Search results for: frequency ratio
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 8071

Search results for: frequency ratio

541 Examining the Overuse of Cystoscopy in the Evaluation of Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Prospective Study

Authors: Ilija Kelepurovski, Stefan Lazorovski, Pece Petkovski, Marian Anakievski, Svetlana Petkovska

Abstract:

Introduction: Benign prostatic hyperplasia (BPH) is a common condition that affects men over the age of 50 and is characterized by an enlarged prostate gland that can cause lower urinary tract symptoms (LUTS). Uroflowmetry and cystoscopy are two commonly used diagnostic tests to evaluate LUTS and diagnose BPH. While both tests can be useful, there is a risk of overusing cystoscopy and underusing uroflowmetry in the evaluation of LUTS. The aim of this study was to compare the use of uroflowmetry and cystoscopy in a prospective cohort of 100 patients with suspected BPH or other urinary tract conditions and to assess the diagnostic yield of each test. Materials and Methods: This was a prospective study of 100 male patients over the age of 50 with suspected BPH or other urinary tract conditions who underwent uroflowmetry and cystoscopy for the evaluation of LUTS at a single tertiary care center. Inclusion criteria included male patients over the age of 50 with suspected BPH or other urinary tract conditions, while exclusion criteria included previous urethral or bladder surgery, active urinary tract infection, and significant comorbidities. The primary outcome of the study was the frequency of cystoscopy in the evaluation of LUTS, and the secondary outcome was the diagnostic yield of each test. Results: Of the 100 patients included in the study, 86 (86%) were diagnosed with BPH and 14 (14%) had other urinary tract conditions. The mean age of the study population was 67 years. Uroflowmetry was performed on all 100 patients, while cystoscopy was performed on 70 (70%) of the patients. The diagnostic yield of uroflowmetry was high, with a clear diagnosis made in 92 (92%) of the patients. The diagnostic yield of cystoscopy was also high, with a clear diagnosis made in 63 (90%) of the patients who underwent the procedure. There was no statistically significant difference in the diagnostic yield of uroflowmetry and cystoscopy (p = 0.20). Discussion: Our study found that uroflowmetry is an effective and well-tolerated diagnostic tool for evaluating LUTS and diagnosing BPH, with a high diagnostic yield and low risk of complications. Cystoscopy is also a useful diagnostic tool, but it is more invasive and carries a small risk of complications such as bleeding or urinary tract infection. Both tests had a high diagnostic yield, suggesting that either test can provide useful information in the evaluation of LUTS. However, the fact that 70% of the study population underwent cystoscopy raises concerns about the potential overuse of this test in the evaluation of LUTS. This is especially relevant given the focus on patient-centered care and the need to minimize unnecessary or invasive procedures. Our findings underscore the importance of considering the clinical context and using evidence-based guidelines. Conclusion: In this prospective study of 100 patients with suspected BPH or other urinary tract conditions, we found that uroflowmetry and cystoscopy were both valuable diagnostic tools for the evaluation of LUTS. However, the potential overuse of cystoscopy in this population warrants further investigation and highlights the need for careful consideration of the optimal use of diagnostic tests in the evaluation of LUTS and the diagnosis of BPH. Further research is needed to better understand the relative roles of uroflowmetry and cystoscopy in the diagnostic workup of patients with LUTS, and to develop evidence-based guidelines for their appropriate use.

Keywords: uroflowmetry, cystoscopy, LUTS, BPH

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540 Evaluation of the Effectiveness of Crisis Management Support Bases in Tehran

Authors: Sima Hajiazizi

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Tehran is a capital of Iran, with the capitals of the world to natural disasters such as earthquake and flood vulnerable has known. City has stated on three faults, Ray, Mosha, and north according to report of JICA in 2000, the most casualties and destruction was the result of active fault Ray. In 2003, the prevention and management of crisis in Tehran to conduct prevention and rehabilitation of the city, under the Ministry has active. Given the breadth and lack of appropriate access in the city, was considered decentralized management for crisis management support, in each region, in order to position the crisis management headquarters at the time of crises and implementation of programs for prevention and education of the citizens and also to position the bases given in some areas of the neighboring provinces at the time of the accident for help and a number of databases to store food and equipment needed at the time of the disaster. In this study, the bases for one, six, nine and eleven regions of Tehran in the field of management and training are evaluated. Selected areas had local accident and experience of practice for disaster management and local training has been experiencing challenges. The research approach was used qualitative research methods underlying Ground theory. At first, the information obtained through the study of documents and Semi-structured interviews by administrators, officials of training and participant observation in the classroom, line by line, and then it was coded in two stages, by comparing and questioning concepts, categories and extract according to the indicators is obtained from literature studies, subjects were been central. Main articles according to the frequency and importance of the phenomenon were called and they were drawn diagram paradigm and at the end with the intersections phenomena and their causes with indicators extracted from the texts, approach each phenomenon and the effectiveness of the bases was measured. There are two phenomenons in management; 1. The inability to manage the vast and complex crisis events and to resolve minor incidents due to the mismatch between managers. 2. Weaknesses in the implementation of preventive measures and preparedness to manage crisis is causal of situations, fields and intervening. There are five phenomenons in the field of education; 1. In the six-region participation and interest is high. 2. In eleven-region training partnerships for crisis management were to low that next by maneuver in schools and local initiatives such as advertising and use of aid groups have increased. 3. In nine-region, contributions to education in the area of crisis management at the beginning were low that initiatives like maneuver in schools and communities to stimulate and increase participation have increased sensitivity. 4. Managers have been disagreement with the same training in all areas. Finally for the issues that are causing the main issues, with the help of concepts extracted from the literature, recommendations are provided.

Keywords: crises management, crisis management support bases, vulnerability, crisis management headquarters, prevention

Procedia PDF Downloads 157
539 Validation of Global Ratings in Clinical Performance Assessment

Authors: S. J. Yune, S. Y. Lee, S. J. Im, B. S. Kam, S. Y. Baek

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This study aimed to determine the reliability of clinical performance assessments, having been emphasized by ability-based education, and professors overall assessment methods. We addressed the following problems: First, we try to find out whether there is a difference in what we consider to be the main variables affecting the clinical performance test according to the evaluator’s working period and the number of evaluation experience. Second, we examined the relationship among the global rating score (G), analytic global rating score (Gc), and the sum of the analytical checklists (C). What are the main factors affecting clinical performance assessments in relation to the numbers of times the evaluator had administered evaluations and the length of their working period service? What is the relationship between overall assessment score and analytic checklist score? How does analytic global rating with 6 components in OSCE and 4 components in sub-domains (Gc) CPX: aseptic practice, precision, systemic approach, proficiency, successfulness, and attitude overall assessment score and task-specific analytic checklist score sum (C) affect the professor’s overall global rating assessment score (G)? We studied 75 professors who attended a 2016 Bugyeoung Consortium clinical skills performances test evaluating third and fourth year medical students at the Pusan National University Medical school in South Korea (39 prof. in OSCE, 36 prof. in CPX; all consented to participate in our study). Each evaluator used 3 forms; a task-specific analytic checklist, subsequent analytic global rating scale with sub-6 domains, and overall global scale. After the evaluation, the professors responded to the questionnaire on the important factors of clinical performance assessment. The data were analyzed by frequency analysis, correlation analysis, and hierarchical regression analysis using SPSS 21.0. Their understanding of overall assessment was analyzed by dividing the subjects into groups based on experiences. As a result, they considered ‘precision’ most important in overall OSCE assessment, and ‘precise accuracy physical examination’, ‘systemic approaches to taking patient history’, and ‘diagnostic skill capability’ in overall CPX assessment. For OSCE, there was no clear difference of opinion about the main factors, but there was for CPX. Analytic global rating scale score, overall rating scale score, and analytic checklist score had meaningful mutual correlations. According to the regression analysis results, task-specific checklist score sum had the greatest effect on overall global rating. professors regarded task-specific analytic checklist total score sum as best reflecting overall OSCE test score, followed by aseptic practice, precision, systemic approach, proficiency, successfulness, and attitude on a subsequent analytic global rating scale. For CPX, subsequent analytic global rating scale score, overall global rating scale score, and task-specific checklist score had meaningful mutual correlations. These findings support explanations for validity of professors’ global rating in clinical performance assessment.

Keywords: global rating, clinical performance assessment, medical education, analytic checklist

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538 Female Autism Spectrum Disorder and Understanding Rigid Repetitive Behaviors

Authors: Erin Micali, Katerina Tolstikova, Cheryl Maykel, Elizabeth Harwood

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Female ASD is seldomly studied separately from males. Further, females with ASD are disproportionately underrepresented in the research at a rate of 3:1 (male to female). As such, much of the current understanding about female rigid repetitive behaviors (RRBs) stems from research’s understanding of male RRBs. This can be detrimental to understanding female ASD because this understanding of female RRBs largely discounts female camouflaging and the possibility that females present their autistic symptoms differently. Current literature suggests that females with ASD engage in fewer RRBs than males with ASD and when females do engage in RRBs, they are likely to engage in more subtle, less overt obsessions and repetitive behaviors than males. Method: The current study utilized a mixed methods research design to identify the type and frequency of RRBs that females with ASD engaged in by using a cross-sectional design. The researcher recruited only females to be part of the present study with the criteria they be at least age six and not have co-occurring cognitive impairment. Results: The researcher collected previous testing data (Autism Diagnostic Interview-Revised (ADI-R), Child or Adolescent/Adult Sensory Profile-2, Autism/ Empathy Quotient, Yale Brown Obsessive Compulsive Checklist, Rigid Repetitive Behavior Checklist (evaluator created list), and demographic questionnaire) from 25 total participants. The participants ages ranged from six to 52. The participants were 96% Caucasion and 4% Latin American. Qualitative analysis found the current participant pool engaged in six RRB themes including repetitive behaviors, socially restrictive behaviors, repetitive speech, difficulty with transition, obsessive behaviors, and restricted interests. The current dataset engaged in socially restrictive behaviors and restrictive interests most frequently. Within the main themes 40 subthemes were isolated, defined, and analyzed. Further, preliminary quantitative analysis was run to determine if age impacted camouflaging behaviors and overall presentation of RRBs. Within this dataset this was not founded. Further qualitative data will be run to determine if this dataset engaged in more overt or subtle RRBs to confirm or rebuff previous research. The researcher intends to run SPSS analysis to determine if there was statistical difference between each RRB theme and overall presentation. Secondly, each participant will be analyzed for presentation of RRB, age, and previous diagnoses. Conclusion: The present study aimed to assist in diagnostic clarity. This was achieved by collecting data from a female only participant pool across the lifespan. Current data aided in clarity of the type of RRBs engage in. A limited sample size was a barrier in this study.

