Search results for: cost optimization

Authors: Milton Ixquiac, Erick Montenegro, Francisco Reynoso, Matthew Schmidt, Thomas Mazur, Tianyu Zhao, Hiram Gay, Geoffrey Hugo, Lauren Henke, Jeff Michael Michalski, Angel Velarde, Vicky de Falla, Franky Reyes, Osmar Hernandez, Edgar Aparicio Ruiz, Baozhou Sun

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Purpose: Radiotherapy departments in low- and middle-income countries (LMICs) like Guatemala have recently introduced intensity-modulated radiotherapy (IMRT). IMRT has become the standard of care in high-income countries (HIC) due to reduced toxicity and improved outcomes in some cancers. The purpose of this work is to show the agreement between the dosimetric results shown in the Dose Volume Histograms (DVH) to the objectives proposed in the adopted protocol. This is the initial experience with an O-ring Linac. Methods and Materials: An O-Linac Linac was installed at our clinic in Guatemala in 2019 and has been used to treat approximately 90 patients daily with IMRT. This Linac is a completely Image Guided Device since to deliver each radiotherapy session must take a Mega Voltage Cone Beam Computerized Tomography (MVCBCT). In each MVCBCT, the Linac deliver 9 UM, and they are taken into account while performing the planning. To start the standardization, the TG263 was employed in the nomenclature and adopted a hypofractionated protocol to treat ChestWall, including supraclavicular nodes achieving 40.05Gy in 15 fractions. The planning was developed using 4 semiarcs from 179-305 degrees. The planner must create optimization volumes for targets and Organs at Risk (OARs); the difficulty for the planner was the dose base due to the MVCBCT. To evaluate the planning modality, we used 30 chestwall cases. Results: The plans created manually achieve the protocol objectives. The protocol objectives are the same as the RTOG1005, and the DHV curves look clinically acceptable. Conclusions: Despite the O-ring Linac doesn´t have the capacity to obtain kv images, the cone beam CT was created using MV energy, the dose delivered by the daily image setup process still without affect the dosimetric quality of the plans, and the dose distribution is acceptable achieving the protocol objectives.

Keywords: hypofrationation, VMAT, chestwall, radiotherapy planning

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Authors: Lijuan Zhou, Mengqi Wu, Changyong Niu

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Attributed graph clustering can utilize the graph topology and node attributes to uncover hidden community structures and patterns in complex networks, aiding in the understanding and analysis of complex systems. Utilizing contrastive learning for attributed graph clustering can effectively exploit meaningful implicit relationships between data. However, existing attributed graph clustering methods based on contrastive learning suffer from the following drawbacks: 1) Complex data augmentation increases computational cost, and inappropriate data augmentation may lead to semantic drift. 2) The selection of positive and negative samples neglects the intrinsic cluster structure learned from graph topology and node attributes. Therefore, this paper proposes a method called self-supervised Attributed Graph Clustering with Dual Contrastive Loss constraints (AGC-DCL). Firstly, Siamese Multilayer Perceptron (MLP) encoders are employed to generate two views separately to avoid complex data augmentation. Secondly, the neighborhood contrastive loss is introduced to constrain node representation using local topological structure while effectively embedding attribute information through attribute reconstruction. Additionally, clustering-oriented contrastive loss is applied to fully utilize clustering information in global semantics for discriminative node representations, regarding the cluster centers from two views as negative samples to fully leverage effective clustering information from different views. Comparative clustering results with existing attributed graph clustering algorithms on six datasets demonstrate the superiority of the proposed method.

Keywords: attributed graph clustering, contrastive learning, clustering-oriented, self-supervised learning

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Authors: Jun-Lun Jiang, Bing-Sheng Yu

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Processing of flat-panel displays generates huge amount of wasted glass polishing powder, with high concentration of cerium and other elements such as lanthanum. According to the current statistics, consumption of polishing powder was approximately ten thousand tons per year in the world. Nevertheless, wasted polishing powder was usually buried or burned. If the lanthanum and cerium compounds in the wasted polishing powder could be recycled, that will greatly reduce enterprise cost and implement waste circulation. Cathodes of SOFCs are the principal consisting of rare earth elements such as lanthanum and cerium. In this study, we recycled the lanthanum and cerium from wasted glass polishing powder by acid-solution method, and synthesized La0.8Sr0.05Ca0.15Fe0.8Co0.8O3-δ and Gd0.1Ce0.9O2 (LSCCF-GDC) composite cathode material for SOFCs by glycinenitrate combustion (GNP) method. The results show that the recovery rates of lanthanum and cerium could accomplish up to 80% and 100% under 10N nitric acid solution within one hour. Comparing with the XRD data of the commercial LSCCF-GDC powder and the LSCCF-GDC product synthesized with chemicals, we find that the LSCCF-GDC was successfully synthesized with the recycled La & Ce solution by GNP method. The effect of adding ammonia to the product was also discussed, the grain size is finer and recovery rate of the product is higher without the addition of ammonia to the solution.

Keywords: glass polishing powder, acid solution, recycling, composite cathodes of solid oxide fuel, cell (SOFC), perovskite, glycine-nitrate combustion(GNP) method

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Authors: Băilă Diana Irinel, Păcurar Răzvan, Păcurar Ancuța

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Although the volumes of fibre reinforced polymer composites (FRPs) used for aircraft applications is a relatively small percentage of total use, the materials often find their most sophisticated applications in this industry. In aerospace, the performance criteria placed upon materials can be far greater than in other areas – key aspects are light-weight, high-strength, high-stiffness, and good fatigue resistance. Composites were first used by the military before the technology was applied to commercial planes. Nowadays, composites are widely used, and this has been the result of a gradual direct substitution of metal components followed by the development of integrated composite designs as confidence in FRPs has increased. The airplane uses a range of components made from composites, including the fin and tailplane. In the last years, composite materials are increasingly used in automotive applications due to the improvement of material properties. In the aerospace and automotive sector, the fuel consumption is proportional to the weight of the body of the vehicle. A minimum of 20% of the cost can be saved if it used polymer composites in place of the metal structures and the operating and maintenance costs are alco very low. Glass fiber-epoxy composites are widely used in the making of aircraft and automobile body parts and are not only limited to these fields but also used in ship building, structural applications in civil engineering, pipes for the transport of liquids, electrical insulators in reactors. This article was establish the high-performance of composite material, a type glass-epoxy used in automotive and aeronautic domains, concerning the tensile and flexural tests and SEM analyzes.

