Search results for: final outcome
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4275

Search results for: final outcome

3675 Material Concepts and Processing Methods for Electrical Insulation

Authors: R. Sekula

Abstract:

Epoxy composites are broadly used as an electrical insulation for the high voltage applications since only such materials can fulfill particular mechanical, thermal, and dielectric requirements. However, properties of the final product are strongly dependent on proper manufacturing process with minimized material failures, as too large shrinkage, voids and cracks. Therefore, application of proper materials (epoxy, hardener, and filler) and process parameters (mold temperature, filling time, filling velocity, initial temperature of internal parts, gelation time), as well as design and geometric parameters are essential features for final quality of the produced components. In this paper, an approach for three-dimensional modeling of all molding stages, namely filling, curing and post-curing is presented. The reactive molding simulation tool is based on a commercial CFD package, and include dedicated models describing viscosity and reaction kinetics that have been successfully implemented to simulate the reactive nature of the system with exothermic effect. Also a dedicated simulation procedure for stress and shrinkage calculations, as well as simulation results are presented in the paper. Second part of the paper is dedicated to recent developments on formulations of functional composites for electrical insulation applications, focusing on thermally conductive materials. Concepts based on filler modifications for epoxy electrical composites have been presented, including the results of the obtained properties. Finally, having in mind tough environmental regulations, in addition to current process and design aspects, an approach for product re-design has been presented focusing on replacement of epoxy material with the thermoplastic one. Such “design-for-recycling” method is one of new directions associated with development of new material and processing concepts of electrical products and brings a lot of additional research challenges. For that, one of the successful products has been presented to illustrate the presented methodology.

Keywords: curing, epoxy insulation, numerical simulations, recycling

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3674 Financial Audit Planning: Its Importance in Kosovo Entrepreneurship

Authors: Shpetim Rezniqi

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Over the years has increased, and increasingly has become necessary to make audit of financial statements. An auditor to perform an audit, should plan its audit in order to provide a high-quality audit and to be performed in an economic, efficient, effective and timely. This phase of the audit is also important stages of reach to the final goal of an audit to be professional and based in Kosovo and International Standards on Auditing. Always considering Kosovo as a new state and once out of war, where everything in its entrepreneurship started from the lowest stage of economic development and aim at development and regional and European integration, planning and performing audit becomes even more important.

Keywords: control, accounting, planning, analysis

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3673 Multivariate Analysis of Student’s Performance in Statistic Courses in Humanities Sciences

Authors: Carla Silva

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The aim of this research is to study the relationship between the performance of humanities students in different statistics classes and their performance in their specific courses. Several factors are been studied, such as gender and final grades in statistics and math. Participants of this study comprised a sample of students at a Lisbon University during their academic year. A significant relationship tends to appear between these factors and the performance of these students. However this relationship tends to be stronger with students who had previous studied calculus and math.

Keywords: education, performance, statistic, humanities

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3672 The Analgesic Impact of Adding Intrathecal Ketamine to Spinal Anaesthesia for Hip or Knee Arthroplasty: A Clinical Audit

Authors: Carl Ashworth, Matthys Campher

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Spinal anaesthesia has been identified as the “gold standard” for primary elective total hip and knee arthroplasty, which is most commonly performed using longer-acting local anaesthetics, such as hyperbaric bupivacaine, to prolong the duration of anaesthesia and analgesia suitable for these procedures. Ketamine is known to have local anaesthetic effects with potent analgesic properties and has been evaluated as a sole anaesthetic agent via intrathecal administration; however, the use of intrathecal ketamine as an adjunct to intrathecal hyperbaric bupivacaine, morphine, and fentanyl has not been extensively studied. The objective of this study was to identify the potential analgesic effects of the addition of intrathecal ketamine to spinal anaesthesia and to compare the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine. The medical records of patients who underwent elective hip- or knee arthroplasty under spinal anaesthesia performed by an individual anaesthetist with either intrathecal hyperbaric bupivacaine, morphine and fentanyl or intrathecal hyperbaric bupivacaine, morphine, fentanyl and ketamine between June 4, 2020, and June 4, 2022, were retrospectively reviewed. These encounters were reviewed and analyzed from a perioperative pain perspective, with the primary outcome measure as the oral morphine equivalent (OME) usage in the 48 hours post-spinal anaesthesia, and secondary outcome measures including time to breakthrough analgesia, self-reported pain scores at rest and during movement at 24 and 48 hours after surgery, adverse effects of analgesia, complications, and length of stay. There were 26 patients identified who underwent TKR between June 4, 2020, and June 4, 2022, and 25 patients who underwent THR with the same conditions. It was identified that patients who underwent traditional spinal anaesthesia with the addition of ketamine for elective hip- or knee arthroplasty had a lower mean total OME in the 48 hours immediately post-spinal anaesthesia yet had a shorter time to breakthrough analgesia administration. The proposed mechanism of action for intrathecal ketamine as an additive to traditional spinal anaesthesia for elective hip- or knee arthroplasty is that it may prolong and attenuate the analgesic effect of traditional spinal anaesthesia. There were no significant differences identified in comparing the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine.

Keywords: anaesthesia, spinal, intra-thecal, ketamine, spinal-morphine, bupivacaine

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3671 Implementation of a Web-Based Clinical Outcomes Monitoring and Reporting Platform across the Fortis Network

Authors: Narottam Puri, Bishnu Panigrahi, Narayan Pendse

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Background: Clinical Outcomes are the globally agreed upon, evidence-based measurable changes in health or quality of life resulting from the patient care. Reporting of outcomes and its continuous monitoring provides an opportunity for both assessing and improving the quality of patient care. In 2012, International Consortium Of HealthCare Outcome Measurement (ICHOM) was founded which has defined global Standard Sets for measuring the outcome of various treatments. Method: Monitoring of Clinical Outcomes was identified as a pillar of Fortis’ core value of Patient Centricity. The project was started as an in-house developed Clinical Outcomes Reporting Portal by the Fortis Medical IT team. Standard sets of Outcome measurement developed by ICHOM were used. A pilot was run at Fortis Escorts Heart Institute from Aug’13 – Dec’13.Starting Jan’14, it was implemented across 11 hospitals of the group. The scope was hospital-wide and major clinical specialties: Cardiac Sciences, Orthopedics & Joint Replacement were covered. The internally developed portal had its limitations of report generation and also capturing of Patient related outcomes was restricted. A year later, the company provisioned for an ICHOM Certified Software product which could provide a platform for data capturing and reporting to ensure compliance with all ICHOM requirements. Post a year of the launch of the software; Fortis Healthcare has become the 1st Healthcare Provider in Asia to publish Clinical Outcomes data for the Coronary Artery Disease Standard Set comprising of Coronary Artery Bypass Graft and Percutaneous Coronary Interventions) in the public domain. (Jan 2016). Results: This project has helped in firmly establishing a culture of monitoring and reporting Clinical Outcomes across Fortis Hospitals. Given the diverse nature of the healthcare delivery model at Fortis Network, which comprises of hospitals of varying size and specialty-mix and practically covering the entire span of the country, standardization of data collection and reporting methodology is a huge achievement in itself. 95% case reporting was achieved with more than 90% data completion at the end of Phase 1 (March 2016). Post implementation the group now has one year of data from its own hospitals. This has helped identify the gaps and plan towards ways to bridge them and also establish internal benchmarks for continual improvement. Besides the value created for the group includes: 1. Entire Fortis community has been sensitized on the importance of Clinical Outcomes monitoring for patient centric care. Initial skepticism and cynicism has been countered by effective stakeholder engagement and automation of processes. 2. Measuring quality is the first step in improving quality. Data analysis has helped compare clinical results with best-in-class hospitals and identify improvement opportunities. 3. Clinical fraternity is extremely pleased to be part of this initiative and has taken ownership of the project. Conclusion: Fortis Healthcare is the pioneer in the monitoring of Clinical Outcomes. Implementation of ICHOM standards has helped Fortis Clinical Excellence Program in improving patient engagement and strengthening its commitment to its core value of Patient Centricity. Validation and certification of the Clinical Outcomes data by an ICHOM Certified Supplier adds confidence to its claim of being leaders in this space.

