Search results for: Dominic Asitanga
10 Quantifying the Effects of Canopy Cover and Cover Crop Species on Water Use Partitioning in Micro-Sprinkler Irrigated Orchards in South Africa
Authors: Zanele Ntshidi, Sebinasi Dzikiti, Dominic Mazvimavi
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South Africa is a dry country and yet it is ranked as the 8th largest exporter of fresh apples (Malus Domestica) globally. Prime apple producing regions are in the Eastern and Western Cape Provinces of the country where all the fruit is grown under irrigation. Climate change models predict increasingly drier future conditions in these regions and the frequency and severity of droughts is expected to increase. For the sustainability and growth of the fruit industry it is important to minimize non-beneficial water losses from the orchard floor. The aims of this study were firstly to compare the water use of cover crop species used in South African orchards for which there is currently no information. The second aim was to investigate how orchard water use (evapotranspiration) was partitioned into beneficial (tree transpiration) and non-beneficial (orchard floor evaporation) water uses for micro-sprinkler irrigated orchards with different canopy covers. This information is important in order to explore opportunities to minimize non-beneficial water losses. Six cover crop species (four exotic and two indigenous) were grown in 2 L pots in a greenhouse. Cover crop transpiration was measured using the gravimetric method on clear days. To establish how water use was partitioned in orchards, evapotranspiration (ET) was measured using an open path eddy covariance system, while tree transpiration was measured hourly throughout the season (October to June) on six trees per orchard using the heat ratio sap flow method. On selected clear days, soil evaporation was measured hourly from sunrise to sunset using six micro-lysimeters situated at different wet/dry and sun/shade positions on the orchard floor. Transpiration of cover crops was measured using miniature (2 mm Ø) stem heat balance sap flow gauges. The greenhouse study showed that exotic cover crops had significantly higher (p < 0.01) average transpiration rates (~3.7 L/m2/d) than the indigenous species (~ 2.2 L/m²/d). In young non-bearing orchards, orchard floor evaporative fluxes accounted for more than 60% of orchard ET while this ranged from 10 to 30% in mature orchards with a high canopy cover. While exotic cover crops are preferred by most farmers, this study shows that they use larger quantities of water than indigenous species. This in turn contributes to a larger orchard floor evaporation flux. In young orchards non-beneficial losses can be minimized by adopting drip or short range micro-sprinkler methods that reduce the wetted soil fraction thereby conserving water.Keywords: evapotranspiration, sap flow, soil evaporation, transpiration
Procedia PDF Downloads 3879 Children's Literature with Mathematical Dialogue for Teaching Mathematics at Elementary Level: An Exploratory First Phase about Students’ Difficulties and Teachers’ Needs in Third and Fourth Grade
Authors: Goulet Marie-Pier, Voyer Dominic, Simoneau Victoria
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In a previous research project (2011-2019) funded by the Quebec Ministry of Education, an educational approach was developed based on the teaching and learning of place value through children's literature. Subsequently, the effect of this approach on the conceptual understanding of the concept among first graders (6-7 years old) was studied. The current project aims to create a series of children's literature to help older elementary school students (8-10 years old) in developing a conceptual understanding of complex mathematical concepts taught at their grade level rather than a more typical procedural understanding. Knowing that there are no educational material or children's books that exist to achieve our goals, four stories, accompanied by mathematical activities, will be created to support students, and their teachers, in the learning and teaching of mathematical concepts that can be challenging within their mathematic curriculum. The stories will also introduce a mathematical dialogue into the characters' discourse with the aim to address various mathematical foundations for which there are often erroneous statements among students and occasionally among teachers. In other words, the stories aim to empower students seeking a real understanding of difficult mathematical concepts, as well as teachers seeking a way to teach these difficult concepts in a way that goes beyond memorizing rules and procedures. In order to choose the concepts that will be part of the stories, it is essential to understand the current landscape regarding the main difficulties experienced by students in third and fourth grade (8-10 years old) and their teacher’s needs. From this perspective, the preliminary phase of the study, as discussed in the presentation, will provide critical insight into the mathematical concepts with which the target grade levels struggle