Search results for: total joint replacement
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 10266

Search results for: total joint replacement

9666 From Responses of Macroinvertebrate Metrics to the Definition of Reference Thresholds

Authors: Hounyèmè Romuald, Mama Daouda, Argillier Christine

Abstract:

The present study focused on the use of benthic macrofauna to define the reference state of an anthropized lagoon (Nokoué-Benin) from the responses of relevant metrics to proxies. The approach used is a combination of a joint species distribution model and Bayesian networks. The joint species distribution model was used to select the relevant metrics and generate posterior probabilities that were then converted into posterior response probabilities for each of the quality classes (pressure levels), which will constitute the conditional probability tables allowing the establishment of the probabilistic graph representing the different causal relationships between metrics and pressure proxies. For the definition of the reference thresholds, the predicted responses for low-pressure levels were read via probability density diagrams. Observations collected during high and low water periods spanning 03 consecutive years (2004-2006), sampling 33 macroinvertebrate taxa present at all seasons and sampling points, and measurements of 14 environmental parameters were used as application data. The study demonstrated reliable inferences, selection of 07 relevant metrics and definition of quality thresholds for each environmental parameter. The relevance of the metrics as well as the reference thresholds for ecological assessment despite the small sample size, suggests the potential for wider applicability of the approach for aquatic ecosystem monitoring and assessment programs in developing countries generally characterized by a lack of monitoring data.

Keywords: pressure proxies, bayesian inference, bioindicators, acadjas, functional traits

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9665 Ruminal VFA of Beef Fed Different Protein

Authors: P. Paengkoum, S. C. Chen, S. Paengkoum

Abstract:

Six male growing Thai-indigenous beef cattle with body weight (BW) of 154±13.2 kg were randomly assigned in replicated 3×3 Latin square design, and fed with different levels of crude protein (CP) in total mixed ration (TMR) diets. CP levels in diets were 4.3%, 7.3% and 10.3% base on dry matter (DM). Ruminal ammonia nitrogen (NH3-N) and blood urea nitrogen (BUN) concentrations increased (P<0.01) with increasing CP levels. Moreover, there is a positive relationship between BUN and ruminal NH3-N. Rumen pH, total volatile fatty acid (VFA), molar proportions of acetate, propionate and butyrate were not affected by CP levels (P>0.05).

Keywords: Thai-indigenous beef cattle, crude protein, volatile fatty acid (VFA), total mixed ration (TMR) diets

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9664 Analysis of a Differential System to Get Insights on the Potential Establishment of Microsporidia MB in the Mosquito Population for Malaria Control

Authors: Charlene N. T. Mfangnia, Henri E. Z. Tonnang, Berge Tsanou, Jeremy Herren

Abstract:

Microsporidia MB is a recently discovered symbiont capable of blocking the transmission of Plasmodium from mosquitoes to humans. The symbiont can spread both horizontally and vertically among the mosquito population. This dual transmission gives the symbiont the ability to invade the mosquito population. The replacement of the mosquito population by the population of symbiont-infected mosquitoes then appears as a promising strategy for malaria control. In this context, the present study uses differential equations to model the transmission dynamics of Microsporidia MB in the population of female Anopheles mosquitoes. Long-term propagation scenarios of the symbiont, such as extinction, persistence or total infection, are obtained through the determination of the target and basic reproduction numbers, the equilibria, and the study of their stability. The stability is illustrated numerically, and the contribution of vertical and horizontal transmission in the spread of the symbiont is assessed. Data obtained from laboratory experiments are then used to explain the low prevalence observed in nature. The study also shows that the male death rate, the mating rate and the attractiveness of MB-positive mosquitoes are the factors that most influence the transmission of the symbiont. In addition, the introduction of temperature and the study of bifurcations show the significant influence of the environmental condition in the propagation of Microsporidia MB. This finding proves the necessity of taking into account environmental variables for the potential establishment of the symbiont in a new area.

Keywords: differential equations, stability analysis, malaria, microsporidia MB, horizontal transmission, vertical transmission, numerical illustration

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9663 The Association between Gene Polymorphisms of GPX, SEPP1, and SEP15, Plasma Selenium Levels, Urinary Total Arsenic Concentrations, and Prostate Cancer

Authors: Yu-Mei Hsueh, Wei-Jen Chen, Yung-Kai Huang, Cheng-Shiuan Tsai, Kuo-Cheng Yeh

Abstract:

Prostate cancer occurs in men over the age of 50, and rank sixth of the top ten cancers in Taiwan, and the incidence increased gradually over the past decade in Taiwan. Arsenic is confirmed as a carcinogen by International Agency for Research on (IARC). Arsenic induces oxidative stress may be a risk factor for prostate cancer, but the mechanism is not clear. Selenium is an important antioxidant element. Whether the association between plasma selenium levels and risk of prostate cancer are modified by different genotype of selenoprotein is still unknown. Glutathione peroxidase, selenoprotein P (SEPP1) and 15 kDa selenoprotein (SEP 15) are selenoprotein and regulates selenium transport and the oxidation and reduction reaction. However, the association between gene polymorphisms of selenoprotein and prostate cancer is not yet clear. The aim of this study is to determine the relationship between plasma selenium, polymorphism of selenoprotein, urinary total arsenic concentration and prostate cancer. This study is a hospital-based case-control study. Three hundred twenty-two cases of prostate cancer and age (±5 years) 1:1 matched 322 control group were recruited from National Taiwan University Hospital, Taipei Medical University Hospital, and Wan Fang Hospital. Well-trained personnel carried out standardized personal interviews based on a structured questionnaire. Information collected included demographic and socioeconomic characteristics, lifestyle and disease history. Blood and urine samples were also collected at the same time. The Research Ethics Committee of National Taiwan University Hospital, Taipei, Taiwan, approved the study. All patients provided informed consent forms before sample and data collection. Buffy coat was to extract DNA, and the polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) was used to measure the genotypes of SEPP1 rs3797310, SEP15 rs5859, GPX1 rs1050450, GPX2 rs4902346, GPX3 rs4958872, and GPX4 rs2075710. Plasma concentrations of selenium were determined by inductively coupled plasma mass spectrometry (ICP-MS).Urinary arsenic species concentrations were measured by high-performance liquid chromatography links hydride generator and atomic absorption spectrometer (HPLC-HG-AAS). Subject with high education level compared to those with low educational level had a lower prostate cancer odds ratio (OR) Mainland Chinese and aboriginal people had a lower OR of prostate cancer compared to Fukien Taiwanese. After adjustment for age, educational level, subjects with GPX1 rs1050450 CT and TT genotype compared to the CC genotype have lower, OR of prostate cancer, the OR and 95% confidence interval (Cl) was 0.53 (0.31-0.90). SEPP1 rs3797310 CT+TT genotype compared to those with CC genotype had a marginally significantly lower OR of PC. The low levels of plasma selenium and the high urinary total arsenic concentrations had the high OR of prostate cancer in a significant dose-response manner, and SEPP1 rs3797310 genotype modified this joint association.