Keywords: glass-epoxy composite, traction and flexion tests, SEM analysis, acoustic emission (AE) signals

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Authors: Sujit Kumar Guchhait, Subir Paul

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One of the major research areas is to find an alternative source of energy to fulfill the energy crisis and environmental problems. The Fuel cell is such kind of energy producing unit. Use of fuel cell to produce renewable energy for commercial purpose is limited by the high cost of Pt based electrode material. Development of high energetic, as well as inexpensive fuel cell electrode materials, is needs of hour to produce clean energy using derive bio-fuel. In this present investigation, inexpensive Cu-Ni-CeO2 electrode material has been synthesized by using pulse current. The surface morphology of the electrode materials is controlled by several deposition parameters to increase the rate of electrochemical oxidation of alcoholic fuel, ethanol. The electrochemical characterization of the developed material was done by Cyclic Voltammetry (CV) and Chronoamperometry (CA) and Electrochemical Impedance Spectroscopy test. It is interesting to find that both these materials have shown high electrocatalytic properties in terms of high exchange current density (I0), low polarization resistance (Rp) and low impedance. It is seen that the addition of CeO2 to Ni-Cu has outperformed Pt as far as high electrocatalytic properties are concerned. The exchange current density on the Cu-Ni-CeO2 electrode surface for ethanol oxidation is about eight times higher than the same on the Pt surface with much lower polarization resistance than the later. The surface morphology of the electrode materials has been revealed by Field Effect Scanning Electron Microscope (FESEM). It is seen that grains are narrow and subspherical with 3D surface containing pores in between two elongated grains. XRD study exhibits the presence of Ni and CeO2 on the Cu surface.

Keywords: electro-catalyst, alcoholic fuel, cyclic voltammetry, potentiodynamic polarization, EIS, XRD, SEM

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Authors: F. M. Pisano, M. Ciminello

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Aerospace, mechanical, and civil engineering infrastructures can take advantages from damage detection and identification strategies in terms of maintenance cost reduction and operational life improvements, as well for safety scopes. The challenge is to detect so called “barely visible impact damage” (BVID), due to low/medium energy impacts, that can progressively compromise the structure integrity. The occurrence of any local change in material properties, that can degrade the structure performance, is to be monitored using so called Structural Health Monitoring (SHM) systems, in charge of comparing the structure states before and after damage occurs. SHM seeks for any "anomalous" response collected by means of sensor networks and then analyzed using appropriate algorithms. Independently of the specific analysis approach adopted for structural damage detection and localization, textual reports, tables and graphs describing possible outlier coordinates and damage severity are usually provided as artifacts to be elaborated for information extraction about the current health conditions of the structure under investigation. Visual Analytics can support the processing of monitored measurements offering data navigation and exploration tools leveraging the native human capabilities of understanding images faster than texts and tables. Herein, a SHM system enrichment by integration of a Visual Analytics component is investigated. Analytical dashboards have been created by combining worksheets, so that a useful Visual Analytics tool is provided to structural analysts for exploring the structure health conditions examined by a Principal Component Analysis based algorithm.

Keywords: interactive dashboards, optical fibers, structural health monitoring, visual analytics

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Authors: Nikoloz Jalabadze, Roin Chedia, Lili Nadaraia, Levan Khundadze

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Nanocrystalline materials in powder condition can be manufactured by a number of different methods, however manufacture of composite materials product in the same nanocrystalline state is still a problem because the processes of compaction and synthesis of nanocrystalline powders go with intensive growth of particles – the process which promotes formation of pieces in an ordinary crystalline state instead of being crystallized in the desirable nanocrystalline state. To date spark plasma sintering (SPS) has been considered as the most promising and energy efficient method for producing dense bodies of composite materials. An advantage of the SPS method in comparison with other methods is mainly low temperature and short time of the sintering procedure. That finally gives an opportunity to obtain dense material with nanocrystalline structure. Graphene has recently garnered significant interest as a reinforcing phase in composite materials because of its excellent electrical, thermal and mechanical properties. Graphene nanoplatelets (GNPs) in particular have attracted much interest as reinforcements for ceramic matrix composites (mostly in Al2O3, Si3N4, TiO2, ZrB2 a. c.). SPS has been shown to fully densify a variety of ceramic systems effectively including Al2O3 and often with improvements in mechanical and functional behavior. Alumina consolidated by SPS has been shown to have superior hardness, fracture toughness, plasticity and optical translucency compared to conventionally processed alumina. Knowledge of how GNPs influence sintering behavior is important to effectively process and manufacture process. In this study, the effects of GNPs on the SPS processing of Al2O3 are investigated by systematically varying sintering temperature, holding time and pressure. Our experiments showed that SPS process is also appropriate for the synthesis of nanocrystalline powders of alumina-graphene composites. Depending on the size of the molds, it is possible to obtain different amount of nanopowders. Investigation of the structure, physical-chemical, mechanical and performance properties of the elaborated composite materials was performed. The results of this study provide a fundamental understanding of the effects of GNP on sintering behavior, thereby providing a foundation for future optimization of the processing of these promising nanocomposite systems.

Keywords: alumina oxide, ceramic matrix composites, graphene nanoplatelets, spark-plasma sintering

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Authors: Aleksandra Łochowicz, Daria Świętochowska, Loredano Pollegioni, Nazim Ocal, Franck Charmantray, Laurence Hecquet, Katarzyna Szymańska

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Multienzymatic cascade reactions are nowadays widely used in pharmaceutical, chemical and cosmetics industries to produce high valuable compounds. They can be carried out in two ways, step by step and one-pot. If two or more enzymes are in the same reaction vessel is necessary to work out the compromise to run the reaction in optimal conditions for each enzyme. So far most of the reports of multienzymatic cascades concern on usage of free enzymes. Unfortunately using free enzymes as catalysts of reactions accomplish high cost. What is more, free enzymes are soluble in solvents which makes reuse impossible. To overcome this obstacle enzymes can be immobilized what provides heterogeneity of biocatalyst that enables reuse and easy separation of the enzyme from solvents and reaction products. Usually, immobilization increase also the thermal and operational stability of enzyme. The advantages of using immobilized multienzymes are enhanced enzyme stability, improved cascade enzymatic activity via substrate channeling, and ease of recovery for reuse. The one-pot immobilized multienzymatic cascade can be carried out in mixed or coimmobilized type. When biocatalysts are coimmobilized on the same carrier the are in close contact to each other which increase the reaction rate and catalytic efficiency, and eliminate the lag time. However, in this type providing the optimal conditions both in the process of immobilization and cascade reaction for each enzyme is complicated. Herein, we examined immobilization of 3 enzymes: D-amino acid oxidase from Rhodotorula gracilis, commercially available catalase and transketolase from Geobacillus stearothermophilus. As a support we used silica monoliths with hierarchical structure of pores. Then we checked their stability and reusability in one-pot cascade of L-erythrulose and hydroxypuryvate acid synthesis.