Keywords: clinical outcomes, healthcare delivery, patient centricity, ICHOM

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3670 Orientation towards Social Entrepreneurship-Prioritary: Givens for Overcoming Social Inequality

Authors: Revaz Gvelesiani

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Nowadays, social inequality increasingly strengthens the trend from business entrepreneurship to social entrepreneurship. It can be said that business entrepreneurs, according to their interests, move towards social entrepreneurship. Effectively operating markets create mechanisms, which lead to 'good' behavior. This is the most important feature of the rationally functioning society. As for the prospects of social entrepreneurship, expansion of entrepreneurship concept at the social arena may lead to such an outcome, when people who are skeptical about business, become more open towards entrepreneurship as a type of activity. This is the way which by means of increased participation in entrepreneurship promotes fair distribution of wealth. Today 'entrepreneurship for all' is still a dream, although the one, which may come true.

Keywords: social entrepreneurship, business entrepreneurship, functions of entrepreneurship, social inequality, social interests, interest groups, interest conflicts

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3669 A Case Study on Utility of 18FDG-PET/CT Scan in Identifying Active Extra Lymph Nodes and Staging of Breast Cancer

Authors: Farid Risheq, M. Zaid Alrisheq, Shuaa Al-Sadoon, Karim Al-Faqih, Mays Abdulazeez

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Breast cancer is the most frequently diagnosed cancer worldwide, and a common cause of death among women. Various conventional anatomical imaging tools are utilized for diagnosis, histological assessment and TNM (Tumor, Node, Metastases) staging of breast cancer. Biopsy of sentinel lymph node is becoming an alternative to the axillary lymph node dissection. Advances in 18-Fluoro-Deoxi-Glucose Positron Emission Tomography/Computed Tomography (18FDG-PET/CT) imaging have facilitated breast cancer diagnosis utilizing biological trapping of 18FDG inside lesion cells, expressed as Standardized Uptake Value (SUVmax). Objective: To present the utility of 18FDG uptake PET/CT scans in detecting active extra lymph nodes and distant occult metastases for breast cancer staging. Subjects and Methods: Four female patients were presented with initially classified TNM stages of breast cancer based on conventional anatomical diagnostic techniques. 18FDG-PET/CT scans were performed one hour post 18FDG intra-venous injection of (300-370) MBq, and (7-8) bed/130sec. Transverse, sagittal, and coronal views; fused PET/CT and MIP modality were reconstructed for each patient. Results: A total of twenty four lesions in breast, extended lesions to lung, liver, bone and active extra lymph nodes were detected among patients. The initial TNM stage was significantly changed post 18FDG-PET/CT scan for each patient, as follows: Patient-1: Initial TNM-stage: T1N1M0-(stage I). Finding: Two lesions in right breast (3.2cm2, SUVmax=10.2), (1.8cm2, SUVmax=6.7), associated with metastases to two right axillary lymph nodes. Final TNM-stage: T1N2M0-(stage II). Patient-2: Initial TNM-stage: T2N2M0-(stage III). Finding: Right breast lesion (6.1cm2, SUVmax=15.2), associated with metastases to right internal mammary lymph node, two right axillary lymph nodes, and sclerotic lesions in right scapula. Final TNM-stage: T2N3M1-(stage IV). Patient-3: Initial TNM-stage: T2N0M1-(stage III). Finding: Left breast lesion (11.1cm2, SUVmax=18.8), associated with metastases to two lymph nodes in left hilum, and three lesions in both lungs. Final TNM-stage: T2N2M1-(stage IV). Patient-4: Initial TNM-stage: T4N1M1-(stage III). Finding: Four lesions in upper outer quadrant area of right breast (largest: 12.7cm2, SUVmax=18.6), in addition to one lesion in left breast (4.8cm2, SUVmax=7.1), associated with metastases to multiple lesions in liver (largest: 11.4cm2, SUV=8.0), and two bony-lytic lesions in left scapula and cervicle-1. No evidence of regional or distant lymph node involvement. Final TNM-stage: T4N0M2-(stage IV). Conclusions: Our results demonstrated that 18FDG-PET/CT scans had significantly changed the TNM stages of breast cancer patients. While the T factor was unchanged, N and M factors showed significant variations. A single session of PET/CT scan was effective in detecting active extra lymph nodes and distant occult metastases, which were not identified by conventional diagnostic techniques, and might advantageously replace bone scan, and contrast enhanced CT of chest, abdomen and pelvis. Applying 18FDG-PET/CT scan early in the investigation, might shorten diagnosis time, helps deciding adequate treatment protocol, and could improve patients’ quality of life and survival. Trapping of 18FDG in malignant lesion cells, after a PET/CT scan, increases the retention index (RI%) for a considerable time, which might help localize sentinel lymph node for biopsy using a hand held gamma probe detector. Future work is required to demonstrate its utility.

Keywords: axillary lymph nodes, breast cancer staging, fluorodeoxyglucose positron emission tomography/computed tomography, lymph nodes

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3668 Learning Difficulties of Children with Disabilities

Authors: Chalise Kiran

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The learning difficulties of children with disabilities are always a matter of concern when we talk about educational needs and quality education of children with disabilities. This paper is the outcome of the review of the literatures based on the literatures on the educational needs and learning difficulties of children with disabilities. For the paper, different studies written on children with disabilities and their education were collected through search engines. The literature put together was analyzed from the angle of learning difficulties faced by children with disabilities and the same were used as a precursor to arrive at the findings on the learning of the children. The analysis showed that children with disabilities face learning difficulties. The reasons for these difficulties could be attributed to factors in terms of authority, structure, school environment, and behaviors of teachers and parents, and the society as a whole.