Keywords: prostate cancer, plasma selenium concentration, urinary total arsenic concentrations, glutathione peroxidase, selenoprotein P, selenoprotein 15, gene polymorphism

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9662 Aspects of the Reproductive Biology of Brook Trout Neolissochilus stracheyi (Day, 1871) in Northern, Thailand

Authors: Thapanee Pholdee, Apinun Suvarnaraksha

Abstract:

Reproductive biology of Brook trout, Neolissochilus stracheyi (Day, 1871), were sampled in the Northern of Thailand during October 2010 - September 2011 from the fisherman, using gillnet of various mesh sizes. For the study of relationships between total length and body weight, spawning seasons, sex ratio and fecundity. At least 66 fish samples were used every month. The result showed that the total 821 Brook trout had 7.4-61(23.32±5.91 cm). There were 353 males that had fish samples there were 8.5-45.1 cm of TL (22.36±5.91cm) and 468 females that had 7.4±61 cm of TL (24.04±7.09 cm). The relationships equation between total length and weight was W = 0.008TL³.⁰⁶⁴ (r² = 0.940) for total fish, W=0.007TL³.¹⁰⁷ (r² = 0.946) for females and W=0.010TL³.⁰⁰³ (r² = 0.930) for males. The relative condition factor (K) of male and female was 1.090±0.067 and 1.116±0.102 respectively. The max of GSI was in June for male and female. The spawning season was found all year round with three peaks: January, June, and August. Estimated fecundity of mature ovaries ranged from 220 to 3,500 eggs. The estimated average fecundity was 1404.55 ±651.51 eggs. The relationships between fecundity and total length revealed F= 121.1TL-2100 and relationships between fecundity and weight revealed F= 4.535 + 128.78. The results from studies can be further applied to the economic culture, conservation, and management of the Brook trout in Northern, Thailand.

Keywords: reproductive biology, Neolissochilus stracheyi, Northern Thailand, Brook trout

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9661 Reactivation of Hydrated Cement and Recycled Concrete Powder by Thermal Treatment for Partial Replacement of Virgin Cement

Authors: Gustave Semugaza, Anne Zora Gierth, Tommy Mielke, Marianela Escobar Castillo, Nat Doru C. Lupascu

Abstract:

The generation of Construction and Demolition Waste (CDW) has globally increased enormously due to the enhanced need in construction, renovation, and demolition of construction structures. Several studies investigated the use of CDW materials in the production of new concrete and indicated the lower mechanical properties of the resulting concrete. Many other researchers considered the possibility of using the Hydrated Cement Powder (HCP) to replace a part of Ordinary Portland Cement (OPC), but only very few investigated the use of Recycled Concrete Powder (RCP) from CDW. The partial replacement of OPC for making new concrete intends to decrease the CO₂ emissions associated with OPC production. However, the RCP and HCP need treatment to produce the new concrete of required mechanical properties. The thermal treatment method has proven to improve HCP properties before their use. Previous research has stated that for using HCP in concrete, the optimum results are achievable by heating HCP between 400°C and 800°C. The optimum heating temperature depends on the type of cement used to make the Hydrated Cement Specimens (HCS), the crushing and heating method of HCP, and the curing method of the Rehydrated Cement Specimens (RCS). This research assessed the quality of recycled materials by using different techniques such as X-ray Diffraction (XRD), Differential Scanning Calorimetry (DSC) and thermogravimetry (TG), Scanning electron Microscopy (SEM), and X-ray Fluorescence (XRF). These recycled materials were thermally pretreated at different temperatures from 200°C to 1000°C. Additionally, the research investigated to what extent the thermally treated recycled cement could partially replace the OPC and if the new concrete produced would achieve the required mechanical properties. The mechanical properties were evaluated on the RCS, obtained by mixing the Dehydrated Cement Powder and Recycled Powder (DCP and DRP) with water (w/c = 0.6 and w/c = 0.45). The research used the compressive testing machine for compressive strength testing, and the three-point bending test was used to assess the flexural strength.

Keywords: hydrated cement powder, dehydrated cement powder, recycled concrete powder, thermal treatment, reactivation, mechanical performance

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9660 Impact of Climate Change and Anthropogenic Effect on Hilsa Fishery Management in South-East Asia: Urgent Need for Trans-Boundary Policy

Authors: Dewan Ali Ahsan

Abstract:

Hilsa (Tenualosa ilisha) is one of the most important anadromous fish species of the trans-boundary ecosystem of Bangladesh, India and Myanmar. Hilsa is not only an economically important species specially for Bangladesh and India, but also for the integral part of the culture of the Bangladesh and India. This flag-ship species in Bangladesh contributed alone of 10.82% of the total fish production of the country and about 75% of world’s total catch of hilsa comes from Bangladesh alone. As hilsa is an anadromous fish, it migrates from the Bay of Bengal to rivers for spawning, nursing and growing and for all of these purposes hilsa needs freshwaters. Ripe broods prefer turbid, fast flowing freshwater for spawning but young prefer clear and slow flowing freshwater. Climate change (salinity intrusion, sea level rise, temperature rise, impact of fresh water flow), unplanned developmental activities and other anthropogenic activities all together are severely damaging the hilsa stock and its habitats. So, climate change and human interferences are predicted to have a range of direct and indirect impacts on marine and freshwater hilsa fishery, with implications for fisheries-dependent economies, coastal communities and fisherfolk. The present study identified that salinity intrusion, siltation in river bed, decrease water flow from upstream, fragmentation of river in dry season, over exploitation, use of small mesh nets are the major reasons to affect the upstream migration of hilsa and its sustainable management. It has been also noticed that Bangladesh government has taken some actions for hilsa management. Government is trying to increase hilsa production not only by conserving jatka (juvenile hilsa) but also protecting the brood hilsa during the breeding seasons by imposing seasonal ban on fishing, restricted mesh size etc. Unfortunately, no such management plans are available for Indian and Myanmar territory. As hilsa is a highly migratory trans-boundary fish in the Bay of Bengal (and all of these countries share the same stock), it is essential to adopt a joint management policy (by Bangladesh-India-Myanmar) for the sustainable management for the hilsa stock.

