Search results for: multi-criteria evaluation (MCE)

Authors: Manohar Salla, Mark S. Butler, Ruby Pelingon, Geraldine Kaeslin, Daniel E. Croker, Janet C. Reid, Jong Min Baek, Paul V. Bernhardt, Elizabeth M. J. Gillam, Matthew A. Cooper, Avril A. B. Robertson

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MCC950 is a potent and selective inhibitor of the NOD-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome that shows early promise for treatment of inflammatory diseases. The identification of major metabolites of lead molecule is an important step during drug development process. It provides an information about the metabolically labile sites in the molecule and thereby helping medicinal chemists to design metabolically stable molecules. To identify major metabolites of MCC950, the compound was incubated with human liver microsomes and subsequent analysis by (+)- and (−)-QTOF-ESI-MS/MS revealed a major metabolite formed due to hydroxylation on 1,2,3,5,6,7-hexahydro-s-indacene moiety of MCC950. This major metabolite can lose two water molecules and three possible regioisomers were synthesized. Co-elution of major metabolite with each of the synthesized compounds using HPLC-ESI-SRM-MS/MS revealed the structure of the metabolite (±) N-((1-hydroxy-1,2,3,5,6,7-hexahydro-s-indacen-4-yl)carbamoyl)-4-(2-hydroxypropan-2-yl)furan-2-sulfonamide. Subsequent synthesis of individual enantiomers and coelution in HPLC-ESI-SRM-MS/MS using a chiral column revealed the metabolite was R-(+)- N-((1-hydroxy-1,2,3,5,6,7-hexahydro-s-indacen-4-yl)carbamoyl)-4-(2-hydroxypropan-2-yl)furan-2-sulfonamide. To study the possible cytochrome P450 enzyme(s) responsible for the formation of major metabolite, MCC950 was incubated with a panel of cytochrome P450 enzymes. The result indicated that CYP1A2, CYP2A6, CYP2B6, CYP2C9, CYP2C18, CYP2C19, CYP2J2 and CYP3A4 are most likely responsible for the formation of the major metabolite. The biological activity of the major metabolite and the other synthesized regioisomers was also investigated by screening for for NLRP3 inflammasome inhibitory activity and cytotoxicity. The major metabolite had 170-fold less inhibitory activity (IC50-1238 nM) than MCC950 (IC50-7.5 nM). Interestingly, one regioisomer had shown nanomolar inhibitory activity (IC50-232 nM). However, no evidence of cytotoxicity was observed with any of these synthesized compounds when tested in human embryonic kidney 293 cells (HEK293) and human liver hepatocellular carcinoma G2 cells (HepG2). These key findings give an insight into the SAR of the hexahydroindacene moiety of MCC950 and reveal a metabolic soft spot which could be blocked by chemical modification.

Keywords: Cytochrome P450, inflammasome, MCC950, metabolite, microsome, NLRP3

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Authors: Abdelmanie Suleimat, Nagham Abu Shaqra, Sawsan Majali, Issam Adawi, Heba Abo Shindi, Anas Al Mohtaseb

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The Government of Jordan recognizes that maternal mortality constitutes a grave public health problem. Over the past two decades, there has been significant progress in improving the quality of maternal health services, resulting in improved maternal and child health outcomes. Despite these efforts, measurement and analysis of maternal mortality remained a challenge, with significant discrepancies from previous national surveys that inhibited accuracy. In response with support from USAID, the Jordan Maternal Mortality Surveillance Response (JMMSR) System was established to collect, analyze, and equip policymakers with data for decision-making guided by interdisciplinary multi-levelled advisory groups aiming to eliminate preventable maternal deaths, A 2016 Public Health Bylaw required the notification of deaths among women of reproductive age. The JMMSR system was launched in 2018 and continues annually, analyzing data received from health facilities, to guide policy to prevent avoidable deaths. To date, there have been four annual national maternal mortality reports (2018-2021). Data is collected, reviewed by advisory groups, and then consolidated in an annual report to inform and guide the Ministry of Health (MOH); JMMSR collects the necessary information to calculate an accurate maternal mortality ratio and assists in identifying leading causes and contributing factors for each maternal death. Based on this data, national response plans are created. A monitoring and evaluation plan was designed to define, track, and improve implementation through indicators. Over the past four years, one of these indicators, ‘percent of facilities notifying respective health directorates of all deaths of women of reproductive age,’ increased annually from 82.16%, 92.95%, and 92.50% to 97.02%, respectively. The Government of Jordan demonstrated commitment to the JMMSR system by designating the MOH to primarily host the system and lead the development and dissemination of policies and procedures to standardize implementation. The data was translated into practical and evidence-based recommendations. The successful impact of results deepened the understanding of maternal mortality in Jordan, which convinced the MOH to amend the Bylaw now mandating electronic reporting of all births and neonatal deaths from health facilities to empower the JMMSR system, by developing a stillbirths and neonatal mortality surveillance and response system.

Keywords: maternal health, maternal mortality, preventable maternal deaths, maternal morbidity

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Authors: P. Vindin, R. Cordier, N. J. Wilson, H. Lee

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Engagement in community-based activities such as education, employment, and social relationships can improve the quality of life for individuals with Autism Spectrum Disorder (ASD). Community mobility is vital to attaining independence for individuals with ASD. Learning to drive and gaining a driver’s license is a critical link to community mobility; however, for individuals with ASD acquiring safe driving skills can be a challenging process. Issues related to anxiety, executive function, and social communication may affect driving behaviours. Driving training and education aimed at addressing barriers faced by learner drivers with ASD can help them improve their driving performance. A multi-site randomized controlled trial (RCT) was conducted to evaluate the effectiveness of an autism-specific driving training intervention for improving the on-road driving performance of learner drivers with ASD. The intervention was delivered via a training manual and interactive website consisting of five modules covering varying driving environments starting with a focus on off-road preparations and progressing through basic to complex driving skill mastery. Seventy-two learner drivers with ASD aged 16 to 35 were randomized using a blinded group allocation procedure into either the intervention or control group. The intervention group received 10 driving lessons with the instructors trained in the use of an autism-specific driving training protocol, whereas the control group received 10 driving lessons as usual. Learner drivers completed a pre- and post-observation drive using a standardized driving route to measure driving performance using the Driving Performance Checklist (DPC). They also completed anxiety, executive function, and social responsiveness measures. The findings showed that there were significant improvements in driving performance for both the intervention (d = 1.02) and the control group (d = 1.15). However, the differences were not significant between groups (p = 0.614) or study sites (p = 0.842). None of the potential moderator variables (anxiety, cognition, social responsiveness, and driving instructor experience) influenced driving performance. This study is an important step toward improving community mobility for individuals with ASD showing that an autism-specific driving training intervention can improve the driving performance of leaner drivers with ASD. It also highlighted the complexity of conducting a multi-site design even when sites were matched according to geography and traffic conditions. Driving instructors also need more and clearer information on how to communicate with learner drivers with restricted verbal expression.

Keywords: autism spectrum disorder, community mobility, driving training, transportation

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Authors: Hacer Kobya Bulut, Ilknur Kahriman, Birsel C. Demirbag

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Introduction and Purpose: The lives of children with cancer are affected by long term hospitalizations in a negative way due to complications arising from diagnosis or treatment. However, the children's parents are known to have difficulties in meeting their children’s needs and providing home care after cancer treatment or during remission process. Supporting these children and their parents by giving a planned discharge training starting from the hospital and home care leads to reducing hospital applications, hospitalizations, hospital costs, shortening the length of hospital stay and increasing the satisfaction of the children with cancer and their families. This study was conducted to investigate the status of children and their parents' unplanned application to hospital and re-hospitalization. Methods: The study was carried out with 65 children with hematological malignancy in 0-17 age group and their families in a hematology clinic and polyclinic of a university hospital in Trabzon. Data were collected with survey methodology between August-November, 2015 through face to face interview using numbers, percentage and chi-square test in the evaluation. Findings: Most of the children were leukemia (90.8%) and 49.2% had been ill over 13 months. Few of the parents (32.3%) stated that they had received discharge and home care training (24.6%) but most of them (69.2%) found themselves enough in providing home care. Very few parents (6.2%) received home care training after their children being discharged and the majority of parents (61.5%) faced difficulties in home care and had no one to call around them. The parents expressed that in providing care to their children with hematological malignance, they faced difficulty in feeding them (74.6%), explaining their disease (50.0%), giving their oral medication (47.5%), providing hygiene (43.5%) and providing oral care (39.3%). The question ‘What are the emergency situations in which you have to bring your children to a doctor immediately?' was replied as fever (89.2%), severe nausea and vomiting (87.7%), hemorrhage (86.2%) and pain (81.5%). The study showed that 50.8% of the children had unplanned applications to hospitals and 33.8% of them identified as unplanned hospitalization and the first causes of this were fever and pain. The study showed that the frequency of applications (%78.8) and hospitalizations (%81.8) was higher for boys and a statistically significant difference was found between gender and unplanned applications (X=4.779; p=0.02). Applications (48.5%) and hospitalizations (40.9%) were found lower for the parents who had received hospital discharge training, and a significant difference was determined between receiving training and unplanned hospitalizations (X=8.021; p=0.00). Similarly, applications (30.3%) and hospitalizations (40.9%) was found lower for the ones who had received home care training, and a significant difference was determined between receiving home care training and unplanned hospitalizations (X=4.758; p=0.02). Conclusion: It was found out that caregivers of children with cancer did not receive training related to home care and complications about treatment after discharging from hospital, so they faced difficulties in providing home care and this led to an increase in unplanned hospital applications and hospitalizations.