Keywords: biocatalysts, enzyme immobilization, multienzymatic reaction, silica carriers

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Authors: Liqin Zhang, Liang Yan

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This paper addresses the speed synchronization control problem for a network-based multi-motor system from the perspective of cluster consensus theory. Each motor is considered as a single agent connected through fixed and undirected network. This paper presents an improved control protocol from three aspects. First, for the purpose of improving both tracking and synchronization performance, this paper presents a distributed leader-following method. The improved control protocol takes the importance of each motor’s speed into consideration, and all motors are divided into different groups according to speed weights. Specifically, by using control parameters optimization, the synchronization error and tracking error can be regulated and decoupled to some extent. The simulation results demonstrate the effectiveness and superiority of the proposed strategy. In practical engineering, the simplified models are unrealistic, such as single-integrator and double-integrator. And previous algorithms require the acceleration information of the leader available to all followers if the leader has a varying velocity, which is also difficult to realize. Therefore, the method focuses on an observer-based variable structure algorithm for consensus tracking, which gets rid of the leader acceleration. The presented scheme optimizes synchronization performance, as well as provides satisfactory robustness. What’s more, the existing algorithms can obtain a stable synchronous system; however, the obtained stable system may encounter some disturbances that may destroy the synchronization. Focus on this challenging technological problem, a state-dependent-switching approach is introduced. In the presence of unmeasured angular speed and unknown failures, this paper investigates a distributed fault-tolerant consensus tracking algorithm for a group non-identical motors. The failures are modeled by nonlinear functions, and the sliding mode observer is designed to estimate the angular speed and nonlinear failures. The convergence and stability of the given multi-motor system are proved. Simulation results have shown that all followers asymptotically converge to a consistent state when one follower fails to follow the virtual leader during a large enough disturbance, which illustrates the good performance of synchronization control accuracy.

Keywords: consensus control, distributed follow, fault-tolerant control, multi-motor system, speed synchronization

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Authors: Zixuan Zhao, Lingbin Du, Le Wang, Youqing Wang, Yi Yang, Jingjun Chen, Hengjin Dong

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Objectives: Few results from public attitudes for lung cancer screening are available both in China and abroad. This study aimed to identify preferred lung cancer screening modalities in a Chinese population and predict uptake rates of different modalities. Materials and Methods: A discrete choice experiment questionnaire was administered to 392 Chinese individuals aged 50–74 years who were at high risk for lung cancer. Each choice set had two lung screening options and an option to opt-out, and respondents were asked to choose the most preferred one. Both mixed logit analysis and stepwise logistic analysis were conducted to explore whether preferences were related to respondent characteristics and identify which kinds of respondents were more likely to opt out of any screening. Results: On mixed logit analysis, attributes that were predictive of choice at 1% level of statistical significance included the screening interval, screening venue, and out-of-pocket costs. The preferred screening modality seemed to be screening by low-dose computed tomography (LDCT) + blood test once a year in a general hospital at a cost of RMB 50; this could increase the uptake rate by 0.40 compared to the baseline setting. On stepwise logistic regression, those with no endowment insurance were more likely to opt out; those who were older and housewives/househusbands, and those with a health check habit and with commercial endowment insurance were less likely to opt out from a screening programme. Conclusions: There was considerable variance between real risk and self-perceived risk of lung cancer among respondents, and further research is required in this area. Lung cancer screening uptake can be increased by offering various screening modalities, so as to help policymakers further design the screening modality.

Keywords: lung cancer, screening, China., discrete choice experiment

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Authors: Pia Kastl

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Potentials of blended learning are the flexibility of learning and the possibility to get in touch with lecturers and fellow students on site. By combining face-to-face sessions with digital self-learning units, the learning process can be optimized, and learning success increased. To examine wether blended learning outperforms online and face-to-face teaching, a theory-based questionnaire survey was conducted. The results show that the interaction and cooperation among students is poorly provided in blended learning, and face-to-face teaching performs better in this respect. The aim of this article is to identify concrete suggestions students have for improving cooperation and interaction in blended learning courses. For this purpose, interviews were conducted with students from various academic disciplines in face-to-face, online, or blended learning courses (N= 60). The questions referred to opinions and suggestions for improvement regarding the course design of the respective learning environment. The analysis was carried out by qualitative content analysis. The results show that students perceive the interaction as beneficial to their learning. They verbalize their knowledge and are exposed to different perspectives. In addition, emotional support is particularly important in exam phases. Interaction and cooperation were primarily enabled in the face-to-face component of the courses studied, while there was very limited contact with fellow students in the asynchronous component. Forums offered were hardly used or not used at all because the barrier to asking a question publicly is too high, and students prefer private channels for communication. This is accompanied by the disadvantage that the interaction occurs only among people who already know each other. Creating contacts is not fostered in the blended learning courses. Students consider optimization possibilities as a task of the lecturers in the face-to-face sessions: Here, interaction and cooperation should be encouraged through get-to-know-you rounds or group work. It is important here to group the participants randomly to establish contact with new people. In addition, sufficient time for interaction is desired in the lecture, e.g., in the context of discussions or partner work. In the digital component, students prefer synchronous exchange at a fixed time, for example, in breakout rooms or an MS Teams channel. The results provide an overview of how interaction and cooperation can be implemented in blended learning courses. Positive design possibilities are partly dependent on subject area and course. Future studies could tie in here with a course-specific analysis.

