Search results for: Lagos university teaching hospital

Authors: Shilpa Avarebeel

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Background: India is one of the seven identified countries in South-East Asia region, regularly reporting dengue infection and may soon transform into a major niche for dengue epidemics. Objective: To study the clinical profile of dengue in our setting with special reference to respiratory complication. Study design: Descriptive and exploratory study, for one year in 2014. All patients confirmed as dengue infection were followed and their clinical profile, along with outcome was determined. Study proforma was designed based on the objective of the study and it was pretested and used after modification. Data was analyzed using statistical software SPSS-Version 16. Data were expressed as mean ±S .D for parametric variables and actual frequencies or percentage for non-parametric data. Comparison between groups was done using students’ t-test for independent groups, Chie square test, one-way ANOVA test, Karl Pearson’s correlation test. Statistical significance is taken at P < 0.05. Results: Study included 134 dengue positive cases. 81% had dengue fever, 18% had dengue hemorrhagic fever, and one had dengue shock syndrome. Most of the cases reported were during the month of June. Maximum number of cases was in the age group of 26-35 years. Average duration of hospital stay was less than seven days. Fever and myalgia was present in all the 134 patients, 16 had bleeding manifestation. 38 had respiratory symptoms, 24 had breathlessness, and 14 had breathlessness and dry cough. On clinical examination of patients with respiratory symptoms, all twenty-eight had hypoxia features, twenty-four had signs of pleural effusion, and four had ARDS features. Chest x-ray confirmed the same. Among the patients with respiratory symptoms, the mean platelet count was 26,537 c/cmm. There was no statistical significant difference in the platelet count in those with ARDS and other dengue complications. Average four units of platelets were transfused to all those who had ARDS in view of bleeding tendency. Mechanical ventilator support was provided for ARDS patients. Those with pleural effusion and pulmonary oedema were given NIV (non-invasive ventilation) support along with supportive care. However, steroids were given to patients with ARDS and 10 patients with signs of respiratory distress. 100%. Mortality was seen in patients with ARDS. Conclusion: Dengue has to be checked for those presenting with fever and breathlessness. Supportive treatments remain the cornerstone of treatment. Platelet transfusion has to be given only by clinical judgment. Steroids have no role except in early ARDS, which is controversial. Early NIV support helps in speedy recovery of dengue patients with respiratory distress.

Keywords: adult respiratory distress syndrome, dengue fever, non-invasive ventilation, pulmonary complication

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Authors: G. Hafner

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A method developed at the University of Stuttgart will be presented: ‘Analysis, Evaluation and Optimization of Food Management’. A major focus is represented by quantification of food losses and food waste as well as their classification and evaluation regarding a system optimization through waste prevention. For quantification and accounting of food, food losses and food waste along the food chain, a clear definition of core terms is required at the beginning. This includes their methodological classification and demarcation within sectors of the food value chain. The food chain is divided into agriculture, industry and crafts, trade and consumption (at home and out of home). For adjustment of core terms, the authors have cooperated with relevant stakeholders in Germany for achieving the goal of holistic and agreed definitions for the whole food chain. This includes modeling of sub systems within the food value chain, definition of terms, differentiation between food losses and food wastage as well as methodological approaches. ‘Food Losses’ and ‘Food Wastes’ are assigned to individual sectors of the food chain including a description of the respective methods. The method for analyzing, evaluation and optimization of food management systems consist of the following parts: Part I: Terms and Definitions. Part II: System Modeling. Part III: Procedure for Data Collection and Accounting Part. IV: Methodological Approaches for Classification and Evaluation of Results. Part V: Evaluation Parameters and Benchmarks. Part VI: Measures for Optimization. Part VII: Monitoring of Success The method will be demonstrated at the example of an invesigation of food losses and food wastage in the Federal State of Bavaria including an extrapolation of respective results to quantify food wastage in Germany.

Keywords: food losses, food waste, resource management, waste management, system analysis, waste minimization, resource efficiency

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Authors: Alina Rahim, Joanne Moffatt, Jessica Taylor, Joseph Hartland, Tamer Abdelrazik

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Background: In 2011, 15% of maternal deaths in Uganda were due to hypertensive disorders (pre-eclampsia and eclampsia). The majority of these deaths are avoidable with optimum antenatal care. The aim of the study was to evaluate how antenatal monitoring of pre-eclampsia was carried out in a low resource setting and to identify barriers to best practice as recommended by the World Health Organisation (WHO) as part of a 4th year medical student External Student Selected component field trip. Method: Women admitted to hospital with pre-eclampsia in rural Uganda (Villa Maria and Kitovu Hospitals) over a year-long period were identified using the maternity register and antenatal record book. It was not possible to obtain notes for all cases identified on the maternity register. Therefore a total of thirty sets of notes were reviewed. The management was recorded and compared to Ugandan National Guidelines and WHO recommendations. Additional qualitative information on routine practice was established by interviewing staff members from the obstetric and midwifery teams. Results: From the records available, all patients in this sample were managed according to WHO recommendations during labour. The rate of Caesarean section as a mode of delivery was noted to be high in this group of patients; 56% at Villa Maria and 46% at Kitovu. Antenatally two WHO recommendations were not routinely met: aspirin prophylaxis and calcium supplementation. This was due to lack of resources, and lack of attendance at antenatal clinic leading to poor detection of high-risk patients. Medical management of pre-eclampsia varied between individual patients, overall 93.3% complied with Ugandan national guidelines. Two patients were treated with diuretics, which is against WHO guidance. Discussion: Antenatal monitoring of pre-eclampsia is important in reducing severe morbidity, long-term disability and mortality amongst mothers and their babies 2 . Poor attendance at antenatal clinic is a barrier to healthcare in low-income countries. Increasing awareness of the importance of these visits for women should be encouraged. The majority of cases reviewed in this sample of women were treated according to Ugandan National Guidelines. It is recommended to commence the use of aspirin prophylaxis for women at high-risk of developing pre-eclampsia and the creation of detailed guidelines for Uganda which would allow for standardisation of care county-wide.