Keywords: cancer, children, unplanned application, unplanned hospitalization

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Authors: Yonit Nissim, Eyal Weissblueth

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This research is the continuation of a process that began in 2010 with the goal of redesigning the training program for future early childhood teachers at the Ohalo College, to integrate technology and provide 21st-century skills. The article focuses on a study of the processes involved in developing a special educational unit which challenged students with the task of designing, planning and building an internet site for kindergartens. This project was part of their second-year studies in the early childhood track of an interdisciplinary course entitled 'Educating for the Future.' The goal: enabling students to gain experience in developing an internet site specifically for kindergartens, and gain familiarity with Google platforms, the acquisition and use of innovative skills and the integration of technology in pedagogy. Research questions examined how students handled the task of building an internet site. The study explored whether the guided process of building a site helped them develop proficiency in creativity, teamwork, evaluation and learning appropriate to the 21st century. The research tool was a questionnaire constructed by the researchers and distributed online to the students. Answers were collected from 50-course participants. Analysis of the participants’ responses showed that, along with the significant experience and benefits that students gained from building a website for kindergarten, ambivalence was shown toward the use of new, unfamiliar and complex technology. This attitude was characterized by unease and initial emotional distress triggered by the departure from routine training to an island of uncertainty. A gradual change took place toward the adoption of innovation with the help of empathy, training, and guidance from the instructors, leading to the students’ success in carrying out the task. Initial success led to further successes, resulting in a quality product and a feeling of personal competency among the students. A clear and extreme emotional shift was observed on the spectrum from a sense of difficulty and dissatisfaction to feelings of satisfaction, joy, competency and cognitive understanding of the importance of facing a challenge and succeeding. The findings of this study can contribute to increased understanding of the complex training process of future kindergarten teachers, coping with a changing world, and pedagogy that is supported by technology.

Keywords: early childhood teachers, educating for the future, emotions, kindergarten website

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Authors: Akanksha Dicholkar, Celin Jacob, Omkar More

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Work force instability, as demonstrated by high rates of staff turnover and lingering vacancy rates, continues to be a major challenge faced by health care organizations. The impact is manifested in workflow inefficiencies, delays in delivering patient care, and dissatisfaction among patients and staff, all of which can have significant negative effects on quality of care and patient safety. In addition, the staggering administrative costs created by a transient work force threaten health care organizations financial viability. One nurse retention strategy is to have newly hired nurses partake in Preceptorship. Precepting is a way to enculturate new employees into their role. Also good professional, collegial relationship between an experienced nurse and a newly hired nurse relations was evidenced. This study demonstrates impact of preceptor program on absconding rate, employee satisfaction & Patient satisfaction. Purpose of study: To decrease absconding rate. Objective: 1. To reduce the high absconding rate among nurses in Aster Medcity (AMC). 2. To facilitate the acclimatization of the newly hired nurse into their role, focusing on professional growth, inter-professional relationships and clinical skills required for the job. Methodology: Descriptive study by Convenience sampling method and collect data by direct observation, questionnaire, interviews. Sample size as per Sample size statistical table at 95 % CI. We conducted a pre and post intervention analysis to assess the impact of Preceptorship at AMC, with a daily occupancy of approx. 300 patients. Result: Preceptor program has had a significant improvement positive impact on all measured parameters. Absconding rate came down from 20% to 0% (P= 0.001). Patient satisfaction scores rose from 85% to 95%. Employee satisfaction rose form 65% to 85%. Conclusion: The project proved that Preceptor Development Programme and the steps taken in hand holding of the new joinees were effective in reducing the absconding rate among nurses and improved the overall satisfaction of new nurses. Preceptee satisfaction with the preceptorship experience was correlated with favorable evaluation of the relationship between the preceptee and preceptor. These findings indicate that when preceptors and preceptees have the benefit of formal preceptorship programs that are well supported, and when the preceptors’ efforts are rewarded, satisfaction is enhanced for both participants, preceptor commitment to the role is reinforced.

Keywords: absconding rate, preceptor, employee satisfaction index, satisfaction index

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Authors: Yuji Fujino, Kazu Amimoto, Kazuhiro Fukata, Masahide Inoue, Hidetoshi Takahashi, Shigeru Makita

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Aim: Pusher behavior (PB) is a disorder in which stroke patients shift their body weight toward the affected side of the body (the hemiparetic side) and push away from the non-hemiparetic side. These patients often use further pushing to resist any attempts to correct their position to upright. It is known that the subcortical white matter lesion (SWML) usually correlates of gait or balance function in stroke patients. However, it is unclear whether the SWML influences PB. The purpose of this study was to investigate if the damage of SWML affects the severity of PB on acute stroke patients. Methods: Fourteen PB patients without thalamic or cortical lesions (mean age 73.4 years, 17.5 days from onset) participated in this study. Evaluation of PB was performed according to the Scale for Contraversive Pushing (SCP) for sitting and/or standing. We used modified criteria wherein the SCP subscale scores in each section of the scale were >0. As a clinical measurement, patients were evaluated by the Stroke Impairment Assessment Set (SIAS). For the depiction of SWML, we used T2-weighted fluid-attenuated inversion-recovery imaging. The degree of damage on SWML was assessed using the Fazekas scale. Patients were divided into two groups in the presence of SWML (SWML+ group; Fazekas scale grade 1-3, SWML- group; Fazekas scale grade 0). The independent t-test was used to compare the SCP and SIAS. This retrospective study was approved by the Ethics Committee. Results: In SWML+ group, the SCP was 3.7±1.0 points (mean±SD), the SIAS was 28.0 points (median). In SWML- group, the SCP was 2.0±0.2 points, and the SIAS was 31.5 points. The SCP was significantly higher in SWML+ group than in SWML- group (p<0.05). The SIAS was not significant in both groups (p>0.05). Discussion: It has been considered that the posterior thalamus is the neural structures that process the afferent sensory signals mediating graviceptive information about upright body orientation in humans. Therefore, many studies reported that PB was typically associated with unilateral lesions of the posterior thalamus. However, the result indicates that these extra-thalamic brain areas also contribute to the network controlling upright body posture. Therefore, SMWL might induce dysfunction through malperfusion in distant thalamic or other structurally intact neural structures. This study had a small sample size. Therefore, future studies should be performed with a large number of PB patients. Conclusion: The present study suggests that SWML can be definitely associated with PB. The patients with SWML may be severely incapacitating.