the most. From this data, the research team will select the concepts and develop their stories in the second phase of the study. Two questions are preliminary to the implementation of our approach, namely (1) what mathematical concepts are considered the most “difficult to teach” by teachers in the third and fourth grades? and (2) according to teachers, what are the main difficulties encountered by their students in numeracy? Self-administered online questionnaires using the SimpleSondage software will be sent to all third and fourth-grade teachers in nine school service centers in the Quebec region, representing approximately 300 schools. The data that will be collected in the fall of 2022 will be used to compare the difficulties identified by the teachers with those prevalent in the scientific literature. Considering that this ensures consistency between the proposed approach and the true needs of the educational community, this preliminary phase is essential to the relevance of the rest of the project. It is also an essential first step in achieving the two ultimate goals of the research project, improving the learning of elementary school students in numeracy, and contributing to the professional development of elementary school teachers.Keywords: children’s literature, conceptual understanding, elementary school, learning and teaching, mathematics
Procedia PDF Downloads 888 A Comparison of Two and Three Dimensional Motion Capture Methodologies in the Analysis of Underwater Fly Kicking Kinematics
Authors: Isobel M. Thompson, Dorian Audot, Dominic Hudson, Martin Warner, Joseph Banks
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Underwater fly kick is an essential skill in swimming, which can have a considerable impact upon overall race performance in competition, especially in sprint events. Reduced wave drags acting upon the body under the surface means that the underwater fly kick will potentially be the fastest the swimmer is travelling throughout the race. It is therefore critical to understand fly kicking techniques and determining biomechanical factors involved in the performance. Most previous studies assessing fly kick kinematics have focused on two-dimensional analysis; therefore, the three-dimensional elements of the underwater fly kick techniques are not well understood. Those studies that have investigated fly kicking techniques using three-dimensional methodologies have not reported full three-dimensional kinematics for the techniques observed, choosing to focus on one or two joints. There has not been a direct comparison completed on the results obtained using two-dimensional and three-dimensional analysis, and how these different approaches might affect the interpretation of subsequent results. The aim of this research is to quantify the differences in kinematics observed in underwater fly kicks obtained from both two and three-dimensional analyses of the same test conditions. In order to achieve this, a six-camera underwater Qualisys system was used to develop an experimental methodology suitable for assessing the kinematics of swimmer’s starts and turns. The cameras, capturing at a frequency of 100Hz, were arranged along the side of the pool spaced equally up to 20m creating a capture volume of 7m x 2m x 1.5m. Within the measurement volume, error levels were estimated at 0.8%. Prior to pool trials, participants completed a landside calibration in order to define joint center locations, as certain markers became occluded once the swimmer assumed the underwater fly kick position in the pool. Thirty-four reflective markers were placed on key anatomical landmarks, 9 of which were then removed for the pool-based trials. The fly-kick swimming conditions included in the analysis are as follows: maximum effort prone, 100m pace prone, 200m pace prone, 400m pace prone, and maximum pace supine. All trials were completed from a push start to 15m to ensure consistent kick cycles were captured. Both two-dimensional and three-dimensional kinematics are calculated from joint locations, and the results are compared. Key variables reported include kick frequency and kick amplitude, as well as full angular kinematics of the lower body. Key differences in these variables obtained from two-dimensional and three-dimensional analysis are identified. Internal rotation (up to 15º) and external rotation (up to -28º) were observed using three-dimensional methods. Abduction (5º) and adduction (15º) were also reported. These motions are not observed in the two-dimensional analysis. Results also give an indication of different techniques adopted by swimmers at various paces and orientations. The results of this research provide evidence of the strengths of both two dimensional and three dimensional motion capture methods in underwater fly kick, highlighting limitations which could affect the interpretation of results from both methods.Keywords: swimming, underwater fly kick, performance, motion capture
Procedia PDF Downloads 1327 Freight Time and Cost Optimization in Complex Logistics Networks, Using a Dimensional Reduction Method and K-Means Algorithm
