarding HIS implementation and its impact on patient care. The study will utilize SPSS and SmartPLS software for robust data analysis, ensuring precise and comprehensive insights into the correlation between leadership effectiveness and HIS success. We hypothesize that strong, visionary leadership is essential for the successful adoption and optimization of HIS, leading to enhanced patient outcomes and increased satisfaction with healthcare services. By applying advanced statistical methods, we aim to identify key leadership traits and practices that significantly contribute to these improvements. Our research will provide actionable insights for policymakers and healthcare administrators in China, offering evidence-based recommendations to foster leadership that champions HIS and drives continuous improvement in healthcare delivery. This study will contribute to the global discourse on health information systems, emphasizing the future role of leadership in transforming healthcare environments and outcomes.

Keywords: health information systems, leadership, patient outcomes, healthcare satisfaction

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Authors: Antarip Bhattacharya, Dhritiman Maitra

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Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia due to autonomous production of parathormone (PTH) and the third most common endocrine disorder. Upto 2% of postmenopausal women could have this condition. Primary hyperparathyroidism is characterized by hypercalcemia with a high or insufficiently suppressed level of parathyroid hormone and is caused by a solitary parathyroid adenoma in 85-90% of patients. PHPT may also be caused by parathyroid hyperplasia (involving multiple glands) or parathyroid carcinoma. Associated morbidities and sequelae include decreased bone mineral density, fractures, kidney stones, hypertension, cardiac comorbidities and psychiatric disorder which entail huge costs for treatment. In the year 2021, by virtue of running a Breast and Endocrine Surgery clinic in a Tier 1 city at a tertiary care hospital, the opportunity to be associated with patients of hyperparathyroidism came our way. Here, we shall describe the spectrum of clinical presentations and customisation of treatment for parathyroid diseases with reference to the above patients. A retrospective analysis of the data of all patients presenting with symptoms of parathyroid diseases was made and classified according to the cause. 13 patients had presented with symptoms of hyperparathyroidism and each case presented with unique symptoms and necessitated detailed evaluation. The treatment or surgery offered to each patient was tailored to his/her individual disease and led to favourable outcomes. Diseases affecting parathyroid are not as rare as we believe. Each case merits detailed clinical evaluation, investigations and tailoring of suitable treatment with regard to medical management and extent of surgery. Intra-operative frozen section/iOPTH monitoring are really useful adjuncts for intra-operative decision making.

Keywords: hyperparathyroidism, parathyroid adenoma, parathyroid surgery, PTH

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

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

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

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Authors: John Scanlon, Antony Raymond, Randeep Aujla, Peter D’Alessandro, Satyen Gohil

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Background: The incidence of significant acute chondral injuries with patella dislocation is around 10-15%. It is accepted that chondral procedures should only be performed in the presence of joint stability Methods:Patients were identified from surgeon/hospital logs. Patient demographics, lesion size and location, surgical procedure, patient reported outcome measures, post-operative MR imaging, and complications were recorded. PROMs and patient satisfaction was obtained. Results:20 knees (18 patients) were included. Mean age was 18.6 years (range; 11-39), and the mean follow-up was 16.6 months (range; 2-70). The defect locations were the lateral femoral condyle (9/20; 45%), patella (9/20; 45%), medial femoral condyle (1/20; 5%) and the trochlea (1/20; 5%). The mean defect size was 2.6cm2. Twelve knees were treated with cartilage fixation, 5 with microfracture, and 3 with OATS. At follow up, the overall mean Lysholm score was 77.4 (± 17.1), with no chondral regenerative procedure being statistically superior. There was no difference in Lysholm scores between those patients having acute medial patellofemoral ligament reconstruction versus medial soft tissue plication (p=0.59). Five (25%) knees required re-operation (one arthroscopic arthrolysis; one patella chondroplasty; two removal of loose bodies; one implant adjustment). Overall, 90% responded as being satisfied with surgery. Conclusion: Our aggressive pathway to identify and treat acute cartilage defects with early operative intervention and patella stabilisation has shown high rates of satisfaction and Lysholm scores. The full range of chondral restoration options should be considered by surgeons managing these patients.