Keywords: antenatal monitoring, low resource setting, pre-eclampsia, Uganda

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Authors: Ya-Chu May Tsai, Ibrahim Yacoub, Eoin Casey

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The Australian and New Zealand College of Anaesthetists (ANZCA) advises that smoking should not be permitted within 12 hours of surgery. There is little information in the medical literature regarding patients awareness of perioperative smoking cessation recommendations nor their appreciation of how smoking might negatively impact their perioperative course. The aim of the study is to assess the prevalence of current smokers presenting to Werribee Mercy Hospital (WMH) and to evaluate if pre-operative provision of both written and verbal pre-operative advice was, 1: Effective in improving patient awareness of the benefits of pre-operative smoking cessation, 2: Associated with an increase in the number of elective surgical patients who stop smoking at least 12 hours pre-operatively. Methods: The initial survey included all patients who presented to WMH for elective surgical procedures from 19 – 30 September 2016 using a standardized questionnaire focused on patients’ smoking history and their awareness of smoking cessation preoperatively. The intervention consisted of a standard pre-operative phone call to all patients advising them of the increased perioperative risks associated with smoking, and advised patients to cease 12 hours prior. In addition, written information on smoking cessation strategies were sent out in mail at least 1 week prior to planned procedure date to all patients. Questionnaire-based study after the intervention was conducted on day of elective procedure from 10 – 21 October 2016 inclusive. Primary outcomes measured were patient’s awareness of smoking cessation and proportion of smokers who quit >12 hours, considered a clinically meaning duration to reduce anaesthetics complications. Comparison of pre and post intervention results were made using SPSS 21.0. Results: In the pre-intervention group (n=156), 36 (22.4%) patients were current smokers, 46 were ex-smokers (29.5%) and 74 were non-smokers (48.1%). Of the smokers, 12 (33%) reported having been informed of smoking cessation prior to operation and 8 (22%) were aware of increased intra- and perioperative adverse events associated with smoking. In the post-intervention group n= 177, 38 (21.5%) patients were current smokers, 39 were ex-smokers (22.0%) and 100 were non-smokers (56.5%). Of the smokers, 32 (88.9%) reported having been informed of smoking cessation prior to operation and 35 (97.2%) reported being aware of increased intra- and perioperative adverse events associated with smoking. The median time since last smoke in the pre-intervention group was 5.5 hours (Q1-Q3 = 2-14) compared with 13 hours (Q1-Q3 = 5-24) in post intervention group. Amongst the smokers, smoking cessation at least 12 hours prior to surgery significantly increased from 27.8% pre-intervention to 52.6% post intervention (P=0.03). Conclusion: A standard preoperative phone call and written instruction on smoking cessation guidelines at time of waitlist placement increase preoperative smoking cessation rates by almost 2-fold.

Keywords: anaesthesia, audit, perioperative medicine, smoking cessation

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Authors: Md. Mahamud Hassan, Shantanu Biswas Linkon, Nur Mohammad Khan

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Over the last three decades, the primary education system in Bangladesh has experienced significant improvement, but it has failed to cope with different social and cultural aspects, which present many challenges for children, families, and the public school system. Neglecting our own contextual learning environment, it is a matter of sorrow that much attention has been paid to the more physical outcome-focused model, which is nothing but mere infrastructural development, and less subtle to the environment that suits the child's psychology and improves their social, emotional, physical, and moral competency. In South Asia, the symbol of education was never the little red house of colonial architecture but “A Guru sitting under a tree", whereas a responsive and inclusive design approach could help to create more innovative learning environments. Such an approach incorporates how the built, natural, and cultural environment shapes the learner; in turn, learners shape the learning. This research will be conducted to, i) identify the major issues and drawbacks of government policy for primary education development programs; ii) explore and evaluate the morphology of the conventional model of school, and iii) propose an alternative model in a collaborative design process with the stakeholders for maximizing the relationship between the physical learning environments and learners by treating “the built environment” as “the third teacher.” Based on observation, this research will try to find out to what extent built, and natural environments can be utilized as a teaching tool for a more optimal learning environment. It should also be evident that there is a significant gap in the state policy, predetermined educational specifications, and implementation process in response to stakeholders’ involvement. The outcome of this research will contribute to a people-place sensitive design approach through a more thoughtful and responsive architectural process.

Keywords: built environment, conventional planning, indigenous learning space, responsive design

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Authors: Merilin Ivanova Ivanova, Kalin Dimitrov Atanasov, Stefan Petrov Enchev

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Backgroud: Neuromyelitis optica spectrum disorder, also known as Devic’s disease, is a relapsing demyelinating autoimmune inflammatory disorder of the central nervous system associated with anti-aquaporin 4 (AQP4) antibodies that can manifest with devastating secondary neurological deficits. Most commonly affected are the optic nerves and the spinal cord-clinically this is often presented with optic neuritis (loss of vision), transverse myelitis(weakness or paralysis of extremities),lack of bladder and bowel control, numbness. APS is a core clinical entity of NMOSD and adds to the clinical representation the following symptoms: intractable nausea, vomiting and hiccup, it usually occurs isolated at onset, and can lead to a significant delay in the diagnosis. The condition may have features similar to multiple sclerosis (MS) but the episodes are worse in NMO and it is treated differently. It could be relapsing or monophasic. Possible complications are visual field defects and motor impairment, with potential blindness and irreversible motor deficits. In severe cases, myogenic respiratory failure ensues. The incidence of reported cases is approximately 0.3–4.4 per 100,000. Paediatric cases of NMOSD are rare but have been reported occasionally, comprising less than 5% of the reported cases. Objective: The case serves to show the difficulty when it comes to the diagnostic processes regarding a rare autoimmune disease with non- specific symptoms, taking large interval of rimes to reveal as complete clinical manifestation of the aforementioned syndrome, as well as the necessity of multidisciplinary approach in the setting of а general paediatric department in аn emergency hospital. Methods: itpatient's history, clinical presentation, and information from the used diagnostic tools(MRI with contrast of the central nervous system) lead us to the conclusion .This was later on confirmed by the positive results from the anti-aquaporin 4 (AQP4) antibody serology test. Conclusion: APS is a common symptom of NMOSD and is considered a challenge in a differential-diagnostic plan. Gaining an increased awareness of this disease/syndrome, obtaining a detailed patient history, and performing thorough physical examinations are essential if we are to reduce and avoid misdiagnosis.

Keywords: neuromyelitis, devic's disease, hiccup, autoimmune, MRI

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Authors: Liang Wang, Wei Zhang

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There have been some existing researches on design-based engineering learning (DBEL) and project-based or problem-based engineering learning (PBEL). Those findings have greatly promoted the reform of engineering education in China. However, the engineering with a big E means that more and more engineering activities are designed and operated by communities of practice (CoPs), namely community-based engineering learning. However, whether community-based engineering learning can promote students' innovation has not been verified in published articles. This study fills this gap by investigating the relationship between community-based learning approach and students’ creativity, using engineering identity as an intermediary variable. The goal of this study is to discover the core features of community-based engineering learning, and make the features more beneficial for students’ creativity. The study created and adapted open survey items from previously published studies and a scale on learning community, students’ creativity and engineering identity. Firstly, qualitative content analysis methods by MAXQDA were used to analyze 32 open-ended questionnaires. Then the authors collected data (n=322) from undergraduate students in engineering competition teams and engineering laboratories in Zhejiang University, and structural equation modelling (SEM) was used to understand the relationship between different factors. The study finds: (a) community-based engineering learning has four main elements like real-task context, self-inquiry learning, deeply-consulted cooperation and circularly-iterated design, (b) community-based engineering learning can significantly enhance the engineering undergraduate students’ creativity, and (c) engineering identity partially moderated the relationship between community-based engineering learning and undergraduate students' creativity. The findings further illustrate the value of community-based engineering learning for undergraduate students. In the future research, the authors should further clarify the core mechanism of community-based engineering learning, and pay attention to the cultivation of undergraduate students’ engineer identity in learning community.