Keywords: autism spectrum disorder, camouflaging, rigid repetitive behaviors, gender disparity

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537 Knowledge of Sexually Transmitted Infections and Socio-Demographic Factors Affecting High Risk Sex among Unmarried Youths in Nigeria

Authors: Obasanjo Afolabi Bolarinwa

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This study assesses the levels of knowledge of sexually transmitted infections among unmarried youths in Nigeria; examines the pattern of high risk sex among unmarried youths in Nigeria; investigate the socio-demographic factors (age, place of residence, religion, level of education, wealth index and employment status) affecting the practice of high-risk sexual behaviour and ascertain the relationships between knowledge of sexually transmitted infections and practice of high risk sex. The goal of the study is to identify the factors associated with the practice of high risk sex among youth. These were with a view to identifying critical actions needed to reduce high risk sexual behaviour among youths. The study employed secondary data. The data for the study were extracted from the 2013 Nigeria Demographic and Health Survey (NDHS). The 2013 NDHS collected information from 38,948 Women ages 15-49 years and 17,359 men ages 15-49. A total of 7,744 female and 6,027 male respondents were utilized in the study. In order to adjust for the effect of oversampling of the population, the weighting factor provided by Measure DHS was applied. The data were analysed using frequency distribution and logistic regression. The results show that both male (92.2%) and female (93.6%) have accurate knowledge of sexually transmitted infections. The study also revealed that prevalence of high risk sexual behavior is high among Nigerian youths; this is evident as 77.7% (female) and 78.4% (male) are engaging in high risk sexual behavior. The bivariate analysis shows that age of respondent (χ2=294.2; p < 0.05), religion (χ2=136.64; p < 0.05), wealth index (χ2=17.38; p < 0.05), level of education (χ2=34.73; p < 0.05) and employment status (χ2=94.54; p < 0.05) were individual factors significantly associated with high risk sexual behaviour among male while age of respondent (χ2=327.07; p < 0.05), place of residence (χ2=6.71; p < 0.05), religion (χ2=81.04; p < 0.05), wealth index (χ2=7.41; p < 0.05), level of education (χ2=18.12; p < 0.05) and employment status (χ2=51.02; p < 0.05) were individual factors significantly associated with high risk sexual behaviour among female. Furthermore, the study shows that there is a relationship between knowledge of sexually transmitted infections and high risk sex among male (χ2=38.32; p < 0.05) and female (χ2=18.37; p < 0.05). At multivariate level, the study revealed that individual characteristics such as age, religion, place of residence, wealth index, levels of education and employment status were statistically significantly related with high risk sexual behaviour among male and female (p < 0.05). Lastly, the study shows that knowledge of sexually transmitted infection was significantly related to high risk sexual behaviour among youths (p < 0.05). The study concludes that there is a high level of knowledge of sexually transmitted infections among unmarried youths in Nigeria. The practice of high risk sex is high among unmarried youths but higher among male youths. The prevalence of high risk sexual activity is higher for males when they are at disadvantage and higher for females when they are at advantage. Socio-demographic factors like age of respondents, religion, wealth index, place of residence, employment status and highest level of education are factors influencing high risk sexual behaviour among youths.

Keywords: high risk sex, wealth index, sexual behaviour, knowledge

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536 Lightweight Sheet Molding Compound Composites by Coating Glass Fiber with Cellulose Nanocrystals

Authors: Amir Asadi, Karim Habib, Robert J. Moon, Kyriaki Kalaitzidou

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There has been considerable interest in cellulose nanomaterials (CN) as polymer and polymer composites reinforcement due to their high specific modulus and strength, low density and toxicity, and accessible hydroxyl side groups that can be readily chemically modified. The focus of this study is making lightweight composites for better fuel efficiency and lower CO2 emission in auto industries with no compromise on mechanical performance using a scalable technique that can be easily integrated in sheet molding compound (SMC) manufacturing lines. Light weighting will be achieved by replacing part of the heavier components, i.e. glass fibers (GF), with a small amount of cellulose nanocrystals (CNC) in short GF/epoxy composites made using SMC. CNC will be introduced as coating of the GF rovings prior to their use in the SMC line. The employed coating method is similar to the fiber sizing technique commonly used and thus it can be easily scaled and integrated to industrial SMC lines. This will be an alternative route to the most techniques that involve dispersing CN in polymer matrix, in which the nanomaterials agglomeration limits the capability for scaling up in an industrial production. We have demonstrated that incorporating CNC as a coating on GF surface by immersing the GF in CNC aqueous suspensions, a simple and scalable technique, increases the interfacial shear strength (IFSS) by ~69% compared to the composites produced by uncoated GF, suggesting an enhancement of stress transfer across the GF/matrix interface. As a result of IFSS enhancement, incorporation of 0.17 wt% CNC in the composite results in increases of ~10% in both elastic modulus and tensile strength, and 40 % and 43 % in flexural modulus and strength respectively. We have also determined that dispersing 1.4 and 2 wt% CNC in the epoxy matrix of short GF/epoxy SMC composites by sonication allows removing 10 wt% GF with no penalty on tensile and flexural properties leading to 7.5% lighter composites. Although sonication is a scalable technique, it is not quite as simple and inexpensive as coating the GF by passing through an aqueous suspension of CNC. In this study, the above findings are integrated to 1) investigate the effect of CNC content on mechanical properties by passing the GF rovings through CNC aqueous suspension with various concentrations (0-5%) and 2) determine the optimum ratio of the added CNC to the removed GF to achieve the maximum possible weight reduction with no cost on mechanical performance of the SMC composites. The results of this study are of industrial relevance, providing a path toward producing high volume lightweight and mechanically enhanced SMC composites using cellulose nanomaterials.

Keywords: cellulose nanocrystals, light weight polymer-matrix composites, mechanical properties, sheet molding compound (SMC)

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535 Microplastics Accumulation and Abundance Standardization for Fluvial Sediments: Case Study for the Tena River

Authors: Mishell E. Cabrera, Bryan G. Valencia, Anderson I. Guamán

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Human dependence on plastic products has led to global pollution, with plastic particles ranging in size from 0.001 to 5 millimeters, which are called microplastics (hereafter, MPs). The abundance of microplastics is used as an indicator of pollution. However, reports of pollution (abundance of MPs) in river sediments do not consider that the accumulation of sediments and MPs depends on the energy of the river. That is, the abundance of microplastics will be underestimated if the sediments analyzed come from places where the river flows with a lot of energy, and the abundance will be overestimated if the sediment analyzed comes from places where the river flows with less energy. This bias can generate an error greater than 300% of the MPs value reported for the same river and should increase when comparisons are made between 2 rivers with different characteristics. Sections where the river flows with higher energy allow sands to be deposited and limit the accumulation of MPs, while sections, where the same river has lower energy, allow fine sediments such as clays and silts to be deposited and should facilitate the accumulation of MPs particles. That is, the abundance of MPs in the same river is underrepresented when the sediment analyzed is sand, and the abundance of MPs is overrepresented if the sediment analyzed is silt or clay. The present investigation establishes a protocol aimed at incorporating sample granulometry to calibrate MPs quantification and eliminate over- or under-representation bias (hereafter granulometric bias). A total of 30 samples were collected by taking five samples within six work zones. The slope of the sampling points was less than 8 degrees, referred to as low slope areas, according to the Van Zuidam slope classification. During sampling, blanks were used to estimate possible contamination by MPs during sampling. Samples were dried at 60 degrees Celsius for three days. A flotation technique was employed to isolate the MPs using sodium metatungstate with a density of 2 gm/l. For organic matter digestion, 30% hydrogen peroxide and Fenton were used at a ratio of 6:1 for 24 hours. The samples were stained with rose bengal at a concentration of 200 mg/L and were subsequently dried in an oven at 60 degrees Celsius for 1 hour to be identified and photographed in a stereomicroscope with the following conditions: Eyepiece magnification: 10x, Zoom magnification (zoom knob): 4x, Objective lens magnification: 0.35x for analysis in ImageJ. A total of 630 fibers of MPs were identified, mainly red, black, blue, and transparent colors, with an overall average length of 474,310 µm and an overall median length of 368,474 µm. The particle size of the 30 samples was calculated using 100 g per sample using sieves with the following apertures: 2 mm, 1 mm, 500 µm, 250 µm, 125 µm and 0.63 µm. This sieving allowed a visual evaluation and a more precise quantification of the microplastics present. At the same time, the weight of sediment in each fraction was calculated, revealing an evident magnitude: as the presence of sediment in the < 63 µm fraction increases, a significant increase in the number of MPs particles is observed.