Keywords: blended learning, higher education, hybrid teaching, qualitative research, student learning

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Authors: Meral Tuncbilek, Duygu Sac, Irem Durmaz, Rengul Cetin Atalay

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Nucleoside analogs are a pharmacologically diverse family that includes cytotoxic compounds, antiviral agents, and immunosuppressive molecules. Purine nucleoside derivatives such as fludarabine, cladribine, and pentostatin are significant drugs used in chemotherapy for the treatment of solid tumors and hematological malignancies. In this study, we synthesized novel purine ribonucleoside analogs containing a 4-(4-substituted phenylsulfonyl) piperazine in the substituent at N6- and O-substituted sulfonyl group at 5’-position as putative cytotoxic agents. The newly obtained compounds were then characterized for their cytotoxicity in human cancer cell lines. The 5’, 6-disubstituted 9-(β-D-ribofuranosyl)purine derivatives (44-67) were readily obtained from commercially available inosine in seven steps in very cost effective synthesis approach. The newly synthesized compounds were first evaluated for their anti-tumor activities against human liver (Huh7), colon (HCT116) and breast (MCF7) carcinoma cell lines. The IC50 values were in micromolar concentrations with 5’, 6-disubstituted purine nucleoside derivatives. Time-dependent IC50 values for each molecule were also calculated in comparison with known cytotoxic agents Camptothecin (CPT), 5-Fluorouracil (5-FU), Cladribine, Pentostatine and Fludarabine. N6-(4-trifluoromethyl phenyl) / N6-(4-bromophenyl) and 5’-O-(4-methoxybenzene sulfonyl) / 5’-O-(benzenesulfonyl) derivatives 54, 64 displayed the best cytotoxic activity with IC50 values of 8.8, 7 µM against MCF7 cell line. The N6-(4-methylphenyl) analog 50 was also very active (IC50= 10.7 μM) against HCT116 cell line. Furthermore, compound 64 had a better cytotoxic activity than the known cell growth inhibitors 5-FU and Fludarabine on Huh7 (1.5 vs 30.7, 29.9 μM for 5-FU and Fludarabine).

Keywords: cytotoxic activity, Huh7, HCT116, MCF7, nucleoside, synthesis

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Authors: Tomasz Komornicki

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The possibilities of cross-border traffic depend on the degree of permeability of a given border as well as the state of the existing transport infrastructure. The aim of this paper is to identify the impact of economic transformation, EU accession, and infrastructure development on modal shifts in border traffic through the Polish eastern boundary. In the 1980s railway was still the main mode of cross-border transport in Poland. At the beginning of the 1990s, the role of the road and rail transborder passenger traffic was similar, but since 1993, the role of rail was decreasing. The general decline in rail infrastructure in Poland continued uninterruptedly until accession to the European Union. The slow opposite trend can be observed later as a result of the inflow of European funds. In the countries neighbouring Poland from the east, these processes took place with some delay, and the loss of railway position was not so drastic. Therefore, cross-border railway connections have been maintained for quite a long time since the break-up of the USSR. However, finally, cross-border rail transport proved to be completely inflexible in relation to both economic, geopolitical, and transport transformations. It has been shown that the current modal split of the passenger border traffic was shaped by the following factors: a) closure of many transborder railway lines, especially local ones; b) the signing of an agreement on minor border traffic with Ukraine; c) rapidly growing number of citizens of Ukraine working in Poland (unofficial transportation of workers by car directly to their workplaces in Poland); d) the emergence of low-cost air connections between Ukraine and Poland and the growing role of air transport in the Russia-Poland relationship. The summary points to the possibility of a renewed increase in the importance of rail transport on the eastern border of the European Union.

Keywords: modal change, border, rail transport, Poland

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Authors: Paola Causin, Andrea Aspri, Alessandro Benfenati

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Diffuse Optical Tomography (DOT) is an emergent medical imaging technique which employs NIR light to estimate the spatial distribution of optical coefficients in biological tissues for diagnostic purposes, in a noninvasive and non-ionizing manner. DOT reconstruction is a severely ill-conditioned problem due to prevalent scattering of light in the tissue. In this contribution, we present our research in adopting hybrid knowledgedriven/data-driven approaches which exploit the existence of well assessed physical models and build upon them neural networks integrating the availability of data. Namely, since in this context regularization procedures are mandatory to obtain a reasonable reconstruction [1], we explore the use of neural networks as tools to include prior information on the solution. 2. Materials and Methods The idea underlying our approach is to leverage neural networks to solve PDE-constrained inverse problems of the form 𝒒 ∗ = 𝒂𝒓𝒈 𝒎𝒊𝒏𝒒 𝐃(𝒚, 𝒚̃), (1) where D is a loss function which typically contains a discrepancy measure (or data fidelity) term plus other possible ad-hoc designed terms enforcing specific constraints. In the context of inverse problems like (1), one seeks the optimal set of physical parameters q, given the set of observations y. Moreover, 𝑦̃ is the computable approximation of y, which may be as well obtained from a neural network but also in a classic way via the resolution of a PDE with given input coefficients (forward problem, Fig.1 box ). Due to the severe ill conditioning of the reconstruction problem, we adopt a two-fold approach: i) we restrict the solutions (optical coefficients) to lie in a lower-dimensional subspace generated by auto-decoder type networks. This procedure forms priors of the solution (Fig.1 box ); ii) we use regularization procedures of type 𝒒̂ ∗ = 𝒂𝒓𝒈𝒎𝒊𝒏𝒒 𝐃(𝒚, 𝒚̃)+ 𝑹(𝒒), where 𝑹(𝒒) is a regularization functional depending on regularization parameters which can be fixed a-priori or learned via a neural network in a data-driven modality. To further improve the generalizability of the proposed framework, we also infuse physics knowledge via soft penalty constraints (Fig.1 box ) in the overall optimization procedure (Fig.1 box ). 3. Discussion and Conclusion DOT reconstruction is severely hindered by ill-conditioning. The combined use of data-driven and knowledgedriven elements is beneficial and allows to obtain improved results, especially with a restricted dataset and in presence of variable sources of noise.