Keywords: community-based engineering learning, students' creativity, engineering identity, moderate effect

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Authors: Glebert C. Dadol, Pamela Mae L. Ucab, Camila Flor Y. Lobarbio, Noel Peter B. Tan

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Water scarcity is a global problem and membrane-based desalination technologies are one of the promising solutions to this problem. In this study, a passive solar-driven membrane distiller was fabricated and tested for its desalination performance. The distiller was composed of a TiNOX plate solar absorber, cellulose-based upper and lower hydrophilic layers, a hydrophobic middle layer, and aluminum heatsinks. The effect of the middle layer material and thickness on the desalination performance was investigated in terms of distillate productivity and salinity. The materials used for the middle layer were a screen mesh (2 mm, 4 mm, 6 mm thickness) to generate an air gap, a PTFE membrane (0.3 mm thickness)), and a combination of the screen mesh and the PTFE membrane (2.3 mm total thickness). Salt water (35 g/L NaCl) was desalinated using the distiller at a rooftop setting at the University of San Carlos, Cebu City, Philippines. The highest distillate productivity of 1.08 L/m2-h was achieved using a 2-mm screen mesh (air gap) but it also resulted in a high distillate salinity of 25.20 g/L. Increasing the thickness of the air gap lowered the distillate salinity but also decreased the distillate productivity. The lowest salinity of 1.07 g/L was achieved using a 6-mm air gap but the productivity was reduced to 0.08 L/m2-h. The use of the hydrophobic PTFE membrane increased the productivity (0.44 L/m2-h) compared to a 6-mm air gap but produced a distillate with high salinity (16.68 g/L). When using a combination of the screen mesh and the PTFE membrane, the productivity was 0.13 L/m2-h and a distillate salinity of 1.61 g/L. The distiller with a thick air gap as the middle layer can deliver a distillate with low salinity and is preferred over a thin hydrophobic PTFE membrane. The use of a combination of the air gap and PTFE membrane slightly increased the productivity with comparable distillate salinity. Modifications and optimizations to the distiller can be done to improve further its performance.

Keywords: desalination, membrane distillation, passive solar-driven membrane distiller, solar distillation

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Authors: Rajish Shil, Mohammad Ali Houri, Mohammad Milad Ismail, Fatimah Al Kaabi

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The clinical presentation of Primary hyperparathyroidism can vary from simple asymptomatic hypercalcemia to severe life-threatening hypercalcemic crisis with multi-organ dysfunction, which can be due to parathyroid adenoma or sometimes with malignant cancer. This cascade of clinical presentation can lead to a diagnostic and therapeutic challenge for treating the disease. We are presenting a case of severe hypercalcemic crisis due to parathyroid adenoma with an emphasis on early management, diagnosis, and interventions to prevent any lifelong complications and any permanent organ dysfunction. A 30 years old female with a history of primary Infertility, admitted to Al Ain Hospital critical care unit with Acute Severe Necrotizing Pancreatitis. She initially had a 1-month history of abdominal pain on and off, for which she was treated conservatively with no much improvement, and later on, she developed life-threatening severe pancreatitis, which required her to be admitted to the critical care unit. She was transferred from a private healthcare facility, where she was found to have a very high level of calcium up to 15mmol/L. She received systemic Zoledronic Acid, which lowered her calcium level transiently and later was increased again. She went on to develop multiple end-organ damages along with multiple electrolytes disturbances. She was found to have high levels of Parathyroid hormone, which was correlated with a parathyroid mass on the neck via radiological imaging. After a long course of medical treatment to lower the calcium to a near-normal level, parathyroidectomy was done, which showed parathyroid adenoma on histology. She developed hungry bone syndrome after the surgery and pancreatic pseudocyst after resolving of pancreatitis. She required aggressive treatment with Intravenous calcium for her hypocalcemia as she received zoledronic acid at the beginning of the disease. Later on, she was discharged on long term calcium and other electrolytes supplements. In patients presenting with hypercalcemia, it is prudent to investigate and start treatment early to prevent complications and end-organ damage from hypercalcemia and also to treat the primary cause of the hypercalcemia, with conscious follow up to prevent hypocalcemic complications after treatment. It is important to follow up patients with parathyroid adenomas for a long period in order to detect any recurrence of the tumor or to make sure if the primary tumor is either benign or malignant.

Keywords: hypercalcemia, pancreatitis, hypocalcemia, hyperparathyroidism

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Authors: Paulson Young Ofenimu Okhawere

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Research suggests that the main trait differentiating social entrepreneurs from traditional entrepreneurs is empathy. And although prior research has established the relevance of empathy in predicting social entrepreneurial intentions in different contexts, its usefulness at predicting social entrepreneurial intentions in emerging economy like Nigeria is yet to be well established. Whereas, it is well known that students in tertiary institutions in Nigeria (e.g. Universities, Polytechnics, and Colleges of Education) are given entrepreneurial orientations by being made to offer compulsory courses in entrepreneurship, research focusing on the effect of such students’ entrepreneurial orientation on entrepreneurial intentions is scant. To address this gap in the entrepreneurship literature, this study attempts to enhance our understanding by focusing on students selected from one University of Technology, one Polytechnic, and one College of Education in Niger State of Nigeria. The purpose of this study, therefore, is to examine the mechanism through which students’ institutional level entrepreneurial orientations affect their social entrepreneurial intentions and the role empathy plays in this relationship. Building on complexity theory (Satish & Streufert, 2003, 2001), this study proposes empathy as a proximal antecedent of social entrepreneurial intentions and that it is the mechanism through which the students’ entrepreneurial orientations affect their social entrepreneurial intentions. Data collected from 598 respondents were analyzed using multilevel structural equation modelling with Mplus version 7.3. The findings reveal that (i) although students’ entrepreneurial orientation directly relates to their social entrepreneurial intentions, this relationship differs according to the kind of institution; and (ii) students’ entrepreneurial orientations positively relates to social entrepreneurial intentions indirectly through empathy. Finally, the paper discusses the theoretical and practical implications of the findings, highlights the study’s strengths and limitations, and then maps out some directions for future research.