Keywords: microplastics, pollution, sediments, Tena River

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534 Evaluation of Different Cropping Systems under Organic, Inorganic and Integrated Production Systems

Authors: Sidramappa Gaddnakeri, Lokanath Malligawad

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Any kind of research on production technology of individual crop / commodity /breed has not brought sustainability or stability in crop production. The sustainability of the system over years depends on the maintenance of the soil health. Organic production system includes use of organic manures, biofertilizers, green manuring for nutrient supply and biopesticides for plant protection helps to sustain the productivity even under adverse climatic condition. The study was initiated to evaluate the performance of different cropping systems under organic, inorganic and integrated production systems at The Institute of Organic Farming, University of Agricultural Sciences, Dharwad (Karnataka-India) under ICAR Network Project on Organic Farming. The trial was conducted for four years (2013-14 to 2016-17) on fixed site. Five cropping systems viz., sequence cropping of cowpea – safflower, greengram– rabi sorghum, maize-bengalgram, sole cropping of pigeonpea and intercropping of groundnut + cotton were evaluated under six nutrient management practices. The nutrient management practices are NM1 (100% Organic farming (Organic manures equivalent to 100% N (Cereals/cotton) or 100% P2O5 (Legumes), NM2 (75% Organic farming (Organic manures equivalent to 75% N (Cereals/cotton) or 100% P2O5 (Legumes) + Cow urine and Vermi-wash application), NM3 (Integrated farming (50% Organic + 50% Inorganic nutrients, NM4 (Integrated farming (75% Organic + 25% Inorganic nutrients, NM5 (100% Inorganic farming (Recommended dose of inorganic fertilizers)) and NM6 (Recommended dose of inorganic fertilizers + Recommended rate of farm yard manure (FYM). Among the cropping systems evaluated for different production systems indicated that the Groundnut + Hybrid cotton (2:1) intercropping system found more remunerative as compared to Sole pigeonpea cropping system, Greengram-Sorghum sequence cropping system, Maize-Chickpea sequence cropping system and Cowpea-Safflower sequence cropping system irrespective of the production systems. Production practices involving application of recommended rates of fertilizers + recommended rates of organic manures (Farmyard manure) produced higher net monetary returns and higher B:C ratio as compared to integrated production system involving application of 50 % organics + 50 % inorganic and application of 75 % organics + 25 % inorganic and organic production system only Both the two organic production systems viz., 100 % Organic production system (Organic manures equivalent to 100 % N (Cereals/cotton) or 100 % P2O5 (Legumes) and 75 % Organic production system (Organic manures equivalent to 75 % N (Cereals) or 100 % P2O5 (Legumes) + Cow urine and Vermi-wash application) are found to be on par. Further, integrated production system involving application of organic manures and inorganic fertilizers found more beneficial over organic production systems.

Keywords: cropping systems, production systems, cowpea, safflower, greengram, pigeonpea, groundnut, cotton

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533 Validating Quantitative Stormwater Simulations in Edmonton Using MIKE URBAN

Authors: Mohamed Gaafar, Evan Davies

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Many municipalities within Canada and abroad use chloramination to disinfect drinking water so as to avert the production of the disinfection by-products (DBPs) that result from conventional chlorination processes and their consequential public health risks. However, the long-lasting monochloramine disinfectant (NH2Cl) can pose a significant risk to the environment. As, it can be introduced into stormwater sewers, from different water uses, and thus freshwater sources. Little research has been undertaken to monitor and characterize the decay of NH2Cl and to study the parameters affecting its decomposition in stormwater networks. Therefore, the current study was intended to investigate this decay starting by building a stormwater model and validating its hydraulic and hydrologic computations, and then modelling water quality in the storm sewers and examining the effects of different parameters on chloramine decay. The presented work here is only the first stage of this study. The 30th Avenue basin in Southern Edmonton was chosen as a case study, because the well-developed basin has various land-use types including commercial, industrial, residential, parks and recreational. The City of Edmonton has already built a MIKE-URBAN stormwater model for modelling floods. Nevertheless, this model was built to the trunk level which means that only the main drainage features were presented. Additionally, this model was not calibrated and known to consistently compute pipe flows higher than the observed values; not to the benefit of studying water quality. So the first goal was to complete modelling and updating all stormwater network components. Then, available GIS Data was used to calculate different catchment properties such as slope, length and imperviousness. In order to calibrate and validate this model, data of two temporary pipe flow monitoring stations, collected during last summer, was used along with records of two other permanent stations available for eight consecutive summer seasons. The effect of various hydrological parameters on model results was investigated. It was found that model results were affected by the ratio of impervious areas. The catchment length was tested, however calculated, because it is approximate representation of the catchment shape. Surface roughness coefficients were calibrated using. Consequently, computed flows at the two temporary locations had correlation coefficients of values 0.846 and 0.815, where the lower value pertained to the larger attached catchment area. Other statistical measures, such as peak error of 0.65%, volume error of 5.6%, maximum positive and negative differences of 2.17 and -1.63 respectively, were all found in acceptable ranges.

Keywords: stormwater, urban drainage, simulation, validation, MIKE URBAN

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532 Effect of Particle Size Variations on the Tribological Properties of Porcelain Waste Added Epoxy Composites

Authors: B. Yaman, G. Acikbas, N. Calis Acikbas

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Epoxy based materials have advantages in tribological applications due to their unique properties such as light weight, self-lubrication capacity and wear resistance. On the other hand, their usage is often limited by their low load bearing capacity and low thermal conductivity values. In this study, it is aimed to improve tribological and also mechanical properties of epoxy by reinforcing with ceramic based porcelain waste. It is well-known that the reuse or recycling of waste materials leads to reduction in production costs, ease of manufacturing, saving energy, etc. From this perspective, epoxy and epoxy matrix composites containing 60wt% porcelain waste with different particle size in the range of below 90µm and 150-250µm were fabricated, and the effect of filler particle size on the mechanical and tribological properties was investigated. The microstructural characterization was carried out by scanning electron microscopy (SEM), and phase analysis was determined by X-ray diffraction (XRD). The Archimedes principle was used to measure the density and porosity of the samples. The hardness values were measured using Shore-D hardness, and bending tests were performed. Microstructural investigations indicated that porcelain particles were homogeneously distributed and no agglomerations were encountered in the epoxy resin. Mechanical test results showed that the hardness and bending strength were increased with increasing particle size related to low porosity content and well embedding to the matrix. Tribological behavior of these composites was evaluated in terms of friction, wear rates and wear mechanisms by ball-on-disk contact with dry and rotational sliding at room temperature against WC ball with a diameter of 3mm. Wear tests were carried out at room temperature (23–25°C) with a humidity of 40 ± 5% under dry-sliding conditions. The contact radius of cycles was set to 5 mm at linear speed of 30 cm/s for the geometry used in this study. In all the experiments, 3N of constant test load was applied at a frequency of 8 Hz and prolonged to 400m wear distance. The friction coefficient of samples was recorded online by the variation in the tangential force. The steady-state CoFs were changed in between 0,29-0,32. The dimensions of the wear tracks (depth and width) were measured as two-dimensional profiles by a stylus profilometer. The wear volumes were calculated by integrating these 2D surface areas over the diameter. Specific wear rates were computed by dividing the wear volume by the applied load and sliding distance. According to the experimental results, the use of porcelain waste in the fabrication of epoxy resin composites can be suggested to be potential materials due to allowing improved mechanical and tribological properties and also providing reduction in production cost.

Keywords: epoxy composites, mechanical properties, porcelain waste, tribological properties

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531 Temporal and Spatio-Temporal Stability Analyses in Mixed Convection of a Viscoelastic Fluid in a Porous Medium

Authors: P. Naderi, M. N. Ouarzazi, S. C. Hirata, H. Ben Hamed, H. Beji

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The stability of mixed convection in a Newtonian fluid medium heated from below and cooled from above, also known as the Poiseuille-Rayleigh-Bénard problem, has been extensively investigated in the past decades. To our knowledge, mixed convection in porous media has received much less attention in the published literature. The present paper extends the mixed convection problem in porous media for the case of a viscoelastic fluid flow owing to its numerous environmental and industrial applications such as the extrusion of polymer fluids, solidification of liquid crystals, suspension solutions and petroleum activities. Without a superimposed through-flow, the natural convection problem of a viscoelastic fluid in a saturated porous medium has already been treated. The effects of the viscoelastic properties of the fluid on the linear and nonlinear dynamics of the thermoconvective instabilities have also been treated in this work. Consequently, the elasticity of the fluid can lead either to a Hopf bifurcation, giving rise to oscillatory structures in the strongly elastic regime, or to a stationary bifurcation in the weakly elastic regime. The objective of this work is to examine the influence of the main horizontal flow on the linear and characteristics of these two types of instabilities. Under the Boussinesq approximation and Darcy's law extended to a viscoelastic fluid, a temporal stability approach shows that the conditions for the appearance of longitudinal rolls are identical to those found in the absence of through-flow. For the general three-dimensional (3D) perturbations, a Squire transformation allows the deduction of the complex frequencies associated with the 3D problem using those obtained by solving the two-dimensional one. The numerical resolution of the eigenvalue problem concludes that the through-flow has a destabilizing effect and selects a convective configuration organized in purely transversal rolls which oscillate in time and propagate in the direction of the main flow. In addition, by using the mathematical formalism of absolute and convective instabilities, we study the nature of unstable three-dimensional disturbances. It is shown that for a non-vanishing through-flow, general three-dimensional instabilities are convectively unstable which means that in the absence of a continuous noise source these instabilities are drifted outside the porous medium, and no long-term pattern is observed. In contrast, purely transversal rolls may exhibit a transition to absolute instability regime and therefore affect the porous medium everywhere including in the absence of a noise source. The absolute instability threshold, the frequency and the wave number associated with purely transversal rolls are determined as a function of the Péclet number and the viscoelastic parameters. Results are discussed and compared to those obtained from laboratory experiments in the case of Newtonian fluids.

Keywords: instability, mixed convection, porous media, and viscoelastic fluid

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530 Ultrasound Assisted Alkaline Potassium Permanganate Pre-Treatment of Spent Coffee Waste

Authors: Rajeev Ravindran, Amit K. Jaiswal

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Lignocellulose is the largest reservoir of inexpensive, renewable source of carbon. It is composed of lignin, cellulose and hemicellulose. Cellulose and hemicellulose is composed of reducing sugars glucose, xylose and several other monosaccharides which can be metabolised by microorganisms to produce several value added products such as biofuels, enzymes, aminoacids etc. Enzymatic treatment of lignocellulose leads to the release of monosaccharides such as glucose and xylose. However, factors such as the presence of lignin, crystalline cellulose, acetyl groups, pectin etc. contributes to recalcitrance restricting the effective enzymatic hydrolysis of cellulose and hemicellulose. In order to overcome these problems, pre-treatment of lignocellulose is generally carried out which essentially facilitate better degradation of lignocellulose. A range of pre-treatment strategy is commonly employed based on its mode of action viz. physical, chemical, biological and physico-chemical. However, existing pretreatment strategies result in lower sugar yield and formation of inhibitory compounds. In order to overcome these problems, we proposes a novel pre-treatment, which utilises the superior oxidising capacity of alkaline potassium permanganate assisted by ultra-sonication to break the covalent bonds in spent coffee waste to remove recalcitrant compounds such as lignin. The pre-treatment was conducted for 30 minutes using 2% (w/v) potassium permanganate at room temperature with solid to liquid ratio of 1:10. The pre-treated spent coffee waste (SCW) was subjected to enzymatic hydrolysis using enzymes cellulase and hemicellulase. Shake flask experiments were conducted with a working volume of 50mL buffer containing 1% substrate. The results showed that the novel pre-treatment strategy yielded 7 g/L of reducing sugar as compared to 3.71 g/L obtained from biomass that had undergone dilute acid hydrolysis after 24 hours. From the results obtained it is fairly certain that ultrasonication assists the oxidation of recalcitrant components in lignocellulose by potassium permanganate. Enzyme hydrolysis studies suggest that ultrasound assisted alkaline potassium permanganate pre-treatment is far superior over treatment by dilute acid. Furthermore, SEM, XRD and FTIR were carried out to analyse the effect of the new pre-treatment strategy on structure and crystallinity of pre-treated spent coffee wastes. This novel one-step pre-treatment strategy was implemented under mild conditions and exhibited high efficiency in the enzymatic hydrolysis of spent coffee waste. Further study and scale up is in progress in order to realise future industrial applications.