Keywords: hilsa, climate change, south-east Asia, fishery management

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9659 Effect of Polymer Coated Urea on Nutrient Efficiency and Nitrate Leaching Using Maize and Annual Ryegrass

Authors: Amrei Voelkner, Nils Peters, Thomas Mannheim

Abstract:

The worldwide exponential growth of the population and the simultaneous increasing food production requires the strategic realization of sustainable and improved cultivation systems to ensure the fertility of arable land and to guarantee the food supply for the whole world. To fulfill this target, large quantities of fertilizers have to be applied to the field, but the long-term environmental impacts remain uncertain. Thus, a combined system would be necessary to increase the nutrient availability for plants while reducing nutrient losses (e.g. NO3- by leaching) to the environment. To enhance the nutrient efficiency, polymer coated fertilizer with a controlled release behavior have been developed. This kind of fertilizer ensures a delayed release of nutrients to synchronize the nutrient supply with the demand of different crops. In the last decades, research focused primarily on semi-permeable polyurethane coatings, which remain in the soil for a long period after the complete solvation of the fertilizer core. Within the implementation of the new European Regulation Directive the replacement of non-degradable synthetic polymers by degradable coatings is necessary. It was, therefore, the objective of this study to develop a total biodegradable polymer (to CO2 and H2O) coating according to ISO 17556 and to compare the retarding effect of the biodegradable coatings with commercially available non-degradable products. To investigate the effect of ten selected coated urea fertilizer on the yield of annual ryegrass and maize, the fresh and dry mass, the percentage of total nitrogen and main nutrients were analyzed in greenhouse experiments in sixfold replications using near-infrared spectroscopy. For the experiments, a homogenized and air-dried loamy sand (Cambic Luvisol) was equipped with a basic fertilization of P, K, Mg and S. To investigate the effect of nitrogen level increase, three levels (80%, 100%, 120%) were established, whereas the impact of CRF granules was determined using a N-level of 100%. Additionally, leaching of NO3- from pots planted with annual ryegrass was examined to evaluate the retention capacity of urea by the polymer coating. For this, leachate from Kick-Brauckmann-Pots was collected daily and analyzed for total nitrogen, NO3- and NH4+ in twofold repetition once a week using near-infrared spectroscopy. We summarize from the results that the coated fertilizer have a clear impact on the yield of annual ryegrass and maize. Compared to the control, an increase of fresh and dry mass could be recognized. Partially, the non-degradable coatings showed a retarding effect for a longer period, which was however reflected by a lower fresh and dry mass. It was ascertained that the percentage of leached-out nitrate could be reduced markedly. As a conclusion, it could be pointed out that the impact of coated fertilizer of all polymer types might contribute to a reduction of negative environmental impacts in addition to their fertilizing effect.

Keywords: biodegradable polymers, coating, enhanced efficiency fertilizers, nitrate leaching

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9658 Cystic Ganglionosis in Child: Rare Entity

Authors: Jatinder Pal Singh, Harpreet Singh, Gagandeep Singh Digra, Mandeep Kaur Sidhu, Pawan Kumar

Abstract:

Introduction: Ganglion cyst is a benign condition in which there is a cystic lesion in relation to a joint or a tendon sheath arising from myxoid degeneration of fibrous connective tissue. These can be unilocular or multilocular. In rare cases, there may be multiple ganglion cysts, known as cystic ganglionosis. They can occur at any age but are commonly seen in adults. Clinically they may be asymptomatic or present as swelling or mass effect in adjacent structures. These are common in extremities such as hands and feet. Case Presentation: 11-year-old female child presented with slowly progressive painless swelling of her right hand since the age of 4. Antenatal and perinatal history was unremarkable. Her family history was negative. She denies fever, malaise, morning stiffness, weight loss, fatigue, restriction of joint movements, or any sensory and motor deficit. Lab parameters were negative for inflammatory or infectious etiology. No other joint or extremity involvement was present. On physical examination, the swelling was present on the dorsum and palmer aspect of the right hand and wrist. They were non-tender on palpation without any motor or sensory deficit. MRI hand revealed multiple well-defined fluid signal intensity cystic appearing lesions in periarticular/intraarticular locations in relation to distal radio-ulnar, radio-carpal, intercarpal, carpometacarpal, metacarpophalangeal and interphalangeal joints as well as peritendinous location around flexor tendons more so in the region of wrist, palm, 1st and 5th digit and along extensor tendons in the region of wrist, largest one noted along flexor pollicis longus tendon in thenar region and along 1st digit measuring approx. 4.6 x 1.2 x 1.2 centimeter. Pressure erosions and bone remodelling were noted in the bases of the 2nd to 5th metacarpals, capitate, trapezoid, the distal shaft of 1st metacarpal, and proximal phalanx of 1st digit. Marrow edema was noted in the base and proximal shaft of the 4th metacarpal and proximal shaft of the 3rd metacarpal – likely stress or pressure related. The patient was advised of aspiration, but the family refused the procedure. Therefore the patient was kept on conservative treatment. Conclusion: Cystic ganglionosis is a rare condition with very few cases reported in the medical literature. Its prevalence and association are not known because of the rarity of this condition. It should be considered as an important differential in patients presenting with soft tissue swelling in extremities. Treatment option includes conservative management, aspiration, and surgery. Aspiration has a high recurrence rate. Although surgery has a low recurrence rate, it carries a high rate of complications. Imaging with MRI is essential for confirmation of the cystic nature of lesions and their relation with the joint capsules or tendons. This helps in differentiating from other soft tissue lesions and presurgical planning.

Keywords: radiology, rare, cystic ganglionosis, child

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9657 Physico-Chemical Parameters and Economic Evaluation of Bio-Ethanol Produced from Waste of Starting Dates in South Algeria

Authors: Insaf Mehani, Bachir Bouchekima

Abstract:

The fight against climate change and the replacement of fossil energies nearing exhaustion gradually emerge as major societal and economic challenges. It is possible to develop common dates of low commercial value, and put on the local and international market a new generation of products with high added values such as bio ethanol. Besides its use in chemical synthesis, bio ethanol can be blended with gasoline to produce a clean fuel while improving the octane.