Keywords: institutional level, entrepreneurial orientation, empathy, social entrepreneurial intentions

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Authors: Humphrey Atwijukiire, Gladys Nakidde, Anne Tweheyo Otwine, Jane Kabami

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Experiences of HIV Positive Serostatus Disclosure to Sexual Partner Among Individuals in Discordant Couples in Mbarara City, Southwestern Uganda Introduction: Disclosure of HIV status is key in HIV management. Despite many studies on serostatus disclosure, there is a gap in experiences regarding HIV status disclosure among discordant couples. This study explored the lived experiences of serostatus disclosure among discordant couples in Mbarara City, South Western Uganda. Methods: We conducted 12 in-depth interviews using translated interview guide, and audio recorders. Participants were purposively enrolled in the study. The study was conducted at three public health facilities in Mbarara City. Data was analyzed using thematic content analysis. Approval for this research was obtained from Mbarara University Research Ethics Committee and administrative clearance from city clerk of Mbarara City. Results: The mean age of participants was 38 years. An equal number of males (six) and females participated. Most of them had at least secondary level education, only three had primary education. Experienced benefits of HIV serostatus disclosure included: social support and care; decisions regarding health, fertility, and child bearing; sharing information on HIV prevention and protection; positive living; and, ease of HIV disclosure. The challenges included: misunderstandings in the families. Conclusion: Socially, psychologically and financially PLWHIV have benefited from their negative partners. Health wise, they have been supported, and cared for, but some have faced challenges, such as family misunderstandings. Couple HIV counseling and testing by a trained health worker is beneficial in HIV care and could mitigate the challenges related HIV serostatus disclosure.

Keywords: discordant couples, disclosure, experiences, HIV

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Authors: Che Hsiu Chen, Su Yun Chen, Hon Wen Cheng

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Traditional core stability, core endurance, and balance exercises on a stable surface with isometric muscle actions, low loads, and multiple repetitions, which may not improvements the swimming and running economy performance. However, the effects of high intensity core muscle exercise training on jump height, sprint, and aerobic fitness remain unclear. The purpose of this study was to examine whether high intensity core muscle exercises training could improve sport performances in dancers. Thirty healthy university dancer students (28 women and 2 men; age 20.0 years, height 159.4 cm, body mass 52.7 kg) were voluntarily participated in this study, and each participant underwent five suspension exercises (e.g., hip abduction in plank alternative, hamstring curl, 45-degree row, lunge and oblique crunch). Each type of exercise was performed for 30-second, with 30-second of rest between exercises, two times per week for eight weeks and each exercise session was increased by 10-second every week. We measured agility, explosive force, anaerobic and cardiovascular fitness in dancer performance before and after eight weeks of training. The results showed that the 8-week high intensity core muscle training would significantly increase T-test agility (7.78%), explosive force of acceleration (3.35%), vertical jump height (8.10%), jump power (6.95%), lower extremity anaerobic ability (7.10%) and oxygen uptake efficiency slope (4.15%). Therefore, it can be concluded that eight weeks of high intensity core muscle exercises training can improve not only agility, sprint ability, vertical jump ability, anaerobic and but also cardiovascular fitness measures as well.

Keywords: balance, jump height, sprint, maximal oxygen uptake

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Authors: Gichun Cha, Dongwan Lee, Junkyeong Kim, Aoqi Zhang, Seunghee Park

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All the world are studying the construction technology of double deck tunnel in order to respond to the increasing urban traffic demands and environmental changes. Advanced countries have the construction technology of the double deck tunnel structure. but the domestic country began research on it. Construction technologies are important. But Safety evaluation of structure is necessary to prevent possible accidents during construction. Thus, the double deck tunnel was required the shape management of middle slabs. The domestic country is preparing the construction of double deck tunnel for an alternate route and a pleasant urban environment. Shape management of double deck tunnel has been no research because it is a new attempted technology. The present, a similar study is bridge structure for the shape management. Bridge is implemented shape model using terrestrial laser scanning(TLS). Therefore, we proceed research on the bridge slabs because there is a similar structure of double deck tunnel. In the study, we develop shape management method of bridge slabs using TLS. We select the Test-bed for measurement site. This site is bridge located on Sungkyunkwan University Natural Sciences Campus. This bridge has a total length of 34m, the vertical height of 8.7m from the ground. It connects Engineering Building #1 and Engineering Building #2. Point cloud data for shape management is acquired the TLS and We utilized the Leica ScanStation C10/C5 model. We will confirm the Maximum displacement area of middle slabs using Least-Squares Fitting. We expect to raise stability for double deck tunnel through shape management for middle slabs.

Keywords: bridge slabs, least squares, safety evaluation, shape management method, terrestrial laser scanning

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Authors: Donghwan Lee, Gichun Cha, Jooyoung Park, Junkyeong Kim, Seunghee Park

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3D shape models of the existing structure are required for many purposes such as safety and operation management. The traditional 3D modeling methods are based on manual or semi-automatic reconstruction from close-range images. It occasions great expense and time consuming. The Terrestrial Laser Scanner (TLS) is a common survey technique to measure quickly and accurately a 3D shape model. This TLS is used to a construction site and cultural heritage management. However there are many limits to process a TLS point cloud, because the raw point cloud is massive volume data. So the capability of carrying out useful analyses is also limited with unstructured 3-D point. Thus, segmentation becomes an essential step whenever grouping of points with common attributes is required. In this paper, members segmentation algorithm was presented to separate a raw point cloud which includes only 3D coordinates. This paper presents a clustering approach based on a fuzzy method for this objective. The Fuzzy C-Means (FCM) is reviewed and used in combination with a similarity-driven cluster merging method. It is applied to the point cloud acquired with Lecia Scan Station C10/C5 at the test bed. The test-bed was a bridge which connects between 1st and 2nd engineering building in Sungkyunkwan University in Korea. It is about 32m long and 2m wide. This bridge was used as pedestrian between two buildings. The 3D point cloud of the test-bed was constructed by a measurement of the TLS. This data was divided by segmentation algorithm for each member. Experimental analyses of the results from the proposed unsupervised segmentation process are shown to be promising. It can be processed to manage configuration each member, because of the segmentation process of point cloud.

Keywords: fuzzy c-means (FCM), point cloud, segmentation, terrestrial laser scanner (TLS)

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Authors: Hanan Eltayeb, Reem Al Refaie

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To be able to connect and relate to shows spoken in a foreign language, advanced learners must understand not only linguistics inferences but also cultural, metacognitive, and pragmatic connotations in colloquial Egyptian TV series. These connotations are needed to both understand the different facets of the dramas put before them, and they’re also consistently grown and formulated through watching these shows. The inferences have become a staple in the Egyptian colloquial culture over the years, making their way into day-to-day conversations as Egyptians use them to speak, relate, joke, and connect with each other, without having known one another from previous times. As for advanced learners, they need to understand these inferences not only to watch these shows, but also to be able to converse with Egyptians on a level that surpasses the formal, or standard. When faced with some of the somewhat recent shows on the Egyptian screens, learners faced challenges in understanding pragmatics, cultural, and religious background of the target language and consequently not able to interact effectively with a native speaker in real-life situations. This study aims to enhance the linguistic and cultural proficiency of learners through studying two genres of TV Colloquial Egyptian series. Study samples derived from two recent comedian and social Egyptian series ('The Seventh Neighbor' سابع جار, and 'Nelly and Sherihan' نيللي و شريهان). When learners watch such series, they are usually faced with a problem understanding inferences that have to do with social, religious, and political events that are addressed in the series. Using discourse analysis of the sematic, semantic, pragmatic, cultural, and linguistic characteristics of the target language, some major deductions were highlighted and repeated, showing a pattern in both. The research paper concludes that there are many sets of lingual and para-lingual phrases, idioms, and proverbs to be acquired and used effectively by teaching these series. The strategies adopted in the study can be applied to different types of media, like movies, TV shows, and even cartoons, to enhance student proficiency.