Keywords: children with disabilities, learning difficulties, education, disabled children

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3667 Cu₂(ZnSn)(S)₄ Electrodeposition from a Single Bath for Photovoltaic Applications

Authors: Mahfouz Saeed

Abstract:

Cu₂(ZnSn)(S)₄ (CTZS) offers potential advantages over CuInGaSe₂ (CIGS) as solar thin film because to its higher band gap. Preparing such photovoltaic materials by electrochemical techniques is particularly attractive due to the lower processing cost and the high throughput of such techniques. Several recent publications report CTZS electroplating; however, the electrochemical process still facing serious challenges such as a sulfur atomic ration which is about 50% of the total alloy. We introduce in this work an improved electrolyte composition which enables the direct electrodeposition of CTZS from a single bath. The electrolyte is significantly more dilute in comparison to common baths described in the literature. The bath composition we introduce is: 0.0032 M CuSO₄, 0.0021 M ZnSO₄, 0.0303 M SnCl₂, 0.0038 M Na₂S₂O₃, and 0.3 mM Na₂S₂O3. PHydrion is applied to buffer the electrolyte to pH=2, and 0.7 M LiCl is applied as supporting electrolyte. Electrochemical process was carried at a rotating disk electrode which provides quantitative characterization of the flow (room temperature). Comprehensive electrochemical behavior study at different electrode rotation rates are provided. The effects of agitation on atomic composition of the deposit and its adhesion to the molybdenum back contact are discussed. The post treatment annealing was conducted under sulfur atmosphere with no need for metals addition from the gas phase during annealing. The potential which produced the desired atomic ratio of CTZS at -0.82 V/NHE. Smooth deposit, with uniform composition across the sample surface and depth was obtained at 500 rpm rotation speed. Final sulfur atomic ratio was adjusted to 50.2% in order to have the desired atomic ration. The final composition was investigated using Energy-dispersive X-ray spectroscopy technique (EDS). XRD technique used to analyze CTZS crystallography and thickness. Complete and functional CTZS PV devices were fabricated by depositing all the required layers in the correct order and the desired optical properties. Acknowledgments: Case Western Reserve University for the technical help and for using their instruments.

Keywords: photovoltaic, CTZS, thin film, electrochemical

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3666 A Double-Blind, Randomized, Controlled Trial on N-Acetylcysteine for the Prevention of Acute Kidney Injury in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Authors: Sara Ataei, Molouk Hadjibabaie, Amirhossein Moslehi, Maryam Taghizadeh-Ghehi, Asieh Ashouri, Elham Amini, Kheirollah Gholami, Alireza Hayatshahi, Mohammad Vaezi, Ardeshir Ghavamzadeh

Abstract:

Acute kidney injury (AKI) is one of the complications of hematopoietic stem cell transplantation and is associated with increased mortality. N-acetylcysteine (NAC) is a thiol compound with antioxidant and vasodilatory properties that has been investigated for the prevention of AKI in several clinical settings. In the present study, we evaluated the effects of intravenous NAC on the prevention of AKI in allogeneic hematopoietic stem cell transplantation patients. A double-blind randomized placebo-controlled trial was conducted, and 80 patients were recruited to receive 100 mg/kg/day NAC or placebo as intermittent intravenous infusion from day -6 to day +15. AKI was determined on the basis of the Risk-Injury-Failure-Loss-Endstage renal disease and AKI Network criteria as the primary outcome. We assessed urine neutrophil gelatinase-associated lipocalin (uNGAL) on days -6, -3, +3, +9, and +15 as the secondary outcome. Moreover, transplant-related outcomes and NAC adverse reactions were evaluated during the study period. Statistical analysis was performed using appropriate parametric and non-parametric methods including Kaplan–Meier for AKI and generalized estimating equation for uNGAL. At the end of the trial, data from 72 patients were analyzed (NAC: 33 patients and placebo: 39 patients). Participants of each group were not different considering baseline characteristics. AKI was observed in 18% of NAC recipients and 15% of placebo group patients, and the occurrence pattern was not significantly different (p = 0.73). Moreover, no significant difference was observed between groups for uNGAL measures (p = 0.10). Transplant-related outcomes were similar for both groups, and all patients had successful engraftment. Three patients did not tolerate NAC because of abdominal pain, shortness of breath and rash with pruritus and were dropped from the intervention group before transplantation. However, the frequency of adverse reactions was not significantly different between groups. In conclusion, our findings could not show any clinical benefits from high-dose NAC particularly for AKI prevention in allogeneic hematopoietic stem cell transplantation patients.

Keywords: acute kidney injury, N-acetylcysteine, hematopoietic stem cell transplantation, urine neutrophil gelatinase-associated lipocalin, randomized controlled trial

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3665 The Impact of a Leadership Change on Individuals' Behaviour and Incentives: Evidence from the Top Tier Italian Football League

Authors: Kaori Narita, Juan de Dios Tena Horrillo, Claudio Detotto

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Decisions on replacement of leaders are of significance and high prevalence in any organization, and concerns many of its stakeholders, whether it is a leader in a political party or a CEO of a firm, as indicated by high media coverage of such events. This merits an investigation into the consequences and implications of a leadership change on the performances and behavior of organizations and their workers. Sport economics provides a fruitful field to explore these issues due to the high frequencies of managerial changes in professional sports clubs and the transparency and regularity of observations of team performance and players’ abilities. Much of the existing research on managerial change focuses on how this affects the performance of an organization. However, there is scarcely attention paid to the consequences of such events on the behavior of individuals within the organization. Changes in behavior and attitudes of a group of workers due to a managerial change could be of great interest in management science, psychology, and operational research. On the other hand, these changes cannot be observed in the final outcome of the organization, as this is affected by many other unobserved shocks, for example, the stress level of workers with the need to deal with a difficult situation. To fill this gap, this study shows the first attempt to evaluate the impact of managerial change on players’ behaviors such as attack intensity, aggressiveness, and efforts. The data used in this study is from the top tier Italian football league (“Serie A”), where an average of 13 within season replacements of head coaches were observed over the period of seasons from 2000/2001 to 2017/18. The preliminary estimation employs Pooled Ordinary Least Square (POLS) and club-season Fixed Effect (FE) in order to assess the marginal effect of having a new manager on the number of shots, corners and red/yellow cards after controlling for a home-field advantage, ex ante abilities and current positions in the league of a team and their opponent. The results from this preliminary estimation suggest that the teams do not show a significant difference in their behaviors before and after the managerial change. To build on these preliminary results, other methods, including propensity score matching and non-linear model estimates, will be used. Moreover, the study will further investigate these issues by considering other measurements of attack intensity, aggressiveness, and efforts, such as possessions, a number of fouls and the athletic performance of players, respectively. Finally, the study is going to investigate whether these results vary over the characteristics of a new head coach, for example, their age and experience as a manager and a player. Thus far, this study suggests that certain behaviours of individuals in an organisation are not immediately affected by a change in leadership. To confirm this preliminary finding and lead to a more solid conclusion, further investigation will be conducted in the aforementioned manner, and the results will be elaborated in the conference.