Keywords: pushing behavior, subcortical white matter lesion, acute phase, stroke

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Authors: Jason Hoellwarth, Atiya Oomatia, Anuj Chavan, Kevin Tetsworth, Munjed Al Muderis

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Introduction: Percutaneous EndoProsthetic Osseointegration for Limbs (PEPOL) facilitates improved quality of life (QOL) and objective mobility for most amputees discontent with their traditional socket prosthesis (TSP) experience. Some amputees desiring PEPOL have residual bone much shorter than the currently marketed press-fit implant lengths of 14-16 cm, potentially a risk for failure to integrate. We report on the techniques used, complications experienced, the management of those complications, and the overall mobility outcomes of seven patients who had femur distraction osteogenesis (DO) with a Freedom nail followed by PEPOL. Method: Retrospective evaluation of a prospectively maintained database identified nine patients (5 females) who had transfemoral DO in preparation for PEPOL with two years of follow-up after PEPOL. Six patients had traumatic causes of amputation, one had perinatal complications, one was performed to manage necrotizing fasciitis and one was performed as a result of osteosarcoma. Result: The average age at which DO commenced was 39.4±15.9 years, and seven patients had their amputation more than ten years prior (average 25.5±18.8 years). The residual femurs, on average, started at 102.2±39.7 mm and were lengthened 58.1±20.7 mm, 98±45% of the goal (99±161% of the original bone length). Five patients (56%) had a complication requiring additional surgery: four events of inadequate regeneration were managed with continued lengthening to the desired goal followed by autograft placement harvested from contralateral femur reaming; one patient had the cerclage wires break, which required operative replacement. All patients had osseointegration performed at 355±123 days after the initial lengthening nail surgery. One patient had K-level >2 before DO, at a mean of 3.4±0.6 (2.6-4.4) years following osseointegration. Six patients had K-level >2. The 6-Minute Walk Test remained unchanged (267±56 vs. 308 ± 117 meters). Patient self-rating of prosthesis function, problems, and amputee situation did not significantly change from before DO to after osseointegration. Six patients required additional surgery following osseointegration: six to remove fixation plates placed to maintain distraction osteogenesis length at osseointegration; two required irritation and debridement for infection. Conclusion: Extremely short residual femurs, which make TSP use troublesome, can be lengthened with externally controlled telescoping nails and successfully achieve osseointegration. However, it is imperative to counsel patients that additional surgery to address inadequate regeneration or to remove painful hardware used to maintain fixation may be necessary. This may improve the amputee’s expectations before beginning a potentially arduous process.

Keywords: osseointegration, limb lengthening, quality of life, amputation

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Authors: Naomi Sakamoto, Eisuke Fukuma, Mika Nashimoto, Yoshitomo Koshida

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Background: Selective localization of the metastatic lymph node with clip and removal of clipped nodes with sentinel lymph node (SLN), known as targeted axillary dissection (TAD), reduced false-negative rates (FNR) of SLN biopsy (SLNB) after neoadjuvant chemotherapy (NAC). For the patients who achieved nodal pathologic complete response (pCR), accurate staging of axilla by TAD lead to omit axillary lymph node dissection (ALND), decreasing postoperative arm morbidity without a negative effect on overall survival. This study aimed to investigate the ultrasound (US) identification rate and success removal rate of two kinds of ultrasound-visible clips placed in metastatic lymph nodes during TAD procedure. Methods: This prospective study was conducted using patients with clinically T1-3, N1, 2, M0 breast cancer undergoing NAC followed by surgery. A US-visible clip was placed in the suspicious lymph node under US guidance before neoadjuvant chemotherapy. Before surgery, US examination was performed to evaluate the detection rate of clipped node. During the surgery, the clipped node was removed using several localization techniques, including hook-wire localization, dye-injection, or fluorescence technique, followed by a dual-technique SLNB and resection of palpable nodes if present. For the fluorescence technique, after injection of 0.1-0.2 mL of indocyanine green dye (ICG) into the clipped node, ICG fluorescent imaging was performed using the Photodynamic Eye infrared camera (Hamamatsu Photonics k. k., Shizuoka, Japan). For the dye injection method, 0.1-0.2 mL of pyoktanin blue dye was injected into the clipped node. Results: A total of 29 patients were enrolled. Hydromark™ breast biopsy site markers (Hydromark, T3 shape; Devicor Medical Japan, Tokyo, Japan) was used in 15patients, whereas a UltraCor™ Twirl™ breast marker (Twirl; C.R. Bard, Inc, NJ, USA) was placed in 14 patients. US identified the clipped node marked with the UltraCore Twirl in 100% (14/14) and with the Hydromark in 93.3% (14/15, p = ns). Success removal of clipped node marked with the UltraCore Twirl was achieved in 100% (14/14), whereas the node marked with the Hydromark was removed in 80% (12/15) (p = ns). Conclusions: The ultrasound identification rate differed between the two types of ultrasound-visible clips, which also affected the success removal rate of clipped nodes. Labelling the positive node with a US-highly-visible clip allowed successful TAD.

Keywords: breast cancer, neoadjuvant chemotherapy, targeted axillary dissection, breast tissue marker, clip

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Authors: Ankit Tyagi, Reet Kamal Tiwari, Naveen James

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Landslide is the major geo-environmental problem of Himalaya because of high ridges, steep slopes, deep valleys, and complex system of streams. They are mainly triggered by rainfall and earthquake and causing severe damage to life and property. In Uttarakhand, the Tehri reservoir rim area, which is situated in the lesser Himalaya of Garhwal hills, was selected for landslide hazard zonation (LHZ). The study utilized different types of data, including geological maps, topographic maps from the survey of India, Landsat 8, and Cartosat DEM data. This paper presents the use of a weighted overlay method in LHZ using fourteen causative factors. The various data layers generated and co-registered were slope, aspect, relative relief, soil cover, intensity of rainfall, seismic ground shaking, seismic amplification at surface level, lithology, land use/land cover (LULC), normalized difference vegetation index (NDVI), topographic wetness index (TWI), stream power index (SPI), drainage buffer and reservoir buffer. Seismic analysis is performed using peak horizontal acceleration (PHA) intensity and amplification factors in the evaluation of the landslide hazard index (LHI). Several digital image processing techniques such as topographic correction, NDVI, and supervised classification were widely used in the process of terrain factor extraction. Lithological features, LULC, drainage pattern, lineaments, and structural features are extracted using digital image processing techniques. Colour, tones, topography, and stream drainage pattern from the imageries are used to analyse geological features. Slope map, aspect map, relative relief are created by using Cartosat DEM data. DEM data is also used for the detailed drainage analysis, which includes TWI, SPI, drainage buffer, and reservoir buffer. In the weighted overlay method, the comparative importance of several causative factors obtained from experience. In this method, after multiplying the influence factor with the corresponding rating of a particular class, it is reclassified, and the LHZ map is prepared. Further, based on the land-use map developed from remote sensing images, a landslide vulnerability study for the study area is carried out and presented in this paper.

Keywords: weighted overlay method, GIS, landslide hazard zonation, remote sensing

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Authors: Sabri Serkan Gulluoglu

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The study is aimed at examining the effects of internet marketing with IPTV on human beings. Internet marketing with IPTV is emerging as an integral part of business strategies in today’s technologically advanced world and the business activities all over the world are influences with the emergence of this modern marketing tool. As the population of the Internet and on-line users’ increases, new research issues have arisen concerning the demographics and psychographics of the on-line user and the opportunities for a product or service. In recent years, we have seen a tendency of various services converging to the ubiquitous Internet Protocol based networks. Besides traditional Internet applications such as web browsing, email, file transferring, and so forth, new applications have been developed to replace old communication networks. IPTV is one of the solutions. In the future, we expect a single network, the IP network, to provide services that have been carried by different networks today. For finding some important effects of a video based technology market web site on internet, we determine to apply a questionnaire on university students. Recently some researches shows that in Turkey the age of people 20 to 24 use internet when they buy some electronic devices such as cell phones, computers, etc. In questionnaire there are ten categorized questions to evaluate the effects of IPTV when shopping. There were selected 30 students who are filling the question form after watching an IPTV channel video for 10 minutes. This sample IPTV channel is “buy.com”, it look like an e-commerce site with an integrated IPTV channel on. The questionnaire for the survey is constructed by using the Likert scale that is a bipolar scaling method used to measure either positive or negative response to a statement (Likert, R) it is a common system that is used is the surveys. By following the Likert Scale “the respondents are asked to indicate their degree of agreement with the statement or any kind of subjective or objective evaluation of the statement. Traditionally a five-point scale is used under this methodology”. For this study also the five point scale system is used and the respondents were asked to express their opinions about the given statement by picking the answer from the given 5 options: “Strongly disagree, Disagree, Neither agree Nor disagree, Agree and Strongly agree”. These points were also rates from 1-5 (Strongly disagree, Disagree, Neither disagree Nor agree, Agree, Strongly agree). On the basis of the data gathered from the questionnaire some results are drawn in order to get the figures and graphical representation of the study results that can demonstrate the outcomes of the research clearly.