Keywords: bio-energy, waste dates, bio ethanol, Algeria

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9656 A BIM-Based Approach to Assess COVID-19 Risk Management Regarding Indoor Air Ventilation and Pedestrian Dynamics

Authors: T. Delval, C. Sauvage, Q. Jullien, R. Viano, T. Diallo, B. Collignan, G. Picinbono

Abstract:

In the context of the international spread of COVID-19, the Centre Scientifique et Technique du Bâtiment (CSTB) has led a joint research with the French government authorities Hauts-de-Seine department, to analyse the risk in school spaces according to their configuration, ventilation system and spatial segmentation strategy. This paper describes the main results of this joint research. A multidisciplinary team involving experts in indoor air quality/ventilation, pedestrian movements and IT domains was established to develop a COVID risk analysis tool based on Building Information Model. The work started with specific analysis on two pilot schools in order to provide for the local administration specifications to minimize the spread of the virus. Different recommendations were published to optimize/validate the use of ventilation systems and the strategy of student occupancy and student flow segmentation within the building. This COVID expertise has been digitized in order to manage a quick risk analysis on the entire building that could be used by the public administration through an easy user interface implemented in a free BIM Management software. One of the most interesting results is to enable a dynamic comparison of different ventilation system scenarios and space occupation strategy inside the BIM model. This concurrent engineering approach provides users with the optimal solution according to both ventilation and pedestrian flow expertise.

Keywords: BIM, knowledge management, system expert, risk management, indoor ventilation, pedestrian movement, integrated design

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9655 Effect of Replacing Maize with Acha Offal in Broiler Chicken Diets on Performance, Haematology and Serum Biochemicals

Authors: Sudik S. D., Raymon J. B., Maidala A., Lawan A., Bagudu I. A.

Abstract:

An experiment was conducted with 240 Abor Acre broilers to determine the effect of replacing maize with acha offal (Digitaria exilis) on performance, haematology, and serum biochemical. Chicks were allotted to six diets (T1, T2, T3, T4, T5, and T6) with acha offal (AO) at 0.0%, 5.0%, 7.5%, 10.0%, 12.5% and 15.0% respectively as replacement of maize with 4 replicates consisting of 10 birds per replicate in a completely randomized design. They were allowed ad libitum accessed to feed and water throughout a 42 days experiment. The results showed that at the starter phase, only feed conversion ratio (FCR) was significantly affected (p < 0.05). Chicks fed T5 had best FCR more than those fed T1 while those fed T2, T3, T4, and T6 had similar FCR comparable with T1. At the finisher stage, final weight (FW), total weight change (TWC), average daily gain (ADG), and FCR were significantly affected (p < 0.05). Chickens fed T3, T4, T5, and T6 had similar FW, TWC, and ADG and higher than those fed T1; those fed T2 had similar FW, TWG, and DWG with T1. Chickens fed T6 had best FCR, followed by those fed T3, T4, and T5, while those T2 had worse FCR similar with those fed T1. Eviscerated weight was significantly affected (p < 0.05) by treatment. Birds fed T4, T5, and T6 had higher eviscerated weight followed by T3 while those fed T2 had least eviscerated weight comparable with those fed T1. The entire organs (Gizzard, heart, kidneys, liver, lungs, pancreas, and proventriculus) were not significantly affected (p > 0.05) by treatments. Packed cell volume (PCV) and red blood cell (RBC) were significantly (p < 0.05) affected by treatment. Birds fed T4, T5, and T6 had higher and similar PCV and RBC with those fed T1 while those fed T2 and T3 had lower PCV and RBC. The entire serum metabolites were not significantly affected (p > 0.05) by treatments. In conclusion, acha offal can replace maize in starter and finisher broilers’ diets at 12.5% and 15.0%, respectively, without an adverse effect.

Keywords: broiler, acha offal, maize, performance, eviscerated, haematology, serum

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9654 Development of Probability Distribution Models for Degree of Bending (DoB) in Chord Member of Tubular X-Joints under Bending Loads

Authors: Hamid Ahmadi, Amirreza Ghaffari

Abstract:

Fatigue life of tubular joints in offshore structures is not only dependent on the value of hot-spot stress, but is also significantly influenced by the through-the-thickness stress distribution characterized by the degree of bending (DoB). The DoB exhibits considerable scatter calling for greater emphasis in accurate determination of its governing probability distribution which is a key input for the fatigue reliability analysis of a tubular joint. Although the tubular X-joints are commonly found in offshore jacket structures, as far as the authors are aware, no comprehensive research has been carried out on the probability distribution of the DoB in tubular X-joints. What has been used so far as the probability distribution of the DoB in reliability analyses is mainly based on assumptions and limited observations, especially in terms of distribution parameters. In the present paper, results of parametric equations available for the calculation of the DoB have been used to develop probability distribution models for the DoB in the chord member of tubular X-joints subjected to four types of bending loads. Based on a parametric study, a set of samples was prepared and density histograms were generated for these samples using Freedman-Diaconis method. Twelve different probability density functions (PDFs) were fitted to these histograms. The maximum likelihood method was utilized to determine the parameters of fitted distributions. In each case, Kolmogorov-Smirnov test was used to evaluate the goodness of fit. Finally, after substituting the values of estimated parameters for each distribution, a set of fully defined PDFs have been proposed for the DoB in tubular X-joints subjected to bending loads.

Keywords: tubular X-joint, degree of bending (DoB), probability density function (PDF), Kolmogorov-Smirnov goodness-of-fit test

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9653 Totally Implantable Venous Access Device for Long Term Parenteral Nutrition in a Patient with High Output Enterocutaneous Fistula Due to Advanced Malignancy

Authors: Puneet Goyal, Aarti Agarwal

Abstract:

Background and Objective: Nutritional support is an integral part of palliative care of advanced non-resectable abdominal malignancy patients, though is frequently neglected aspect. Non-Healing high output Entero-cutaneous fistulas sometimes require long term parenteral nutrition, to take care of catabolism and replacement of nutrients. We present a case of inoperable pancreatic malignancy with high output entero-cutaneous fistula, which was provided parenteral nutritional support with the use of Totally Implantable Venous Access Device (TIVAD). Method and Results: 55 year old man diagnosed with carcinoma pancreas had developed high entero-cutaneous fistula. His tumor was found to be inoperable and was on total parenteral nutrition through routine central line. This line was difficult to maintain as he required it for a long term TPN. He was planned to undergo Totally Implantable Venous Access Device (TIVAD) implantation. 8Fr single lumen catheter with Groshong non-return Valve (Bard Access Systems, Inc. USA) was inserted through right internal jugular vein, under fluoroscopic guidance. The catheter was tunneled subcutaneously and brought towards infraclavicular pocket, cut at appropriate length and connected to port and locked. Port was sutured in floor of pocket. Free flow of blood aspirated, flushed with heparinized saline. There was no kink observed in entire length of catheter under fluoroscopy. Skin over infraclavicular pocket was sutured. Long term catheter care and associated risks were explained to patient and relatives. Patient continued to receive total parenteral nutrition as well as other supportive therapy though TIVAD for next 6 weeks, till his demise. Conclusion: TIVADs are standard of care for long term venous access solutions in cancer patients requiring chemotherapy. In this case, we extended its use for providing parenteral nutrition and other supportive therapy. TIVADs can be implanted in advanced cancer patients for providing venous access solution required for various palliative treatments and medications. This will help in improving quality of life and satisfaction amongst terminally ill cancer patients.