Authors: Egemen Sert, Leila Hedayatifar, Rachel A. Rigg, Amir Akhavan, Olha Buchel, Dominic Elias Saadi, Aabir Abubaker Kar, Alfredo J. Morales, Yaneer Bar-Yam
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The complexity of providing timely and cost-effective distribution of finished goods from industrial facilities to customers makes effective operational coordination difficult, yet effectiveness is crucial for maintaining customer service levels and sustaining a business. Logistics planning becomes increasingly complex with growing numbers of customers, varied geographical locations, the uncertainty of future orders, and sometimes extreme competitive pressure to reduce inventory costs. Linear optimization methods become cumbersome or intractable due to a large number of variables and nonlinear dependencies involved. Here we develop a complex systems approach to optimizing logistics networks based upon dimensional reduction methods and apply our approach to a case study of a manufacturing company. In order to characterize the complexity in customer behavior, we define a “customer space” in which individual customer behavior is described by only the two most relevant dimensions: the distance to production facilities over current transportation routes and the customer's demand frequency. These dimensions provide essential insight into the domain of effective strategies for customers; direct and indirect strategies. In the direct strategy, goods are sent to the customer directly from a production facility using box or bulk trucks. In the indirect strategy, in advance of an order by the customer, goods are shipped to an external warehouse near a customer using trains and then "last-mile" shipped by trucks when orders are placed. Each strategy applies to an area of the customer space with an indeterminate boundary between them. Specific company policies determine the location of the boundary generally. We then identify the optimal delivery strategy for each customer by constructing a detailed model of costs of transportation and temporary storage in a set of specified external warehouses. Customer spaces help give an aggregate view of customer behaviors and characteristics. They allow policymakers to compare customers and develop strategies based on the aggregate behavior of the system as a whole. In addition to optimization over existing facilities, using customer logistics and the k-means algorithm, we propose additional warehouse locations. We apply these methods to a medium-sized American manufacturing company with a particular logistics network, consisting of multiple production facilities, external warehouses, and customers along with three types of shipment methods (box truck, bulk truck and train). For the case study, our method forecasts 10.5% savings on yearly transportation costs and an additional 4.6% savings with three new warehouses.Keywords: logistics network optimization, direct and indirect strategies, K-means algorithm, dimensional reduction
Procedia PDF Downloads 1386 The Use of Telecare in the Re-design of Overnight Supports for People with Learning Disabilities: Implementing a Cluster-based Approach in North Ayrshire
Authors: Carly Nesvat, Dominic Jarrett, Colin Thomson, Wilma Coltart, Thelma Bowers, Jan Thomson
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Introduction: Within Scotland, the Same As You strategy committed to moving people with learning disabilities out of long-stay hospital accommodation into homes in the community. Much of the focus of this movement was on the placement of people within individual homes. In order to achieve this, potentially excessive supports were put in place which created dependence, and carried significant ongoing cost primarily for local authorities. The greater focus on empowerment and community participation which has been evident in more recent learning disability strategy, along with the financial pressures being experienced across the public sector, created an imperative to re-examine that provision, particularly in relation to the use of expensive sleepover supports to individuals, and the potential for this to be appropriately scaled back through the use of telecare. Method: As part of a broader programme of redesigning overnight supports within North Ayrshire, a cluster of individuals living in close proximity were identified, who were in receipt of overnight supports, but who were identified as having the capacity to potentially benefit from their removal. In their place, a responder service was established (an individual staying overnight in a nearby service user’s home), and a variety of telecare solutions were placed within individual’s homes. Active and passive technology was connected to an Alarm Receiving Centre, which would alert the local responder service when necessary. Individuals and their families were prepared for the change, and continued to be informed about progress with the pilot. Results: 4 individuals, 2 of whom shared a tenancy, had their sleepover supports removed as part of the pilot. Extensive data collection in relation to alarm activation was combined with feedback from the 4 individuals, their families, and staff involved in their support. Varying perspectives emerged within the feedback. 