Keywords: Egyptian series, culture, linguistic competence, pragmatics, semantics, social

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Authors: Louise Ödlund, Danica Djuric Ilic

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From a system perspective, there are several benefits of DH. A possibility to utilize the excess heat from waste incineration and biomass-based combined heat and power (CHP) production (e.g. possibility to utilize the excess heat from electricity production) are two examples. However, in a future sustainable society, the benefits of DH may be less obvious. Due to the climate changes and increased energy efficiency of buildings, the demand for space heating is expected to decrease. Due to the society´s development towards circular economy, a larger amount of the waste will be material recycled, and the possibility for DH production by the energy recovery through waste incineration will be reduced. Furthermore, the benefits of biomass-based CHP production will be less obvious since the marginal electricity production will no longer be linked to high greenhouse gas emissions due to an increased share of renewable electricity capacity in the electricity system. The purpose of the study is (1) to provide an overview of the possible development of other sectors which may influence the DH in the future and (2) to detect new business strategies which would enable for DH to adapt to the future conditions and remain competitive to alternative heat production in the future. A system approach was applied where DH is seen as a part of an integrated system which consists of other sectors as well. The possible future development of other sectors and the possible business strategies for DH producers were searched through a systematic literature review In order to remain competitive to the alternative heat production in the future, DH producers need to develop new business strategies. While the demand for space heating is expected to decrease, the space cooling demand will probably increase due to the climate changes, but also due to the better insulation of buildings in the cases where the home appliances are the heat sources. This opens up a possibility for applying DH-driven absorption cooling, which would increase the annual capacity utilization of the DH plants. The benefits of the DH related to the energy recovery from the waste incineration will exist in the future since there will always be a need to take care of materials and waste that cannot be recycled (e.g. waste containing organic toxins, bacteria, such as diapers and hospital waste). Furthermore, by operating central controlled heat pumps, CHP plants, and heat storage depending on the intermittent electricity production variation, the DH companies may enable an increased share of intermittent electricity production in the national electricity grid. DH producers can also enable development of local biofuel supply chains and reduce biofuel production costs by integrating biofuel and DH production in local DH systems.

Keywords: district heating, sustainable business strategies, sustainable development, system approach

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Authors: Fatemeh Rasooli, Behzad Simiari, Pooya Payandemehr, Amir Nejati, Maryam Bahreini, Atefeh Abdollahi

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Introduction: Pain is a complex physiological reaction to tissue injury. In the course of painful procedures such as nerve block, ice has been shown to be a feasible and inexpensive material to control pain. It delays nerve conduction, actives other senses and reduces inflammatory and painful responses. This study assessed the effect of ice in reducing pain caused by needling and infiltration during digital block. Patient satisfaction recorded as a secondary outcome. Methods: This study was designed as a non-blinded randomized clinical trial approved by Tehran University of Medical Sciences Ethical Committee. Informed consent was taken from all the participants who were then randomly divided into two groups. Digital block performed by standard approach in selected patients. Tubes of ice were prepared in gloves and were fragmented at a time of application for circling around the finger. Tubes were applied for 6 minutes before digital nerve block in the site of needling in the case group. Patients in the control group underwent digital nerve block with the conventional method without ice administration. Numeric Rating Scale (NRS) used for grading pain. 0 used for no pain and 10 for the worst pain that patient had experienced until now. Scores were analyzed by Wilcoxon Rank Sum test and compared in case and control groups. Results: 100 patients aged 16-50 years were enrolled. Mean NRS scores with and without ice were 1.5 mm (S.D ± 1.44) and 6.8 mm (S.D ± 1.40) for needling pain and for infiltration pain were 2.7mm ( S.D ±1.65) and 8.5mm ( S.D ± 1.47), respectively (p<0.001). Besides, patients’ satisfactions were significantly higher in the ice group (p<0.001). Conclusion: Application of ice for 6 minutes significantly reduced pain of needling and infiltration in digital nerve block; thus, it seems to be a feasible and inexpensive material which acts effectively to decrease pain and stress before the procedure.

Keywords: digital block, ice, needle, pain

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Authors: Livia Herle

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A large part of the Principality of Liechtenstein is covered by forest. Three-quarters of this forest is defined as protective due to the alpine landscape of the country, which is deteriorating the quality of the wood. Nevertheless, the forest is one of the most important sources of raw material. However, out of the wood harvested annually in Liechtenstein, about two-thirds are used directly as an energy source, drastically shortening up the carbon storage cycle of wood. Furthermore, due to climate change, forest structures are changing. Predictions for the forest in Liechtenstein have stated that the spruce will mostly vanish in low altitudes, only being able to survive in the higher regions. In contrast, hardwood species will experience a rise, resulting in a more mixed forest. Thus, the main research focus will be put upon the potential of hardwood as well as prolonging the lifespan of a timber log before ending up as an energy source. An analysis of the local occurrence of hardwood species and their quality will serve as a tool to implement this knowledge upon constructional solutions. As a system that works with short spam timber and thus qualifies for the regional conditions of hardwood, reciprocal frame systems will be further investigated. These can be defined as load-bearing structures with only two beams connecting at a time, avoiding complex joining situations. Furthermore, every beam is mutually supporting. This allows the usage of short pieces of preferably massive wood. As a result, the system permits for an easy assembly but also disassembly. To promote a more circular application of wood, possible cascading scenarios of the structural solutions will be added. In a workshop at the School of Architecture of the University of Liechtenstein in the Sommer Semester 2024, prototypes in 1:1 of reciprocal frame systems using only local hardwood will help as a tool to further test the theoretical analyses.

Keywords: hardwood, cascading wood, reciprocal frames, crooked wood, forest structures, climate change

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Authors: Attahiru Sifawa Ahmad

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The media; electronic, print, and social, is playing very significant roles towards promoting political awareness and stability of any nation. However, for the media to play its role effectively, a clear and sound grasp of the language of communication is necessary. Otherwise, there is the tendency of the media spreading wrong and, or, misinterpreted information to the public, capable of generating rancour and political instability. One such clear misinterpretation or misrepresentation of information was the Hausa metaphorical expression, Kare Jinni Biri Jinni quoted from the statement made by Rtd. General Muhammadu Buhari, sometimes in April, 2013, while addressing his supporters from Niger State. In the political presentation of the term Kare - Jini Biri – Jini, quoted and translated by many print media in Nigeria, it was interpreted to mean; ‘The Dog and the Baboon will be soaked in blood’, denoting bloodshed and declaration of war. However, the term Kare - jini Biri - Jini, literally; the Dog with blood and the Baboon with blood, or, the Dog is bleeding the Baboon is bleeding, or, both the Dog and the Baboon sustained injuries. It is a metaphorical expression denoting a hot competition, and serious struggle, between two competing parties that are closer in strength and stamina. The expression got its origin among the hunting communities in traditional Hausa Societies. From experience, it was always not easy to wrestle and hunt Baboon by the Hunter’s Dog. In many instances, it ended a futile exercise, and even at instances whereby the latter hunted the former, it would be after a serious struggle with both two sustaining injuries. This paper seeks to highlight the poverty of vocabulary, and poor grasp of Nigerian languages among Journalists and young citizens in the country. The paper, therefore, advocated for the retention and effective teaching of the indigenous languages in primary and secondary school’s curriculums in Nigeria. The paper equally analysed the political origin of the print media in Nigeria, how since its first appearance, the print Media is being assigned very important political role by political elites in the country.