Keywords: parenteral nutrition, totally implantable venous access device, long term venous access, interventions in anesthesiology

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9652 Design and Development of Engine Valve Train Wear Test Rig for the Assessment of Valve Train Tribochemistry

Authors: V. Manjunath, C. V. Chandrashekara

Abstract:

Ecosystem authority calls for the use of lubricants with less effect on the nature in terms of exhaust emission, while engine user demands more mileage per liter of fuel without any compromise on engine durability. From this viewpoint, engine manufacturers require the optimum combination of materials and lubricant additive package to minimize friction and wear in the engine components like piston, crankshaft and valve train etc. The demands are placed for requirements to operate at higher speeds, loads, temperature and for extended replacement intervals of engine oil. Besides, it is necessary to accurately predict the lubricant life or the replacement interval to prevent lubrication and valve-train components failure. Experimental tribology evaluation of new engine oils requires large amount of time and energy. Hence low cost bench test is necessary for industries and original equipment manufacturing companies (OEM) to study the performance of lubricants. The present work outlines the procedure for the design and development of a valve train wear rig (MCR) to simulate the ASTMD-6891 and to develop new engine test for Indian automobile sector to evaluate lubricants for Indian automobile market. In order to improve the lubrication between cam and follower of internal combustion engine, the influence of materials or oils viscosity and additives on the friction and wear characteristics are examined with test rig by increasing the contact load at two different revolution speed. From the experimentation following results are made obvious. Temperature, Torque, speed and wear plots are used to validate the data obtained from the newly developed multi-cam cam rig (MCR) with follower against a cast iron camshaft. Camshaft lobe wear is measured at seven different locations on cam profile. Tribofilm formed using 5W-30 oil is evaluated and correlated with the standard test results.

Keywords: ASTMD-6891, multi-cam rig (MCR), 5W-30, cam-profile

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9651 Effect of Thermal Treatment on Phenolic Content, Antioxidant, and Alpha-Amylase Inhibition Activities of Moringa stenopetala Leaves

Authors: Daniel Assefa, Engeda Dessalegn, Chetan Chauhan

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Moringa stenopetala is a socioeconomic valued tree that is widely available and cultivated in the Southern part of Ethiopia. The leaves have been traditionally used as a food source with high nutritional and medicinal values. The present work was carried out to evaluate the effect of thermal treatment on the total phenolic content, antioxidant and alpha-amylase inhibition activities of aqueous leaf extracts during maceration and different decoction time interval (5, 10 and 15 min). The total phenolic content was determined by the Folin-ciocalteu methods whereas antioxidant activities were determined by 2,2-diphenyl-1-picryl-hydrazyl(DPPH) radical scavenging, reducing power and ferrous ion chelating assays and alpha-amylase inhibition activity was determined using 3,5-dinitrosalicylic acid method. Total phenolic content ranged from 34.35 to 39.47 mgGAE/g. Decoction for 10 min extract showed ferrous ion chelating (92.52), DPPH radical scavenging (91.52%), alpha-amylase inhibition (69.06%) and ferric reducing power (0.765), respectively. DPPH, reducing power and alpha-amylase inhibition activities showed positive linear correlation (R2=0.853, R2= 0.857 and R2=0.930), respectively with total phenolic content but ferrous ion chelating activity was found to be weakly correlated (R2=0.481). Based on the present investigation, it could be concluded that major loss of total phenolic content, antioxidant and alpha-amylase inhibition activities of the crude leaf extracts of Moringa stenopetala leaves were observed at decoction time for 15 min. Therefore, to maintain the total phenolic content, antioxidant, and alpha-amylase inhibition activities of leaves, cooking practice should be at the optimum decoction time (5-10 min).

Keywords: alpha-amylase inhibition, antioxidant, Moringa stenopetala, total phenolic content

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9650 Total Phenols, Total Flavonoids Contents and Free Radical Scavenging Activity of Seeds Extracts of Lawsonia alba (henna) from Algeria

Authors: Rekia. Cherbi, Mokhtar. Saidi, Mohamed. Yousfi, Zhor. Rahmani

Abstract:

Lawsonia alba (Henna) is widely used in folkloric medicinal for a treatment of various skin diseases such as Eczema (atopic dermatitis), boils and sores. The aim of the present study is to determine the antioxidant activity, total phenolics, flavonoids, and condensed tannins content of extracts from the seeds of Lawsonia. alba grown in Algeria and selected from three different regions (Adrar, Biskra, and Ouargla). Total phenolics content ranged from 68,42 ± 0,54 to 88,31 ± 0,78mg gallic acid equivalents (GAE)/g dry weight, the flavonoids content varied from 1,13 ± 0,0035 to 1,367 ± 0,002mg quercetin equivalents (Q)/ g dry weight and condensed tannins (14,47 ± 0,138 to 25,50 ± 0,076 mg catechin equivalents (CE)/g dry weight). The antioxidant activities of the extracts were evaluated by DPPH assay. The results showed that all extracts from the seeds of Lawsonia. alba seem to be good trappers of radicals, the IC50 values of the extracts ranged between 0,00826 and 0,01 g/l.

Keywords: antioxidant activity, Lawsonia. alba, phenolic compounds, seeds

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9649 Carbon Nanotubes and Novel Applications for Textile

Authors: Ezgi Ismar

Abstract:

Carbon nanotubes (CNTs) are different from other allotropes of carbon, such as graphite, diamond and fullerene. Replacement of metals in flexible textiles has an advantage. Particularly in the last decade, both their electrical and mechanical properties have become an area of interest for Li-ion battery applications where the conductivity has a major importance. While carbon nanotubes are conductive, they are also less in weight compared to convectional conductive materials. Carbon nanotubes can be used inside the fiber so they can offer to create 3-D structures. In this review, you can find some examples of how carbon nanotubes adapted to textile products.