3 of the individuals were clearly described as benefitting from the change, and the greater sense of independence it brought, while more concerns were evident in relation to the fourth. Some family members expressed a need for greater preparation in relation to the change and ongoing information provision. Some support staff also expressed a need for more information, to help them understand the new support arrangements for an individual, as well as noting concerns in relation to the outcomes for one participant. Conclusion: Developing a telecare response in relation to a cluster of individuals was facilitated by them all being supported by the same care provider. The number of similar clusters of individuals being identified within North Ayrshire is limited. Developing other solutions such as a response service for redesign will potentially require greater collaboration between different providers of home support, as well as continuing to explore the full range of telecare, including digital options. The pilot has highlighted the need for effective preparatory and ongoing engagement with staff and families, as well as the challenges which can accompany making changes to long-standing packages of support.Keywords: challenges, change, engagement, telecare
Procedia PDF Downloads 1775 Intervention To Prevent Infections And Reinfections With Intestinal Parasites In People Living With Human Immunodeficiency Virus In Some Parts Of Eastern Cape, South Africa
Authors: Ifeoma Anozie, Teka Apalata, Dominic Abaver
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Introduction: Despite use of Anti-retroviral therapy to reduce the incidence of opportunistic infections among HIV/AIDS patients, rapid episodes of re-infection after deworming are still common occurrences because pharmaceutical intervention alone does not prevent reinfection. Unsafe water and inadequate personal hygiene and parasitic infections are widely expected to accelerate the progression of HIV infection. This is because the chronic immunosuppression of HIV infection encourages susceptibility to opportunistic (including parasitic) infections which is linked to CD4+ cell count of <200 cells/μl. Intestinal parasites such as G. intestinalis and Entamoeba spp are ubiquitous protozoa that remain infectious over a long time in an environment and show resistance to standard disinfection. To control re-infection, the social factors that underpin the prevention need to be controlled. This study aims at prevention of intestinal parasites in people living with HIV/AIDS by using a treatment, hygiene education and sanitation (THEdS) bundle approach. Methods: This study was conducted in four clinics (Ngangelizwe health centre, Tsolo gateway clinic, Idutywa health centre and Nqamakwe health centre) across the seven districts in Eastern cape, South Africa. The four clinics were divided in two: experimental and control, for the purpose of intervention. Data was collected from March 2019 to February 2020. Six hundred participants were screened for intestinal parasitic infections. Stool samples were collected and analysed twice: before (Pre-test infection screening) and after (Post-test re-infection) THEdS bundle intervention. The experimental clinics received full intervention package, which include therapeutic treatment, health education on personal hygiene and sanitation training, while the control clinics received only therapeutic treatment for those found with intestinal parasitic infections. Results: Baseline prevalence of Intestinal Parasites isolated shows 12 intestinal parasites with overall frequency of 65, with Ascaris lumbricoides having most frequency (44.6%). The intervention had a cure rate of 60%, with odd ratio of 1.42, which indicates that the intervention group is 1.42 times more likely of parasite clearing as compared to the control group. The relative risk ratio of 1.17 signifies that there is 1.17 times more likelihood to clear intestinal parasite if there no intervention. Discussion and conclusion: Infection with multiple parasites can cause health defects, especially among HIV/AIDS patients. Efficiency of some HIV vaccines in HIV/AIDS patients is affected because treatment of re-infection amplifies drug resistance, affects the efficacy of the front-line drugs, and still permits transmission. In South Africa, treatment of intestinal parasites is usually offered to clinic attending HIV/AIDS patients upon suspicion but not as a mandate for patients being initiated into Antiretroviral (ART) program. The effectiveness of THEdS bundle advocates for inclusiveness of mandatory screening for intestinal parasitic infections among attendees of HIV/Aids clinics on regular basis.Keywords: cure rate, , HIV/AIDS patients, intestinal parasites, intervention studies, reinfection rate
Procedia PDF Downloads 754 Tales of Two Cities: 'Motor City' Detroit and 'King Cotton' Manchester: Transatlantic Transmissions and Transformations, Flows of Communications, Commercial and Cultural Connections