Keywords: spent coffee waste, alkaline potassium permanganate, ultra-sonication, physical characterisation

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529 Amorphous Aluminophosphates: An Insight to the Changes in Structural Properties and Catalytic Activity by the Incorporation of Transition Metals

Authors: A. Hamza, H. Kathyayini, N. Nagaraju

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Aluminophosphates, both amorphous and crystalline materials find applications as adsorbents, ceramics, and pigments and as catalysts/catalyst supports in organic fine chemical synthesis. Most of the applications are varied depending on the type of metal incorporated, particle size, surface area, porosity and morphology of aluminophosphate. The porous and surface properties of these materials are normally fine-tuned by adopting various preparation methodologies. Numerous crystalline microporous and mesoporous aluminophosphates and metal-aluminophosphates have been reported in literature, in which the synthesis has been carried out by using structure directing organic molecules/surfactants. In present work, amorphous aluminophosphate (AlP) and metal-aluminophosphates MAlP (M = Cu, Zn, Cr, Fe, Ce and Zr) and their mixed forms M-1M2AlP are prepared under a typical precipitation condition, i.e. at low temperature in order to keep the Von-Weirmann relative super saturation of the precipitating medium and obtain small size precipitate particles. These materials are prepared without using any surfactants. All materials are thoroughly characterised for surface and bulk properties by N2 adsorption-desorption technique, XRD, FT-IR, TG and SEM. The materials are also analysed for the amount and the strength of their surface acid sites, by NH3-TPD and CO2-TPD techniques respectively. All the materials prepared in the work are investigated for their catalytic activity in following applications in the synthesis of industrially important Jasminaldehyde via, aldol condensation of n-heptanal and benzaldehyde, in the synthesis of biologically important chalcones by Claisen-shmidth condensation of benzaldehyde and substituted chalcones. The effect of the amount of the catalysts, duration of the reaction, temperature of the reaction, molar ratio of the reactants has been studied. The porosity of pure aluminophosphate is found to be changed significantly by the incorporation of transition metals during preparation of aluminophosphate. The pore size increased from microporous to mesoporous and finally to macroporous by following order of metals Cu = Zn < Cr < Ce < Fe = Zr. The change in surface area and porosity of double metal-aluminophosphates depended on the concentration of both the metals. The acidity of aluminophosphate is either increased or decreased which depended on the type and valence of metals loaded. A good number of basic sites are created in metal-aluminophosphates irrespective of the metals used. A maximum catalytic activity for synthesis of both jasminaldehyde and chalcone is obtained by FeAlP as catalysts; these materials are characterized by decreased strength and concentration of acidic sites with optimum level basic sites.

Keywords: amorphous metal-aluminophosphates, surface properties, acidic-basic properties, Aldol, Claisen-Shmidth condensation, jasminaldehyde, chalcone

Procedia PDF Downloads 283
528 Predictors for Success in Methadone Maintenance Treatment Clinic: 24 Years of Experience

Authors: Einat E. Peles, Shaul Schreiber, Miriam Adelson

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Background: Since established more than 50 years ago, methadone maintenance treatment (MMT) is the most effective treatment for opioid addiction, a chronic relapsing brain disorder that became an epidemic in western societies. Treatment includes daily individual optimal medication methadone dose (a long acting mu opioid receptor full agonist), accompanied with psychosocial therapy. It is well established that the longer retention in treatment the better outcome and survival occur. It reduces the likelihood to infectious diseases and overdose death that associated with drug injecting, enhanced social rehabilitation and eliminate criminal activity, and lead to healthy productive life. Aim: To evaluate predictors for long term retention in treatment we analyzed our prospective follow up of a major MMT clinic affiliated to a big tertiary medical center. Population Methods: Between June 25, 1993, and June 24, 2016, all 889 patients ( ≥ 18y) who ever admitted to the clinic were prospectively followed-up until May 2017. Duration in treatment from the first admission until the patient quit treatment or until the end of follow-up (24 years) was taken for calculating cumulative retention in treatment using survival analyses (Kaplan Meier) with log-rank and Cox regression for multivariate analyses. Results: Of the 889 patients, 25.2% were females who admitted to treatment at younger age (35.0 ± 7.9 vs. 40.6 ± 9.8, p < .0005), but started opioid usage at same age (22.3 ± 6.9). In addition to opioid use, on admission to MMT 58.5% had positive urine for benzodiazepines, 25% to cocaine, 12.4% to cannabis and 6.9% to amphetamines. Hepatitis C antibody tested positive in 55%, and HIV in 7.8% of the patients and 40%. Of all patients, 75.7% stayed at least one year in treatment, and of them, 67.7% stopped opioid usage (based on urine tests), and a net reduction observed in all other substance abuse (proportion of those who stopped minus proportion of those who have started). Long term retention up to 24 years was 8.0 years (95% Confidence Interval (CI) 7.4-8.6). Predictors for longer retention in treatment (Cox regression) were being older on admission ( ≥ 30y) Odds Ratio (OR) =1.4 (CI 1.1-1.8), not abusing opioids after one year OR=1.8 (CI 1.5-2.1), not abusing benzodiazepine after one year OR=1.7 (CI 1.4-2.1) and treating with methadone dose ≥ 100mg/day OR =1.8 (CI 1.5-2.3). Conclusions: Treating and following patients over 24 years indicate success of two main outcomes, high rate of retention after one year (75.7%) and high proportion of opiate abuse cessation (67.7%). As expected, longer cumulative retention was associated with patients treated with high adequate methadone dose that successfully result in opioid cessation. Based on these findings, in order to reduce morbidity and mortality, we find the establishment of more MMT clinics within a general hospital, a most urgent necessity.

Keywords: methadone maintenance treatment, epidemic, opioids, retention

Procedia PDF Downloads 175
527 Association of Body Composition Parameters with Lower Limb Strength and Upper Limb Functional Capacity in Quilombola Remnants

Authors: Leonardo Costa Pereira, Frederico Santos Santana, Mauro Karnikowski, Luís Sinésio Silva Neto, Aline Oliveira Gomes, Marisete Peralta Safons, Margô Gomes De Oliveira Karnikowski

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In Brazil, projections of population aging follow all world projections, the birth rate tends to be surpassed by the mortality rate around the year 2045. Historically, the population of Brazilian blacks suffered for several centuries from the oppression of dominant classes. A group, especially of blacks, stands out in relation to territorial, historical and social aspects, and for centuries they have isolated themselves in small communities, in order to maintain their freedom and culture. The isolation of the Quilombola communities generated socioeconomic effects as well as the health of these blacks. Thus, the objective of the present study is to verify the association of body composition parameters with lower and upper limb strength and functional capacity in Quilombola remnants. The research was approved by ethics committee (1,771,159). Anthropometric evaluations of hip and waist circumference, body mass and height were performed. In order to verify the body composition, the relationship between stature and body mass (BM) was performed, generating the body mass index (BMI), as well as the dual-energy X-ray absorptiometry (DEXA) test. The Time Up and Go (TUG) test was used to evaluate the functional capacity, and a maximum repetition test (1MR) for knee extension and handgrip (HG) was applied for strength magnitude analysis. Statistical analysis was performed using the statistical package SPSS 22.0. Shapiro Wilk's normality test was performed. For the possible correlations, the suggestions of the Pearson or Spearman tests were adopted. The results obtained after the interpretation identified that the sample (n = 18) was composed of 66.7% of female individuals with mean age of 66.07 ± 8.95 years. The sample’s body fat percentage (%BF) (35.65 ± 10.73) exceeds the recommendations for age group, as well as the anthropometric parameters of hip (90.91 ± 8.44cm) and waist circumference (80.37 ± 17.5cm). The relationship between height (1.55 ± 0.1m) and body mass (63.44 ± 11.25Kg) generated a BMI of 24.16 ± 7.09Kg/m2, that was considered normal. The TUG performance was 10.71 ± 1.85s. In the 1MR test, 46.67 ± 13.06Kg and in the HG 23.93±7.96Kgf were obtained, respectively. Correlation analyzes were characterized by the high frequency of significant correlations for height, dominant arm mass (DAM), %BF, 1MR and HG variables. In addition, correlations between HG and BM (r = 0.67, p = 0.005), height (r = 0.51, p = 0.004) and DAM (r = 0.55, p = 0.026) were also observed. The strength of the lower limbs correlates with BM (r = 0.69, p = 0.003), height (r = 0.62, p = 0.01) and DAM (r = 0.772, p = 0.001). In this way, we can conclude that not only the simple spatial relationship of mass and height can influence in predictive parameters of strength or functionality, being important the verification of the conditions of the corporal composition. For this population, height seems to be a good predictor of strength and body composition.