Keywords: carbon nanotubes, conductive textiles, nanotechnology, nanotextiles

Procedia PDF Downloads 368
9648 Debris' Effect on Bearing Capacity of Defective Piles in Sand

Authors: A. M. Nasr, W. R. Azzam, K. E. Ebeed

Abstract:

For bored piles, careful cleaning must be used to reduce the amount of material trapped in the drilled hole; otherwise, the debris' presence might cause the soft toe effect, which would affect the axial resistance. There isn't much comprehensive research on bored piles with debris. In order to investigate the behavior of a single pile, a pile composite foundation, a two pile group, a three pile group and a four pile group investigation conducts, forty-eight numerical tests in which the debris is simulated using foam rubber.1m pile diameter and 10m length with spacing 3D and depth of foundation 1m used in this study. It is found that the existence of debris causes a reduction of bearing capacity by 64.58% and 33.23% for single pile and pile composite foundation, respectively, 23.27% and 24.24% for the number of defective piles / total number of pile =1/2 and 1 respectively for two group pile, 10.23%, 19.42% and 28.47% for the number of defective piles / total number of pile =1/3,2/3 and 1 respectively for three group pile and, this reduction increase with the increase in a number of defective piles / a total number of piles and 7.1%, 13.32%,19.02% and 26.36 for the number of defective piles / total number of pile =1/4,2/4,3/4 and 1 respectively for four group pile and decreases with an increase of number of pile duo to interaction effect.

Keywords: debris, Foundation, defective, interaction, board pile

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9647 Experimental Model of the Behaviour of Bolted Angles Connections with Stiffeners

Authors: Abdulkadir Cuneyt Aydin, Mahyar Maali, Mahmut Kılıç, Merve Sağıroğlu

Abstract:

The moment-rotation curves of semi-rigid connections are the visual expressions of the actual behaviour discovered in beam-to-column connections experiments. This research was to determine the behaviour of the connection using full-scale experiments under statically loaded. The stiffeners which are typically attached to beams web or flanges to control local buckling and to increase shear capacity in a beam web are almost always used in modern designs. They must also provide sufficient moment of inertia to control out of plane deformations. This study was undertaken to analyse the influence of stiffeners in the angles and beams on the behaviour of the beam-to-column joints. In addition, the aim was to provide necessary data to improve the Eurocode 3. The main parameters observed are the evolution of the resistance, the stiffness, the rotation capacity, the ductility of a joint and the Energy Dissipation. Experimental tests show that the plastic flexural resistance and the energy dissipation increased when thickness of stiffener beam, thickness of stiffener angles were increased in the test specimens. And also, while stiffness of joints, the bending moment capacity and the maximum bending moment increased with the increasing thickness of stiffener beam, these values decreased with the increasing thickness of stiffener angles. So, it is observed that the beam stiffener of angles are important in improving resistance moment of beam-to-column semi-rigid joints.

Keywords: bolted angles connection, semi-rigid joints, ductility of a joint, angles and beams stiffeners

Procedia PDF Downloads 447
9646 High-Temperature Corrosion of Weldment of Fe-2%Mn-0.5%Si Steel in N2/H2O/H2S-Mixed Gas

Authors: Sang Hwan Bak, Min Jung Kim, Dong Bok Lee

Abstract:

Fe-2%Mn-0.5%Si-0.2C steel was welded and corroded at 600, 700 and 800oC for 20 h in 1 atm of N2/H2S/H2O-mixed gas in order to characterize the high-temperature corrosion behavior of the welded joint. Corrosion proceeded fast and almost linearly. It increased with an increase in the corrosion temperature. H2S formed FeS owing to sulfur released from H2S. The scales were fragile and nonadherent.

Keywords: Fe-Mn-Si steel, corrosion, welding, sulfidation, H2S gas

Procedia PDF Downloads 389
9645 Improvement of Fixed Offshore Structures' Boat Landing Performance Using Practicable Design Criteria

Authors: A. Hamadelnil, Z. Razak, E. Matsoom

Abstract:

Boat landings on fixed offshore structure are designed to absorb the impact energy from the boats approaching the platform for crew transfer. As the size and speed of operating boats vary, the design and maintenance of the boat landings become more challenging. Different oil and gas operators adopting different design criteria for the boat landing design in the region of South East Asia. Rubber strip is used to increase the capacity of the boat landing in absorbing bigger impact energy. Recently, it has been reported that all the rubber strips peel off the boat landing frame within one to two years, and replacement is required to avoid puncturing of the boat’s hull by the exposed sharp edges and bolts used to secure the rubber strip. The capacity of the boat landing in absorbing the impact energy is reduced after the failure of the rubber strip and results in failure of the steel members. The replacement of the rubber strip is costly as it requires a diving spread. The objective of this study is to propose the most practicable criteria to be adopted by oil and gas operators in the design of the boat landings in the region of South East Asia to improve the performance of the boat landing and assure safe operation and cheaper maintenance. This study explores the current design and maintenance challenges of boat landing and compares between the criteria adopted by different operators. In addition, this study explains the reasons behind the denting of many of the boat landing. It also evaluates the effect of grout and rubber strip in the capacity of the boat landing and jacket legs and highlight. Boat landing model and analysis using USFOS and SACS software are carried out and presented in this study considering different design criteria. This study proposes the most practicable criteria to be used in designing the boat landing in South East Asia region to save cost and achieve better performance, safe operation and less cost and maintenance.

Keywords: boat landing, grout, plastic hinge, rubber strip

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9644 Death Due to Ulnar Artery Injury by Glassdoor: A Case Report

Authors: Ashok Kumar Rastogi

Abstract:

Glass is a material commonly used for Glassdoor, glass bottles, cookware, and containers. It can be harmful, as it is a hard and blunt object. Glass has been associated with severe injury and is a common cause of injuries warranting hospital visits to the emergency department (ED). These injuries can be accidental or intentionally inflicted. Broken glass injuries can be severe, even deadly. If broken glass shards fall out on your arm, it may cause fatal injuries. Case history: A 20-year-old male dead body was found aside the road, police informed, and a video recording ceased during an investigation. In the video recording, the person was in a drunken state (unable to walk and disoriented), wandering in the residential area road. He saw a barber shop, the shop door made of Glass. Suddenly, he hit the Glassdoor with his right hand forcefully. The Glassdoor broke into multiple pieces, and multiple injuries were seen over the right hand. Observations: Multiple small and large lacerations were seen over the right anterior part of the elbow. The main injury looked like an incised wound caused by a hard and sharp object. The main injury was noted as a laceration of size 13 x 06 cm bone deep, placed obliquely over the anteromedial aspect of the right elbow joint, its medial end at medial end of elbow joint while its anterior end was 04 cm below the elbow joint with laceration of underline brachialis muscles and complete transaction of ulnar artery and vein, skin margins looking sharply cut with irregular margins with tiny cuts at the medial lower border of laceration. Injuries were antemortem and fresh in nature, caused by hard and blunt objects but looking like hard and sharp objects. All organs were found pale, and the cause of death was shock and hemorrhage because of ulnar vessel injury. Conclusion: The findings of this case report highlight the potentially lethal consequences of glass injuries, especially those involving Glassdoors. The study underscores the importance of accurate interpretation and identification of wounds caused by Glass, as they may resemble injuries caused by other objects. It emphasizes the challenges faced by autopsy surgeons when determining the cause and manner of death in cases where visual evidence of injury is absent or when the weapon is not recovered. Ultimately, this case report serves as a reminder of the potential dangers posed by Glass and the importance of comprehensive forensic examinations.