Keywords: IPTV, internet marketing, online, e-commerce, video based technology

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Authors: Alexander Heckman, Rohan Goswami, Zachi Attia, Paul Friedman, Peter Noseworthy, Demilade Adedinsewo, Pablo Moreno-Franco, Rickey Carter, Tathagat Narula

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Background: Postoperative atrial fibrillation (POAF) is associated with adverse health consequences, higher costs, and longer hospital stays. Utilizing existing predictive models that rely on clinical variables and circulating biomarkers, multiple societies have published recommendations on the treatment and prevention of POAF. Although reasonably practical, there is room for improvement and automation to help individualize treatment strategies and reduce associated complications. Methods and Results: In this retrospective cohort study of solid organ transplant recipients, we evaluated the diagnostic utility of a previously developed AI-based ECG prediction for silent AF on the development of POAF within 30 days of transplant. A total of 2261 non-cardiac transplant patients without a preexisting diagnosis of AF were found to have a 5.8% (133/2261) incidence of POAF. While there were no apparent sex differences in POAF incidence (5.8% males vs. 6.0% females, p=.80), there were differences by race and ethnicity (p<0.001 and 0.035, respectively). The incidence in white transplanted patients was 7.2% (117/1628), whereas the incidence in black patients was 1.4% (6/430). Lung transplant recipients had the highest incidence of postoperative AF (17.4%, 37/213), followed by liver (5.6%, 56/1002) and kidney (3.6%, 32/895) recipients. The AUROC in the sample was 0.62 (95% CI: 0.58-0.67). The relatively low discrimination may result from undiagnosed AF in the sample. In particular, 1,177 patients had at least 1 AI-ECG screen for AF pre-transplant above .10, a value slightly higher than the published threshold of 0.08. The incidence of POAF in the 1104 patients without an elevated prediction pre-transplant was lower (3.7% vs. 8.0%; p<0.001). While this supported the hypothesis that potentially undiagnosed AF may have contributed to the diagnosis of POAF, the utility of the existing AI-ECG screening algorithm remained modest. When the prediction for POAF was made using the first postoperative ECG in the sample without an elevated screen pre-transplant (n=1084 on account of n=20 missing postoperative ECG), the AUROC was 0.66 (95% CI: 0.57-0.75). While this discrimination is relatively low, at a threshold of 0.08, the AI-ECG algorithm had a 98% (95% CI: 97 – 99%) negative predictive value at a sensitivity of 66% (95% CI: 49-80%). Conclusions: This study's principal finding is that the incidence of POAF is rare, and a considerable fraction of the POAF cases may be latent and undiagnosed. The high negative predictive value of AI-ECG screening suggests utility for prioritizing monitoring and evaluation on transplant patients with a positive AI-ECG screening. Further development and refinement of a post-transplant-specific algorithm may be warranted further to enhance the diagnostic yield of the ECG-based screening.

Keywords: artificial intelligence, atrial fibrillation, cardiology, transplant, medicine, ECG, machine learning

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Authors: Ayat-Allah Bouramdane

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Solar Photovoltaic (PV) and Concentrated Solar Power (CSP) do not burn fossil fuels and, therefore, could meet the world's needs for low-carbon power generation as they do not release greenhouse gases into the atmosphere as they generate electricity. The power output of the solar PV module and CSP collector is proportional to the temperature and the amount of solar radiation received by their surface. Hence, the determination of the most convenient locations of PV and CSP systems is crucial to maximizing their output power. This study aims to provide a hands-on and plausible approach to the multi-criteria evaluation of site suitability of PV and CSP plants using a combination of Geographic Referenced Information (GRI) and Analytic Hierarchy Process (AHP). Applying the GRI-based AHP approach is meant to specify the criteria and sub-criteria, to identify the unsuitable areas, the low-, moderate-, high- and very high suitable areas for each layer of GRI, to perform the pairwise comparison matrix at each level of the hierarchy structure based on experts' knowledge, and calculate the weights using AHP to create the final map of solar PV and CSP plants suitability in Morocco with a particular focus on the Dakhla city. The results recognize that solar irradiation is the main decision factor for the integration of these technologies on energy policy goals of Morocco but explicitly account for other factors that cannot only limit the potential of certain locations but can even exclude the Dakhla city classified as unsuitable area. We discuss the sensitivity of the PV and CSP site suitability to different aspects, such as the methodology, the climate conditions, and the technology used in each source, and provide the final recommendations to the Moroccan energy strategy by analyzing if actual Morocco's PV and CSP installations are located within areas deemed suitable and by discussing several cases to provide mutual benefits across the Food-Energy-Water nexus. The adapted methodology and conducted suitability map could be used by researchers or engineers to provide helpful information for decision-makers in terms of sites selection, design, and planning of future solar plants, especially in areas suffering from energy shortages, such as the Dakhla city, which is now one of Africa's most promising investment hubs and it is especially attractive to investors looking to root their operations in Africa and import to European markets.

Keywords: analytic hierarchy process, concentrated solar power, dakhla, geographic referenced information, Morocco, multi-criteria decision-making, photovoltaic, site suitability

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Authors: Jahangir Alam, Ayman El Sabagh, Kamrul Hasan, Shafiqul Islam Sikdar, Celaleddin Barutçular, Sohidul Islam

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The experiment (Germination test and seedling growth) was carried out at the laboratory of Agronomy Department, Hajee Mohammad Danesh Science and Technology University (HSTU), Dinajpur, Bangladesh during January 2014. Germination and seedling growth of 22 existing wheat genotypes in Bangladesh viz. Kheri, Kalyansona, Sonora, Sonalika, Pavon, Kanchan, Akbar, Barkat, Aghrani, Prativa, Sourab, Gourab, Shatabdi, Sufi, Bijoy, Prodip, BARI Gom 25, BARI Gom 26, BARI Gom 27, BARI Gom 28, Durum and Triticale were tested with three salinity levels (0, 100 and 200 mM NaCl) for 10 days in sand culture in small plastic pot. Speed of germination as expressed by germination percentage (GP), rate of germination (GR), germination coefficient (GC) and germination vigor index (GVI) of all wheat genotypes was delayed and germination percentage was reduced due to salinization compared to control. The lower reduction of GP, GR, GC and VI due to salinity was observed in BARI Gom 25, BARI Gom 27, Shatabdi, Sonora, and Akbbar and higher reduction was recorded in BARI Gom 26, Duram, Triticale, Sufi and Kheri. Shoot and root lengths, fresh and dry weights were found to be affected due to salinization and shoot was more affected than root. Under saline conditions, longer shoot and root length were recorded in BARI Gom 25, BARI Gom 27, Akbar, and Shatabdi, i.e. less reduction of shoot and root lengths was observed while, BARI Gom 26, Duram, Prodip and Triticale produced shorted shoot and root lengths. In this study, genotypes BARI Gom 25, BARI Gom 27, Shatabdi, Sonora and Aghrani showed better performance in terms shoot and root growth (fresh and dry weights) and proved to be tolerant genotypes to salinity. On the other hand, Duram, BARI Gom 26, Triticale, Kheri and Prodip affected seriously in terms of fresh and dry weights by the saline environment. BARI Gom 25, BARI Gom 27, Shatabdi, Sonora and Aghrani showed more salt tolerance index (STI) based on shoot dry weight while, BARI Gom 26, Triticale, Durum, Sufi, Prodip and Kalyanson demonstrate lower STI value under saline conditions. Based on the most salt tolerance and susceptible trait, genotypes under 100 and 200 mM NaCl stresses can be arranged as salt tolerance genotypes: BARI Gom 25> BARI Gom 27> Shatabdi> Sonora, and salt susceptible genotypes: BARI Gom 26> Durum> Triticale> Prodip> Sufi> Kheri. Considering the experiment, it can be concluded that the BARI Gom 25 may be treated as the most salt tolerant and BARI Gom 26 as the most salt sensitive genotypes in Bangladesh.

Keywords: genotypes, germination, salinity, wheat

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Authors: Mihlali Mbangeni, Lynn C. Jonas, Rosemary Matikiti-Manyevere

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Coastal and marine tourism is considered among the most rapidly developing subsectors of tourism. That has enabled coastal and marine environments to gain popularity and economically contribute to coastal regions globally. However, in coastal regions of developing cities such as Gqeberha, South Africa, pollution, specifically plastics and waste from ships, are among the prominent challenges in these areas. Thus, there is a need for the management and planning of sustainability in coastal and marine tourism. As a result, the study evaluates the effectiveness of the current sustainability strategies and highlights the barriers and challenges faced by the coastal region. This study made use of the interpretivist paradigm following a qualitative research approach when collecting data. This was done by conducting semi-structured interviews with local government officials, coastal and marine tourism business top managers, as well as ocean economy-related non-profit organization operators through a purposive sampling method. The study employed content analysis to analyse the interview transcripts using a computer-aided qualitative data analysis software that is Atlas.ti. The research findings present current coastal and marine tourism strategies used, such as local government having quarterly meetings with the private sector promoting collaboration between the two entities. A further measure discovered was non-profit organisations conducting educational talks, workshops, and visiting schools to educate pupils within the coastal region about pollution and sustainability. Current challenges experienced in the implementation of sustainability practices include a lack of awareness, low visibility of the local government in promoting sustainability within the regions, and poor participation of the local community in activities such as beach clean-ups. Recommendations for strategies are to equip decision-makers with knowledge and skills to make informed decisions that are inclusive. Furthermore, local community participation should be encouraged through providing incentives. Local government may also be encouraged to allocate adequate resources to assist non-profit organisations’ efforts towards sustainability. A further recommendation would be for coastal and marine tourism businesses to encourage them to create partnerships as well as collaborate with each other instead of competing in their sustainability efforts. The sharing of information about the sustainability of coastal and marine tourism between non-profit organisations, coastal and marine tourism businesses, local government as well as academia through research publications and ensured implementation, as well as evaluation, can contribute towards the sustainability of Gqeberha’s coastal and marine tourism products.