Keywords: African Continental Ancestry Group, body composition, functional capacity, strength

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526 Self-Care and Emotional Wellbeing of Nurses Using Playback Theatre and Expressive Arts

Authors: Radhika Jain

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The nursing community in India face unique challenges ranging from lack of adequate career progression, low social status attached to the profession, poor nurse-to-patient ratio leading to heavy workload resulting in stress and burnout, lack of general recognition and the responsibility of often having to deal with the ire of the patients and their families. This study explores how a combination of Playback Theatre and Expressive Arts could be used as a very powerful tool to understand the concerns, and consequently as a self-care tool to bring about the sense of well-being and emotional awareness for the nurses. For the purpose of this study, Playback Theatre was used as an entry tool to understand the thoughts, feelings and concerns. Playback theatre is a unique improvisational form of theatre developed by Jonathan Fox and Jo Salas in 1975, in which audience share their own stories from their lives and the performers play them back through a range of improv techniques such as metaphor, poetry, music and movement. Playback Theatre helped in first warming them up to the idea of sharing and then gave them the confidence of a safe space to collectively go deeper into their emotional experiences. As the next step, structured sessions of Expressive Arts were conducted with the same set of nurses, for them to work on the issues and concerns they have (and which they shared during the Playback performance). These sessions were to enable longer engagements as many of the concerns expressed were related to perceptions and beliefs that have been ingrained over a period of time and hence it needs a longer engagement to be worked on in detail. The Expressive Art sessions helped in this regard. Expressive arts therapy combines psychology and the creative process to promote emotional growth and healing. The study was conducted at two places: one a geriatric centre and the other, a palliative care centre. The study revealed that concerns and challenges would not be identical across the nursing community or across similar types of health care organizations but would be specific to each organization or centre as the circumstances and set-up at each place would be different. At the geriatric centre, stress and burnout emerged as the main concerns while at the palliative care centre, the main concern that came up was around the difficulty the nurses faced in expressing emotions and in communicating their feelings. The objective analysis of the results of the study indicated how longer-term engagements using Expressive Arts as the modality helped the nurses have better awareness of their emotions and helped them develop tools of self-care tools while also tapping into their emotions to express and experience. The process of eliciting the main concerns from the nurses using a Playback Theatre performance and then following that with subsequent sessions of expressive arts helped the nurses in the way nurses approached their job and the reduced level of overwhelm that they felt.

Keywords: palliative care, nurses, self-care, expressive arts, playback theatre

Procedia PDF Downloads 98
525 Spectroscopy and Electron Microscopy for the Characterization of CdSxSe1-x Quantum Dots in a Glass Matrix

Authors: C. Fornacelli, P. Colomban, E. Mugnaioli, I. Memmi Turbanti

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When semiconductor particles are reduced in scale to nanometer dimension, their optical and electro-optical properties strongly differ from those of bulk crystals of the same composition. Since sampling is often not allowed concerning cultural heritage artefacts, the potentialities of two non-invasive techniques, such as Raman and Fiber Optic Reflectance Spectroscopy (FORS), have been investigated and the results of the analysis on some original glasses of different colours (from yellow to orange and deep red) and periods (from the second decade of the 20th century to present days) are reported in the present study. In order to evaluate the potentialities of the application of non-invasive techniques to the investigation of the structure and distribution of nanoparticles dispersed in a glass matrix, Scanning Electron Microscopy (SEM) and energy-disperse spectroscopy (EDS) mapping, together with Transmission Electron Microscopy (TEM) and Electron Diffraction Tomography (EDT) have also been used. Raman spectroscopy allows a fast and non-destructive measure of the quantum dots composition and size, thanks to the evaluation of the frequencies and the broadening/asymmetry of the LO phonons bands, respectively, though the important role of the compressive strain arising from the glass matrix and the possible diffusion of zinc from the matrix to the nanocrystals should be taken into account when considering the optical-phonons frequency values. The incorporation of Zn has been assumed by an upward shifting of the LO band related to the most abundant anion (S or Se), while the role of the surface phonons as well as the confinement-induced scattering by phonons with a non-zero wavevectors on the Raman peaks broadening has been verified. The optical band gap varies from 2.42 eV (pure CdS) to 1.70 eV (CdSe). For the compositional range between 0.5≤x≤0.2, the presence of two absorption edges has been related to the contribution of both pure CdS and the CdSxSe1-x solid solution; this particular feature is probably due to the presence of unaltered cubic zinc blende structures of CdS that is not taking part to the formation of the solid solution occurring only between hexagonal CdS and CdSe. Moreover, the band edge tailing originating from the disorder due to the formation of weak bonds and characterized by the Urbach edge energy has been studied and, together with the FWHM of the Raman signal, has been assumed as a good parameter to evaluate the degree of topological disorder. SEM-EDS mapping showed a peculiar distribution of the major constituents of the glass matrix (fluxes and stabilizers), especially concerning those samples where a layered structure has been assumed thanks to the spectroscopic study. Finally, TEM-EDS and EDT were used to get high-resolution information about nanocrystals (NCs) and heterogeneous glass layers. The presence of ZnO NCs (< 4 nm) dispersed in the matrix has been verified for most of the samples, while, for those samples where a disorder due to a more complex distribution of the size and/or composition of the NCs has been assumed, the TEM clearly verified most of the assumption made by the spectroscopic techniques.

Keywords: CdSxSe1-x, EDT, glass, spectroscopy, TEM-EDS

Procedia PDF Downloads 288
524 Synthesis of LiMₓMn₂₋ₓO₄ Doped Co, Ni, Cr and Its Characterization as Lithium Battery Cathode

Authors: Dyah Purwaningsih, Roto Roto, Hari Sutrisno

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Manganese dioxide (MnO₂) and its derivatives are among the most widely used materials for the positive electrode in both primary and rechargeable lithium batteries. The MnO₂ derivative compound of LiMₓMn₂₋ₓO₄ (M: Co, Ni, Cr) is one of the leading candidates for positive electrode materials in lithium batteries as it is abundant, low cost and environmentally friendly. Over the years, synthesis of LiMₓMn₂₋ₓO₄ (M: Co, Ni, Cr) has been carried out using various methods including sol-gel, gas condensation, spray pyrolysis, and ceramics. Problems with these various methods persist including high cost (so commercially inapplicable) and must be done at high temperature (environmentally unfriendly). This research aims to: (1) synthesize LiMₓMn₂₋ₓO₄ (M: Co, Ni, Cr) by reflux technique; (2) develop microstructure analysis method from XRD Powder LiMₓMn₂₋ₓO₄ data with the two-stage method; (3) study the electrical conductivity of LiMₓMn₂₋ₓO₄. This research developed the synthesis of LiMₓMn₂₋ₓO₄ (M: Co, Ni, Cr) with reflux. The materials consisting of Mn(CH₃COOH)₂. 4H₂O and Na₂S₂O₈ were refluxed for 10 hours at 120°C to form β-MnO₂. The doping of Co, Ni and Cr were carried out using solid-state method with LiOH to form LiMₓMn₂₋ₓO₄. The instruments used included XRD, SEM-EDX, XPS, TEM, SAA, TG/DTA, FTIR, LCR meter and eight-channel battery analyzer. Microstructure analysis of LiMₓMn₂₋ₓO₄ was carried out on XRD powder data by two-stage method using FullProf program integrated into WinPlotR and Oscail Program as well as on binding energy data from XPS. The morphology of LiMₓMn₂₋ₓO₄ was studied with SEM-EDX, TEM, and SAA. The thermal stability test was performed with TG/DTA, the electrical conductivity was studied from the LCR meter data. The specific capacity of LiMₓMn₂₋ₓO₄ as lithium battery cathode was tested using an eight-channel battery analyzer. The results showed that the synthesis of LiMₓMn₂₋ₓO₄ (M: Co, Ni, Cr) was successfully carried out by reflux. The optimal temperature of calcination is 750°C. XRD characterization shows that LiMn₂O₄ has a cubic crystal structure with Fd3m space group. By using the CheckCell in the WinPlotr, the increase of Li/Mn mole ratio does not result in changes in the LiMn₂O₄ crystal structure. The doping of Co, Ni and Cr on LiMₓMn₂₋ₓO₄ (x = 0.02; 0.04; 0; 0.6; 0.08; 0.10) does not change the cubic crystal structure of Fd3m. All the formed crystals are polycrystals with the size of 100-450 nm. Characterization of LiMₓMn₂₋ₓO₄ (M: Co, Ni, Cr) microstructure by two-stage method shows the shrinkage of lattice parameter and cell volume. Based on its range of capacitance, the conductivity obtained at LiMₓMn₂₋ₓO₄ (M: Co, Ni, Cr) is an ionic conductivity with varying capacitance. The specific battery capacity at a voltage of 4799.7 mV for LiMn₂O₄; Li₁.₀₈Mn₁.₉₂O₄; LiCo₀.₁Mn₁.₉O₄; LiNi₀.₁Mn₁.₉O₄ and LiCr₀.₁Mn₁.₉O₄ are 88.62 mAh/g; 2.73 mAh/g; 89.39 mAh/g; 85.15 mAh/g; and 1.48 mAh/g respectively.

Keywords: LiMₓMn₂₋ₓO₄, solid-state, reflux, two-stage method, ionic conductivity, specific capacity

Procedia PDF Downloads 176
523 Contentious Politics during a Period of Transition to Democracy from an Authoritarian Regime: The Spanish Cycle of Protest of November 1975-December 1978

Authors: Juan Sanmartín Bastida

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When a country experiences a period of transition from authoritarianism to democracy, involving an earlier process of political liberalization and a later process of democratization, a cycle of protest usually outbreaks, as there is a reciprocal influence between that kind of political change and the frequency and scale of social protest events. That is what happened in Spain during the first years of its transition to democracy from the Francoist authoritarian regime, roughly between November 1975 and December 1978. Thus, the object of this study is to show and explain how that cycle of protest started, developed, and finished in relation to such a political change, and offer specific information about the main features of all protest cycles: the social movements that arose during that period, the number of protest events by month, the forms of collective action that were utilized, the groups of challengers that engaged in contentious politics, the reaction of the authorities to the action and claims of those groups, etc. The study of this cycle of protest, using the primary sources and analytical tools that characterize the model of research of protest cycles, will make a contribution to the field of contentious politics and its phenomenon of cycles of contention, and more broadly to the political and social history of contemporary Spain. The cycle of protest and the process of political liberalization of the authoritarian regime began around the same time, but the first concluded long before the process of democratization was completed in 1982. The ascending phase of the cycle and therefore the process of liberalization started with the death of Francisco Franco and the proclamation of Juan Carlos I as King of Spain in November 1975; the peak of the cycle was around the first months of 1977; the descending phase started after the first general election of June 1977; and the level of protest stabilized in the last months of 1978, a year that finished with a referendum in which the Spanish people approved the current democratic constitution. It was then when we can consider that the cycle of protest came to an end. The primary sources are the news of protest events and social movements in the three main Spanish newspapers at the time, other written or audiovisual documents, and in-depth interviews; and the analytical tools are the political opportunities that encourage social protest, the available repertoire of contention, the organizations and networks that brought together people with the same claims and allowed them to engage in contentious politics, and the interpretative frames that justify, dignify and motivates their collective action. These are the main four factors that explain the beginning, development and ending of the cycle of protest, and therefore the accompanying social movements and events of collective action. Among those four factors, the political opportunities -their opening, exploitation, and closure-proved to be most decisive.