Authors: Dominic Sagar
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Manchester ‘King Cotton’, the first truly industrial city of the nineteenth century, passing on the baton to Detroit ‘Motor City’, is the first truly modern city. We are exploring the tales of the two cities, their rise and fall and subsequent post-industrial decline, their transitions and transformations, whilst alongside paralleling their corresponding, commercial, cultural, industrial and even agricultural, artistic and musical transactions and connections. The paper will briefly contextualize how technologies of the industrial age and modern age have been instrumental in the development of these cities and other similar cities including New York. However, the main focus of the study will be the present and more importantly the future, how globalisation and the advancements of digital technologies and industries have shaped the cities developments from AlanTuring and the making of the first programmable computer to the effect of digitalisation and digital initiatives. Manchester now has a thriving creative digital infrastructure of Digilabs, FabLabs, MadLabs and hubs, the study will reference the Smart Project and the Manchester Digital Development Association whilst paralleling similar digital and creative industrial initiatives now starting to happen in Detroit. The paper will explore other topics including the need to allow for zones of experimentation, areas to play, think and create in order develop and instigate new initiatives and ideas of production, carrying on the tradition of influential inventions throughout the history of these key cities. Other topics will be briefly touched on, such as urban farming, citing the Biospheric foundation in Manchester and other similar projects in Detroit. However, the main thread will focus on the music industries and how they are contributing to the regeneration of cities. Musically and artistically, Manchester and Detroit have been closely connected by the flow and transmission of information and transfer of ideas via ‘cars and trains and boats and planes’ through to the new ‘super highway’. From Detroit to Manchester often via New York and Liverpool and back again, these musical and artistic connections and flows have greatly affected and influenced both cities and the advancement of technology are still connecting the cities. In summary two hugely important industrial cities, subsequently both experienced massive decline in fortunes, having had their large industrial hearts ripped out, ravaged leaving dying industrial carcasses and car crashes of despair, dereliction, desolation and post-industrial wastelands vacated by a massive exodus of the cities’ inhabitants. To examine the affinity, similarity and differences between Manchester & Detroit, from their industrial importance to their post-industrial decline and their current transmutations, transformations, transient transgressions, cities in transition; contrasting how they have dealt with these problems and how they can learn from each other. With a view to framing these topics with regard to how various communities have shaped these cities and the creative industries and design [the new cotton/car manufacturing industries] are reinventing post-industrial cities, to speculate on future development of these themes in relation to Globalisation, digitalisation and how cities can function to develop solutions to communal living in cities of the future.Keywords: cultural capital, digital developments, musical initiatives, zones of experimentation
Procedia PDF Downloads 1943 Assessment of Efficiency of Underwater Undulatory Swimming Strategies Using a Two-Dimensional CFD Method
Authors: Dorian Audot, Isobel Margaret Thompson, Dominic Hudson, Joseph Banks, Martin Warner
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In competitive swimming, after dives and turns, athletes perform underwater undulatory swimming (UUS), copying marine mammals’ method of locomotion. The body, performing this wave-like motion, accelerates the fluid downstream in its vicinity, generating propulsion with minimal resistance. Through this technique, swimmers can maintain greater speeds than surface swimming and take advantage of the overspeed granted by the dive (or push-off). Almost all previous work has considered UUS when performed at maximum effort. Critical parameters to maximize UUS speed are frequently discussed; however, this does not apply to most races. In only 3 out of the 16 individual competitive swimming events are athletes likely to attempt to perform UUS with the greatest speed, without thinking of the cost of locomotion. In the other cases, athletes will want to control the speed of their underwater swimming, attempting to maximise speed whilst considering energy expenditure appropriate to the duration of the event. Hence, there is a need to understand how swimmers adapt their underwater strategies to optimize the speed within the allocated energetic cost. This paper develops a consistent methodology that enables different sets of UUS kinematics to