Keywords: coastal and marine tourism threats, coastal and marine tourism trends, strategies for coastal and marine tourism sustainability, sustainability

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Authors: Rebecca Zahra, Joseph G. Vella, Ernest Cachia

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The notion of cloud computing is rapidly gaining ground in the IT industry and is appealing mostly due to making computing more adaptable and expedient whilst diminishing the total cost of ownership. This paper focuses on the software as a service (SaaS) architecture of cloud computing which is used for the outsourcing of databases with their associated business processes. One approach for offering SaaS is basing the system’s architecture on multi-tenancy. Multi-tenancy allows multiple tenants (users) to make use of the same single application instance. Their requests and configurations might then differ according to specific requirements met through tenant customisation through the software. Despite the known advantages, companies still feel uneasy to opt for the multi-tenancy with data security being a principle concern. The fact that multiple tenants, possibly competitors, would have their data located on the same server process and share the same database tables heighten the fear of unauthorised access. Security is a vital aspect which needs to be considered by application developers, database administrators, data owners and end users. This is further complicated in cloud-based multi-tenant system where boundaries must be established between tenants and additional access control models must be in place to prevent unauthorised cross-tenant access to data. Moreover, when altering the database state, the transactions need to strictly adhere to the tenant’s known business processes. This paper focuses on the fact that security in cloud databases should not be considered as an isolated issue. Rather it should be included in the initial phases of the database design and monitored continuously throughout the whole development process. This paper aims to identify a number of the most common security risks and threats specifically in the area of multi-tenant cloud systems. Issues and bottlenecks relating to security risks in cloud databases are surveyed. Some techniques which might be utilised to overcome them are then listed and evaluated. After a description and evaluation of the main security threats, this paper produces a list of software requirements to ensure that proper security policies are implemented by a software development team when designing and implementing a multi-tenant based SaaS. This would then assist the cloud service providers to define, implement, and manage security policies as per tenant customisation requirements whilst assuring security for the customers’ data.

Keywords: cloud computing, data management, multi-tenancy, requirements, security

Procedia PDF Downloads 156

Authors: L. D. Upegui, Isabel Alvarez-Solorza, Karina Garduno-Ulloa, Maren Boecker

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Introduction: The increasing prevalence rate of resistant and multiresistant bacterial strains to antibiotics is a threat to public health and requires a rapid multifunctional answer. Individuals that are affected by resistant strains present a higher morbidity and mortality than individuals that are infected with the same species of bacteria but with sensitive strains. There have been identified risk factors that are related to the misuse and overuse of antibiotics, like socio-demographic characteristics and psychological aspects of the individuals that have not been explored objectively due to a lack of valid and reliable instruments for their measurement. Objective: To validate a questionnaire for the evaluation of the levels of knowledge related to the use of antibiotics in a Mexican population. Materials and Methods: Analytical cross-sectional observational study. The questionnaire consists of 12 items to evaluated knowledge (1=no, 2=not sure, 3=yes) regarding the use of antibiotics, with higher scores corresponding to a higher level of knowledge. Data are collected in a sample of students. Data collection is still ongoing. In this abstract preliminary results of 30 respondents are reported which were collected during pilot-testing. The validation of the instrument was done using the Rasch model. Fit to the Rasch model was tested checking overall fit to the model, unidimensionality, local independence and evaluating the presence of Differential Item Functioning (DIF) by age and gender. The software Rumm2030 and the SPSS were used for the analyses. Results: The participants of the pilot-testing presented an average age of 32 years ± 12.6 and 53% were women. The preliminary results indicated that the items showed good fit to the Rasch model (chi-squared=12.8 p=0.3795). Unidimensionality (number of significant t-tests of 3%) could be proven, the items were locally independent, and no DIF was observed. Knowledge was the smallest regarding statements on the role of antibiotics in treating infections, e.g., most of the respondents did not know that antibiotics would not work against viral infections (70%) and that they could also cause side effects (87%). The knowledge score ranged from 0 to 100 points with a transformed measurement (mean of knowledge 27.1 ± 4.8). Conclusions: The instrument showed good psychometric proprieties. The low scores of knowledge about antibiotics suggest that misinterpretations on the use of these medicaments were prevalent, which could influence the production of antibiotic resistance. The application of this questionnaire will allow the objective identification of 'Hight risk groups', which will be the target population for future educational campaigns, to reduce the knowledge gaps on the general population as an effort against antibiotic resistance.

Keywords: antibiotics, knowledge, misuse, overuse, questionnaire, Rasch model, validation

Procedia PDF Downloads 156

Authors: Mustafa Metin Donma, Orkide Donma

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Obesity in children particularly draws attention because it may threaten the individual’s future life due to many chronic diseases it may lead to. Most of these diseases, including obesity itself altogether are related to inflammation. For this reason, inflammation-related parameters gain importance. Within this context, complete blood cell counts, ratios or indices derived from these counts have recently found some platform to be used as inflammatory markers. So far, mostly adipokines were investigated within the field of obesity. The liver is at the center of the metabolic pathways network. Metabolic inflammation is closely associated with cellular dysfunction. In this study, hematologic inflammatory markers and two major hepatokines, cytokines produced predominantly by the liver, fibroblast growth factor-21 (FGF-21) and fetuin A were investigated in pediatric obesity. Two groups were constituted from seventy-six obese children based on World Health Organization criteria. Group 1 was composed of children whose age- and sex-adjusted body mass index (BMI) percentiles were between 95 and 99. Group 2 consists of children who are above the 99ᵗʰ percentile. The first and the latter groups were defined as obese (OB) and morbid obese (MO). Anthropometric measurements of the children were performed. Informed consent forms and the approval of the institutional ethics committee were obtained. Blood cell counts and ratios were determined by an automated hematology analyzer. The related ratios and indexes were calculated. Statistical evaluation of the data was performed by the SPSS program. There was no statistically significant difference in terms of neutrophil-to lymphocyte ratio, monocyte-to-high density lipoprotein cholesterol ratio and the platelet-to-lymphocyte ratio between the groups. Mean platelet volume and platelet distribution width values were decreased (p<0.05), total platelet count, red cell distribution width (RDW) and systemic immune inflammation index values were increased (p<0.01) in MO group. Both hepatokines were increased in the same group; however, increases were not statistically significant. In this group, also a strong correlation was calculated between FGF-21 and RDW when controlled by age, hematocrit, iron and ferritin (r=0.425; p<0.01). In conclusion, the association between RDW, a hematologic inflammatory marker, and FGF-21, an inflammation-related hepatokine, found in MO group is an important finding discriminating between OB and MO children. This association is even more powerful when controlled by age and iron-related parameters.

Keywords: childhood obesity, fetuin A , fibroblast growth factor-21, hematologic markers, red cell distribution width

Procedia PDF Downloads 198

Authors: Claudia Cabezas-Zabala, Jairo Lindarte-Artunduaga, Carlos Mario Zuluaga-Dominguez

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Amaranth is an emerging pseudocereal rich in such essential nutrients as protein and dietary fiber, which was employed as an ingredient in the formulation of crackers to evaluate the rheological performance and sensory acceptability of the obtained food. A completely randomized factorial design was used with two factors: (A) ratio of wheat and amaranth flour used in the preparation of the dough, in proportion 90:10 and 80:20 (% w/w) and (B) two levels of inulin addition of 8.4% and 16.7 %, having two control doughs made from amaranth and wheat flour, respectively. Initially, the functional properties of the formulations mentioned were measured, showing no significant differences in the water absorption capacity (WAC) and swelling power (SP), having mean values between 1.66 and 1.81 g/g for WAC and between 1.75 and 1.86 g/g for SP, respectively. The amaranth flour had the highest water holding capacity (WHR) of 8.41 ± 0.15 g/g and emulsifying activity (EA) of 74.63 ± 1.89 g/g. Moreover, the rheological behavior, measured through the use of farinograph, extensograph, Mixolab, and falling index, showed that the formulation containing 20% of amaranth flour and 7.16% of inulin had a rheological behavior similar to the control produced exclusively with wheat flour, being the former, the one selected for the preparation of crackers. For this formulation, the farinograph showed a mixing tolerance index of 11 UB, indicating a strong and cohesive dough; likewise, the Mixolab showed dough reaches stability at 6.47 min, indicating a good resistance to mixing. On the other hand, the extensograph exhibited a dough resistance of 637 UB, as well as extensibility of 13.4 mm, which corresponds to a strong dough capable of resisting the laminate. Finally, the falling index was 318 s, which indicates the crumb will retain enough air to enhance the crispness of a characteristic cracker. Finally, a sensory consumer test did not show significant differences in the evaluation of aroma between the control and the selected formulation, while this latter had a significantly lower rating in flavor. However, a purchase intention of 70 % was observed among the population surveyed. The results obtained in this work give perspectives for the industrial use of amaranth in baked goods. Additionally, amaranth has been a product typically linked to indigenous populations in the Andean South American countries; therefore, the search for diversification and alternatives of use for this pseudocereal has an impact on the social and economic conditions of such communities. The technological versatility and nutritional quality of amaranth is an advantage for consumers, favoring the consumption of healthy products with important contributions of dietary fiber and protein.