Keywords: glassdoor, incised, wound, laceration, autopsy

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9643 Determining Factors Influencing the Total Funding in Islamic Banking of Indonesia

Authors: Euphrasia Susy Suhendra, Lies Handrijaningsih

Abstract:

The banking sector as an intermediary party or intermediaries occupies a very important position in bridging the needs of working capital investment in the real sector with funds owner. This will certainly make money more effectively to improve the economic value added. As an intermediary, Islamic banks raise funds from the public and then distribute in the form of financing. In practice, the distribution of funding that is run by Islamic Banking is not as easy as, in theory, because, in fact, there are many financing problems; some are caused by lacking the assessment and supervision of banks to customers. This study aims to analyze the influence of the Third Party Funds, Return on Assets (ROA), Non Performing Financing (NPF), and Financing Deposit Ratio (FDR) to Total Financing provided to the Community by Islamic Banks in Indonesia. The data used is monthly data released by Bank of Indonesia in Islamic Banking Statistics in the time period of January 2009 - December 2013. This study uses cointegration test to see the long-term relationship, and use error correction models to examine the relationship of short-term. The results of this study indicate that the Third Party Fund has a short-term effect on total funding, Return on Assets has a long term effect on the total financing, Non Performing Financing has long-term effects of total financing, and Financing deposit ratio has the effect of short-term and long-term of the total financing provided by Islamic Banks in Indonesia.

Keywords: Islamic banking, third party fund, return on asset, non-performing financing, financing deposit ratio

Procedia PDF Downloads 444
9642 Importance of Flexibility Training for Older Adults: A Narrative Review

Authors: Andrej Kocjan

Abstract:

Introduction: Mobility has been shown to play an important role of health and quality of life among older adults. Falls, which are often related to decreased mobility, as well as to neuromuscular deficits, represent the most common injury among older adults. Fall risk has been shown to increase with reduced lower extremity flexibility. The aim of the paper is to assess the importance of flexibility training on joint range of motion and functional performance among elderly population. Methods: We performed literature research on PubMed and evaluated articles published until 2000. The articles found in the search strategy were also added. The population of interest included older adults (≥ 65 years of age). Results: Flexibility training programs still represent an important part of several rehabilitation programs. Static stretching and proprioceptive neuromuscular facilitation are the most frequently used techniques to improve the length of the muscle-tendon complex. Although the effectiveness of type of stretching seems to be related to age and gender, static stretching is a more appropriate technique to enhance shoulder, hip, and ankle range of motion in older adults. Stretching should be performed in multiple sets with holds of more than 60 seconds for a single muscle group. Conclusion: The literature suggests that flexibility training is an effective method to increase joint range of motion in older adults. In the light of increased functional outcome, activities such as strengthening, balance, and aerobic exercises should be incorporated into a training program for older people. Due to relatively little published literature, it is still not possible to prescribe detailed recommendations regarding flexibility training for older adults.

Keywords: elderly, exercise, flexibility, falls

Procedia PDF Downloads 169
9641 A Multi Objective Reliable Location-Inventory Capacitated Disruption Facility Problem with Penalty Cost Solve with Efficient Meta Historic Algorithms

Authors: Elham Taghizadeh, Mostafa Abedzadeh, Mostafa Setak

Abstract:

Logistics network is expected that opened facilities work continuously for a long time horizon without any failure; but in real world problems, facilities may face disruptions. This paper studies a reliable joint inventory location problem to optimize cost of facility locations, customers’ assignment, and inventory management decisions when facilities face failure risks and doesn’t work. In our model we assume when a facility is out of work, its customers may be reassigned to other operational facilities otherwise they must endure high penalty costs associated with losing service. For defining the model closer to real world problems, the model is proposed based on p-median problem and the facilities are considered to have limited capacities. We define a new binary variable (Z_is) for showing that customers are not assigned to any facilities. Our problem involve a bi-objective model; the first one minimizes the sum of facility construction costs and expected inventory holding costs, the second one function that mention for the first one is minimizes maximum expected customer costs under normal and failure scenarios. For solving this model we use NSGAII and MOSS algorithms have been applied to find the pareto- archive solution. Also Response Surface Methodology (RSM) is applied for optimizing the NSGAII Algorithm Parameters. We compare performance of two algorithms with three metrics and the results show NSGAII is more suitable for our model.

Keywords: joint inventory-location problem, facility location, NSGAII, MOSS

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9640 Thick Disc Molecular Gas Fraction in NGC 6946

Authors: Narendra Nath Patra

Abstract:

Several recent studies reinforce the existence of a thick molecular disc in galaxies along with the dynamically cold thin disc. Assuming a two-component molecular disc, we model the disc of NGC 6946 as a four-component system consists of stars, HI, thin disc molecular gas, and thick disc molecular gas in vertical hydrostatic equilibrium. Following, we set up the joint Poisson-Boltzmann equation of hydrostatic equilibrium and solve it numerically to obtain a three-dimensional density distribution of different baryonic components. Using the density solutions and the observed rotation curve, we further build a three-dimensional dynamical model of the molecular disc and consecutively produce simulated CO spectral cube and spectral width profile. We find that the simulated spectral width profiles distinguishably differs for different assumed thick disc molecular gas fraction. Several CO spectral width profiles are then produced for different assumed thick disc molecular gas fractions and compared with the observed one to obtain the best fit thick disc molecular gas fraction profile. We find that the thick disc molecular gas fraction in NGC 6946 largely remains constant across its molecular disc with a mean value of 0.70 +/- 0.09. We also estimate the amount of extra-planar molecular gas in NGC 6946. We find 60% of the total molecular gas is extra-planar at the central region, whereas this fraction reduces to ~ 35% at the edge of the molecular disc. With our method, for the first time, we estimate the thick disc molecular gas fraction as a function of radius in an external galaxy with sub-kpc resolution.