Keywords: behaviour, effort, manager characteristics, managerial change, sport economics

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3664 Development of an Integrated System for the Treatment of Rural Domestic Wastewater: Emphasis on Nutrient Removal

Authors: Prangya Ranjan Rout, Puspendu Bhunia, Rajesh Roshan Dash

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In a developing country like India, providing reliable and affordable wastewater treatment facilities in rural areas is a huge challenge. With the aim of enhancing the nutrient removal from rural domestic wastewater while reducing the cost of treatment process, a novel, integrated treatment system consisting of a multistage bio-filter with drop aeration and a post positioned attached growth carbonaceous denitrifying-bioreactor was designed and developed in this work. The bio-filter was packed with ‘dolochar’, a sponge iron industry waste, as an adsorbent mainly for phosphate removal through physiochemical approach. The Denitrifying bio-reactor was packed with many waste organic solid substances (WOSS) as carbon sources and substrates for biomass attachment, mainly to remove nitrate in biological denitrification process. The performance of the modular system, treating real domestic wastewater was monitored for a period of about 60 days and the average removal efficiencies during the period were as follows: phosphate, 97.37%; nitrate, 85.91%, ammonia, 87.85%, with mean final effluent concentration of 0.73, 9.86, and 9.46 mg/L, respectively. The multistage bio-filter played an important role in ammonium oxidation and phosphate adsorption. The multilevel drop aeration with increasing oxygenation, and the special media used, consisting of certain oxides were likely beneficial for nitrification and phosphorus removal, respectively, whereas the nitrate was effectively reduced by biological denitrification in the carbonaceous bioreactor. This treatment system would allow multipurpose reuse of the final effluent. Moreover, the saturated dolochar can be used as nutrient suppliers in agricultural practices and the partially degraded carbonaceous substances can be subjected to composting, and subsequently used as an organic fertilizer. Thus, the system displays immense potential for treating domestic wastewater significantly decreasing the concentrations of nutrients and more importantly, facilitating the conversion of the waste materials into usable ones.

Keywords: nutrient removal, denitrifying bioreactor, multi-stage bio-filter, dolochar, waste organic solid substances

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3663 Aquatic Therapy Improving Balance Function of Individuals with Stroke: A Systematic Review with Meta-Analysis

Authors: Wei-Po Wu, Wen-Yu Liu, Wei−Ting Lin, Hen-Yu Lien

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Introduction: Improving balance function for individuals after stroke is a crucial target in physiotherapy. Aquatic therapy which challenges individual’s postural control in an unstable fluid environment may be beneficial in enhancing balance functions. The purposes of the systematic review with meta-analyses were to validate the effects of aquatic therapy in improving balance functions for individuals with strokes in contrast to conventional physiotherapy. Method: Available studies were explored from three electronic databases: PubMed, Scopus, and Web of Science. During literature search, the published date of studies was not limited. The study design of the included studies should be randomized controlled trials (RCTs) and the studies should contain at least one outcome measurement of balance function. The PEDro scale was adopted to assess the quality of included studies, while the 'Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence' was used to evaluate the level of evidence. After the data extraction, studies with same outcome measures were pooled together for meta-analysis. Result: Ten studies with 282 participants were included in analyses. The research qualities of the studies were ranged from fair to good (4 to 8 points). Levels of evidence of the included studies were graded as level 2 and 3. Finally, scores of Berg Balance Scale (BBS), Eye closed force plate center of pressure velocity (anterior-posterior, medial-lateral axis) and Timed up and Go test were pooled and analyzed separately. The pooled results shown improvement in balance function (BBS mean difference (MD): 1.39 points; 95% confidence interval (CI): 0.05-2.29; p=0.002) (Eye closed force plate center of pressure velocity (anterior-posterior axis) MD: 1.39 mm/s; 95% confidence interval (CI): 0.93-1.86; p<0.001) (Eye closed force plate center of pressure velocity (medial-lateral) MD: 1.48 mm/s; 95% confidence interval (CI): 0.15-2.82; p=0.03) and mobility (MD: 0.9 seconds; 95% CI: 0.07-1.73; p=0.03) of stroke individuals after aquatic therapy compared to conventional therapy. Although there were significant differences between two treatment groups, the differences in improvement were relatively small. Conclusion: The aquatic therapy improved general balance function and mobility in the individuals with stroke better than conventional physiotherapy.

Keywords: aquatic therapy, balance function, meta-analysis, stroke, systematic review

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3662 Validation of a Placebo Method with Potential for Blinding in Ultrasound-Guided Dry Needling

Authors: Johnson C. Y. Pang, Bo Peng, Kara K. L. Reeves, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding is potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26 ± 5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms, and quality of life (QOL), were analyzed by repeated measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: ultrasound-guided dry needling, dry needling, knee osteoarthritis, physiotheraphy

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3661 Post-Application Effects of Selected Management Strategies to the Citrus Nematode (Tylenchulus semipenetrans) Population Densities

Authors: Phatu William Mashela, Pontsho Edmund Tseke, Kgabo Martha Pofu

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‘Inconsistent results’ in nematode suppression post-application of botanical-based products created credibility concerns. Relative to untreated control, sampling for nematodes post-application of botanical-based products suggested significant increases in nematode population densities. ‘Inconsistent results’ were confirmed in Tylenchulus semipenetrans on Citrus jambhiri seedlings when sampling was carried out at 120 days post-application of a granular Nemarioc-AG phytonematicide. The objective of this study was to determine post-application effects of untreated control, Nemarioc-AG phytonematicide and aldicarb to T. semipenetrans population densities on C. jambhiri seedlings. Two hundred and ten seedlings were each inoculated with 10000 T. semipenetrans eggs and second-stage juveniles (J2) in plastic pots containing 2700 ml growing mixture. A week after inoculation, seedlings were equally split and subjected to once-off treatment of 2 g aldicarb, 2 g Nemarioc-AG phytonematicide and untreated control. Five seedlings from each group were randomly placed on greenhouse benches to serve as a sampling block, with a total of 14 blocks. The entire block was sampled weekly and assessed for final nematode population density (Pf). After the final assessment, post-regression of untreated Pf to increasing sampling intervals exhibited positive quadratic relations, with the model explaining 90% associations, with optimum Pf of 13804 eggs and J2 at six weeks post-application. In contrast, treated Pf and increasing sampling interval exhibited negative quadratic relations, with the model explaining 95% and 92% associations in phytonematicide and aldicarb, respectively. In the phytonematicide, Pf was 974 eggs and J2, whereas that in aldicarb was 2205 eggs and J2 at six weeks. In conclusion, temporal cyclic nematode population growth provided an empirically-based explanation of ‘inconsistent results’ in nematode suppression post-application of the two nematode management strategies.