Keywords: patella dislocation, chondral restoration, knee, patella stabilisation

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Authors: Phoutsathaphone Sibounheuang, Phayom Sookaneknun Olson, Chanuttha Ploylearmsang, Santiparp Sookaneknun, Chanthanom Manithip

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Patient satisfaction is an outcome that can be measured and used to improve diabetes care and management. There are limited instruments for assessing patient satisfaction covering the whole process of diabetes management. In this study, the questionnaire was developed with items pooled from a systematic review of qualitative studies of patients’ and healthcare providers’ perspectives in diabetes management. The questionnaire consists of 11 domains with 45 items. The Thai version was translated to Lao and then checked by back-translating it into Thai. We tested the questionnaire on 150 diabetes patients in Thailand and 150 in Lao People Democratic Republic (PDR). Validity was performed by factor analysis and Pearson correlation. Internal consistency reliability was estimated by calculating Cronbach’s alpha. The study was approved by the Mahasarakham University Ethics Committee, and the National Ethics Committee for Health Research, Lao PDR. The Thai and Lao versions showed the construct validity by principal component analysis. This consisted of 11 domains which account for 71.23% of the variance (Thai version) and 71.66% of the variance (Lao version) in the total patient satisfaction scores. The Kaiser-Meyer-Olkin (KMO) measures were 0.85 for the Thai version and 0.75 for the Lao version. The Bartlett tests of sphericity of both versions were significant (p < 0.001). The factor loadings of all items in both versions were > 0.40. The convergent validity of the Thai and Lao versions was 93.63% and 79.54% respectively. The discriminant validity for the Thai and Lao versions was 92.68% and 88.68% respectively. Cronbach’s alpha was 0.95 in both versions. The Patient Satisfaction Questionnaire (PSQ) in both versions had acceptable properties. This study has yielded evidence supporting the validity and reliability of both versions.

Keywords: construct validity, diabetes management, patient satisfaction, questionnaire development, reliability

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Authors: Célia Barreto Carvalho, Carolina da Motta, José Pinto-Gouveia, Ermelindo Bernardo Peixoto

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Auditory hallucinations among the most invalidating and distressing experiences reported by patients diagnosed with schizophrenia, leading to feelings of powerlessness and helplessness towards their illness. In more severe cases, these auditory hallucinations can take the form of commanding voices, which are often related to high suicidality rates in these patients. Several authors propose that the meanings attributed to the hallucinatory experience, rather than characteristics like form and content, can be determinant in patients’ reactions to hallucinatory activity, particularly in the case of voice-hearing experiences. In this study, 48 patients diagnosed with paranoid schizophrenia presenting auditory hallucinations were studied. Multiple regression analyses were computed to study the influence of several developmental aspects, such as family and social dynamics, bullying, depression, and socio-cognitive variables on the auditory hallucinations, on patients’ attributions and relationships with their voices, and on the resulting invalidation of hallucinatory experience. Overall, results showed how relationships with voices can mirror several aspects of interpersonal relationship with others, and how self-schemas, depression and actual social relationships help shaping the voice-hearing experience. Early experiences of victimization and submission help predict the attributions of omnipotence of the voices, and increased hostility from parents seems to increase the malevolence of the voices, suggesting that socio-cognitive factors can significantly contribute to the etiology and maintenance of auditory hallucinations. The understanding of the characteristics of auditory hallucinations and the relationships patients established with their voices can allow the development of more promising therapeutic interventions that can be more effective in decreasing invalidation caused by this devastating mental illness.