Keywords: contentious politics, cycles of protest, political opportunities, social movements, Spanish transition to democracy

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522 A Machine Learning Approach for Assessment of Tremor: A Neurological Movement Disorder

Authors: Rajesh Ranjan, Marimuthu Palaniswami, A. A. Hashmi

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With the changing lifestyle and environment around us, the prevalence of the critical and incurable disease has proliferated. One such condition is the neurological disorder which is rampant among the old age population and is increasing at an unstoppable rate. Most of the neurological disorder patients suffer from some movement disorder affecting the movement of their body parts. Tremor is the most common movement disorder which is prevalent in such patients that infect the upper or lower limbs or both extremities. The tremor symptoms are commonly visible in Parkinson’s disease patient, and it can also be a pure tremor (essential tremor). The patients suffering from tremor face enormous trouble in performing the daily activity, and they always need a caretaker for assistance. In the clinics, the assessment of tremor is done through a manual clinical rating task such as Unified Parkinson’s disease rating scale which is time taking and cumbersome. Neurologists have also affirmed a challenge in differentiating a Parkinsonian tremor with the pure tremor which is essential in providing an accurate diagnosis. Therefore, there is a need to develop a monitoring and assistive tool for the tremor patient that keep on checking their health condition by coordinating them with the clinicians and caretakers for early diagnosis and assistance in performing the daily activity. In our research, we focus on developing a system for automatic classification of tremor which can accurately differentiate the pure tremor from the Parkinsonian tremor using a wearable accelerometer-based device, so that adequate diagnosis can be provided to the correct patient. In this research, a study was conducted in the neuro-clinic to assess the upper wrist movement of the patient suffering from Pure (Essential) tremor and Parkinsonian tremor using a wearable accelerometer-based device. Four tasks were designed in accordance with Unified Parkinson’s disease motor rating scale which is used to assess the rest, postural, intentional and action tremor in such patient. Various features such as time-frequency domain, wavelet-based and fast-Fourier transform based cross-correlation were extracted from the tri-axial signal which was used as input feature vector space for the different supervised and unsupervised learning tools for quantification of severity of tremor. A minimum covariance maximum correlation energy comparison index was also developed which was used as the input feature for various classification tools for distinguishing the PT and ET tremor types. An automatic system for efficient classification of tremor was developed using feature extraction methods, and superior performance was achieved using K-nearest neighbors and Support Vector Machine classifiers respectively.

Keywords: machine learning approach for neurological disorder assessment, automatic classification of tremor types, feature extraction method for tremor classification, neurological movement disorder, parkinsonian tremor, essential tremor

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521 Effectiveness, Safety, and Tolerability Profile of Stribild® in HIV-1-infected Patients in the Clinical Setting

Authors: Heiko Jessen, Laura Tanus, Slobodan Ruzicic

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Objectives: The efficacy of Stribild®, an integrase strand transfer inhibitor (INSTI) -based STR, has been evaluated in randomized clinical trials and it has demonstrated durable capability in terms of achieving sustained suppression of HIV-1 RNA-levels. However, differences in monitoring frequency, existing selection bias and profile of patients enrolled in the trials, may all result in divergent efficacy of this regimen in routine clinical settings. The aim of this study was to assess the virologic outcomes, safety and tolerability profile of Stribild® in a routine clinical setting. Methods: This was a retrospective monocentric analysis on HIV-1-infected patients, who started with or were switched to Stribild®. Virological failure (VF) was defined as confirmed HIV-RNA>50 copies/ml. The minimum time of follow-up was 24 weeks. The percentage of patients remaining free of therapeutic failure was estimated using the time-to-loss-of-virologic-response (TLOVR) algorithm, by intent-to-treat analysis. Results: We analyzed the data of 197 patients (56 ART-naïve and 141 treatment-experienced patients), who fulfilled the inclusion criteria. Majority (95.9%) of patients were male. The median time of HIV-infection at baseline was 2 months in treatment-naïve and 70 months in treatment-experienced patients. Median time [IQR] under ART in treatment-experienced patients was 37 months. Among the treatment-experienced patients 27.0% had already been treated with a regimen consisting of two NRTIs and one INSTI, whereas 18.4% of them experienced a VF. The median time [IQR] of virological suppression prior to therapy with Stribild® in the treatment-experienced patients was 10 months [0-27]. At the end of follow-up (median 33 months), 87.3% (95% CI, 83.5-91.2) of treatment-naïve and 80.3% (95% CI, 75.8-84.8) of treatment-experienced patients remained free of therapeutic failure. Considering only treatment-experienced patients with baseline VL<50 copies/ml, 83.0% (95% CI, 78.5-87.5) remained free of therapeutic failure. A total of 17 patients stopped treatment with Stribild®, 5.4% (3/56) of them were treatment-naïve and 9.9% (14/141) were treatment-experienced patients. The Stribild® therapy was discontinued in 2 (1.0%) because of VF, loss to follow-up in 4 (2.0%), and drug-drug interactions in 2 (1.0%) patients. Adverse events were in 7 (3.6%) patients the reason to switch from therapy with Stribild® and further 2 (1.0%) patients decided personally to switch. The most frequently observed adverse events were gastrointestinal side effects (20.0%), headache (8%), rash events (7%) and dizziness (6%). In two patients we observed an emergence of novel resistances in integrase-gene. The N155H evolved in one patient and resulted in VF. In another patient S119R evolved either during or shortly upon switch from therapy with Stribild®. In one further patient with VF two novel mutations in the RT-gene were observed when compared to historical genotypic test result (V106I/M and M184V), whereby it is not clear whether they evolved during or already before the switch to Stribild®. Conclusions: Effectiveness of Stribild® for treatment-naïve patients was consistent with data obtained in clinical trials. The safety and tolerability profile as well as resistance development confirmed clinical efficacy of Stribild® in a daily practice setting.

Keywords: ART, HIV, integrase inhibitor, stribild

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520 Selective Extraction of Lithium from Native Geothermal Brines Using Lithium-ion Sieves

Authors: Misagh Ghobadi, Rich Crane, Karen Hudson-Edwards, Clemens Vinzenz Ullmann

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Lithium is recognized as the critical energy metal of the 21st century, comparable in importance to coal in the 19th century and oil in the 20th century, often termed 'white gold'. Current global demand for lithium, estimated at 0.95-0.98 million metric tons (Mt) of lithium carbonate equivalent (LCE) annually in 2024, is projected to rise to 1.87 Mt by 2027 and 3.06 Mt by 2030. Despite anticipated short-term stability in supply and demand, meeting the forecasted 2030 demand will require the lithium industry to develop an additional capacity of 1.42 Mt of LCE annually, exceeding current planned and ongoing efforts. Brine resources constitute nearly 65% of global lithium reserves, underscoring the importance of exploring lithium recovery from underutilized sources, especially geothermal brines. However, conventional lithium extraction from brine deposits faces challenges due to its time-intensive process, low efficiency (30-50% lithium recovery), unsuitability for low lithium concentrations (<300 mg/l), and notable environmental impacts. Addressing these challenges, direct lithium extraction (DLE) methods have emerged as promising technologies capable of economically extracting lithium even from low-concentration brines (>50 mg/l) with high recovery rates (75-98%). However, most studies (70%) have predominantly focused on synthetic brines instead of native (natural/real), with limited application of these approaches in real-world case studies or industrial settings. This study aims to bridge this gap by investigating a geothermal brine sample collected from a real case study site in the UK. A Mn-based lithium-ion sieve (LIS) adsorbent was synthesized and employed to selectively extract lithium from the sample brine. Adsorbents with a Li:Mn molar ratio of 1:1 demonstrated superior lithium selectivity and adsorption capacity. Furthermore, the pristine Mn-based adsorbent was modified through transition metals doping, resulting in enhanced lithium selectivity and adsorption capacity. The modified adsorbent exhibited a higher separation factor for lithium over major co-existing cations such as Ca, Mg, Na, and K, with separation factors exceeding 200. The adsorption behaviour was well-described by the Langmuir model, indicating monolayer adsorption, and the kinetics followed a pseudo-second-order mechanism, suggesting chemisorption at the solid surface. Thermodynamically, negative ΔG° values and positive ΔH° and ΔS° values were observed, indicating the spontaneity and endothermic nature of the adsorption process.

