Search results for: multi floating body
Commenced in January 2007
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Edition: International
Paper Count: 7956

Search results for: multi floating body

126 Environmental Life Cycle Assessment of Circular, Bio-Based and Industrialized Building Envelope Systems

Authors: N. Cihan KayaçEtin, Stijn Verdoodt, Alexis Versele

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The construction industry is accounted for one-third of all waste generated in the European Union (EU) countries. The Circular Economy Action Plan of the EU aims to tackle this issue and aspires to enhance the sustainability of the construction industry by adopting more circular principles and bio-based material use. The Interreg Circular Bio-Based Construction Industry (CBCI) project was conceived to research how this adoption can be facilitated. For this purpose, an approach is developed that integrates technical, legal and social aspects and provides business models for circular designing and building with bio-based materials. In the scope of the project, the research outputs are to be displayed in a real-life setting by constructing a demo terraced single-family house, the living lab (LL) located in Ghent (Belgium). The realization of the LL is conducted in a step-wise approach that includes iterative processes for design, description, criteria definition and multi-criteria assessment of building components. The essence of the research lies within the exploratory approach to the state-of-art building envelope and technical systems options for achieving an optimum combination for a circular and bio-based construction. For this purpose, nine preliminary designs (PD) for building envelope are generated, which consist of three basic construction methods: masonry, lightweight steel construction and wood framing construction supplemented with bio-based construction methods like cross-laminated timber (CLT) and massive wood framing. A comparative analysis on the PDs was conducted by utilizing several complementary tools to assess the circularity. This paper focuses on the life cycle assessment (LCA) approach for evaluating the environmental impact of the LL Ghent. The adoption of an LCA methodology was considered critical for providing a comprehensive set of environmental indicators. The PDs were developed at the component level, in particular for the (i) inclined roof, (ii-iii) front and side façade, (iv) internal walls and (v-vi) floors. The assessment was conducted on two levels; component and building level. The options for each component were compared at the first iteration and then, the PDs as an assembly of components were further analyzed. The LCA was based on a functional unit of one square meter of each component and CEN indicators were utilized for impact assessment for a reference study period of 60 years. A total of 54 building components that are composed of 31 distinct materials were evaluated in the study. The results indicate that wood framing construction supplemented with bio-based construction methods performs environmentally better than the masonry or steel-construction options. An analysis on the correlation between the total weight of components and environmental impact was also conducted. It was seen that masonry structures display a high environmental impact and weight, steel structures display low weight but relatively high environmental impact and wooden framing construction display low weight and environmental impact. The study provided valuable outputs in two levels: (i) several improvement options at component level with substitution of materials with critical weight and/or impact per unit, (ii) feedback on environmental performance for the decision-making process during the design phase of a circular single family house.

Keywords: circular and bio-based materials, comparative analysis, life cycle assessment (LCA), living lab

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125 Challenges and Proposals for Public Policies Aimed At Increasing Energy Efficiency in Low-Income Communities in Brazil: A Multi-Criteria Approach