Keywords: auditory hallucination, beliefs, life events, schizophrenia

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Authors: Rafia Hassan, Ali Rizwan, Sadaf Farhan, Bushra Sabir

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The purpose of this study is to compare the conventional crop monitoring system with the satellite based crop monitoring system in Pakistan. This study is conducted for SUPARCO (Space and Upper Atmosphere Research Commission). The study focused on the wheat crop, as it is the main cash crop of Pakistan and province of Punjab. This study will answer the following: Which system is better in terms of cost, time and man power? The man power calculated for Punjab CRS is: 1,418 personnel and for SUPARCO: 26 personnel. The total cost calculated for SUPARCO is almost 13.35 million and CRS is 47.705 million. The man hours calculated for CRS (Crop Reporting Service) are 1,543,200 hrs (136 days) and man hours for SUPARCO are 8, 320hrs (40 days). It means that SUPARCO workers finish their work 96 days earlier than CRS workers. The results show that the satellite based crop monitoring system is efficient in terms of manpower, cost and time as compared to the conventional system, and also generates early crop forecasts and estimations. The research instruments used included: Interviews, physical visits, group discussions, questionnaires, study of reports and work flows. A total of 93 employees were selected using Yamane’s formula for data collection, which is done with the help questionnaires and interviews. Comparative graphing is used for the analysis of data to formulate the results of the research. The research findings also demonstrate that although conventional methods have a strong impact still in Pakistan (for crop monitoring) but it is the time to bring a change through technology, so that our agriculture will also be developed along modern lines.

Keywords: area frame, crop reporting service, CRS, sample frame, SRS/GIS, satellite remote sensing/ geographic information system

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Authors: Syed Dawood M. Taimur

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Background: Peripheral arterial disease (PAD) is under diagnosed in primary care practices, yet the extent of unrecognized PAD in patients with coronary artery disease (CAD) is unknown. Objective: To assess the prevalence of previously unrecognized PAD in patients undergoing coronary angiogram and to determine the relationship between the presence of PAD and severity of CAD. Material & Methods: This five years retrospective study was conducted at an invasive lab of the department of Cardiology, Ibrahim Cardiac Hospital & Research Institute from January 2010 to December 2014. Total 77 patients were included in this study. Study variables were age, sex, risk factors like hypertension, diabetes mellitus, dyslipidaemia, smoking habit and positive family history for ischemic heart disease, coronary artery and peripheral artery profile. Results: Mean age was 56.83±13.64 years, Male mean age was 53.98±15.08 years and female mean age was 54.5±1.73years. Hypertension was detected in 55.8%, diabetes in 87%, dyslipidaemia in 81.8%, smoking habits in 79.2% and 58.4% had a positive family history. After catheterization 88.3% had peripheral arterial disease and 71.4% had coronary artery disease. Out of 77 patients, 52 had both coronary and peripheral arterial disease which was statistically significant (p < .014). Coronary angiogram revealed 28.6% (22) patients had triple vessel disease, 23.3% (18) had single vessel disease, 19.5% (15) had double vessel disease and 28.6% (22) were normal coronary arteries. The peripheral angiogram revealed 54.5% had superficial femoral artery disease, 26% had anterior tibial artery disease, 27.3% had posterior tibial artery disease, 20.8% had common iliac artery disease, 15.6% had common femoral artery disease and 2.6% had renal artery disease. Conclusion: There is a strong and definite correlation between coronary and peripheral arterial disease. We found that cardiovascular risk factors were in fact risk factors for both PAD and CAD.

Keywords: coronary artery disease (CAD), peripheral artery disease(PVD), risk, factors, correlation, cathetarization

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Authors: Halimatu S. Abdullahi, Ray E. Sheriff, Fatima Mahieddine

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Agriculture is essential to the continuous existence of human life as they directly depend on it for the production of food. The exponential rise in population calls for a rapid increase in food with the application of technology to reduce the laborious work and maximize production. Technology can aid/improve agriculture in several ways through pre-planning and post-harvest by the use of computer vision technology through image processing to determine the soil nutrient composition, right amount, right time, right place application of farm input resources like fertilizers, herbicides, water, weed detection, early detection of pest and diseases etc. This is precision agriculture which is thought to be solution required to achieve our goals. There has been significant improvement in the area of image processing and data processing which has being a major challenge. A database of images is collected through remote sensing, analyzed and a model is developed to determine the right treatment plans for different crop types and different regions. Features of images from vegetations need to be extracted, classified, segmented and finally fed into the model. Different techniques have been applied to the processes from the use of neural network, support vector machine, fuzzy logic approach and recently, the most effective approach generating excellent results using the deep learning approach of convolution neural network for image classifications. Deep Convolution neural network is used to determine soil nutrients required in a plantation for maximum production. The experimental results on the developed model yielded results with an average accuracy of 99.58%.