Keywords: inverse problem in tomography, deep learning, diffuse optical tomography, regularization

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Authors: Joanna Smoluk-Sikorska, Władysława Łuczka

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Organic farming is an important element of sustainable agriculture. It has been developing very dynamically in Poland, especially since Poland’s accession to the EU. Nevertheless, properly functioning organic market is a necessary condition justifying development of organic agriculture. Despite significant improvement, this market in Poland is still in the initial stage of growth. An important element of the market is distribution, especially retail, which offers specified product range to consumers. Therefore, there is a need to investigate retail outlets offering organic food in order to improve functioning of this part of the market. The inquiry research conducted in three types of outlets offering organic food, between 2011 and 2012 in the 8 largest Polish cities, shows that the majority of outlets offer cereals, processed fruit and vegetables as well as spices and the least shops – meat and sausages. The distributors mostly indicate unsatisfactory product range of suppliers as the reason for this situation. The main providers of the outlets are wholesalers, particularly in case of processed products, and in fresh products – organic farms. A very important distribution obstacle is dispersion of producers, which generates high transportation costs and what follows that, high price of organics. In the investigated shops, the most often used price calculation method is a cost method. The majority of the groceries and specialist shops apply margins between 21 and 40%. The margin in specialist outlets is the highest, in regard to the qualified service and advice. In turn, most retail networks declare the margin between 0 and 20%, which is consistent with low-price strategy applied in these shops. Some lacks in the product range of organics and in particular high prices cause that the demand volume is rather low. Therefore there is a need to support certain market actions, e.g. on-farm processing or promotion.

Keywords: organic food, retail, product range, supply sources

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Authors: Nizar Ghali, Bernard Fortin, Guy Lacroix

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In Quebec, colonoscopies volumes have continued to rise in recent years in the absence of effective monitoring mechanism for the appropriateness and the quality of these exams. In 2010, November, Quebec Government introduced the colorectal cancer-screening program in the objective to control for volume and cost imperfection. This program is based on clinical standards and was initiated for first group of institutions. One year later, Government adds financial incentives for participants institutions. In this analysis, we want to assess for the causal effect of the two components of this program: clinical pathways and financial incentives. Especially we assess for the reform effect on healthcare quality and population health in the context that medical remuneration is not directly dependent on this additional funding offered by the program. We have data on admissions episodes and deaths for 8 years. We use multistate model analog to difference in difference approach to estimate reform effect on the transition probability between different states for each patient. Our results show that the reform reduced length of stay without deterioration in hospital mortality or readmission rate. In the other hand, the program contributed to decrease the hospitalization rate and a less invasive treatment approach for colorectal surgeries. This is a sign of healthcare quality and population health improvement. We demonstrate in this analysis that physicians’ behavior can be affected by both clinical standards and financial incentives even if offered to facilities.

Keywords: multi-state and multi-episode transition model, healthcare quality, length of stay, transition probability, difference in difference

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Authors: Shweh Fern Loo, Jun Yin Ong, Than Zaw Oo

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Acute respiratory distress syndrome (ARDS) is a common serious condition of bilateral lung infiltrates that develops secondary to various underlying conditions such as diseases or injuries. ARDS with severe hypercapnia is associated with higher ICU mortality and morbidity. Venovenous Extracorporeal membrane oxygenation (VV-ECMO) support has been established to avert life-threatening hypoxemia and hypercapnic respiratory failure despite optimal conventional mechanical ventilation. However, VV-ECMO is relatively not advisable in particular groups of patients, especially in multi-organ failure, advanced age, hemorrhagic complications and irreversible central nervous system pathology. We presented a case of a 79-year-old Chinese lady without any pre-existing lung disease admitted to our hospital intensive care unit (ICU) after acute presentation of breathlessness and chest pain. After extensive workup, she was diagnosed with rapidly progressing acute interstitial pneumonia with ARDS and hypercapnia respiratory failure. The patient received lung protective strategies of mechanical ventilation and neuromuscular blockage therapy as per clinical guidelines. However, hypercapnia respiratory failure was refractory, and she was deemed not a good candidate for VV-ECMO support given her advanced age and high vasopressor requirements from shock. Alternative therapy with extracorporeal CO2 removal (ECCO2R) was considered and implemented. The patient received 12 days of ECCO2R paired with muscle paralysis, optimization of lung-protective mechanical ventilation and dialysis. Unfortunately, the patient still had refractory hypercapnic respiratory failure with dual vasopressor support despite prolonged therapy. Given failed and futile medical treatment, the family opted for withdrawal of care, a conservative approach, and comfort care, which led to her demise. The effectivity of extracorporeal CO2 removal may depend on disease burden, involvement and severity of the disease. There is insufficient data to make strong recommendations about its benefit-risk ratio for ECCO2R devices, and further studies and data would be required. Nonetheless, ECCO2R can be considered an alternative treatment for refractory hypercapnic respiratory failure patients who are unsuitable for initiating venovenous ECMO.

Keywords: extracorporeal CO2 removal (ECCO2R), acute respiratory distress syndrome (ARDS), acute interstitial pneumonia (AIP), hypercapnic respiratory failure

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Authors: Thewodros K. Geberemariam

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The rapid physical expansion of urbanization coupled with aging infrastructure presents a unique decision and management challenges for many big city municipalities. Cities must therefore upgrade and maintain the existing aging urban drainage infrastructure systems to keep up with the demands. Given the overall contribution of assets to municipal revenue and the importance of infrastructure to the success of a livable city, many municipalities are currently looking for a robust and smart urban drainage infrastructure asset management solution that combines management, financial, engineering and technical practices. This robust decision-making shall rely on sound, complete, current and relevant data that enables asset valuation, impairment testing, lifecycle modeling, and forecasting across the multiple asset portfolios. On this paper, predictive computational intelligence (CI) and multi-class machine learning (ML) coupled with online, offline, and historical record data that are collected from an array of multi-parameter sensors are used for the extraction of different operational and non-conforming patterns hidden in structured and unstructured data to determine and produce actionable insight on the current and future states of the network. This paper aims to improve the strategic decision-making process by identifying all possible alternatives; evaluate the risk of each alternative, and choose the alternative most likely to attain the required goal in a cost-effective manner using historical and near real-time urban drainage infrastructure data for urban drainage infrastructures assets that have previously not benefited from computational intelligence and machine learning advancements.