Keywords: amaranth, crackers, rheology, pseudocereals, kneaded products

Procedia PDF Downloads 119

Authors: N. Perko, N. Kavran, M. Bukljas, I. Berbic

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This paper is a result of implemented research on proposed introduced methodology for nautical ports capacity planning by introducing a multi-criteria approach of defined criteria and impacts at the Adriatic Sea. The purpose was analysing the determinants -characteristics of infrastructure and services of nautical ports capacity allocated, especially nowadays due to COVID-19 pandemic, as crucial for the successful operation of nautical ports. Giving the importance of the defined priorities for short-term and long-term planning is essential not only in terms of the development of nautical tourism but also in terms of developing the maritime system, but unfortunately, this is not always carried out. Evaluation of the use of resources should follow from a detailed analysis of all aspects of resources bearing in mind that nautical tourism used resources in a sustainable manner and generate effects in the tourism and maritime sectors. Consequently, the identified multiplier effect of nautical tourism, which should be defined and quantified in detail, should be one of the major competitive products on the Croatian Adriatic and the Mediterranean. Research of nautical tourism is necessary to quantify the effects and required planning system development. In the future, the greatest threat to the long-term sustainable development of nautical tourism can be its further uncontrolled or unlimited and undirected development, especially under pressure markedly higher demand than supply for new moorings in the Mediterranean. Results of this implemented research are applicable to nautical ports management and decision-makers of maritime transport system development. This paper will present implemented research and obtained result-developed methodology for nautical port capacity planning -port capacity planning multi-criteria decision-making. A proposed methodological approach of multi-criteria capacity planning includes four criteria (spatial - transport, cost - infrastructure, ecological and organizational criteria, and additional services). The importance of the criteria and sub-criteria is evaluated and carried out as the basis for sensitivity analysis of the importance of the criteria and sub-criteria. Based on the analysis of the identified and quantified importance of certain criteria and sub-criteria, as well as sensitivity analysis and analysis of changes of the quantified importance, scientific and applicable results will be presented. These obtained results have practical applicability by management of nautical ports in the planning of increasing capacity and further development and for the adaptation of existing nautical ports. Obtained research is applicable and replicable in other seas, and results are especially important and useful in this COVID-19 pandemic challenging maritime development framework.

Keywords: Adriatic Sea, capacity, infrastructures, maritime system, methodology, nautical ports, nautical tourism, service

Procedia PDF Downloads 190

Authors: Victor N. Anisimov, Lyubov A. Boyko, Yazgul R. Almukhametova, Natalia V. Galkina, Alexander V. Latanov

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Modern commercials presented on billboards, TV and on the Internet contain a lot of information about the product or service in text form. However, this information cannot always be perceived and understood by consumers. Typical sociological focus group studies often cannot reveal important features of the interpretation and understanding information that has been read in text messages. In addition, there is no reliable method to determine the degree of understanding of the information contained in a text. Only the fact of viewing a text does not mean that consumer has perceived and understood the meaning of this text. At the same time, the tools based on marketing analysis allow only to indirectly estimate the process of reading and understanding a text. Therefore, the aim of this work is to develop a valid method of recording objective indicators in real time for assessing the fact of reading and the degree of text comprehension. Psychophysiological parameters recorded during text reading can form the basis for this objective method. We studied the relationship between multimodal psychophysiological parameters and the process of text comprehension during reading using the method of correlation analysis. We used eye-tracking technology to record eye movements parameters to estimate visual attention, electroencephalography (EEG) to assess cognitive load and polygraphic indicators (skin-galvanic reaction, SGR) that reflect the emotional state of the respondent during text reading. We revealed reliable interrelations between perceiving the information and the dynamics of psychophysiological parameters during reading the text in commercials. Eye movement parameters reflected the difficulties arising in respondents during perceiving ambiguous parts of text. EEG dynamics in rate of alpha band were related with cumulative effect of cognitive load. SGR dynamics were related with emotional state of the respondent and with the meaning of text and type of commercial. EEG and polygraph parameters together also reflected the mental difficulties of respondents in understanding text and showed significant differences in cases of low and high text comprehension. We also revealed differences in psychophysiological parameters for different type of commercials (static vs. video, financial vs. cinema vs. pharmaceutics vs. mobile communication, etc.). Conclusions: Our methodology allows to perform multimodal evaluation of text perusal and the quality of text reading in commercials. In general, our results indicate the possibility of designing an integral model to estimate the comprehension of reading the commercial text in percent scale based on all noticed markers.

Keywords: reading, commercials, eye movements, EEG, polygraphic indicators

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Authors: Alexsandro Bayestorff da Cunha, Dpebora Caline de Mello, Camila Alves Corrêa

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In the production of fiberboards, an adhesive based on urea-formaldehyde resin is used, which has the advantages of low cost, homogeneity of distribution, solubility in water, high reactivity in an acid medium, and high adhesion to wood. On the other hand, as a disadvantage, there is low resistance to humidity and the release of formaldehyde. The objective of the study was to determine the viability of adding industrial boiler ash to the urea formaldehyde-based adhesive for the production of medium-density fiberboard. The raw material used was composed of Pinus spp fibers, urea-formaldehyde resin, paraffin emulsion, ammonium sulfate, and boiler ash. The experimental plan, consisting of 8 treatments, was completely randomized with a factorial arrangement, with 0%, 1%, 3%, and 5% ash added to the adhesive, with and without the application of a catalyst. In each treatment, 4 panels were produced with density of 750 kg.m⁻³, dimensions of 40 x 40 x 1,5 cm, 12% urea formaldehyde resin, 1% paraffin emulsion and hot pressing at a temperature of 180ºC, the pressure of 40 kgf/cm⁻² for a time of 10 minutes. The different compositions of the adhesive were characterized in terms of viscosity, pH, gel time and solids, and the panels by physical and mechanical properties, in addition to evaluation using the IMAL DPX300 X-ray densitometer and formaldehyde emission by the perforator method. The results showed a significant reduction of all adhesive properties with the use of the catalyst, regardless of the treatment; while the percentage increase of ashes provided an increase in the average values of viscosity, gel time, and solids and a reduction in pH for the panels with a catalyst; for panels without catalyst, the behavior was the opposite, with the exception of solids. For the physical properties, the results of the variables of density, compaction ratio, and thickness were equivalent and in accordance with the standard, while the moisture content was significantly reduced with the use of the catalyst but without the influence of the percentage of ash. The density profile for all treatments was characteristic of medium-density fiberboard, with more compacted and dense surfaces when compared to the central layer. For thickness, the swelling was not influenced by the catalyst and the use of ash, presenting average values within the normalized parameters. For mechanical properties, the influence of ashes on the adhesive was negatively observed in the modulus of rupture from 1% and in the traction test from 3%; however, only this last property, in the percentages of 3% and 5%, were below the minimum limit of the norm. The use of catalyst and ashes with percentages of 3% and 5% reduced the formaldehyde emission of the panels; however, only the panels that used adhesive with catalyst presented emissions below 8mg of formaldehyde / 100g of the panel. In this way, it can be said that boiler ash can be added to the adhesive with a catalyst without impairing the technological properties by up to 1%.