Keywords: convolution, feature extraction, image analysis, validation, precision agriculture

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Authors: N. Anjana

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Worldwide, the prevalence of mental illnesses is increasing. The issues of persons with mental illness and their caregivers have been well documented in the literature. However, data regarding the factors affecting the caregiving experience of children with parental mental illnesses is sparse. This systematic review aimed to examine the existing literature of the factors affecting the caregiving experience of children of parents with mental illnesses. A comprehensive search of databases such as PubMed, EBSCO, JSTOR, ProQuest Central, Taylor and Francis Online, and Google Scholar were performed to identify peer-reviewed papers examining the factors associated with caregiving experiences of children with parental mental illnesses such as schizophrenia and major depression, for the 10-year period ending November 2019. Two researchers screened studies for eligibility. One researcher extracted data from eligible studies while a second performed verification of results for accuracy and completeness. Quality appraisal was conducted by both reviewers. Data describing major factors associated with caregiving experiences of children with parental mental illnesses were synthesized and reported in narrative form. Five studies were considered eligible and included in this review. Findings are organized under major themes such as the impact of parental mental illness on children’s daily life, how children provide care to their mentally ill parents as primary carers, social and relationship factors associated with their caregiving, positive and negative experiences in caregiving and how children cope with their experiences with parental mental illnesses. Literature relating to the caregiving experiences of children with parental mental illnesses is sparse. More research is required to better understand the children’s caregiving experiences related to parental mental illnesses so as to better inform management for enhancing their mental health, wellbeing, and caregiving practice.

Keywords: caregiving experience, children, parental mental illnesses, wellbeing

Procedia PDF Downloads 139

Authors: A. Dinelka Panagoda, Bathiya Bandara, Chamod Wijetunga, Chathura Malinda, Lakmal Rupasinghe, Chethana Liyanapathirana

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This research takes us forward with the concepts of Federated Learning and Software-Defined Networking (SDN) to introduce an efficient malware detection technique and provide a mitigation mechanism to give birth to a resilient and automated healthcare sector network system by also adding the feature of extended privacy preservation. Due to the daily transformation of new malware attacks on hospital Integrated Clinical Environment (ICEs), the healthcare industry is at an undefinable peak of never knowing its continuity direction. The state of blindness by the array of indispensable opportunities that new medical device inventions and their connected coordination offer daily, a factor that should be focused driven is not yet entirely understood by most healthcare operators and patients. This solution has the involvement of four clients in the form of hospital networks to build up the federated learning experimentation architectural structure with different geographical participation to reach the most reasonable accuracy rate with privacy preservation. While the logistic regression with cross-entropy conveys the detection, SDN comes in handy in the second half of the research to stack up the initial development phases of the system with malware mitigation based on policy implementation. The overall evaluation sums up with a system that proves the accuracy with the added privacy. It is no longer needed to continue with traditional centralized systems that offer almost everything but not privacy.

Keywords: software-defined network, federated learning, privacy, integrated clinical environment, decentralized learning, malware detection, malware mitigation