Keywords: computational intelligence, machine learning, urban drainage infrastructure, machine learning, classification, prediction, asset management space

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Authors: Pascal Mwenge, Tumisang Seodigeng

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The increase in urbanisation in South Africa has led to an increase in water demand and a decline in freshwater supply. Despite this, poor water usage is still a major challenge in South Africa, for instance, freshwater is still used for non-drinking applications. The freshwater shortage can be alleviated by using other sources of water for non-portable purposes such as greywater treated with activated biochar produced from agricultural waste. The success of activated biochar produced from agricultural waste to treat greywater can be both economically and environmentally beneficial. Greywater treated with activated biochar produced from agricultural waste is considered a cost-effective wastewater treatment.  This work was aimed at determining the ability of activated biochar to remove Total Suspended Solids (TSS), Ammonium (NH₄-N), Nitrate (NO₃-N), and Chemical Oxygen Demand (COD) from greywater. The experiments were carried out in 800 ml laboratory plastic cylinders used as filter columns. 2.5 cm layer of gravel was used at the bottom and top of the column to sandwich the activated biochar material. Activated biochar (200 g and 400 g) was loaded in a column and used as a filter medium for greywater. Samples were collected after a week and sent for analysis. Four types of greywater were treated: Kitchen, floor cleaning water, shower and laundry water. The findings showed: 95% removal of TSS, 76% of NO₃-N and 63% of COD on kitchen greywater and 85% removal of NH₄-N on bathroom greywater, as highest removal of efficiency of the studied pollutants. The results showed that activated biochar produced from agricultural waste reduces a certain amount of pollutants from greywater. The results also indicated the ability of activated biochar to treat greywater for onsite non-potable reuse purposes.

Keywords: activated biochar produced from agriculture waste, ammonium, NH₄-N, chemical oxygen demand, COD, greywater, nitrate, NO₃-N, total suspended solids, TSS

Procedia PDF Downloads 174

Authors: Marco Picco, Mahmood Alam

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Improving the energy performance of existing buildings can be challenging, particularly when facades cannot be modified, and the only available option is internal insulation. In such cases, the choice of the most suitable material becomes increasingly complex, as in addition to thermal transmittance and capital cost, the designer needs to account for the impact of the intervention on the internal spaces, and in particular the loss of usable space due to the additional layers of materials installed. This paper explores this issue by analysing a case study of an average office building needing to go through a refurbishment in order to reach the limits imposed by current regulations to achieve energy efficiency in buildings. The building is simulated through dynamic performance simulation under three different climate conditions in order to evaluate its energy needs. The use of Vacuum Insulated Panels as an option for energy refurbishment is compared to traditional insulation materials (XPS, Mineral Wool). For each scenario, energy consumptions are calculated and, in combination with their expected capital costs, used to perform a financial feasibility analysis. A holistic approach is proposed, taking into account the impact of the intervention on internal space by quantifying the value of the lost usable space and used in the financial feasibility analysis. The proposed approach highlights how taking into account different drivers will lead to the choice of different insulation materials, showing how accounting for the economic value of space can make VIPs an attractive solution for energy retrofitting under various climate conditions.

Keywords: vacuum insulated panels, building performance simulation, payback period, building energy retrofit

Procedia PDF Downloads 130

Authors: Pi-Chi Wu, Tsui-Ping Chu, Hsiu-Hung Wang

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Background: The ability to provide immediate medical service in outpatient departments is one of the keys to patient satisfaction. Objectives: This project used electronic equipment to integrate nursing care information to patient care at a blood pressure diagnostic counter. Through process reengineering, the average patient waiting time decreased from 35 minutes to 5 minutes, while service satisfaction increased from a score of 2.7 to 4.6. Methods: Data was collected from a local hospital in Southern Taiwan from a daily average of 2,200 patients in the outpatient department. Previous waiting times were affected by (1) space limitations, (2) the need to help guide patient mobility, (3) the need for nurses to appease irate patients and give instructions, (4), the need for patients to replace lost counter tickets, (5) the need to re-enter information, (6) the replacement of missing patient information. An ad hoc group was established to enhance patient satisfaction and shorten waiting times for patients to see a doctor. A four step strategy consisting of (1) counter relocation, (2) queue reorganization, (3) electronic information integration, (4) process reengineering was implemented. Results: Implementation of the developed strategy decreased patient waiting time from 35 minutes to an average of 5 minutes, and increased patient satisfaction scores from 2.7 to 6.4. Conclusion: Through the integration of information technology and process transformation, waiting times were drastically reduced, patient satisfaction increased, and nurses were allowed more time to engage in more cost-effective services. This strategy was simultaneously enacted in separate hospitals throughout Taiwan.

Keywords: process reengineering, electronic information integration, patient satisfaction, patient waiting time

Procedia PDF Downloads 354

Authors: Chor Yi Ng, Christine Kong, Loretta Teo, Stephen Yau, FC Cheung, TL Poon, Francis Lee

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Purpose: Dynamic conformal arc (DCA) and intensity modulated radiotherapy (IMRT) are two treatment techniques commonly used for stereotactic radiosurgery/radiotherapy of cranial lesions. IMRT plans usually give better dose conformity while DCA plans have better dose fall off. Rapid dose fall off is preferred for radiotherapy of cranial lesions, but dose conformity is also important. For certain lesions, DCA plans have good conformity, while for some lesions, the conformity is just unacceptable with DCA plans, and IMRT has to be used. The choice between the two may not be apparent until each plan is prepared and dose indices compared. We described a deviation index (DI) which is a measurement of the deviation of the target shape from a sphere, and test its functionality to choose between the two techniques. Method and Materials: From May 2015 to May 2017, our institute has performed stereotactic radiotherapy for 105 patients treating a total of 115 lesions (64 DCA plans and 51 IMRT plans). Patients were treated with the Varian Clinac iX with HDMLC. Brainlab Exactrac system was used for patient setup. Treatment planning was done with Brainlab iPlan RT Dose (Version 4.5.4). DCA plans were found to give better dose fall off in terms of R50% (R50% (DCA) = 4.75 Vs R50% (IMRT) = 5.242) while IMRT plans have better conformity in terms of treatment volume ratio (TVR) (TVR(DCA) = 1.273 Vs TVR(IMRT) = 1.222). Deviation Index (DI) is proposed to better facilitate the choice between the two techniques. DI is the ratio of the volume of a 1 mm shell of the PTV and the volume of a 1 mm shell of a sphere of identical volume. DI will be close to 1 for a near spherical PTV while a large DI will imply a more irregular PTV. To study the functionality of DI, 23 cases were chosen with PTV volume ranged from 1.149 cc to 29.83 cc, and DI ranged from 1.059 to 3.202. For each case, we did a nine field IMRT plan with one pass optimization and a five arc DCA plan. Then the TVR and R50% of each case were compared and correlated with the DI. Results: For the 23 cases, TVRs and R50% of the DCA and IMRT plans were examined. The conformity for IMRT plans are better than DCA plans, with majority of the TVR(DCA)/TVR(IMRT) ratios > 1, values ranging from 0.877 to1.538. While the dose fall off is better for DCA plans, with majority of the R50%(DCA)/ R50%(IMRT) ratios < 1. Their correlations with DI were also studied. A strong positive correlation was found between the ratio of TVRs and DI (correlation coefficient = 0.839), while the correlation between the ratio of R50%s and DI was insignificant (correlation coefficient = -0.190). Conclusion: The results suggest DI can be used as a guide for choosing the planning technique. For DI greater than a certain value, we can expect the conformity for DCA plans to become unacceptably great, and IMRT will be the technique of choice.