Keywords: nematode management, residual effect, slow decline of citrus, the citrus nematode

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3660 Preventative Maintenance, Impact on the Optimal Replacement Strategy of Secondhand Products

Authors: Pin-Wei Chiang, Wen-Liang Chang, Ruey-Huei Yeh

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This paper investigates optimal replacement and preventative maintenance policies of secondhand products under a Finite Planning Horizon (FPH). Any consumer wishing to replace their product under FPH would have it undergo minimal repairs. The replacement provided would be required to undergo periodical preventive maintenance done to avoid product failure. Then, a mathematical formula for disbursement cost for products under FPH can be derived. Optimal policies are then obtained to minimize cost. In the first of two segments of the paper, a model for initial product purchase of either new or secondhand products is used. This model is built by analyzing product purchasing price, surplus value of product, as well as the minimal repair cost. The second segment uses a model for replacement products, which are also secondhand products with no limit on usage. This model analyzes the same components as the first as well as expected preventative maintenance cost. Using these two models, a formula for the expected final total cost can be developed. The formula requires four variables (optimal preventive maintenance level, preventive maintenance frequency, replacement timing, age of replacement product) to find minimal cost requirement. Based on analysis of the variables using the expected total final cost model, it was found that the purchasing price and length of ownership were directly related. Also, consumers should choose the secondhand product with the higher usage for replacement. Products with higher initial usage upon acquisition require an earlier replacement schedule. In this case, replacements should be made with a secondhand product with less usage. In addition, preventative maintenance also significantly reduces cost. Consumers that plan to use products for longer periods of time replace their products later. Hence these consumers should choose the secondhand product with lesser initial usage for replacement. Preventative maintenance also creates significant total cost savings in this case. This study provides consumers with a method of calculating both the ideal amount of usage of the products they should purchase as well as the frequency and level of preventative maintenance that should be conducted in order to minimize cost and maintain product function.

Keywords: finite planning horizon, second hand product, replacement, preventive maintenance, minimal repair

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3659 Posterior Acetabular Fractures-Optimizing the Treatment by Enhancing Practical Skills

Authors: Olivera Lupescu, Taina Elena Avramescu, Mihail Nagea, Alexandru Dimitriu

Abstract:

Acetabular fractures represent a real challenge due to their impact upon the long term function of the hip joint, and due to the risk of intra- and peri-operative complications especially that they affect young, active people. That is why treating these fractures require certain skills which must be exercised, regarding the pre-operative planning, as well as the execution of surgery.The authors retrospectively analyse 38 cases with acetabular fractures operated using the posterior approach in our hospital between 01.01.2013- 01.01.2015 for which complete medical records ensure a follow-up of 24 months, in order to establish the main causes of potential errors and to underline the methods for preventing them. This target is included in the Erasmus + project ‘Collaborative learning for enhancing practical skills for patient-focused interventions in gait rehabilitation after orthopedic surgery COR-skills’. This paper analyses the pitfalls revealed by these cases, as well as the measures necessary to enhance the practical skills of the surgeons who perform acetabular surgery. Pre-op planning matched the intra and post-operative outcome in 88% of the analyzed points, from 72% at the beginning to 94% in the last case, meaning that experience is very important in treating this injury. The main problems detected for the posterior approach were: nervous complications - 3 cases, 1 of them a complete paralysis of the sciatic nerve, which recovered 6 months after surgery, and in other 2 cases intra-articular position of the screws was demonstrated by post-operative CT scans, so secondary screw removal was necessary in these cases. We analysed this incident, too, due to lack of information about the relationship between the screws and the joint secondary to this approach. Septic complications appeared in 3 cases, 2 superficial and 1 profound (requiring implant removal). The most important problems were the reduction of the fractures and the positioning of the screws so as not to interfere with the the articular space. In posterior acetabular fractures, pre-op complex planning is important in order to achieve maximum treatment efficacy with minimum of risk; an optimal training of the surgeons insisting on the main points of potential mistakes ensure the success of the procedure, as well as a favorable outcome for the patient.

Keywords: acetabular fractures, articular congruency, surgical skills, vocational training

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3658 Game “EZZRA” as an Innovative Solution

Authors: Mane Varosyan, Diana Tumanyan, Agnesa Martirosyan

Abstract:

There are many catastrophic events that end with dire consequences, and to avoid them, people should be well-armed with the necessary information about these situations. During the last years, Serious Games have increasingly gained popularity for training people for different types of emergencies. The major discussed problem is the usage of gamification in education. Moreover, it is mandatory to understand how and what kind of gamified e-learning modules promote engagement. As the theme is emergency, we also find out people’s behavior for creating the final approach. Our proposed solution is an educational video game, “EZZRA”.

Keywords: gamification, education, emergency, serious games, game design, virtual reality, digitalisation

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3657 Creatine Associated with Resistance Training Increases Muscle Mass in the Elderly

Authors: Camila Lemos Pinto, Juliana Alves Carneiro, Patrícia Borges Botelho, João Felipe Mota

Abstract:

Sarcopenia, a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, currently affects over 50 million people and increases the risk of adverse outcomes such as physical disability, poor quality of life and death. The aim of this study was to examine the efficacy of creatine supplementation associated with resistance training on muscle mass in the elderly. A 12-week, double blind, randomized, parallel group, placebo controlled trial was conducted. Participants were randomly allocated into one of the following groups: placebo with resistance training (PL+RT, n=14) and creatine supplementation with resistance training (CR + RT, n=13). The subjects from CR+RT group received 5 g/day of creatine monohydrate and the subjects from the PL+RT group were given the same dose of maltodextrin. Participants were instructed to ingest the supplement on non-training days immediately after lunch and on training days immediately after resistance training sessions dissolved in a beverage comprising 100 g of maltodextrin lemon flavored. Participants of both groups undertook a supervised exercise training program for 12 weeks (3 times per week). The subjects were assessed at baseline and after 12 weeks. The primary outcome was muscle mass, assessed by dual energy X-ray absorptiometry (DXA). The secondary outcome included diagnose participants with one of the three stages of sarcopenia (presarcopenia, sarcopenia and severe sarcopenia) by skeletal muscle mass index (SMI), handgrip strength and gait speed. CR+RT group had a significant increase in SMI and muscle (p<0.0001), a significant decrease in android and gynoid fat (p = 0.028 and p=0.035, respectively) and a tendency of decreasing in body fat (p=0.053) after the intervention. PL+RT only had a significant increase in SMI (p=0.007). The main finding of this clinical trial indicated that creatine supplementation combined with resistance training was capable of increasing muscle mass in our elderly cohort (p=0.02). In addition, the number of subjects diagnosed with one of the three stages of sarcopenia at baseline decreased in the creatine supplemented group in comparison with the placebo group (CR+RT, n=-3; PL+RT, n=0). In summary, 12 weeks of creatine supplementation associated with resistance training resulted in increases in muscle mass. This is the first research with elderly of both sexes that show the same increase in muscle mass with a minor quantity of creatine supplementation in a short period. Future long-term research should investigate the effects of these interventions in sarcopenic elderly.