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Authors: Mashaal Hooda

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The rationale for conducting this action research was to increase students' Academic Achievement (AA) contexts of studying/researching by employing the Goal Setting intervention (GS). The purposive sample consisted of 10 female undergraduate students at a university in Dubai. The intervention was introduced through workshop classes conducted online. The pre-intervention consisted of discussions concentrating on participants' research contexts amidst a pandemic. The GS moderators were implemented in the class, followed by scaffolding and mentoring interactions and self-reflective accounts of students' actions and feelings of using the intervention to better plan and structure their dissertation tasks. The research incorporated a Mixed Methods Methodology (MMM). Quantitative data collection took place through surveys, while qualitative data were collected using semi-structured interviews. Triangulation of the emergent themes showed a positive increase in students achievable GS, self-regulatory study skills, feedback-seeking behaviours, research organisation and synthesis, self-reflection and Academic Resilient (AR) attitudes amalgamate to enhance students' AA outcomes. Though, students' intrinsic motivational levels to study and research observed minor changes only. Nonetheless, the pebble in the shoe was removed as students AA contexts improved in undertaking better actionable steps for their research. Therefore, the GS intervention enabled students to set, balance, and achieve academic goals while catering to their academic anxieties, mental health concerns, and adaptability to the e-learning platforms amidst the COVID-19 pandemic. Despite the wide-scale changes the pandemic brought to the teaching and learning communities, the GS intervention served as a targeted intervention to help students maintain their achievement contexts in a goal-oriented way.

Keywords: academic achievement, acadeic resilience, COVID-19, goal setting

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Authors: Nkiru Nnaemezie, J. O. Okafor

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The high mortality as a result of pregnancy related illnesses is a global public health problem and a source of concern to most countries including Nigeria. This study was therefore designed to determine the Demographic Variables associated with common pregnancy related illnesses among pregnant mothers in Awka South Local Government Area of Anambra State. The design of the study was an expost-facto research design. All the folders of the pregnant mothers that were studied from 2010-2014 formed the population of the study which included 10,250 folders. Based on the content of the folders, a researcher developed pro-forma (RDP) was used for data collection. Five research questions and five hypotheses were postulated for the study. Research questions postulated were answered using simple percentage. Hypotheses stated were analyzed at 0.05 level of significance using chi-square (X²) statistics. The result among others showed that pregnant mothers within 15-29 years had the most pregnancy related illnesses than mothers on other age brackets. Pregnant mothers with 0-1 parity level experienced the most pregnancy related illnesses than mothers on other parity levels. Public servants experienced the most pregnancy related illnesses than mothers in other occupations. Married pregnant mothers experienced the most pregnancy related illnesses than single mothers. Pregnant mothers with secondary education had the most pregnancy related illnesses than mothers in other education levels. There were significant differences in the common pregnancy related illnesses among the pregnant mothers of the study in relation to the demographic variables of the study which included age, parity, occupation, marital status and educational level. Based on the findings, conclusions were drawn, and the following recommendations among others were made: there is need for health education in terms of educating those pregnant mothers during antenatal clinics; single mothers should be advised to register for antenatal early enough.

Keywords: analysis, demographic variables, pregnancy related illnesses, pregnant mothers

Procedia PDF Downloads 253

Authors: Numfon Rakkhumkaew, Takeru Kawasaki, Makoto Fujie, Takashi Yamada

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Chlorella viruses or chloroviruses contain a gene that encodes a function for chitin synthesis, which is expressed early in viral infection to produce chitin polysaccharide, a polymer of β-1, 4-linked GlcNAc, on the outside of Chlorella cell wall. Interestingly, chlorovirus system is an eco-friendly system which converses CO2 and solar energy from the environment into useful materials. However, infected Chlorella cells are lysed at the final stage of viral infection, and this phenomenon is caused the breaking down of polysaccharide. To postpone the lysing period and prolong the synthesis of chitin polysaccharide on cells, the slow growing virus incorporated with aphidicolin treatment, an inhibitor of DNA synthesis, was investigated. In this study, a total of 25 virus isolates from water samples in Japan region were analyzed for CHS (the gene for CH synthase) gene by PCR (polymerase chain reaction). The accumulation and appearance of chitin polysaccharide on infected cells were detected by biotinylated chitin-binding proteins WGA (wheat germ agglutinin)-biotin for chitin in conjunction with avidin-Cy 2 or Cy 3 and investigated by fluorescence microscopy, observed as green or yellow fluorescence over the cell surface. Among all chlorovirus isolates, cells infected with CNF1 revealed the accumulation of chitin over the cell surface within 30 min p.i. and continued to accumulate on cells until 4 h p.i. before cell lyses which was 1.6 times longer accumulation period than cells infected with CVK2 (prototype virus). Furthermore, addition of aphidicolin could extend the chitin accumulation on cells infected with CNF1 until 8 h p.i. before cell lyses. Whereas, CVK2-infected cells treated with aphidicolin could prolong the chitin synthesis only for 6 h p.i. before cell lyses. Therefore, chitin synthesis by Chlorella-virus system could be prolonged by using slow-growing viral isolates and with aphidicolin.