be investigated. These may have different propulsive efficiencies and force generation mechanisms (e.g.: force distribution along with the body and force magnitude). The developed methodology, therefore, needs to: (i) provide an understanding of the UUS propulsive mechanisms at different speeds, (ii) investigate the key performance parameters when UUS is not performed solely for maximizing speed; (iii) consistently determine the propulsive efficiency of a UUS technique. The methodology is separated into two distinct parts: kinematic data acquisition and computational fluid dynamics (CFD) analysis. For the kinematic acquisition, the position of several joints along the body and their sequencing were either obtained by video digitization or by underwater motion capture (Qualisys system). During data acquisition, the swimmers were asked to perform UUS at a constant depth in a prone position (facing the bottom of the pool) at different speeds: maximum effort, 100m pace, 200m pace and 400m pace. The kinematic data were input to a CFD algorithm employing a two-dimensional Large Eddy Simulation (LES). The algorithm adopted was specifically developed in order to perform quick unsteady simulations of deforming bodies and is therefore suitable for swimmers performing UUS. Despite its approximations, the algorithm is applied such that simulations are performed with the inflow velocity updated at every time step. It also enables calculations of the resistive forces (total and applied to each segment) and the power input of the modeled swimmer. Validation of the methodology is achieved by comparing the data obtained from the computations with the original data (e.g.: sustained swimming speed). This method is applied to the different kinematic datasets and provides data on swimmers’ natural responses to pacing instructions. The results show how kinematics affect force generation mechanisms and hence how the propulsive efficiency of UUS varies for different race strategies.Keywords: CFD, efficiency, human swimming, hydrodynamics, underwater undulatory swimming
Procedia PDF Downloads 2192 Improving the Academic Performance of Students: Management Role of Head Teachers as a Key Contributing Factor
Authors: Dominic Winston Kaku
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The academic performance of students is an area of great concern in education to the various stakeholders of education. This is because the academic performance of students is widely used as a measure of the success of the educational process. There are several factors, such as school-related factors, teachers related factors, pupils or students’ factors, and many others determining their academic performance. It appears that the management role of head teachers as a determining factor of pupils’ academic achievement is not much investigated. The management role of head teachers is an essential element in the educational process that has a huge influence on students’ academic performance. The aim of the research was to examine the management role of head teachers in improving the academic performance of students. The study employed a descriptive survey and was conducted among Junior High Schools in the Ellembelle District of the Western Region of Ghana. The respondents for the study were mainly all the head teachers, teachers, and some selected basic school pupils (JHS) in four-selected public basic schools in the Ellembelle district in the Western part of Ghana. A questionnaire was used to collect primary data from a sampling size of 252 persons, including 226 JHS pupils, all JHS teachers, and head teachers of all four selected schools. Descriptive statistics, specifically frequencies, percentages, pie charts, bar charts, means, and standard deviation, were used to analyse the data, and that formed the basis of the presentation of findings. The study discovered that planning academic activities, fostering relationships between the school and the community, supervising lessons, staff motivation, and punishing students who go wrong are some of the activities the head teachers participate in to help improve students’ academic performance. The academic performance of students is an area of great concern in education to the various stakeholders of education. This is because the academic performance of students is widely used as a measure of the success of the educational process. There are several factors, such as school-related factors, teachers related factors, pupils or students’ factors, and many others determining their academic performance. It appears that the management role of head teachers as a determining factor of pupils’ academic achievement is not much investigated. The management role of head teachers is an essential element in the educational process that has a huge influence on students’ academic performance. The aim of the research was to examine the management role of head teachers in improving the academic performance of students. The study employed a descriptive survey and was conducted among Junior High Schools in the Ellembelle District of the Western Region of Ghana. The