Keywords: creatine, dietetic supplement, elderly, resistance training

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3656 Mineralogy and Fluid Inclusion Study of the Kebbouch South Pb-Zn Deposit, Northwest Tunisia

Authors: Imen Salhi, Salah Bouhlel, Bernrd Lehmann

Abstract:

The Kebbouch South Pb-Zn deposit is located 20 km to the east of El Kef (NW) in the southeastern part of the Triassic diapir belt in the Tunisian Atlas. The deposit is composed of sulfide and non-sulfide zinc-lead ore bodies. The aim of this study is to provide petrographic results, mineralogy, as well as fluid inclusion data of the carbonate-hosted Pb-Zn Kebbouch South deposit. Mineralization forms two major ore types: (1) lenticular dolostones and clay breccias in the contact zone between Triassic and Upper Cretaceous strata;, it consists of small-scale lenticular, strata-or fault-controlled mineralization mainly composed of marcasite, galena, sphalerite, pyrite, and (2) stratiform mineralization in the Bahloul Formation (Upper Cenomanian-Lower Turonian) consisting of framboidal and cubic pyrite, disseminated sphalerite and galena. Non-metalliferous and/or gangue minerals are represented by dolomite, calcite, celestite and quartz. Fluid inclusion petrography study has been carried out on calcite and celestite. Fluid inclusions hosted in celestite are less than 20 µm large and show two types of aqueous inclusions: monophase liquid aqueous inclusions (L), abundant and very small, generally less than 15 µm and liquid-rich two phase inclusions (L+V). The gas phase forms a mobile vapor bubble. Microthermometric analyses of (L+V) fluid inclusions for celestite indicate that the homogenization temperature ranges from 121 to 156°C, and final ice melting temperatures are in the range of – 19 to -9°C corresponding to salinities of 12 to 21 wt% NaCl eq. (L+V) fluid inclusions from calcite are frequently localized along the growth zones; their homogenization temperature ranges from 96 to 164°C with final ice melting temperatures between -16 and -7°C corresponding to salinities of 9 to 19 wt% NaCl eq. According to mineralogical and fluid inclusion studies, mineralization in the Pb – Zn Kebbouch South deposit formed between 96 to 164°C with salinities ranging from 9 to 21 wt% NaCl eq. A contribution of basinal brines in the ore formation of the kebbouch South Pb–Zn deposit is likely. The deposit is part of the family of MVT deposits associated with the salt diapir environment.

Keywords: fluid inclusion, Kebbouch South, mineralogy, MVT deposits, Pb-Zn

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3655 The Use of Vasopressin in the Management of Severe Traumatic Brain Injury: A Narrative Review

Authors: Nicole Selvi Hill, Archchana Radhakrishnan

Abstract:

Introduction: Traumatic brain injury (TBI) is a leading cause of mortality among trauma patients. In the management of TBI, the main principle is avoiding cerebral ischemia, as this is a strong determiner of neurological outcomes. The use of vasoactive drugs, such as vasopressin, has an important role in maintaining cerebral perfusion pressure to prevent secondary brain injury. Current guidelines do not suggest a preferred vasoactive drug to administer in the management of TBI, and there is a paucity of information on the therapeutic potential of vasopressin following TBI. Vasopressin is also an endogenous anti-diuretic hormone (AVP), and pathways mediated by AVP play a large role in the underlying pathological processes of TBI. This creates an overlap of discussion regarding the therapeutic potential of vasopressin following TBI. Currently, its popularity lies in vasodilatory and cardiogenic shock in the intensive care setting, with increasing support for its use in haemorrhagic and septic shock. Methodology: This is a review article based on a literature review. An electronic search was conducted via PubMed, Cochrane, EMBASE, and Google Scholar. The aim was to identify clinical studies looking at the therapeutic administration of vasopressin in severe traumatic brain injury. The primary aim was to look at the neurological outcome of patients. The secondary aim was to look at surrogate markers of cerebral perfusion measurements, such as cerebral perfusion pressure, cerebral oxygenation, and cerebral blood flow. Results: Eight papers were included in the final number. Three were animal studies; five were human studies, comprised of three case reports, one retrospective review of data, and one randomised control trial. All animal studies demonstrated the benefits of vasopressors in TBI management. One animal study showed the superiority of vasopressin in reducing intracranial pressure and increasing cerebral oxygenation over a catecholaminergic vasopressor, phenylephrine. All three human case reports were supportive of vasopressin as a rescue therapy in catecholaminergic-resistant hypotension. The retrospective review found vasopressin did not increase cerebral oedema in TBI patients compared to catecholaminergic vasopressors; and demonstrated a significant reduction in the requirements of hyperosmolar therapy in patients that received vasopressin. The randomised control trial results showed no significant differences in primary and secondary outcomes between TBI patients receiving vasopressin versus those receiving catecholaminergic vasopressors. Apart from the randomised control trial, the studies included are of low-level evidence. Conclusion: Studies favour vasopressin within certain parameters of cerebral function compared to control groups. However, the neurological outcomes of patient groups are not known, and animal study results are difficult to extrapolate to humans. It cannot be said with certainty whether vasopressin’s benefits stand above usage of other vasoactive drugs due to the weaknesses of the evidence. Further randomised control trials, which are larger, standardised, and rigorous, are required to improve knowledge in this field.

Keywords: catecholamines, cerebral perfusion pressure, traumatic brain injury, vasopressin, vasopressors

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3654 Pharyngealization Spread in Ibbi Dialect of Yemeni Arabic: An Acoustic Study

Authors: Fadhl Qutaish

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This paper examines the pharyngealization spread in one of the Yemeni Arabic dialects, namely, Ibbi Arabic (IA). It investigates how pharyngealized sounds spread their acoustic features onto the neighboring vowels and change their default features. This feature has been investigated quietly well in MSA but still has to be deeply studied in the different dialect of Arabic which will bring about a clearer picture of the similarities and the differences among these dialects and help in mapping them based on the way this feature is utilized. Though the studies are numerous, no one of them has illustrated how far in the multi-syllabic word the spread can be and whether it takes a steady or gradient manner. This study tries to fill this gap and give a satisfactory explanation of the pharyngealization spread in Ibbi Dialect. This study is the first step towards a larger investigation of the different dialects of Yemeni Arabic in the future. The data recorded are represented in minimal pairs in which the trigger (pharyngealized or the non-pharyngealized sound) is in the initial or final position of monosyllabic and multisyllabic words. A group of 24 words were divided into four groups and repeated three times by three subjects which will yield 216 tokens that are tested and analyzed. The subjects are three male speakers aged between 28 and 31 with no history of neurological, speaking or hearing problems. All of them are bilingual speakers of Arabic and English and native speakers of Ibbi-Dialect. Recordings were done in a sound-proof room and praat software was used for the analysis and coding of the trajectories of F1 and F2 for the low vowel /a/ to see the effect of pharyngealization on the formant trajectory within the same syllable and in other syllables of the same word by comparing the F1 and F2 formants to the non-pharyngealized environment. The results show that pharyngealization spread is gradient (progressively and regressively). The spread is reflected in the gradual raising of F1 as we move closer towards the trigger and the gradual lowering of F2 as well. The results of the F1 mean values in tri-syllabic words when the trigger is word initially show that there is a raise of 37.9 HZ in the first syllable, 26.8HZ in the second syllable and 14.2HZ in the third syllable. F2 mean values undergo a lowering of 239 HZ in the first syllable, 211.7 HZ in the second syllable and 176.5 in the third syllable. This gradual decrease in the difference of F2 values in the non-pharyngealized and pharyngealized context illustrates that the spread is gradient. A similar result was found when the trigger is word-final which proves that the spread is gradient (progressively and regressively.