Keywords: adsorption, critical minerals, DLE, geothermal brines, geochemistry, lithium, lithium-ion sieves

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519 Examining Smallholder Farmers’ Perceptions of Climate Change and Barriers to Strategic Adaptation in Todee District, Liberia

Authors: Joe Dorbor Wuokolo

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Thousands of smallholder farmers in Todee District, Montserrado county, are currently vulnerable to the negative impact of climate change. The district, which is the agricultural hot spot for the county, is faced with unfavorable changes in the daily temperature due to climate change. Farmers in the district have observed a dramatic change in the ratio of rainfall to sunshine, which has caused a chilling effect on their crop yields. However, there is a lack of documentation regarding how farmers perceive and respond to these changes and challenges. A study was conducted in the region to examine the perceptions of smallholder farmers regarding the negative impact of climate change, the adaptation strategies practice, and the barriers that hinder the process of advancing adaptation strategy. On purpose, a sample of 41 respondents from five towns was selected, including five town chiefs, five youth leaders, five women leaders, and sixteen community members. Women and youth leaders were specifically chosen to provide gender balance and enhance the quality of the investigation. Additionally, to validate the barriers farmers face during adaptation to climate change, this study interviewed eight experts from local and international organizations and government ministries and agencies involved in climate change and agricultural programs on what they perceived as the major barrier in both local and national level that impede farmers adaptation to climate change impact. SPSS was used to code the data, and descriptive statistics were used to analyze the data. The weighted average index (WAI) was used to rank adaptation strategies and the perceived importance of adaptation practices among farmers. On a scale from 0 to 3, 0 indicates the least important technique, and 3 indicates the most effective technique. In addition, the Problem Confrontation Index (PCI) was used to rank the barriers that prevented farmers from implementing adaptation measures. According to the findings, approximately 60% of all respondents considered the use of irrigation systems to be the most effective adaptation strategy, with drought-resistant varieties making up 30% of the total. Additionally, 80% of respondents placed a high value on drought-resistant varieties, while 63% percent placed it on irrigation practices. In addition, 78% of farmers ranked and indicated that unpredictability of the weather is the most significant barrier to their adaptation strategies, followed by the high cost of farm inputs and lack of access to financing facilities. 80% of respondents believe that the long-term changes in precipitation (rainfall) and temperature (hotness) are accelerating. This suggests that decision-makers should adopt policies and increase the capacity of smallholder farmers to adapt to the negative impact of climate change in order to ensure sustainable food production.

Keywords: adaptation strategies, climate change, farmers’ perception, smallholder farmers

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518 Impact of Boundary Conditions on the Behavior of Thin-Walled Laminated Column with L-Profile under Uniform Shortening

Authors: Jaroslaw Gawryluk, Andrzej Teter

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Simply supported angle columns subjected to uniform shortening are tested. The experimental studies are conducted on a testing machine using additional Aramis and the acoustic emission system. The laminate samples are subjected to axial uniform shortening. The tested columns are loaded with the force values from zero to the maximal load destroying the L-shaped column, which allowed one to observe the column post-buckling behavior until its collapse. Laboratory tests are performed at a constant velocity of the cross-bar equal to 1 mm/min. In order to eliminate stress concentrations between sample and support, flexible pads are used. Analyzed samples are made with carbon-epoxy laminate using the autoclave method. The configurations of laminate layers are: [60,0₂,-60₂,60₃,-60₂,0₃,-60₂,0,60₂]T, where direction 0 is along the length of the profile. Material parameters of laminate are: Young’s modulus along the fiber direction - 170GPa, Young’s modulus along the fiber transverse direction - 7.6GPa, shear modulus in-plane - 3.52GPa, Poisson’s ratio in-plane - 0.36. The dimensions of all columns are: length-300 mm, thickness-0.81mm, width of the flanges-40mm. Next, two numerical models of the column with and without flexible pads are developed using the finite element method in Abaqus software. The L-profile laminate column is modeled using the S8R shell elements. The layup-ply technique is used to define the sequence of the laminate layers. However, the model of grips is made of the R3D4 discrete rigid elements. The flexible pad is consists of the C3D20R type solid elements. In order to estimate the moment of the first laminate layer damage, the following initiation criteria were applied: maximum stress criterion, Tsai-Hill, Tsai-Wu, Azzi-Tsai-Hill, and Hashin criteria. The best compliance of results was observed for the Hashin criterion. It was found that the use of the pad in the numerical model significantly influences the damage mechanism. The model without pads characterized a much more stiffness, as evidenced by a greater bifurcation load and damage initiation load in all analyzed criteria, lower shortening, and less deflection of the column in its center than the model with flexible pads. Acknowledgment: The project/research was financed in the framework of the project Lublin University of Technology-Regional Excellence Initiative, funded by the Polish Ministry of Science and Higher Education (contract no. 030/RID/2018/19).

Keywords: angle column, compression, experiment, FEM

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517 Assessment of N₂ Fixation and Water-Use Efficiency in a Soybean-Sorghum Rotation System

Authors: Mmatladi D. Mnguni, Mustapha Mohammed, George Y. Mahama, Alhassan L. Abdulai, Felix D. Dakora

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Industrial-based nitrogen (N) fertilizers are justifiably credited for the current state of food production across the globe, but their continued use is not sustainable and has an adverse effect on the environment. The search for greener and sustainable technologies has led to an increase in exploiting biological systems such as legumes and organic amendments for plant growth promotion in cropping systems. Although the benefits of legume rotation with cereal crops have been documented, the full benefits of soybean-sorghum rotation systems have not been properly evaluated in Africa. This study explored the benefits of soybean-sorghum rotation through assessing N₂ fixation and water-use efficiency of soybean in rotation with sorghum with and without organic and inorganic amendments. The field trials were conducted from 2017 to 2020. Sorghum was grown on plots previously cultivated to soybean and vice versa. The succeeding sorghum crop received fertilizer amendments [organic fertilizer (5 tons/ha as poultry litter, OF); inorganic fertilizer (80N-60P-60K) IF; organic + inorganic fertilizer (OF+IF); half organic + inorganic fertilizer (HIF+OF); organic + half inorganic fertilizer (OF+HIF); half organic + half inorganic (HOF+HIF) and control] and was arranged in a randomized complete block design. The soybean crop succeeding fertilized sorghum received a blanket application of triple superphosphate at 26 kg P ha⁻¹. Nitrogen fixation and water-use efficiency were respectively assessed at the flowering stage using the ¹⁵N and ¹³C natural abundance techniques. The results showed that the shoot dry matter of soybean plants supplied with HOF+HIF was much higher (43.20 g plant-1), followed by OF+HIF (36.45 g plant⁻¹), and HOF+IF (33.50 g plant⁻¹). Shoot N concentration ranged from 1.60 to 1.66%, and total N content from 339 to 691 mg N plant⁻¹. The δ¹⁵N values of soybean shoots ranged from -1.17‰ to -0.64‰, with plants growing on plots previously treated to HOF+HIF exhibiting much higher δ¹⁵N values, and hence lower percent N derived from N₂ fixation (%Ndfa). Shoot %Ndfa values varied from 70 to 82%. The high %Ndfa values obtained in this study suggest that the previous year’s organic and inorganic fertilizer amendments to sorghum did not inhibit N₂ fixation in the following soybean crop. The amount of N-fixed by soybean ranged from 106 to 197 kg N ha⁻¹. The treatments showed marked variations in carbon (C) content, with HOF+HIF treatment recording the highest C content. Although water-use efficiency varied from -29.32‰ to -27.85‰, shoot water-use efficiency, C concentration, and C:N ratio were not altered by previous fertilizer application to sorghum. This study provides strong evidence that previous HOF+HIF sorghum residues can enhance N nutrition and water-use efficiency in nodulated soybean.

Keywords: ¹³C and ¹⁵N natural abundance, N-fixed, organic and inorganic fertilizer amendments, shoot %Ndfa

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516 Effects of a School-Based Mindfulness Intervention on Stress and Emotions on Students Enrolled in an Independent School

Authors: Tracie Catlett

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Students enrolled in high-achieving schools are under tremendous pressure to perform at high levels inside and outside the classroom. Achievement pressure is a prevalent source of stress for students enrolled in high-achieving schools, and female students in particular experience a higher frequency and higher levels of stress compared to their male peers. The practice of mindfulness in a school setting is one tool that has been linked to improved self-regulation of emotions, increased positive emotions, and stress reduction. A mixed methods randomized pretest-posttest no-treatment control trial, evaluated the effects of a six-session mindfulness intervention taught during a regularly scheduled life skills period in an independent day school, one type of high-achieving school. Twenty-nine students in Grades 10 and 11 were randomized by class where Grade 11 students were in the intervention group (n = 14) and Grade 10 students were in the control group (n = 15). Findings from the study produced mixed results. There was no evidence that the mindfulness program reduced participants’ stress levels and negative emotions. In fact, contrary to what was expected, students enrolled in the intervention group experienced higher levels of stress and increased negative emotions at posttreatment when compared to pretreatment. Neither the within-group nor the between-groups changes in stress level were statistically significant, p > .05, and the between-groups effect size was small, d = .2. The study found evidence that the mindfulness program may have had a positive impact on students’ ability to regulate their emotions. The within-group comparison and the between-groups comparison at posttreatment found that students in the mindfulness course experienced statistically significant improvement in the in their ability to regulate their emotions at posttreatment, p = .009 < .05 and p =. 034 < .05, respectively. The between-groups effect size was medium, d =.7, suggesting that the positive differences in emotion regulation difficulties were substantial and have practical implications. The analysis of gender differences as they relate to stress and emotions revealed that female students perceive higher levels of stress and report experiencing stress more often than males. There were no gender differences when analyzing sources of stress experienced by the student participants. Both females and males experience regular achievement pressures related to their school performance and worry about their future, college acceptance, grades, and parental expectations. Females reported an increased awareness of their stress and actively engaged in practicing mindfulness to manage their stress. Students in the treatment group expressed that the practice of mindfulness resulted in feelings of relaxation and calmness.

Keywords: achievement pressure, adolescents, emotion regulation, emotions, high-achieving schools, independent schools, mindfulness, negative affect, positive affect, stress

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515 Influence of Intra-Yarn Permeability on Mesoscale Permeability of Plain Weave and 3D Fabrics

Authors: Debabrata Adhikari, Mikhail Matveev, Louise Brown, Andy Long, Jan Kočí

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A good understanding of mesoscale permeability of complex architectures in fibrous porous preforms is of particular interest in order to achieve efficient and cost-effective resin impregnation of liquid composite molding (LCM). Fabrics used in structural reinforcements are typically woven or stitched. However, 3D fabric reinforcement is of particular interest because of the versatility in the weaving pattern with the binder yarn and in-plain yarn arrangements to manufacture thick composite parts, overcome the limitation in delamination, improve toughness etc. To predict the permeability based on the available pore spaces between the inter yarn spaces, unit cell-based computational fluid dynamics models have been using the Stokes Darcy model. Typically, the preform consists of an arrangement of yarns with spacing in the order of mm, wherein each yarn consists of thousands of filaments with spacing in the order of μm. The fluid flow during infusion exchanges the mass between the intra and inter yarn channels, meaning there is no dead-end of flow between the mesopore in the inter yarn space and the micropore in the yarn. Several studies have employed the Brinkman equation to take into account the flow through dual-scale porosity reinforcement to estimate their permeability. Furthermore, to reduce the computational effort of dual scale flow, scale separation criteria based on the ratio between yarn permeability to the yarn spacing was also proposed to quantify the dual scale and negligible micro-scale flow regime for the prediction of mesoscale permeability. In the present work, the key parameter to identify the influence of intra yarn permeability on the mesoscale permeability has been investigated with the systematic study of weft and warp yarn spacing on the plane weave as well as the position of binder yarn and number of in-plane yarn layers on 3D weave fabric. The permeability tensor has been estimated using an OpenFOAM-based model for the various weave pattern with idealized geometry of yarn implemented using open-source software TexGen. Additionally, scale separation criterion has been established based on the various configuration of yarn permeability for the 3D fabric with both the isotropic and anisotropic yarn from Gebart’s model. It was observed that the variation of mesoscale permeability Kxx within 30% when the isotropic porous yarn is considered for a 3D fabric with binder yarn. Furthermore, the permeability model developed in this study will be used for multi-objective optimizations of the preform mesoscale geometry in terms of yarn spacing, binder pattern, and a number of layers with an aim to obtain improved permeability and reduced void content during the LCM process.