Keywords: chitin, chlorovirus, Chlorella virus, aphidicolin

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Authors: Camelia Porey, Binaya Kumar Jaiswal

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BACKGROUND: Antiphospholipid antibody (APLA) syndrome is an autoimmune disorder predisposing to thrombotic complications affecting CNS either by arterial vasooclusion or venous thrombosis. Cerebral venous sinus thrombosis (CVST) secondarily causes raised intracranial pressure (ICP). However, intracranial hypertension without evidence of CVST is a rare entity. Here we present two cases of elevated ICP with absence of identifiable CVST. CASE SUMMARY: Case 1, 28-year female had a 2 months history of holocranial headache followed by bilateral painless vision loss reaching lack of light perception over 20 days. CSF opening pressure was elevated. Fundoscopy showed bilateral grade 4 papilledema. MRI revealed a partially empty sella with bilateral optic nerve tortuosity. Idiopathic intracranial hypertension (IIH) was diagnosed. With acetazolamide, there was complete resolution of the clinical and radiological abnormalities. 5 months later she presented with acute onset right-sided hemiparesis. MRI was suggestive of acute left MCA infarct.MR venogram was normal. APLA came positive with high titres of Anticardiolipin and Beta 2 glycoprotein both IgG and IgM. Case 2, 23-year female, presented with headache and diplopia of 2 months duration. CSF pressure was elevated and Grade 3 papilledema was seen. MRI showed bilateral optic nerve hyperintensities with nerve head protrusion with normal MRV. APLA profile showed elevated beta 2 glycoprotein IgG and IgA. CONCLUSION: This is an important non thrombotic complication of APLA syndrome and requires further large-scale study for insight into the pathogenesis and early recognition to avoid future complications.

Keywords: APLA syndrome, idiopathic intracranial hypertension, MR venogram, papilledema

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Authors: Özge Selin Çevik, Leyla Şahin, Gülhan Örekeci Temel

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The early postnatal period is critical for the development of cognitive and emotional functions. Maternal separation is a detrimental postnatal influence, whereas environmental enrichment is a therapeutic and protective agent. It is unclear if long-term environmental enrichment can compensate for the effects of maternal separation stress on anxiety behavior. This study was designed to examine how environmental enrichment affects anxiety levels and corticosterone levels in maternally separated rats. There are six main groups in this study: control (C), maternal separation+standard cage (MS), maternal separation+enriched environment (MSE), enriched environment (E), the maternal separation that decapitated at postnatal (PN) 21 (MS21), and standard cage that decapitated at PN21 (STD21). The maternal separation procedure consisted of PN for 21 days (between 09:00 a.m and 12:00 a.m). Enriched (E, MSE) or standard cage environment rats (MS, C) spent PN (22-55) days in either enriched cages or standard cages. Anxiety and locomotor activity were examined with the open field and elevated plus-maze test. Blood corticosterone level was evaluated by the enzyme-linked immunosorbent assay (ELISA) method. Results showed that maternal separation (MS) increased locomotor activity and anxiety. An enriched environment (E) did not change the locomotor activity. MSE group’s anxiety and locomotor activity did not change. Corticosterone levels increased in the maternal separation group that decapitated at the PN 21 days. Maternal separation increases anxiety. Environmental enrichment alone was insufficient to cause alterations in the anxiety level. In addition, environmental enrichment did not ameliorate the anxiety level in maternally separated rats. However, environmental enrichment decreased the locomotor activity in the maternally separated rats.