Keywords: cranial lesions, dynamic conformal arc, IMRT, image guided radiotherapy, stereotactic radiotherapy

Procedia PDF Downloads 219

Authors: A.Boularouk, F. Chouikh, M. Lamri, H. Moualkia, Y. Bouznit

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The principal aim of this study is to considerably reduce the resistivity of the SnO2 thin layers. In this order, we have doped tin oxide with aluminum and antimony incorporation with different atomic percentages (0 and 4%). All the pure and doped SnO2 films were grown by simple, flexible and cost-effective Automatic Spray Pyrolysis Method (ASPM) on glass substrates at a temperature of 350 °C. The microstructural, optical, morphological and electrical properties of the films have been studied. The XRD results demonstrate that all films have polycrystalline nature with a tetragonal rutile structure and exhibit the (200) preferential orientation. It has been observed that all the dopants are soluble in the SnO2 matrix without forming secondary phases. However, dopant introduction does not modify the film growth orientation. The crystallite size of the pure SnO2 film is about 36 nm. The films are highly transparent in the visible region with an average transmittance reaching up to 80% and it slightly reduces with increasing doping concentration (Al and Sb). The optical band gap value was evaluated between 3.60 eV and 3.75 eV as a function of doping. The SEM image reveals that all films are nanostructured, densely continuous, with good adhesion to the substrate. We note again that the surface morphology change with the type and concentration dopant. The minimum resistivity is 0.689*10-4, which is observed for SnO2 film doped 4% Al. This film shows better properties and is considered the best among all films. Finally, we concluded that the physical properties of the pure and doped SnO2 films grown on a glass substrate by ASPM strongly depend on the type and concentration dopant (Al and Sb) and have highly desirable optical and electrical properties and are promising materials for several applications.

Keywords: tin oxide, automatic spray, Al and Sb doped, transmittance, MEB, XRD and UV-VIS

Procedia PDF Downloads 48

Authors: R. Saravanakumar, A. Siva, R. Banupriya, K. Balasubramanian

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Slurry infiltrated fibrous concrete (SIFCON) is one of the recently developed construction material that can be considered as a special type of high performance fibre reinforced concrete (HPFRC) with higher fibre content. Fibre reinforced concrete is essentially a composite material in which fibres out of waste having higher modulus of elasticity. SIFCON is a special type of high fibrous concrete and it is having a high cementious content and sand. The matrix usually consists of cement-sand slurry or fluent mortar. The construction industry is in need of finding cost effective materials for increasing the strength of concrete structures hence an endeavour has been made in the present investigations to study the influence of addition of waste material like Lathe waste from workshop at different dosages to the total weight of concrete. The waste of steel scrap material which is available from the lathe is used as a steel fibre for innovative construction industry. To get sustainable and environmental benefits, lathe scrap as recycled fibres with concrete are likely to be used. An experimental program was carried out to investigate the flexural behavior of Slurry infiltrated fibrous concrete (SIFCON) in which the fibres having an aspect ratio of 100 is used. The investigations were done using M25 mix and tests were carried out as per recommended procedures by appropriate codes. SIFCON specimens with 8%, 10% and 12% volume of fraction fibres are used in this study. Test results were presented in comparison of SIFCON with and without conventional steel reinforcement. The load carrying capacity of SIFCON specimen is higher than conventional concrete and it also reduced crack width. In the SIFCON specimen less number of cracks as compared with conventional concrete.

Keywords: SIFCON, lathe waste, RCC, fibre volume, flexural behaviour

Procedia PDF Downloads 298

Authors: Saeed Poormoaied, Zumbul Atan

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Emergency shipments provide a powerful mechanism to alleviate the risk of imminent stock-outs and can result in substantial benefits in an inventory system. Customer satisfaction and high service level are immediate consequences of utilizing emergency shipments. In this paper, we consider a single-echelon periodic review inventory system consisting of a single local warehouse, being replenished from a central warehouse with ample capacity in an infinite horizon setting. Since the structure of the optimal policy appears to be complicated, we analyze this problem under an order-up-to-S inventory control policy framework, the (S, T) policy, with the emergency shipment consideration. In each period of the periodic review policy, there is a single opportunity at any point of time for the emergency shipment so that in case of stock-outs, an emergency shipment is requested. The goal is to determine the timing and amount of the emergency shipment during a period (emergency shipment policy) as well as the base stock periodic review policy parameters (replenishment policy). We show that how taking advantage of having an emergency shipment during periods improves the performance of the classical (S, T) policy, especially when fixed and unit emergency shipment costs are small. Investigating the structure of the objective function, we develop an exact algorithm for finding the optimal solution. We also provide a heuristic and an approximation algorithm for the periodic review inventory system problem. The experimental analyses indicate that the heuristic algorithm is computationally more efficient than the approximation algorithm, but in terms of the solution efficiency, the approximation algorithm performs very well. We achieve up to 13% cost savings in the (S, T) policy if we apply the proposed emergency shipment policy. Moreover, our computational results reveal that the approximated solution is often within 0.21% of the globally optimal solution.

Keywords: emergency shipment, inventory, periodic review policy, approximation algorithm.

Procedia PDF Downloads 121

Authors: Mehieddine Bouatrous

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Recently bioactive ceramic materials have been applied in the biomedical field as bulk, granular, or coating materials for more than half a century. More recently, bone tissue engineering scaffolds made of highly porous bioactive ceramic, glass-ceramic, and composite materials have also been created. As a result, recent bioactive ceramic structures have a high bioactivity rate, an open pores network, and good mechanical characteristics simulating cortical bone. Cyclowollastonite frameworks are also suggested for use as a graft material. As a porogenous agent, various amounts of the polymethyl methacrylate (PMMA) powders were used in this study successfully to synthesize a highly interrelated, nanostructured porous cyclowollastonite with a large specific surface area where the morphology and porosity were investigated. Porous cyclowollastonite bioactive ceramics were synthesized with a cost-effective and eco-friendly wet chemical method. The synthesized biomaterial is bioactive according to in vitro tests and can be used for bone tissue engineering scaffolds where cyclowollastonite sintered dense discs were submerged in simulated body fluid (S.B.F.) for various periods of time (1-4 weeks), resulting in the formation of a dense and consistent layer of hydroxyapatite on the surface of the ceramics, indicating its good in vitro bioactivity. Therefore, the cyclowollastonite framework exhibits good in vitro bioactivity due to its highly interconnecting porous structure and open macropores. The results demonstrate that even after soaking for several days, the surface of cyclowollastonite ceramic can generate a dense and consistent layer of hydroxyapatite. The results showed that cyclowollastonite framework exhibits good in vitro bioactivity due to highly interconnecting porous structure and open macropores.