Authors: Anna Carolina De Paula Sermarini, Rodrigo Flora Calili

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Energy Efficiency (EE) needs investments, new technologies, greater awareness and management on the side of citizens and organizations, and more planning. However, this issue is usually remembered and discussed only in moments of energy crises, and opportunities are missed to take better advantage of the potential of EE in the various sectors of the economy. In addition, there is little concern about the subject among the less favored classes, especially in low-income communities. Accordingly, this article presents suggestions for public policies that aim to increase EE for low-income housing and communities based on international and national experiences. After reviewing the literature, eight policies were listed, and to evaluate them; a multicriteria decision model was developed using the AHP (Analytical Hierarchy Process) and TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) methods, combined with fuzzy logic. Nine experts analyzed the policies according to 9 criteria: economic impact, social impact, environmental impact, previous experience, the difficulty of implementation, possibility/ease of monitoring and evaluating the policies, expected impact, political risks, and public governance and sustainability of the sector. The results found in order of preference are (i) Incentive program for equipment replacement; (ii) Community awareness program; (iii) EE Program with a greater focus on low income; (iv) Staggered and compulsory certification of social interest buildings; (v) Programs for the expansion of smart metering, energy monitoring and digitalization; (vi) Financing program for construction and retrofitting of houses with the emphasis on EE; (vii) Income tax deduction for investment in EE projects in low-income households made by companies; (viii) White certificates of energy for low-income. First, the policy of equipment substitution has been employed in Brazil and the world and has proven effective in promoting EE. For implementation, efforts are needed from the federal and state governments, which can encourage companies to reduce prices, and provide some type of aid for the purchase of such equipment. In second place is the community awareness program, promoting socio-educational actions on EE concepts and with energy conservation tips. This policy is simple to implement and has already been used by many distribution utilities in Brazil. It can be carried out through bids defined by the government in specific areas, being executed by third sector companies with public and private resources. Third on the list is the proposal to continue the Energy Efficiency Program (which obliges electric energy companies to allocate resources for research in the area) by suggesting the return of the mandatory investment of 60% of the resources in projects for low income. It is also relatively simple to implement, requiring efforts by the federal government to make it mandatory, and on the part of the distributors, compliance is needed. The success of the suggestions depends on changes in the established rules and efforts from the interested parties. For future work, we suggest the development of pilot projects in low-income communities in Brazil and the application of other multicriteria decision support methods to compare the results obtained in this study.

Keywords: energy efficiency, low-income community, public policy, multicriteria decision making

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124 Cell-free Bioconversion of n-Octane to n-Octanol via a Heterogeneous and Bio-Catalytic Approach

Authors: Shanna Swart, Caryn Fenner, Athanasios Kotsiopoulos, Susan Harrison

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Linear alkanes are produced as by-products from the increasing use of gas-to-liquid fuel technologies for synthetic fuel production and offer great potential for value addition. Their current use as low-value fuels and solvents do not maximize this potential. Therefore, attention has been drawn towards direct activation of these aliphatic alkanes to more useful products such as alcohols, aldehydes, carboxylic acids and derivatives. Cytochrome P450 monooxygenases (P450s) can be used for activation of these aliphatic alkanes using whole-cells or cell-free systems. Some limitations of whole-cell systems include reduced mass transfer, stability and possible side reactions. Since the P450 systems are little studied as cell-free systems, they form the focus of this study. Challenges of a cell-free system include co-factor regeneration, substrate availability and enzyme stability. Enzyme immobilization offers a positive outlook on this dilemma, as it may enhance stability of the enzyme. In the present study, 2 different P450s (CYP153A6 and CYP102A1) as well as the relevant accessory enzymes required for electron transfer (ferredoxin and ferredoxin reductase) and co-factor regeneration (glucose dehydrogenase) have been expressed in E. coli and purified by metal affinity chromatography. Glucose dehydrogenase (GDH), was used as a model enzyme to assess the potential of various enzyme immobilization strategies including; surface attachment on MagReSyn® microspheres with various functionalities and on electrospun nanofibers, using self-assembly based methods forming Cross Linked Enzymes (CLE), Cross Linked Enzyme Aggregates (CLEAs) and spherezymes as well as in a sol gel. The nanofibers were synthesized by electrospinning, which required the building of an electrospinning machine. The nanofiber morphology has been analyzed by SEM and binding will be further verified by FT-IR. Covalent attachment based methods showed limitations where only ferredoxin reductase and GDH retained activity after immobilization which were largely attributed to insufficient electron transfer and inactivation caused by the crosslinkers (60% and 90% relative activity loss for the free enzyme when using 0.5% glutaraldehyde and glutaraldehyde/ethylenediamine (1:1 v/v), respectively). So far, initial experiments with GDH have shown the most potential when immobilized via their His-tag onto the surface of MagReSyn® microspheres functionalized with Ni-NTA. It was found that Crude GDH could be simultaneously purified and immobilized with sufficient activity retention. Immobilized pure and crude GDH could be recycled 9 and 10 times, respectively, with approximately 10% activity remaining. The immobilized GDH was also more stable than the free enzyme after storage for 14 days at 4˚C. This immobilization strategy will also be applied to the P450s and optimized with regards to enzyme loading and immobilization time, as well as characterized and compared with the free enzymes. It is anticipated that the proposed immobilization set-up will offer enhanced enzyme stability (as well as reusability and easy recovery), minimal mass transfer limitation, with continuous co-factor regeneration and minimal enzyme leaching. All of which provide a positive outlook on this robust multi-enzyme system for efficient activation of linear alkanes as well as the potential for immobilization of various multiple enzymes, including multimeric enzymes for different bio-catalytic applications beyond alkane activation.