Keywords: reconstituted wood panels, formaldehyde emission, technological properties of panels, perforator

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Authors: Jisun Mo, Paola Boarin

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The impact of common buildings on climate and environment has prompted people to get involved in the green building standards aimed at implementing rating tools or certifications. Thus, green building rating systems were introduced to the construction industry, and the demand for certified green buildings has increased gradually and succeeded considerably in enhancing people’s environmental awareness. However, the existing certification process has been unsatisfactory in attracting stakeholders and/or professionals who are actively engaged in adopting a rating system. It is because they have faced recurring barriers regarding limited information in understanding the rating process, time-consuming procedures and higher costs, which have a direct influence on pursuing green building rating systems. To promote the achievement of green building certifications within the building industry more successfully, this paper aims at designing a Pre-Assessment Tool (PAT) framework that can help stakeholders and/or professionals engaged in the construction industry to clarify their basic knowledge, timeframe and extra costs needed to activate a green building certification. First, taking the first steps towards the rating tool seems to be complicated because of upfront commitment to understanding the overall rating procedure is required. This conceptual PAT framework can increase basic knowledge of the rating tool and the certification process, mainly in terms of all resources or information of each credit requirements. Second, the assessment process of rating tools is generally known as a “lengthy and time-consuming system”, contributing to unenthusiastic reactions concerning green building projects. The proposed framework can predict the timeframe needed to identify how long it will take for a green project to process each credit requirement and the documentation required from the beginning of the certification process to final approval. Finally, most people often have the initial perception that pursuing green building certification costs more than constructing a non-green building, which makes it more difficult to execute rating tools. To overcome this issue, this PAT will help users to estimate the extra expenses such as certification fees and third-party contributions based on the track of the amount of time it takes to implement the rating tool throughout all the related stages. Also, it can prevent unexpected or hidden costs occurring in the process of assessment. Therefore, this proposed PAT framework can be recommended as an effective method to support the decision-making of inexperienced users and play an important role in promoting green building certification.

Keywords: green building rating tools, Pre-Occupancy Evaluation (PrOE), client’s decision-making, certification

Procedia PDF Downloads 248

Authors: Panupong Lohrattanarungrot, Falan Srisuriyachai

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Polymer flooding is a well-known technique used for controlling mobility ratio in heterogeneous reservoirs, leading to improvement of sweep efficiency as well as wellbore profile. However, low injectivity of viscous polymer solution attenuates oil recovery rate and consecutively adds extra operating cost. An attempt of this study is to improve injectivity of polymer solution while maintaining recovery factor, enhancing effectiveness of polymer flooding method. This study is performed by using reservoir simulation program to modify conventional single polymer slug into sequential polymer flooding, emphasizing on increasing of injectivity and also reduction of polymer amount. Selection of operating conditions for single slug polymer including pre-injected water, polymer concentration and polymer slug size is firstly performed for a layered-heterogeneous reservoir with Lorenz coefficient (Lk) of 0.32. A selected single slug polymer flooding scheme is modified into sequential polymer flooding with reduction of polymer concentration in two different modes: Constant polymer mass and reduction of polymer mass. Effects of Residual Resistance Factor (RRF) is also evaluated. From simulation results, it is observed that first polymer slug with the highest concentration has the main function to buffer between displacing phase and reservoir oil. Moreover, part of polymer from this slug is also sacrificed for adsorption. Reduction of polymer concentration in the following slug prevents bypassing due to unfavorable mobility ratio. At the same time, following slugs with lower viscosity can be injected easily through formation, improving injectivity of the whole process. A sequential polymer flooding with reduction of polymer mass shows great benefit by reducing total production time and amount of polymer consumed up to 10% without any downside effect. The only advantage of using constant polymer mass is slightly increment of recovery factor (up to 1.4%) while total production time is almost the same. Increasing of residual resistance factor of polymer solution yields a benefit on mobility control by reducing effective permeability to water. Nevertheless, higher adsorption results in low injectivity, extending total production time. Modifying single polymer slug into sequence of reduced polymer concentration yields major benefits on reducing production time as well as polymer mass. With certain design of polymer flooding scheme, recovery factor can even be further increased. This study shows that application of sequential polymer flooding can be certainly applied to reservoir with high value of heterogeneity since it requires nothing complex for real implementation but just a proper design of polymer slug size and concentration.

Keywords: polymer flooding, sequential, heterogeneous reservoir, residual resistance factor

Procedia PDF Downloads 476

Authors: Bollu Mounica

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Background: Nowadays drug related problems were seen very commonly within the health care practice. These could result in the medication errors, adverse events, drug interactions and harm to patients. Pharmacist has an identified role in minimizing and preventing such type of problems. Objectives: To detect the incidence of drug related problems for the hospitalized patient, and to analyze the clinical pharmacist interventions performed during the review of prescription orders of the general medicine, psychiatry, surgery, pediatrics, gynaecology units of a large tertiary care teaching hospital. Methods: It was a retrospective, observational and interventional study. The analysis took place daily with the following parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, as well as the resulting clinical interventions. For a period starting November 2012 until December 2014, the inpatient medication charts and orders were identified and rectified by ward and practicing clinical pharmacists within the inpatient pharmacy services in a tertiary care teaching hospital on routine daily activities. Data was collected and evaluated. The causes of this problem were identified. Results: A total of 360 patients were followed. Male (71.66%) predominance was noted over females (28.33%). Drug related problems were more commonly seen in patients aged in between 31-60. Most of the DRP observed in the study resulted from the dispensing errors (26.11%), improper drug selection (17.22%), followed by untreated indications (14.4%) Majority of the clinical pharmacist recommendations were on need for proper dispensing (26.11%), and drug change (18.05%). Minor significance of DRPs were noted high (41.11 %), whereas (35.27 %) were moderate and (23.61 %) were major. The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high (86.66%). Conclusion: Our study showed that the prescriptions reviewed had some drug therapy problem and the pharmacist interventions have promoted positive changes needed in the prescriptions. In this context, routine participation of clinical pharmacists in clinical medical rounds facilitates the identification of DRPs and may prevent their occurrence.

Keywords: drug related problems, clinical pharmacist, drug prescriptions, drug related problems, intervention

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Authors: Iris Vogeler, Rogerio Cichota, Armin Werner

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Dairy farms are under pressure to increase productivity while reducing environmental impacts. Effective fertiliser management practices are critical to achieve this. Determination of optimum nitrogen (N) fertilisation rates which maximise pasture growth and minimise N losses is challenging due to variability in plant requirements and likely near-future supply of N by the soil. Remote sensing can be used for mapping N nutrition status of plants and to rapidly assess the spatial variability within a field. An algorithm is, however, lacking which relates the N status of the plants to the expected yield response to additions of N. The aim of this simulation study was to develop a multi-variate model for determining N fertilisation rate for a target percentage of the maximum achievable yield based on the pasture N concentration (ii) use of an algorithm for guiding fertilisation rates, and (iii) evaluation of the model regarding pasture yield and N losses, including N leaching, denitrification and volatilisation. A simulation study was carried out using the Agricultural Production Systems Simulator (APSIM). The simulations were done for an irrigated ryegrass pasture in the Canterbury region of New Zealand. A multi-variate model was developed and used to determine monthly required N fertilisation rates based on pasture N content prior to fertilisation and targets of 50, 75, 90 and 100% of the potential monthly yield. These monthly optimised fertilisation rules were evaluated by running APSIM for a ten-year period to provide yield and N loss estimates from both nonurine and urine affected areas. Comparison with typical fertilisation rates of 150 and 400 kg N/ha/year was also done. Assessment of pasture yield and leaching from fertiliser and urine patches indicated a large reduction in N losses when N fertilisation rates were controlled by the multi-variate model. However, the reduction in leaching losses was much smaller when taking into account the effects of urine patches. The proposed approach based on biophysical modelling to develop a multi-variate model for determining optimum N fertilisation rates dependent on pasture N content is very promising. Further analysis, under different environmental conditions and validation is required before the approach can be used to help adjust fertiliser management practices to temporal and spatial N demand based on the nitrogen status of the pasture.

Keywords: APSIM modelling, optimum N fertilization rate, pasture N content, ryegrass pasture, three dimensional surface response function.