Keywords: Baboon, dog, media, politics

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Authors: Alia Aldarmaki, Ahmad Elshennawy

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There is a global shift in healthcare systems’ emphasizing engaging different stakeholders in selecting quality improvement initiatives and incorporating their preferences to improve the healthcare efficiency and outcomes. Although experts bring scientific knowledge based on the scientific model and their personal experience, other stakeholders can bring new insights and information into the decision-making process. This study attempts to explore the impact of incorporating different stakeholders’ preference in identifying the most significant criteria that should be considered in healthcare for electing the improvement projects. A Framework based on a modified Fuzzy Delphi Method (FDM) was built. In addition to, the subject matter experts, doctors/physicians, nurses, administrators, and managers groups contribute to the selection process. The research identifies potential criteria for evaluating projects in healthcare, then utilizes FDM to capture expertise knowledge. The first round in FDM is intended to validate the identified list of criteria from experts; which includes collecting additional criteria from experts that the literature might have overlooked. When an acceptable level of consensus has been reached, a second round is conducted to obtain experts’ and other related stakeholders’ opinions on the appropriate weight of each criterion’s importance using linguistic variables. FDM analyses eliminate or retain the criteria to produce a final list of the critical criteria to select improvement projects in healthcare. Finally, reliability and validity were investigated using Cronbach’s alpha and factor analysis, respectively. Two case studies were carried out in a public hospital in the United Arab Emirates to test the framework. Both cases demonstrate that even though there were common criteria between the experts and the stakeholders, still stakeholders’ perceptions bring additional critical criteria into the evaluation process, which can impact the outcomes. Experts selected criteria related to strategical and managerial aspects, while the other participants preferred criteria related to social aspects such as health and safety and patients’ satisfaction. The health and safety criterion had the highest important weight in both cases. The analysis showed that Cronbach’s alpha value is 0.977 and all criteria have factor loading greater than 0.3. In conclusion, the inclusion of stakeholders’ perspectives is intended to enhance stakeholders’ engagement, improve transparency throughout the decision process, and take robust decisions.

Keywords: Fuzzy Delphi Method, fuzzy number, healthcare, stakeholders

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Authors: Wenbo Du, Xiaomei Ma

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With the empowerment of Cognitive Diagnostic Assessment (CDA), various domains of language testing and assessment have been investigated to dig out more diagnostic information. What is noticeable is that most of the extant empirical CDA-based research puts much emphasis on individual-level diagnostic purpose with very few concerned about learners’ group-level performance. Even though the personalized diagnostic feedback is the unique feature that differentiates CDA from other assessment tools, group-level diagnostic information cannot be overlooked in that it might be more practical in classroom setting. Additionally, the group-level diagnostic information obtained via current CDA always results in a “flat pattern”, that is, the mastery/non-mastery of all tested skills accounts for the two highest proportion. In that case, the outcome does not bring too much benefits than the original total score. To address these issues, the present study attempts to apply cluster analysis for group classification and quantile regression analysis to pinpoint learners’ performance at different proficiency levels (beginner, intermediate and advanced) thus to enhance the interpretation of the CDA results extracted from a group of EFL learners’ reading performance on a diagnostic reading test designed by PELDiaG research team from a key university in China. The results show that EM method in cluster analysis yield more appropriate classification results than that of CDA, and quantile regression analysis does picture more insightful characteristics of learners with different reading proficiencies. The findings are helpful and practical for instructors to refine EFL reading curriculum and instructional plan tailored based on the group classification results and quantile regression analysis. Meanwhile, these innovative statistical methods could also make up the deficiencies of CDA and push forward the development of language testing and assessment in the future.

Keywords: cognitive diagnostic assessment, diagnostic feedback, EFL reading, quantile regression

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Authors: Ashwinder K. Dhaliwal, G. P. S. Dhillon

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Eucalyptus is one of the most important forest tree species that can tolerate and grow well on degraded and unfertile soils which are not suitable for other tree species. Besides this, these trees have a short rotation and good economic value. However, the gall inducing wasp Leptocybe invasa Fisher and La Salle has been reported from many countries throughout the world. The spread of L. invasa is of huge economic concern as more than 20,000 ha of young Eucalyptus trees have already been affected in southern states of India. The host plant resistance being the first line of defense against insect pests demands the screening of different germplasm source against L. invasa. Keeping this in view, fourteen different clones of Eucalyptus spp. were evaluated for their susceptibility to L. invasa from a replicated clonal trial planted at Punjab Agricultural University, Ludhiana. The degree of gall infestation was recorded from three plants of each clone in each replication. Three branches selected from the lower, middle and upper canopy of the trees were selected for recording the total number of galls induced by L. invasa. The statistical analysis was done as per the procedure laid down for completely randomised block design (CRBD), analysis of variance (ANOVA), critical difference (CD) and variance components using Proc GLM (SAS software 9.3, SAS Institute Ltd. U.S.A). All possible treatment means were compared with Duncan’s multiple range test (DMRT) at 1 % probability level. The results showed that the clones C-9, C-45 and C-42 were completely free from the infestation of L. invasa. However, there was minor infestation of L. invasa on C-2135, C-413, C-407, C-35, C-72 and C-37 clones. The clone C-6 was severely infested by L. invasa followed by C-11, C-12, F-316 and C-25 clones. The information generated by this study will be helpful for future breeding and use in afforestation programmes.