respondents for the study were mainly all the head teachers, teachers, and some selected basic school pupils (JHS) in four-selected public basic schools in the Ellembelle district in the Western part of Ghana. A questionnaire was used to collect primary data from a sampling size of 252 persons, including 226 JHS pupils, all JHS teachers, and head teachers of all four selected schools. Descriptive statistics, specifically frequencies, percentages, pie charts, bar charts, means, and standard deviation, were used to analyse the data, and that formed the basis of the presentation of findings. The study discovered that planning academic activities, fostering relationships between the school and the community, supervising lessons, staff motivation, and punishing students who go wrong are some of the activities the head teachers participate in to help improve students’ academic performance.Keywords: supervision, head teacher, academic performance, planning, motivation, relationships
Procedia PDF Downloads 641 Modern Cardiac Surgical Outcomes in Nonagenarians: A Multicentre Retrospective Observational Study
Authors: Laurence Weinberg, Dominic Walpole, Dong-Kyu Lee, Michael D’Silva, Jian W. Chan, Lachlan F. Miles, Bradley Carp, Adam Wells, Tuck S. Ngun, Siven Seevanayagam, George Matalanis, Ziauddin Ansari, Rinaldo Bellomo, Michael Yii
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Background: There have been multiple recent advancements in the selection, optimization and management of cardiac surgical patients. However, there is limited data regarding the outcomes of nonagenarians undergoing cardiac surgery, despite this vulnerable cohort increasingly receiving these interventions. This study describes the patient characteristics, management and outcomes of a group of nonagenarians undergoing cardiac surgery in the context of contemporary peri-operative care. Methods: A retrospective observational study was conducted of patients 90 to 99 years of age (i.e., nonagenarians) who had undergone cardiac surgery requiring a classic median sternotomy (i.e., open-heart surgery). All operative indications were included. Patients who underwent minimally invasive surgery, transcatheter aortic valve implantation and thoracic aorta surgery were excluded. Data were collected from four hospitals in Victoria, Australia, over an 8-year period (January 2012 – December 2019). The primary objective was to assess six-month mortality in nonagenarians undergoing open-heart surgery and to evaluate the incidence and severity of postoperative complications using the Clavien-Dindo classification system. The secondary objective was to provide a detailed description of the characteristics and peri-operative management of this group. Results: A total of 12,358 adult patients underwent cardiac surgery at the study centers during the observation period, of whom 18 nonagenarians (0.15%) fulfilled the inclusion criteria. The median (IQR) [min-max] age was 91 years (90.0:91.8) [90-94] and 14 patients (78%) were men. Cardiovascular comorbidities, polypharmacy and frailty, were common. The median (IQR) predicted in-hospital mortality by EuroSCORE II was 6.1% (4.1-14.5). All patients were optimized preoperatively by a multidisciplinary team of surgeons, cardiologists, geriatricians and anesthetists. All index surgeries were performed on cardiopulmonary bypass. Isolated coronary artery bypass grafting (CABG) and CABG with aortic valve replacement were the most common surgeries being performed in four and five patients, respectively. Half the study group underwent surgery involving two or more major procedures (e.g. CABG and valve replacement). Surgery was undertaken emergently in 44% of patients. All patients except one experienced at least one postoperative complication. The most common complications were acute kidney injury (72%), new atrial fibrillation (44%) and delirium (39%). The highest Clavien-Dindo complication grade was IIIb occurring once each in three patients. Clavien-Dindo grade IIIa complications occurred in only one patient. The median (IQR) postoperative length of stay was 11.6 days (9.8:17.6). One patient was discharged home and all others to an inpatient rehabilitation facility. Three patients had an unplanned readmission within 30 days of discharge. All patients had follow-up to at least six months after surgery and mortality over this period was zero. The median (IQR) duration of follow-up was 11.3 months (6.0:26.4) and there were no cases of mortality observed within the available follow-up records. Conclusion: In this group of nonagenarians undergoing cardiac surgery, postoperative six-month mortality was zero. Complications were common but generally of low severity. These findings support carefully selected nonagenarian patients being offered cardiac surgery in the context of contemporary, multidisciplinary perioperative care. Further, studies are needed to assess longer-term mortality and functional and quality of life outcomes in this vulnerable surgical cohort.Keywords: cardiac surgery, mortality, nonagenarians, postoperative complications
Procedia PDF Downloads 118