Keywords: galaxies: kinematics and dynamic, galaxies: spiral, galaxies: structure , ISM: molecules, molecular data

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9639 Biosocial Determinants of Maternal and Child Health in Northeast India: A Case Study

Authors: Benrithung Murry

Abstract:

This paper highlights the biosocial determinants of health-seeking behavior in tribal population groups of northeast India, focusing on maternal and child health. The northeastern region of India is a conglomeration of several ethnic groups, most of which are scheduled as tribal groups. A total of 750 ever-married women in reproductive ages (15-49 years) were interviewed from three tribal groups of Nagaland, India using pre-tested and modified maternal health schedule. Data pertaining to reproductive performance of the mothers and their children health status were collected from 12 villages of Dimapur district, Nagaland, India. The sample for study comprises 212 Angami women, 267 Ao women, and 271 Sumi women, all of which belonging to tribal populations of Northeast India. Sex ratios of 15-49 years in these three populations are 1018.18, 1086.69, and 1106.92, respectively. 90% of the populations in the study are nuclear families, with about 10% of households falling below the poverty line as per the cutoffs for India. Female literacy level in these population groups is higher than the national average of 65.46%; however, about 30% of all married women are not engaged in any sort of earnings. Total fertility rates of these populations are alarming (Total Fertility Rate ≥ 6) and far from replacement fertility level, while infant mortality rates are found to be much lower than the national average of 34 per 1000. The perception and practice of maternal health in this region is unimpressive despite the availability of medical amenities. Only 3 % of mothers in the study have reported 4 times antenatal checkups during last two pregnancies. Other mothers have reported 1 to 3 times of antenatal checkups, but about 25% of them never visited a doctor during the entire pregnancy period. About 15% of mothers never took tetanus injection, while 40% of mothers never took iron folic supplements during pregnancy. Almost half of all women and their husbands do not use birth control measures even for the spacing of children, which has an immense impact on prenatal mortality mainly due to deliberate abortions: the percentage of prenatal mortality among Angami, Ao and Sumi populations is 44.88, 31.88 and 54.98, respectively per 1000 live births. The steep decline in fertility levels in most countries is a consequence of the increasing use of modern methods of contraception. However, among users of birth control measures in these populations, it is seen that most couples use it only after they have the desired number of children, thus its use having no substantial influence in reducing fertility. It is also seen that the majority of the children were only partially vaccinated. With many child deliveries being done at home, many newborns are not administered with polio at birth. Two-third of all children do not have complete basic immunization against polio, diphtheria, tetanus, pertussis, bacillus, and hepatitis besides others. Certain adherence to traditional beliefs and customs apart from the socio-economic factors is believed to have been operating in these populations, which determines their health-seeking behavior. While a more in-depth study combining biological, socio-cultural, economic, and genetic factors is suggested, there is an urgent need for intervention in these populations to combat with the poor maternal and child health status.

Keywords: case study, health behavior, mother and child, northeast india

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9638 Design of Robust and Intelligent Controller for Active Removal of Space Debris

Authors: Shabadini Sampath, Jinglang Feng

Abstract:

With huge kinetic energy, space debris poses a major threat to astronauts’ space activities and spacecraft in orbit if a collision happens. The active removal of space debris is required in order to avoid frequent collisions that would occur. In addition, the amount of space debris will increase uncontrollably, posing a threat to the safety of the entire space system. But the safe and reliable removal of large-scale space debris has been a huge challenge to date. While capturing and deorbiting space debris, the space manipulator has to achieve high control precision. However, due to uncertainties and unknown disturbances, there is difficulty in coordinating the control of the space manipulator. To address this challenge, this paper focuses on developing a robust and intelligent control algorithm that controls joint movement and restricts it on the sliding manifold by reducing uncertainties. A neural network adaptive sliding mode controller (NNASMC) is applied with the objective of finding the control law such that the joint motions of the space manipulator follow the given trajectory. A computed torque control (CTC) is an effective motion control strategy that is used in this paper for computing space manipulator arm torque to generate the required motion. Based on the Lyapunov stability theorem, the proposed intelligent controller NNASMC and CTC guarantees the robustness and global asymptotic stability of the closed-loop control system. Finally, the controllers used in the paper are modeled and simulated using MATLAB Simulink. The results are presented to prove the effectiveness of the proposed controller approach.

Keywords: GNC, active removal of space debris, AI controllers, MatLabSimulink

Procedia PDF Downloads 113
9637 Congenital Diaphragmatic Hernia Outcomes in a Low-Volume Center

Authors: Michael Vieth, Aric Schadler, Hubert Ballard, J. A. Bauer, Pratibha Thakkar

Abstract:

Introduction: Congenital diaphragmatic hernia (CDH) is a condition characterized by the herniation of abdominal contents into the thoracic cavity requiring postnatal surgical repair. Previous literature suggests improved CDH outcomes at high-volume regional referral centers compared to low-volume centers. The purpose of this study was to examine CDH outcomes at Kentucky Children’s Hospital (KCH), a low-volume center, compared to the Congenital Diaphragmatic Hernia Study Group (CDHSG). Methods: A retrospective chart review was performed at KCH from 2007-2019 for neonates with CDH, and then subdivided into two cohorts: those requiring ECMO therapy and those not requiring ECMO therapy. Basic demographic data and measures of mortality and morbidity including ventilator days and length of stay were compared to the CDHSG. Measures of morbidity for the ECMO cohort including duration of ECMO, clinical bleeding, intracranial hemorrhage, sepsis, need for continuous renal replacement therapy (CRRT), need for sildenafil at discharge, timing of surgical repair, and total ventilator days were collected. Statistical analysis was performed using IBM SPSS Statistics version 28. One-sample t-tests and one-sample Wilcoxon Signed Rank test were utilized as appropriate.Results: There were a total of 27 neonatal patients with CDH at KCH from 2007-2019; 9 of the 27 required ECMO therapy. The birth weight and gestational age were similar between KCH and the CDHSG (2.99 kg vs 2.92 kg, p =0.655; 37.0 weeks vs 37.4 weeks, p =0.51). About half of the patients were inborn in both cohorts (52% vs 56%, p =0.676). KCH cohort had significantly more Caucasian patients (96% vs 55%, p=<0.001). Unadjusted mortality was similar in both groups (KCH 70% vs CDHSG 72%, p =0.857). Using ECMO utilization (KCH 78% vs CDHSG 52%, p =0.118) and need for surgical repair (KCH 95% vs CDHSG 85%, p =0.060) as proxy for severity, both groups’ mortality were comparable. No significant difference was noted for pulmonary outcomes such as average ventilator days (KCH 43.2 vs. CDHSG 17.3, p =0.078) and home oxygen dependency (KCH 44% vs. CDHSG 24%, p =0.108). Average length of hospital stay for patients treated at KCH was similar to CDHSG (64.4 vs 49.2, p=1.000). Conclusion: Our study demonstrates that outcome in CDH patients is independent of center’s case volume status. Management of CDH with a standardized approach in a low-volume center can yield similar outcomes. This data supports the treatment of patients with CDH at low-volume centers as opposed to transferring to higher-volume centers.

Keywords: ECMO, case volume, congenital diaphragmatic hernia, congenital diaphragmatic hernia study group, neonate

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