Keywords: eucalyptus clones, gall wasp, Leptocybe invasa, screening, susceptibility

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Authors: Samuel E. Okere, Anthony E. Ataga

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Introduction: The microbial ecology of Pleurotus osteratus and Pleurotus tuber–regium spent mushroom substrate (SMS) were characterized to determine other ways of its utilization. Materials and Methods: The microbiological properties of the spent mushroom substrate were determined using standard methods. This study was carried out at the Microbiology Laboratory University of Port Harcourt, Rivers State, Nigeria. Results: Quantitative microbiological analysis revealed that Pleurotus osteratus spent mushroom substrate (POSMS) contained 7.9x10⁵ and 1.2 x10³ cfu/g of total heterotrophic bacteria and total fungi count respectively while Pleurotus tuber-regium spent mushroom substrate (PTSMS) contained 1.38x10⁶ and 9.0 x10² cfu/g of total heterotrophic bacteria count and total fungi count respectively. The fungi species encountered from Pleurotus tuber-regium spent mushroom substrate (PTSMS) include Aspergillus and Cladosporum species, while Aspergillus and Penicillium species were encountered from Pleurotus osteratus spent mushroom substrate (POSMS). However, the bacteria species encountered from Pleurotus tuber-regium spent mushroom substrate include Bacillus, Acinetobacter, Alcaligenes, Actinobacter, and Pseudomonas species while Bacillus, Actinobacteria, Aeromonas, Lactobacillus and Aerococcus species were encountered from Pleurotus osteratus spent mushroom substrate (POSMS). Conclusion: Therefore based on the findings from this study, it can be concluded that spent mushroom substrate contain microorganisms that can be utilized both in bioremediation of oil-polluted soils as they contain important hydrocarbon utilizing microorganisms such as Penicillium, Aspergillus and Bacillus species and also as sources of plant growth-promoting rhizobacteria (PGPR) such as Pseudomonas and Bacillus species which can induce resistance on plants. However, further studies are recommended, especially to molecularly characterize these microorganisms.

Keywords: characterization, microorganisms, mushroom, spent substrate

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Authors: A. A. Bajad, B. P. Sharma, Y. C. Gupta, B. S. Dilt, R. K. Gupta

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The present investigations were carried out at the experimental farm of Department of Floriculture and Landscape Architecture, Dr. Y. S. Parmar University of Horticulture and Forestry, Nauni, Solan, H.P. during 2015 and 2016. The experiment was laid out in a Randomized Block Design (factorial) consisting of 48 treatment combinations of four planting dates viz., D1- mid March, D2-mid April, D3-mid May and D4- mid June and two cultivars namely V1- Kamini and V2 -Poornima with six mulching materials M¬0¬- without mulch, M1- Black plastic mulch (100 µ), M2- Silver plastic mulch (100 µ), M3¬- Transparent plastic mulch (100 µ), M3-Transparent plastic mulch (100 µ), M4¬- Pine needle (100 µ) and M5- Grass (1 inch layer). Among different planting times, D4 i.e. mid June planting obtained best results for number of seed per flower (179.38), germination percent (83.92 %), electrical conductivity (0.97 ds/m), seedling length (7.93 cm), seedling dry weight (7.09 mg), seedling vigour index I (763.79), moisture content (7.83 %) and 1000 seed weight (1.94 g). However, seed yield per plant (14.30 g) was recorded to be maximum in mid of March. Among the cultivars, cv. ‘Poornima’ gave best results for number of seed per plant (187.30). However, cv. ‘Kamini’ recorded the best result for seed yield per plant (12.55), electrical conductivity (1.11 ds/m), germination percent (80.47 %), seedling length (6.39 cm), seedling dry weight (5.11 mg), seedling vigour index I (649.49), moisture content (9.28 %) and 1000 seed weight (1.70 g). Silver plastic obtained best results for number of seed per flower (170.10), seed yield per plant (15.66 g), germination percent (80.17 %), electrical conductivity (1.26 ds/m), seedling length (5.88 cm), seedling dry weight (4.46 mg), seedling vigour index I (616.78), Moisture content (9.35 %) and 100 seed weight (1.97 g).

Keywords: cultivars, mulch materials, planting times, flowers

Procedia PDF Downloads 276

Authors: Tsu-Yun Chiu, Tsung-Hsueh Lu, Tain-Junn Cheng

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Background: Traditional chronic disease management did not pay attention to effects of geographic factors on the compliance of treatment regime, which resulted in geographic inequality in outcomes of chronic disease management. This study aims to examine the geographic distribution and clustering of quality indicators of diabetes care. Method: We first extracted address, demographic information and quality of care indicators (number of visits, complications, prescription and laboratory records) of patients with diabetes for 2014 from medical information system in a medical center in Tainan City, Taiwan, and the patients’ addresses were transformed into district- and village-level data. We then compared the differences of geographic distribution and clustering of quality of care indicators between districts and villages. Despite the descriptive results, rate ratios and 95% confidence intervals (CI) were estimated for indices of care in order to compare the quality of diabetes care among different areas. Results: A total of 23,588 patients with diabetes were extracted from the hospital data system; whereas 12,716 patients’ information and medical records were included to the following analysis. More than half of the subjects in this study were male and between 60-79 years old. Furthermore, the quality of diabetes care did indeed vary by geographical levels. Thru the smaller level, we could point out clustered areas more specifically. Fuguo Village (of Yongkang District) and Zhiyi Village (of Sinhua District) were found to be “hotspots” for nephropathy and cerebrovascular disease; while Wangliau Village and Erwang Village (of Yongkang District) would be “coldspots” for lowest proportion of ≥80% compliance to blood lipids examination. On the other hand, Yuping Village (in Anping District) was the area with the lowest proportion of ≥80% compliance to all laboratory examination. Conclusion: In spite of examining the geographic distribution, calculating rate ratios and their 95% CI could also be a useful and consistent method to test the association. This information is useful for health planners, diabetes case managers and other affiliate practitioners to organize care resources to the areas most needed.

Keywords: catchment area of healthcare, chronic disease management, Geographic information system, quality of diabetes care

Procedia PDF Downloads 279

Authors: Thipsupar Pureprasert, Niwat Anuwongnukroh, Surachai Dechkunakorn, Surapich Loykulanant, Chaveewan Kongkaew, Wassana Wichai

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Objective: Orthodontic elastic bands made from natural rubber continue to be commonly used due to their favorable characteristics. However, there are concerns associated cytotoxicity due to harmful components released during conventional vulcanization (sulfur-based method). With the co-operation of The National Metal and Materials Technology Center (MTEC) and Faculty of Dentistry Mahidol University, a method was introduced to reduce toxic components by leaching the orthodontic elastic bands with NaOH solution. Objectives: To evaluate the mechanical properties of Thai and commercial orthodontic elastic brands (Ormco and W&H) leached with NaOH solution. Material and methods: Three elastic brands (N =30, size ¼ inch, 4.5 oz.) were tested for mechanical properties in terms of initial extension force, residual force, force loss, breaking strength and maximum displacement using a Universal Testing Machine. Results : Force loss significantly decreased in Thai-LEACH and W&H-LEACH, whereas the values increased in Ormco-LEACH (P < 0.05). The data exhibited a significantly decrease in breaking strength with Thai-LEACH and Ormco-LEACH, whereas all 3 brands revealed a significantly decrease in maximum displacement with the leaching process (P < 0.05). Conclusion: Leaching with NaOH solution is a new method, which can remove toxic components from orthodontic latex elastic bands. However, this process can affect their mechanical properties. Leached elastic bands from Thai had comparable properties with Ormco and have potential to be developed as a promising product.