Keywords: pharyngealization, Yemeni Arabic, Ibbi dialect, pharyngealization spread

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3653 Cuban's Supply Chains Development Model: Qualitative and Quantitative Impact on Final Consumers

Authors: Teresita Lopez Joy, Jose A. Acevedo Suarez, Martha I. Gomez Acosta, Ana Julia Acevedo Urquiaga

Abstract:

Current trends in business competitiveness indicate the need to manage businesses as supply chains and not in isolation. The use of strategies aimed at maximum satisfaction of customers in a network and based on inter-company cooperation; contribute to obtaining successful joint results. In the Cuban economic context, the development of productive linkages to achieve integrated management of supply chains is considering a key aspect. In order to achieve this jump, it is necessary to develop acting capabilities in the entities that make up the chains through a systematic procedure that allows arriving at a management model in consonance with the environment. The objective of the research focuses on: designing a model and procedure for the development of integrated management of supply chains in economic entities. The results obtained are: the Model and the Procedure for the Development of the Supply Chains Integrated Management (MP-SCIM). The Model is based on the development of logistics in the network actors, the joint work between companies, collaborative planning and the monitoring of a main indicator according to the end customers. The application Procedure starts from the well-founded need for development in a supply chain and focuses on training entrepreneurs as doers. The characterization and diagnosis is done to later define the design of the network and the relationships between the companies. It takes into account the feedback as a method of updating the conditions and way to focus the objectives according to the final customers. The MP-SCIM is the result of systematic work with a supply chain approach in companies that have consolidated as coordinators of their network. The cases of the edible oil chain and explosives for construction sector reflect results of more remarkable advances since they have applied this approach for more than 5 years and maintain it as a general strategy of successful development. The edible oil trading company experienced a jump in sales. In 2006, the company started the analysis in order to define the supply chain, apply diagnosis techniques, define problems and implement solutions. The involvement of the management and the progressive formation of performance capacities in the personnel allowed the application of tools according to the context. The company that coordinates the explosives chain for construction sector shows adequate training with independence and opportunity in the face of different situations and variations of their business environment. The appropriation of tools and techniques for the analysis and implementation of proposals is a characteristic feature of this case. The coordinating entity applies integrated supply chain management to its decisions based on the timely training of the necessary action capabilities for each situation. Other cases of study and application that validate these tools are also detailed in this paper, and they highlight the results of generalization in the quantitative and qualitative improvement according to the final clients. These cases are: teaching literature in universities, agricultural products of local scope and medicine supply chains.

Keywords: integrated management, logistic system, supply chain management, tactical-operative planning

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3652 Engineering Topology of Construction Ecology in Urban Environments: Suez Canal Economic Zone

Authors: Moustafa Osman Mohammed

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Integration sustainability outcomes give attention to construction ecology in the design review of urban environments to comply with Earth’s System that is composed of integral parts of the (i.e., physical, chemical and biological components). Naturally, exchange patterns of industrial ecology have consistent and periodic cycles to preserve energy flows and materials in Earth’s System. When engineering topology is affecting internal and external processes in system networks, it postulated the valence of the first-level spatial outcome (i.e., project compatibility success). These instrumentalities are dependent on relating the second-level outcome (i.e., participant security satisfaction). Construction ecology approach feedback energy from resources flows between biotic and abiotic in the entire Earth’s ecosystems. These spatial outcomes are providing an innovation, as entails a wide range of interactions to state, regulate and feedback “topology” to flow as “interdisciplinary equilibrium” of ecosystems. The interrelation dynamics of ecosystems are performing a process in a certain location within an appropriate time for characterizing their unique structure in “equilibrium patterns”, such as biosphere and collecting a composite structure of many distributed feedback flows. These interdisciplinary systems regulate their dynamics within complex structures. These dynamic mechanisms of the ecosystem regulate physical and chemical properties to enable a gradual and prolonged incremental pattern to develop a stable structure. The engineering topology of construction ecology for integration sustainability outcomes offers an interesting tool for ecologists and engineers in the simulation paradigm as an initial form of development structure within compatible computer software. This approach argues from ecology, resource savings, static load design, financial other pragmatic reasons, while an artistic/architectural perspective, these are not decisive. The paper described an attempt to unify analytic and analogical spatial modeling in developing urban environments as a relational setting, using optimization software and applied as an example of integrated industrial ecology where the construction process is based on a topology optimization approach.

Keywords: construction ecology, industrial ecology, urban topology, environmental planning

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3651 Exploring the Sources of Innovation in Food Processing SMEs of Kerala

Authors: Bhumika Gupta, Jeayaram Subramanian, Hardik Vachhrajani, Avinash Shivdas

Abstract:

Indian food processing industry is one of the largest in the world in terms of production, consumption, exports and growth opportunities. SMEs play a crucial role within this. Large manufacturing firms largely dominate innovation studies in India. Innovation sources used by SMEs are often different from that of large firms. This paper focuses on exploring various sources of innovation adopted by food processing SMEs in Kerala, South India. Outcome suggests that SMEs use various sources like suppliers, competitors, employees, government/research institutions and customers to get new ideas.

Keywords: food processing, innovation, SMEs, sources of innovation

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3650 Discrimination during a Resume Audit: The Impact of Job Context in Hiring

Authors: Alexandra Roy

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Building on literature on cognitive matching and social categorization and using the correspondence testing method, we test the interaction effect of person characteristics (Gender with physical attractiveness) and job context (client contact, industry status, coworker contact). As expected, while findings show a strong impact of gender with beauty on hiring chances, job context characteristics have also a significant overall effect of this hiring outcome. Moreover, the rate of positive responses varies according some of the recruiter’s characteristics. Results are robust to various sensitivity checks. Implications of the results, limitations of the study, and directions for future research are discussed.