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Authors: Andrey Davydov, Konstantin Sveshnikov, Yulia Voronina

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There is now a lot of interest to the non-perturbative QED-effects, caused by diving of discrete levels into the negative continuum in the supercritical static or adiabatically slowly varying Coulomb fields, that are created by the localized extended sources with Z > Z_cr. Such effects have attracted a considerable amount of theoretical and experimental activity, since in 3+1 QED for Z > Z_cr,1 ≈ 170 a non-perturbative reconstruction of the vacuum state is predicted, which should be accompanied by a number of nontrivial effects, including the vacuum positron emission. Similar in essence effects should be expected also in both 2+1 D (planar graphene-based hetero-structures) and 1+1 D (one-dimensional ‘hydrogen ion’). This report is devoted to the study of such essentially non-perturbative vacuum effects for the supercritical Dirac-Coulomb systems in 1+1D and 2+1D, with the main attention drawn to the vacuum polarization energy. Although the most of works considers the vacuum charge density as the main polarization observable, vacuum energy turns out to be not less informative and in many respects complementary to the vacuum density. Moreover, the main non-perturbative effects, which appear in vacuum polarization for supercritical fields due to the levels diving into the lower continuum, show up in the behavior of vacuum energy even more clear, demonstrating explicitly their possible role in the supercritical region. Both in 1+1D and 2+1D, we explore firstly the renormalized vacuum density in the supercritical region using the Wichmann-Kroll method. Thereafter, taking into account the results for the vacuum density, we formulate the renormalization procedure for the vacuum energy. To evaluate the latter explicitly, an original technique, based on a special combination of analytical methods, computer algebra tools and numerical calculations, is applied. It is shown that, for a wide range of the external source parameters (the charge Z and size R), in the supercritical region the renormalized vacuum energy could significantly deviate from the perturbative quadratic growth up to pronouncedly decreasing behavior with jumps by (-2 x mc^2), which occur each time, when the next discrete level dives into the negative continuum. In the considered range of variation of Z and R, the vacuum energy behaves like ~ -Z^2/R in 1+1D and ~ -Z^3/R in 2+1D, exceeding deeply negative values. Such behavior confirms the assumption of the neutral vacuum transmutation into the charged one, and thereby of the spontaneous positron emission, accompanying the emergence of the next vacuum shell due to the total charge conservation. To the end, we also note that the methods, developed for the vacuum energy evaluation in 2+1 D, with minimal complements could be carried over to the three-dimensional case, where the vacuum energy is expected to be ~ -Z^4/R and so could be competitive with the classical electrostatic energy of the Coulomb source.

Keywords: non-perturbative QED-effects, one- and two-dimensional Dirac-Coulomb systems, supercritical fields, vacuum polarization

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Authors: Shahzad A. Mughal, Ameer A. P. Ghaloo, Faisal Laghari, Mohsin A. Mirza

Abstract:

Job satisfaction and level of job stressors among employees of a university are considered as essential factors responsible for institutional success. Job satisfaction is usually believed as a single baseline variable for the evaluation of a university human resource area. The objectives of this study were to assess the level of job satisfaction and influence of job stressors among university teachers and their association with long term physical health of the employees in government sector universities in Pakistan. A cross-sectional study was conducted on university employees including faculty members and administrative staff of three government sector universities in Sindh province of Pakistan who have completed at least ten years of their job. The study period was six months. All the employees were randomly selected. The job satisfaction scale Questionnaire with yes and no options, together with questions regarding demographic factors, job stress or other working factors and physical health issues were administered in questionnaires. These questionnaires were handed out to 100 faculty members of both genders with permanent job and 50 non faculty staff of grade 17 and above with permanent employment status. Students’ T test and one way ANOVA was applied to categorical variables and Pearson’s correlation analysis was performed to evaluate the correlations between study variables. 121 successful responses were obtained (effective respondent rate 80.6%). The average score of overall job satisfaction was 65.6%. Statistical analysis revealed that the job satisfaction and work related stressors had negative impact on overall health status of the employees with resultant less efficacy and mental stress. The positive relation was perceived by employees for organizational support and high income with job satisfaction. Demographic features such as age and female gender were also linked to the level of job satisfaction and health related issues. The total variation among all responses regarding correlation between job satisfaction job stressors and health related issues was 55%. A study was conducted on University employees of government sector Universities in Pakistan, regarding association of job satisfaction and job stressors with long term physical health of the employees. Study revealed a moderate level of job satisfaction among the employees of all universities included in this study. Attitude and personal relations with heads of the departments and institution along with salary packages were considered as biggest job stressors related correlated directly with physical health. Demographic features and gender were associated factors for job satisfaction. Organizational support was the strongest factor for job satisfaction and results pointed out that by improving support level from University may improve the quality of job satisfaction and overall health of employees.

Keywords: job satisfaction, organizational support, physical health, university employees

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Authors: Yuan-Hao Lee, Chia-Wei Lee, Ming-Fang Lin, Tzu-Huei Wu, Chih-Hsiang Ko, Wing P. Chan

Abstract:

Computed tomography (CT) scan of the head is a good method for investigating cranial lesions. However, radiation-induced oxidative stress can be accumulated in the eyes and promote carcinogenesis and cataract. In this regard, we aimed to protect the eyes with barium sulfate shield(s) during CT scans and investigate the resultant image quality and radiation dose to the eye. Patients who underwent health examinations were selectively enrolled in this study in compliance with the protocol approved by the Ethics Committee of the Joint Institutional Review Board at Taipei Medical University. Participants’ brains were scanned with a water-based marker simultaneously by a multislice CT scanner (SOMATON Definition Flash) under a fixed tube current-time setting or automatic tube current modulation (TCM). The lens dose was measured by Gafchromic films, whose dose response curve was previously fitted using thermoluminescent dosimeters, with or without barium sulfate or bismuth-antimony shield laid above. For the assessment of image quality CT images at slice planes that exhibit the interested regions on the zygomatic, orbital and nasal bones of the head phantom as well as the water-based marker were used for calculating the signal-to-noise and contrast-to-noise ratios. The application of barium sulfate and bismuth-antimony shields decreased 24% and 47% of the lens dose on average, respectively. Under topogram-based TCM, the dose saving power of bismuth-antimony shield was mitigated whereas that of barium sulfate shield was enhanced. On the other hand, the signal-to-noise and contrast-to-noise ratios of DSCT images were decreased separately by barium sulfate and bismuth-antimony shield, resulting in an overall reduction of the CNR. In contrast, the integration of topogram-based TCM elevated signal difference between the ROIs on the zygomatic bones and eyeballs while preferentially decreasing the signal-to-noise ratios upon the use of barium sulfate shield. The results of this study indicate that the balance between eye exposure and image quality can be optimized by combining eye shields with topogram-based TCM on the multislice scanner. Eye shielding could change the photon attenuation characteristics of tissues that are close to the shield. The application of both shields on eye protection hence is not recommended for seeking intraorbital lesions.

Keywords: computed tomography, barium sulfate shield, dose saving, image quality

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Authors: Eliza Torrigue, Efrelyn Iellamo

Abstract:

Maternal death is one of the rising health issues in the Philippines. It is alarming to know that in every hour of each day, a mother gives birth to a child who may not live to see the next day. Statistics shows that intrapartum period and third stage of labor are the very crucial periods for the expectant mother, as well as the first six hours of life for the newborn. To address the issue, The Essential Intrapartum Newborn Care (EINC) was developed. Through this, Obstetric Delivery Room (OB-DR) Nurses shall be updated with the evidence-based maternal and newborn care to ensure patient safety, thus, reducing maternal and child mortality. This study aims to describe the compliance of hospitals, especially of OB-DR nurses, to the EINC Protocols. The researcher aims to link the profile variables of the respondents in terms of age, length of service and formal training to their compliance on the EINC Protocols. The outcome of the study is geared towards the development of appropriate training program for OB-DR Nurses assigned in the delivery room of the hospitals based on the study’s results to sustain the EINC standards. A descriptive correlational method was used. The sample consists of 75 Obstetric Delivery Room (OB-DR) Nurses from three government hospitals in the City of Manila namely, Ospital ng Maynila Medical Center, Tondo Medical Center, and Gat Andres Bonifacio Memorial Medical Center. Data were collected using an evaluative checklist. Ranking, weighted mean, Chi-square and Pearson’s R were used to analyze data. The level of compliance to the EINC Protocols by the respondents was evaluated with an overall mean score of 4.768 implying that OB-DR Nurses have a high regard in complying with the step by step procedure of the EINC. Furthermore, data shows that formal training on EINC have a significant relationship with OB-DR Nurses’ level of compliance during cord care, AMTSL, and immediate newborn care until the first ninety minutes to six hours of life. However, the respondents’ age and length of service do not have a significant relationship with the compliance of OB-DR Nurses on EINC Protocols. In the pursuit of decreasing the maternal mortality in the Philippines, EINC Protocols have been widely implemented in the country especially in the government hospitals where most of the deliveries happen. In this study, it was found out that OB-DR Nurses adhere and are highly compliant to the standards in order to assure that optimum level of care is delivered to the mother and newborn. Formal training on EINC, on the other hand, create the most impact on the compliance of nurses. It is therefore recommended that there must be a structured enhancement training program to plan, implement and evaluate the EINC protocols in these government hospitals.

Keywords: compliance, intrapartum, newborn care, nurses

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