Keywords: leaching, orthodontic elastics, natural rubber latex, orthodontic

Procedia PDF Downloads 267

Authors: Anis Al-Yakhiri

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Introduction: The World Health Organization (WHO) classifies malignant epithelial thyroid tumors into four major groups (papillary, follicular, medullar and undifferentiated) . Papillary thyroid carcinoma (PTC) is the most common type, for about eight out of ten thyroid cancers belong to this histological type. Radioactive iodine (RAI) is considered effective for patients with total or nearly total thyroidectomy, but the beneficial effects of RAI are still controversial. War conditions forced us to study alternative methods of using radioactive iodine in the treatment of patients with PTC. Material and methods: Between January 2014 and June 2021, in Al-Yakhiri hospital, 57 Total Thyroidectomy with Radical BilateralNeckDissection (RBND) were performed, 50 for malignant disease,7 for false positive cytology.RBND involves surgical clearance of Levels II-VI. Mean age was 40.7 years old and 92% of the patients were female. 7(14%) patients had hypothyroidism which required preoperative thyroid hormone treatment. The Thyroid Stimulating Hormone- Suppression Therapy (TSH-ST) immediately started after RBND for mostpatients on the first day. It consisted in reducing the level of TSH< 0.1 mIU/L. Results: The Apron flap was used on most operations (40)80% and with lateral extensions had 10(20%). RBND involves surgical clearance of Levels II-VI performed in all operated patients, besides that, 4(8%) of them had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV) withclearance of Levels IB. The PTC was the most common 80.9% (38 patients from 47)by histopathological report. and 4(8%) patients of 50 had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV). The postoperative mortality rate not observed (0%). The postoperative morbidity rate was 22.8% (n =13).Seroma(8.7%),Hypocalcimia(7%), Wound infection(5.3%), Bleeding(1.8%). To suppress TSH and growth of any residual thyroid theTSH-ST (levothyroxine150 – 600mcg)was performed in all patients 57(100%) on the first day afterRBND. We tracked the results of treatment for two years in 30 patients with PTC, only 3 of them received radioactive iodine abroad. Biennial Recurrence rate for PTC appeared in one woman (2%), who had RAI postoperatively in the form of neck lymph nodes metastasis. Conclusion: For patients with PTC, thyroidectomy plus prophylacticRBND is a safe and efficient procedure and it results in lower recurrence rate. Postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress TSH (not less than 150mcg), decreases incidence of recurrence. Total Thyroidectomy with RBND followed by TSH-ST, in our opinion, applicable optimal treatment scheme care for this patient population.

Keywords: thyroid cancer, Yemen war, absence of radioactive iodine, neck dissection, surgery results

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Authors: Jocelyn D. Perreault

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An exploratory study has been launched in 2013-2014 in the province of Quebec, the state of Vermont (USA) and the region of Zaer in Morocco. We have realized three first case studies in order to better understand the marketing strategies of starting up vineries, which are defined as having a maximum of five years of operations. The methodology used consisted of visiting the vineyards; conducting semi-directed interviews with owner-managers; visiting points-of-sale of the wines and analysing the web sites using an assessment grid. The results indicate many differences between the three firms in their use of their web sites. More precisely, we have noticed that: -The Quebec vineyard uses its web site in collaboration with the touristic actors of its region and the association of the wine makers of the province of Quebec.Positioning is as a touristic attraction. -In comparison,the Moroccan firm limits the content of the web site to itself and its activities and somehow to the wine industry.Positioning is as a wine specialist. -The american firm associated its web site more to farm markets actors and activities of the region.Positioning is as an agricultural actor. -The positionings of the three vineyards are very different from each others and will be discussed more thoroughly during the presentation to better understand the use of web sites, thus contributing to the «brand image». -Improvements to the three web sites have been identified and suggested by more than a hundred of persons using the same grid and comprising students of bachelor and MBA degrees from our university. In general, the web sites have been considered satisfying but requiring several improvements at different levels. Changes or updates have been observed for the Quebec winery web site but practically no changes have been made to the others in the last months. The assessment grid will be presented in more details as well as the global and the partial scores given by the respondents. In conclusion, we have noticed that only one winery is considered as a «heavy and strategic user» of its web site and of Facebook and Twitter.

Keywords: web site, wineries, marketing, positioning, starting up strategies

Procedia PDF Downloads 297

Authors: Enyia James Diwa, Dodeye Ina Igbong, Archibong Archibong Eso

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Gas turbine operators have been faced with the dramatic financial setback resulting from compressor fouling. In a highly deregulated power industry where there is stiffness in the market competition, has made it imperative to improvise means of reducing maintenance cost in other to yield maximum profit. Compressor fouling results from the deposition of contaminants in the presence of oil and moisture on the compressor blade or annulus surfaces, which leads to a loss in flow capacity and compressor efficiency. These combined effects reduce power output, increase heat rate and cause creep life reduction. This paper also contains a model of two gas turbine engines via Cranfield University software known as TURBOMATCH, which is simulation software for detecting engine fouling rate. The model engines are of different configurations and capacities, and are operating in two different modes of constant output power and turbine inlet temperature for a two and three stage filter system. The idea is to investigate the more economically viable filtration systems by gas turbine users based on performance only. It has been demonstrated in the results that the two spool engine is a little more beneficial compared to the single spool. This is as a result of a higher pressure ratio of the two spools as well as the deceleration of the high-pressure compressor and high-pressure turbine speed in a constant TET. Meanwhile, the inlet filtration system was properly designed and balanced with a well-timed and economical compressor washing regime/scheme to control compressor fouling. The different technologies of inlet air filtration and compressor washing are considered and an attempt at optimization with respect to the cost of a combination of both control measures are made.

Keywords: inlet filtration, pressure loss, single spool, two spool

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Authors: Asma Inge-Hanif, Ayyub Ansari Hanif

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The impact of conflicts, the subsequent refugee migration to America and their attempted use of societal resources implicate the lack of further humanitarian aid as a consequence of the abrupt decrease in services and policy changes stemming from new governmental mandates and Executive Orders. Statistical research data indicates a substantial decline in access to standardized health services by refugee women creating a significant alteration in the management of their maternal health care in America, previously shown to result in decreased mortality and morbidity. Studying nursing at Howard University in Washington, D.C., observed doctors were not always sensitive to the needs and modesty concerns of immigrant Muslim women - often unintentionally. Among health care professionals, the prevailing belief should be that every man, woman and child has the right to quality care in a dignified manner and the achievement of optimal health and well-being, regardless of race, creed, socio-economic level or status. In 1987 Muslimat Al Nisaa Health and Social Services Center was established to care for underserved and uninsured women and children. This Center, plus the subsequent shelter, provided direct access to those homeless, refugees, human trafficking and women victims of domestic violence was established and provides the data for this study. Understanding specific culture, social, economic and religious nuances respects their diversity and addressing their basic human needs that they achieve optimal success. The ultimate goal being to facilitate the rescue and housing of those whom escaped from a country/communities where girls are devalued, brought, sold and abused.

Keywords: women, refugee, domestic violence, health care

Procedia PDF Downloads 81