Keywords: correspondence testing, discrimination, hiring, physical attractiveness

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3649 Determining Face-Validity for a Set of Preventable Drug-Related Morbidity Indicators Developed for Primary Healthcare in South Africa

Authors: D. Velayadum, P. Sthandiwe , N. Maharaj, T. Munien, S. Ndamase, G. Zulu, S. Xulu, F. Oosthuizen

Abstract:

Introduction and aims of the study: It is the responsibility of the pharmacist to manage drug-related problems in order to ensure the greatest benefit to the patient. In order to prevent drug-related morbidity, pharmacists should be aware of medicines that may contribute to certain drug-related problems due to their pharmacological action. In an attempt to assist healthcare practitioners to prevent drug-related morbidity (PDRM), indicators for prevention have been designed. There are currently no indicators available for primary health care in developing countries like South Africa, where the majority of the population access primary health care. There is, therefore, a need to develop such indicators, specifically with the aim of assisting healthcare practitioners in primary health care. Methods: A literature study was conducted to compile a comprehensive list of PDRM indicators as developed internationally using the search engines Google Scholar and PubMed. MESH term used to retrieve suitable articles was 'preventable drug-related morbidity indicators'. The comprehensive list of PDRM indicators obtained from the literature study was further evaluated for face validity. Face validity was done in duplicate by 2 sets of independent researchers to ensure 1) no duplication of indicators when compiling a single list, 2) inclusion of only medication available in primary healthcare, and 3) inclusion of medication currently available in South Africa. Results: The list of indicators, compiled from PDRM indicators in the USA, UK, Portugal, Australia, India, and Canada contained 324 PDRM. 184 of these indicators were found to be duplicates, and the duplications were omitted, leaving a final list of 140. The 140 PDRM indicators were evaluated for face-validity, and 97 were accepted as relevant to primary health care in South Africa. 43 indicators did not comply with the criteria and were omitted from the final list. Conclusion: This study is a first step in compiling a list of PDRM indicators for South Africa. It is important to take cognizance to the fact the health systems differ vastly internationally, and it is, therefore, important to develop country-specific indicators.

Keywords: drug-related morbidity, primary healthcare, South Africa, developing countries

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3648 Validation of a Placebo Method with Potential for Blinding in Ultrasound-Guided Dry Needling

Authors: Johnson C. Y. Pang, Bo Pengb, Kara K. L. Reevesc, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding are potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26±5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms and quality of life (QOL), were analyzed by repeated-measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: reliability, jumping, 3D motion analysis, anterior crucial ligament reconstruction

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3647 Chemically Enhanced Primary Treatment: Full Scale Trial Results Conducted at a South African Wastewater Works

Authors: Priyanka Govender, S. Mtshali, Theresa Moonsamy, Zanele Mkwanazi, L. Mthembu

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Chemically enhanced primary treatment (CEPT) can be used at wastewater works to improve the quality of the final effluent discharge, provided that the plant has spare anaerobic digestion capacity. CEPT can transfer part of the organic load to the digesters thereby effectively relieving the hydraulic loading on the plant and in this way can allow the plant to continue operating long after the hydraulic capacity of the plant has been exceeded. This can allow a plant to continue operating well beyond its original design capacity, requiring only fairly simple and inexpensive modifications to the primary settling tanks as well as additional chemical costs, thereby delaying or even avoiding the need for expensive capital upgrades. CEPT can also be effective at plants where high organic loadings prevent the wastewater discharge from meeting discharge standards, especially in the case of COD, phosphates and suspended solids. By increasing removals of these pollutants in the primary settling tanks, CEPT can enable the plant to conform to specifications without the need for costly upgrades. Laboratory trials were carried out recently at the Umbilo WWTW in Durban and these were followed by a baseline assessment of the current plant performance and a subsequent full scale trial on the Conventional plant i.e. West Plant. The operating conditions of the plant are described and the improvements obtained in COD, phosphate and suspended solids, are discussed. The PST and plant overall suspended solids removal efficiency increased by approximately 6% during the trial. Details regarding the effect that CEPT had on sludge production and the digesters are also provided. The cost implications of CEPT are discussed in terms of capital costs as well as operation and maintenance costs and the impact of Ferric chloride on the infrastructure was also studied and found to be minimal. It was concluded that CEPT improves the final quality of the discharge effluent, thereby improving the compliance of this effluent with the discharge license. It could also allow for a delay in upgrades to the plant, allowing the plant to operate above its design capacity. This will be elaborated further upon presentation.

Keywords: chemically enhanced, ferric, wastewater, primary

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3646 Variation of Warp and Binder Yarn Tension across the 3D Weaving Process and its Impact on Tow Tensile Strength

Authors: Reuben Newell, Edward Archer, Alistair McIlhagger, Calvin Ralph

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Modern industry has developed a need for innovative 3D composite materials due to their attractive material properties. Composite materials are composed of a fibre reinforcement encased in a polymer matrix. The fibre reinforcement consists of warp, weft and binder yarns or tows woven together into a preform. The mechanical performance of composite material is largely controlled by the properties of the preform. As a result, the bulk of recent textile research has been focused on the design of high-strength preform architectures. Studies looking at optimisation of the weaving process have largely been neglected. It has been reported that yarns experience varying levels of damage during weaving, resulting in filament breakage and ultimately compromised composite mechanical performance. The weaving parameters involved in causing this yarn damage are not fully understood. Recent studies indicate that poor yarn tension control may be an influencing factor. As tension is increased, the yarn-to-yarn and yarn-to-weaving-equipment interactions are heightened, maximising damage. The correlation between yarn tension variation and weaving damage severity has never been adequately researched or quantified. A novel study is needed which accesses the influence of tension variation on the mechanical properties of woven yarns. This study has looked to quantify the variation of yarn tension throughout weaving and sought to link the impact of tension to weaving damage. Multiple yarns were randomly selected, and their tension was measured across the creel and shedding stages of weaving, using a hand-held tension meter. Sections of the same yarn were subsequently cut from the loom machine and tensile tested. A comparison study was made between the tensile strength of pristine and tensioned yarns to determine the induced weaving damage. Yarns from bobbins at the rear of the creel were under the least amount of tension (0.5-2.0N) compared to yarns positioned at the front of the creel (1.5-3.5N). This increase in tension has been linked to the sharp turn in the yarn path between bobbins at the front of the creel and creel I-board. Creel yarns under the lower tension suffered a 3% loss of tensile strength, compared to 7% for the greater tensioned yarns. During shedding, the tension on the yarns was higher than in the creel. The upper shed yarns were exposed to a decreased tension (3.0-4.5N) compared to the lower shed yarns (4.0-5.5N). Shed yarns under the lower tension suffered a 10% loss of tensile strength, compared to 14% for the greater tensioned yarns. Interestingly, the most severely damaged yarn was exposed to both the largest creel and shedding tensions. This study confirms for the first time that yarns under a greater level of tension suffer an increased amount of weaving damage. Significant variation of yarn tension has been identified across the creel and shedding stages of weaving. This leads to a variance of mechanical properties across the woven preform and ultimately the final composite part. The outcome from this study highlights the need for optimised yarn tension control during preform manufacture to minimize yarn-induced weaving damage.

Keywords: optimisation of preform manufacture, tensile testing of damaged tows, variation of yarn weaving tension, weaving damage

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