Keywords: maternal separation, environment enrichment, stress, hippocampus, anxiety, memory, rat

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Authors: Emmanuel Chibuogu Asogwa, Tochukwu Sunday Belonwu

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An urgent demand for creative solutions has been created by the rapid expansion of medical knowledge, the complexity of patient care, and the requirement for more precise decision-making. As a solution to this problem, the creation of a Medical Intelligent Process Model (MIPM) utilizing ontology-based appears as a promising way to overcome this obstacle and unleash the full potential of healthcare systems. The development of a Medical Intelligent Process Model (MIPM) using ontology-based techniques is motivated by a lack of quick access to relevant medical information and advanced tools for treatment planning and clinical decision-making, which ontology-based techniques can provide. The aim of this work is to develop a structured and knowledge-driven framework that leverages ontology, a formal representation of domain knowledge, to enhance various aspects of healthcare. Object-Oriented Analysis and Design Methodology (OOADM) were adopted in the design of the system as we desired to build a usable and evolvable application. For effective implementation of this work, we used the following materials/methods/tools: the medical dataset for the test of our model in this work was obtained from Kaggle. The ontology-based technique was used with Confusion Matrix, MySQL, Python, Hypertext Markup Language (HTML), Hypertext Preprocessor (PHP), Cascaded Style Sheet (CSS), JavaScript, Dreamweaver, and Fireworks. According to test results on the new system using Confusion Matrix, both the accuracy and overall effectiveness of the medical intelligent process significantly improved by 20% compared to the previous system. Therefore, using the model is recommended for healthcare professionals.

Keywords: ontology-based, model, database, OOADM, healthcare

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Authors: Raja Umer Sajjad, Chang Hee Lee

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Stormwater runoff is the leading contributor to pollution of receiving waters. In response, an efficient stormwater monitoring program is required to quantify and eventually reduce stormwater pollution. The overall goals of stormwater monitoring programs primarily include the identification of high-risk dischargers and the development of total maximum daily loads (TMDLs). The challenge in developing better monitoring program is to reduce the variability in flux estimates due to sampling errors; however, the success of monitoring program mainly depends on the accuracy of the estimates. Apart from sampling errors, manpower and budgetary constraints also influence the quality of the estimates. This study attempted to develop optimum stormwater monitoring design considering both cost and the quality of the estimated pollutants flux. Three years stormwater monitoring data (2012 – 2014) from a mix land use located within Geumhak watershed South Korea was evaluated. The regional climate is humid and precipitation is usually well distributed through the year. The investigation of a large number of water quality parameters is time-consuming and resource intensive. In order to identify a suite of easy-to-measure parameters to act as a surrogate, Principal Component Analysis (PCA) was applied. Means, standard deviations, coefficient of variation (CV) and other simple statistics were performed using multivariate statistical analysis software SPSS 22.0. The implication of sampling time on monitoring results, number of samples required during the storm event and impact of seasonal first flush were also identified. Based on the observations derived from the PCA biplot and the correlation matrix, total suspended solids (TSS) was identified as a potential surrogate for turbidity, total phosphorus and for heavy metals like lead, chromium, and copper whereas, Chemical Oxygen Demand (COD) was identified as surrogate for organic matter. The CV among different monitored water quality parameters were found higher (ranged from 3.8 to 15.5). It suggests that use of grab sampling design to estimate the mass emission rates in the study area can lead to errors due to large variability. TSS discharge load calculation error was found only 2 % with two different sample size approaches; i.e. 17 samples per storm event and equally distributed 6 samples per storm event. Both seasonal first flush and event first flush phenomena for most water quality parameters were observed in the study area. Samples taken at the initial stage of storm event generally overestimate the mass emissions; however, it was found that collecting a grab sample after initial hour of storm event more closely approximates the mean concentration of the event. It was concluded that site and regional climate specific interventions can be made to optimize the stormwater monitoring program in order to make it more effective and economical.