Keywords: permeability, 3D fabric, dual-scale flow, liquid composite molding

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514 The Effect of Metal-Organic Framework Pore Size to Hydrogen Generation of Ammonia Borane via Nanoconfinement

Authors: Jing-Yang Chung, Chi-Wei Liao, Jing Li, Bor Kae Chang, Cheng-Yu Wang

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Chemical hydride ammonia borane (AB, NH3BH3) draws attentions to hydrogen energy researches for its high theoretical gravimetrical capacity (19.6 wt%). Nevertheless, the elevated AB decomposition temperatures (Td) and unwanted byproducts are main hurdles in practical application. It was reported that the byproducts and Td can be reduced with nanoconfinement technique, in which AB molecules are confined in porous materials, such as porous carbon, zeolite, metal-organic frameworks (MOFs), etc. Although nanoconfinement empirically shows effectiveness on hydrogen generation temperature reduction in AB, the theoretical mechanism is debatable. Low Td was reported in AB@IRMOF-1 (Zn4O(BDC)3, BDC = benzenedicarboxylate), where Zn atoms form closed metal clusters secondary building unit (SBU) with no exposed active sites. Other than nanosized hydride, it was also observed that catalyst addition facilitates AB decomposition in the composite of Li-catalyzed carbon CMK-3, MOF JUC-32-Y with exposed Y3+, etc. It is believed that nanosized AB is critical for lowering Td, while active sites eliminate byproducts. Nonetheless, some researchers claimed that it is the catalytic sites that are the critical factor to reduce Td, instead of the hydride size. The group physically ground AB with ZIF-8 (zeolitic imidazolate frameworks, (Zn(2-methylimidazolate)2)), and found similar reduced Td phenomenon, even though AB molecules were not ‘confined’ or forming nanoparticles by physical hand grinding. It shows the catalytic reaction, not nanoconfinement, leads to AB dehydrogenation promotion. In this research, we explored the possible criteria of hydrogen production temperature from nanoconfined AB in MOFs with different pore sizes and active sites. MOFs with metal SBU such as Zn (IRMOF), Zr (UiO), and Al (MIL-53), accompanying with various organic ligands (BDC and BPDC; BPDC = biphenyldicarboxylate) were modified with AB. Excess MOFs were used for AB size constrained in micropores estimated by revisiting Horvath-Kawazoe model. AB dissolved in methanol was added to MOFs crystalline with MOF pore volume to AB ratio 4:1, and the slurry was dried under vacuum to collect AB@MOF powders. With TPD-MS (temperature programmed desorption with mass spectroscopy), we observed Td was reduced with smaller MOF pores. For example, it was reduced from 100°C to 64°C when MOF micropore ~1 nm, while ~90°C with pore size up to 5 nm. The behavior of Td as a function of AB crystalline radius obeys thermodynamics when the Gibbs free energy of AB decomposition is zero, and no obvious correlation with metal type was observed. In conclusion, we discovered Td of AB is proportional to the reciprocal of MOF pore size, possibly stronger than the effect of active sites.

Keywords: ammonia borane, chemical hydride, metal-organic framework, nanoconfinement

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513 Fiberoptic Intubation Skills Training Improves Emergency Medicine Resident Comfort Using Modality

Authors: Nicholus M. Warstadt, Andres D. Mallipudi, Oluwadamilola Idowu, Joshua Rodriguez, Madison M. Hunt, Soma Pathak, Laura P. Weber

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Endotracheal intubation is a core procedure performed by emergency physicians. This procedure is a high risk, and failure results in substantial morbidity and mortality. Fiberoptic intubation (FOI) is the standard of care in difficult airway protocols, yet no widespread practice exists for training emergency medicine (EM) residents in the technical acquisition of FOI skills. Simulation on mannequins is commonly utilized to teach advanced airway techniques. As part of a program to introduce FOI into our ED, residents received hands-on training in FOI as part of our weekly resident education conference. We hypothesized that prior to the hands-on training, residents had little experience with FOI and were uncomfortable with using fiberoptic as a modality. We further hypothesized that resident comfort with FOI would increase following the training. The education intervention consisted of two hours of focused airway teaching and skills acquisition for PGY 1-4 residents. One hour was dedicated to four case-based learning stations focusing on standard, pediatric, facial trauma, and burn airways. Direct, video, and fiberoptic airway equipment were available to use at the residents’ discretion to intubate mannequins at each station. The second hour involved direct instructor supervision and immediate feedback during deliberate practice for FOI of a mannequin. Prior to the hands-on training, a pre-survey was sent via email to all EM residents at NYU Grossman School of Medicine. The pre-survey asked how many FOI residents have performed in the ED, OR, and on a mannequin. The pre-survey and a post-survey asked residents to rate their comfort with FOI on a 5-point Likert scale ("extremely uncomfortable", "somewhat uncomfortable", "neither comfortable nor uncomfortable", "somewhat comfortable", and "extremely comfortable"). The post-survey was administered on site immediately following the training. A two-sample chi-square test of independence was calculated comparing self-reported resident comfort on the pre- and post-survey (α ≤ 0.05). Thirty-six of a total of 70 residents (51.4%) completed the pre-survey. Of pre-survey respondents, 34 residents (94.4%) had performed 0, 1 resident (2.8%) had performed 1, and 1 resident (2.8%) had performed 2 FOI in the ED. Twenty-five residents (69.4%) had performed 0, 6 residents (16.7%) had performed 1, 2 residents (5.6%) had performed 2, 1 resident (2.8%) had performed 3, and 2 residents (5.6%) had performed 4 FOI in the OR. Seven residents (19.4%) had performed 0, and 16 residents (44.4%) had performed 5 or greater FOI on a mannequin. 29 residents (41.4%) attended the hands-on training, and 27 out of 29 residents (93.1%) completed the post-survey. Self-reported resident comfort with FOI significantly increased in post-survey compared to pre-survey questionnaire responses (p = 0.00034). Twenty-one of 27 residents (77.8%) report being “somewhat comfortable” or “extremely comfortable” with FOI on the post-survey, compared to 9 of 35 residents (25.8%) on the pre-survey. We show that dedicated FOI training is associated with increased learner comfort with such techniques. Further direction includes studying technical competency, skill retention, translation to direct patient care, and optimal frequency and methodology of future FOI education.

Keywords: airway, emergency medicine, fiberoptic intubation, medical simulation, skill acquisition

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512 Drug Delivery Cationic Nano-Containers Based on Pseudo-Proteins

Authors: Sophio Kobauri, Temur Kantaria, Nina Kulikova, David Tugushi, Ramaz Katsarava

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The elaboration of effective drug delivery vehicles is still topical nowadays since targeted drug delivery is one of the most important challenges of the modern nanomedicine. The last decade has witnessed enormous research focused on synthetic cationic polymers (CPs) due to their flexible properties, in particular as non-viral gene delivery systems, facile synthesis, robustness, not oncogenic and proven gene delivery efficiency. However, the toxicity is still an obstacle to the application in pharmacotherapy. For overcoming the problem, creation of new cationic compounds including the polymeric nano-size particles – nano-containers (NCs) loading with different pharmaceuticals and biologicals is still relevant. In this regard, a variety of NCs-based drug delivery systems have been developed. We have found that amino acid-based biodegradable polymers called as pseudo-proteins (PPs), which can be cleared from the body after the fulfillment of their function are highly suitable for designing pharmaceutical NCs. Among them, one of the most promising are NCs made of biodegradable Cationic PPs (CPPs). For preparing new cationic NCs (CNCs), we used CPPs composed of positively charged amino acid L-arginine (R). The CNCs were fabricated by two approaches using: (1) R-based homo-CPPs; (2) Blends of R-based CPPs with regular (neutral) PPs. According to the first approach NCs we prepared from CPPs 8R3 (composed of R, sebacic acid and 1,3-propanediol) and 8R6 (composed of R, sebacic acid and 1,6-hexanediol). The NCs prepared from these CPPs were 72-101 nm in size with zeta potential within +30 ÷ +35 mV at a concentration 6 mg/mL. According to the second approach, CPPs 8R6 was blended in organic phase with neutral PPs 8L6 (composed of leucine, sebacic acid and 1,6-hexanediol). The NCs prepared from the blends were 130-140 nm in size with zeta potential within +20 ÷ +28 mV depending on 8R6/8L6 ratio. The stability studies of fabricated NCs showed that no substantial change of the particle size and distribution and no big particles’ formation is observed after three months storage. In vitro biocompatibility study of the obtained NPs with four different stable cell lines: A549 (human), U-937 (human), RAW264.7 (murine), Hepa 1-6 (murine) showed both type cathionic NCs are biocompatible. The obtained data allow concluding that the obtained CNCs are promising for the application as biodegradable drug delivery vehicles. This work was supported by the joint grant from the Science and Technology Center in Ukraine and Shota Rustaveli National Science Foundation of Georgia #6298 'New biodegradable cationic polymers composed of arginine and spermine-versatile biomaterials for various biomedical applications'.

Keywords: biodegradable polymers, cationic pseudo-proteins, nano-containers, drug delivery vehicles

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