Keywords: porous, bioactive, biomaterials, S.B.F, cyclowollastonite, biodegradability

Procedia PDF Downloads 56

Authors: Ni Wayan Sinthia Widiastuti, Komang Rahayu Indrawati

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The increasing number of tourists coming to Bali, causing accommodation facilities, such as hotels have increased. The existence of hotel needs will be the source of labor and cost efficiency, so that hotel management employs employees with different working status. The hospitality industry is one of the sectors that require organizational citizenship behavior because, the main goal of every hotel, in general, was to provide the best service and quality to tourists. The purpose of this study was to determine the differences in organizational citizenship behavior based on work status of employees at the Hotel in Bali in terms of quality of work life. Research sample was chosen randomly through two-stage cluster sampling which succeeds to obtain 126 samples from 11 hotels in Denpasar, Bali. The subjects consisted of 64 employees with Employment Agreement of Uncertain Time or who is often called a permanent employee and 62 employees with Employment Agreement of Certain Time or better known as contract employees, outsourcing, and daily workers. Instruments in this study were the scale of organizational citizenship behavior and the scale of quality of work life. The results of ANCOVA analysis showed there were differences in organizational citizenship behavior based on employee work status in terms of quality of work life. Differences in organizational citizenship behavior and quality of work life based on work status of employees using comparative test was analysis by independent sample t-test shows there were differences in organizational citizenship behavior and quality of work life between employees with different working status in hotels in Bali. The result of the regression analysis showed the functional relationship between quality of work life and organizational citizenship behavior.

Keywords: hotel in Bali, organizational citizenship behavior, quality of work life, work status of employees

Procedia PDF Downloads 264

Authors: Choo Hong Ang

Abstract:

The most popular approach to save energy for large commercial buildings in Malaysia is to replace the existing chiller plant of high kW/ton to one of lower kW/ton. This approach, however, entails large capital outlay with a long payment period of up to 7 years. This paper shows that by using multiple approaches, other than replacing the existing chiller plant, an energy saving of up to 20 %, is possible. The main methodology adopted was to identify and then plugged all heat ingress paths into a building, including putting up glass structures to prevent mixing of internal air-conditioned air with the ambient environment, and replacing air curtains with glass doors. This methodology could save up to 10 % energy bill. Another methodology was to change fixed speed motors of air handling units (AHU) to variable speed drive (VSD) and changing escalators to motion-sensor type. Other methodologies included reducing heat load by blocking air supply to non-occupied parcels, rescheduling chiller plant operation, changing of fluorescent lights to LED lights, and conversion from tariff B to C1. A case example of Komtar, the tallest building in Penang, is given here. The total energy bill for Komtar was USD2,303,341 in 2016 but was reduced to USD 1,842,927.39 in 2018, a significant saving of USD460,413.86 or 20 %. In terms of kWh, there was a reduction from 18, 302,204.00 kWh in 2016 to 14,877,105.00 kWh in 2018, a reduction of 3,425,099.00 kWh or 18.71 %. These methodologies used were relatively low cost and the payback period was merely 24 months. With this achievement, the Komtar building was awarded champion of the Malaysian National Energy Award 2019 and second runner up of the Asean Energy Award. This experience shows that a strong commitment to energy saving is the key to effective energy saving.

Keywords: chiller plant, energy saving measures, heat ingress, large building

Procedia PDF Downloads 84

Authors: Meva Apaydin, Fatih Apaydin

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Role of education in the development of society is great. Teaching and training started with the beginning of the history and different methods and techniques which have been applied as the time passed and changed everything with the aim of raising the level of learning. In addition to the traditional teaching methods, technology has been used in recent years. With the beginning of the use of internet in education, some problems which could not be soluted till that time has been dealt and it is inferred that it is possible to educate the learners by using contemporary methods as well as traditional methods. As an advantage of technological developments, distance education is a system which paves the way for the students to be educated individually wherever and whenever they like without the needs of physical school environment. Distance education has become prevalent because of the physical inadequacies in education institutions, as a result; disadvantageous circumstances such as social complexities, individual differences and especially geographical distance disappear. What’s more, the high-speed of the feedbacks between teachers and learners, improvement in student motivation because there is no limitation of time, low-cost, the objective measuring and evaluation are on foreground. In spite of the fact that there is teaching beneficences in distance education, there are also limitations. Some of the most important problems are that : Some problems which are highly possible to come across may not be solved in time, lack of eye-contact between the teacher and the learner, so trust-worthy feedback cannot be got or the problems stemming from the inadequate technological background are merely some of them. Courses are conducted via distance education in many departments of the universities in our country. In recent years, giving lectures such as Turkish Language, English, and History in the first grades of the academic departments in the universities is an application which is constantly becoming prevalent. In this study, the application of Turkish Language course via distance education system by analyzing advantages and disadvantages of the distance education system which is based on internet.

Keywords: distance education, Turkish language, motivation, benefits

Procedia PDF Downloads 417

Authors: Tahir Khaleeq, Patrick Lancaster, Keji Fakoya, Pedro Ferreira, Usman Ahmed

Abstract:

Introduction: Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety. Materials and Methods: A protocol was developed by the clinical team in collaboration with Advanced Physiotherapy Practitioners (APP) on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes. Results: In total 2489 patients were referred to VFC from internal and external sources. 734 patients were discharged without follow-up and 182 patients were discharged for physiotherapy review. Only 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. 87 patients were triaged into subspecialty clinics. 37 patients were felt to have been referred inappropriately. Discussion: BOA guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review, the remaining patients were appropriately followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.

Keywords: virtual fracture clinic, lockdown, trauma and orthopaedics, Covid- 19

Procedia PDF Downloads 181