Keywords: first flush, pollutant load, stormwater monitoring, surrogate parameters

Procedia PDF Downloads 238

Authors: Matthew Edmunds, Andrew Hunter, Clare Littlewood, Wisha Gul, Gabriel Heppenstall-Harris, Thomas Humphries

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Background: Revision courses for medical students undertaking their final examinations are commonplace throughout the UK. Traditionally these take the form of a series of lectures over multiple weeks or a single day of intensive lectures. The COVID-19 pandemic, however, has required medical educators to create new teaching formats to ensure they adhere to social distancing requirements. It has provided an unexpected opportunity to accelerate the development of students proficiency in the use of ‘technology-enabled communication platforms’, as mandated in the 2018 GMC Outcomes of Graduates. Recent advances in technology have made distance learning possible, whilst also providing novel and more engaging learning opportunities for students. Foundation Year 2 doctors at Aintree University Hospital developed an online series of videos to help prepare medical students in the North West and byond for their final medical school examinations. Method: Eight hour-long videos covering the key topics in medicine and surgery were posted on the Peer Learning Liverpool Youtube channel. These videos were created using new technology such as the screen and audio recording platform, Loom. Each video compromised at least 20 single best answer (SBA) questions, in keeping with the format in most medical school finals. Explanations of the answers were provided, and additional important material was covered. Students were able to ask questions by commenting on the videos, with the authors replying as soon as possible. Feedback was collated using an online Google form. Results: An average of 327 people viewed each video, with 113 students filling in the feedback form. 65.5% of respondents were within one month of their final medical school examinations. The average rating for how well prepared the students felt for their finals was 6.21/10 prior to the course and 8.01/10 after the course. A paired t-test demonstrated a mean increase of 1.80 (95% CI 1.66-1.93). Overall, 98.2% said the online format worked well or very well, and 99.1% would recommend the course to a peer. Conclusions: Based on the feedback received, the online revision course was successful both in terms of preparing students for their final examinations, and with regards to how well the online format worked. Free-text qualitative feedback highlighted advantages such as; students could learn at their own pace, revisit key concepts important to them, and practice exam style questions via the case-based format. Limitations identified included inconsistent audiovisual quality, and requests for a live online Q&A session following the conclusion of the course. This course will be relaunched later in the year with increased opportunities for students to access live feedback. The success of this online course has shown the roll that technology can play in medical education. As well as providing novel teaching modes, online learning allows students to access resources that otherwise would not be available locally, and ensure that they do not miss out on teaching that was previously provided face to face, in the current climate of social distancing.

Keywords: COVID-19 pandemic, Medical School, Online learning, Revision course

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Authors: Swati Tomar, Sunil Kumar Gupta

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The start-up of anammox (anaerobic ammonium oxidation) process in hybrid reactor delineated four distinct phases i.e. cell lysis, lag phase, activity elevation and stationary phase. Cell lysis phase was marked by death and decay of heterotrophic denitrifiers resulting in breakdown of organic nitrogen into ammonium. Lag phase showed initiation of anammox activity with turnover of heterotrophic denitrifiers, which is evident from appearance of NO3-N in the effluent. In activity elevation phase, anammox became the dominant reaction, which can be attributed to consequent reduction of NH4-N into N2 with increased NO3-N in the effluent. Proper selection of mixed seed culture at influent NO2-/NH4+ ratio (1:1) and hydraulic retention time (HRT) of 1 day led to early startup of anammox within 70 days. Pseudo steady state removal efficiencies of NH4+ and NO2- were found as 94.3% and 96.4% respectively, at nitrogen loading rate (NLR) of 0.35 kg N/m3d at an HRT of 1 day. Analysis of the data indicated that attached growth system contributes an additional 11% increase in the ammonium removal and results in an average of 29% reduction in sludge washout rate. Mass balance study of nitrogen indicated that 74.1% of total input nitrogen is converted into N2 gas followed by 11.2% being utilized in biomass development. Scanning electron microscope (SEM) observation of the granular sludge clearly showed the presence of cocci and rod shaped microorganisms intermingled on the external surface of the granules. The average size of anammox granules (1.2-1.5 mm) with an average settling velocity of 45.6 m/h indicated a high degree of granulation resulting into formation of well compacted granules in the anammox process.

Keywords: anammox, hybrid reactor, startup, granulation, nitrogen removal, mixed seed culture

Procedia PDF Downloads 182