Keywords: alkane activation, cytochrome P450 monooxygenase, enzyme catalysis, enzyme immobilization

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123 An Interdisciplinary Maturity Model for Accompanying Sustainable Digital Transformation Processes in a Smart Residential Quarter

Authors: Wesley Preßler, Lucie Schmidt

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Digital transformation is playing an increasingly important role in the development of smart residential quarters. In order to accompany and steer this process and ultimately make the success of the transformation efforts measurable, it is helpful to use an appropriate maturity model. However, conventional maturity models for digital transformation focus primarily on the evaluation of processes and neglect the information and power imbalances between the stakeholders, which affects the validity of the results. The Multi-Generation Smart Community (mGeSCo) research project is developing an interdisciplinary maturity model that integrates the dimensions of digital literacy, interpretive patterns, and technology acceptance to address this gap. As part of the mGeSCo project, the technological development of selected dimensions in the Smart Quarter Jena-Lobeda (Germany) is being investigated. A specific maturity model, based on Cohen's Smart Cities Wheel, evaluates the central dimensions Working, Living, Housing and Caring. To improve the reliability and relevance of the maturity assessment, the factors Digital Literacy, Interpretive Patterns and Technology Acceptance are integrated into the developed model. The digital literacy dimension examines stakeholders' skills in using digital technologies, which influence their perception and assessment of technological maturity. Digital literacy is measured by means of surveys, interviews, and participant observation, using the European Commission's Digital Literacy Framework (DigComp) as a basis. Interpretations of digital technologies provide information about how individuals perceive technologies and ascribe meaning to them. However, these are not mere assessments, prejudices, or stereotyped perceptions but collective patterns, rules, attributions of meaning and the cultural repertoire that leads to these opinions and attitudes. Understanding these interpretations helps in assessing the overarching readiness of stakeholders to digitally transform a/their neighborhood. This involves examining people's attitudes, beliefs, and values about technology adoption, as well as their perceptions of the benefits and risks associated with digital tools. These insights provide important data for a holistic view and inform the steps needed to prepare individuals in the neighborhood for a digital transformation. Technology acceptance is another crucial factor for successful digital transformation to examine the willingness of individuals to adopt and use new technologies. Surveys or questionnaires based on Davis' Technology Acceptance Model can be used to complement interpretive patterns to measure neighborhood acceptance of digital technologies. Integrating the dimensions of digital literacy, interpretive patterns and technology acceptance enables the development of a roadmap with clear prerequisites for initiating a digital transformation process in the neighborhood. During the process, maturity is measured at different points in time and compared with changes in the aforementioned dimensions to ensure sustainable transformation. Participation, co-creation, and co-production are essential concepts for a successful and inclusive digital transformation in the neighborhood context. This interdisciplinary maturity model helps to improve the assessment and monitoring of sustainable digital transformation processes in smart residential quarters. It enables a more comprehensive recording of the factors that influence the success of such processes and supports the development of targeted measures to promote digital transformation in the neighborhood context.

Keywords: digital transformation, interdisciplinary, maturity model, neighborhood

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122 Climate Change Implications on Occupational Health and Productivity in Tropical Countries: Study Results from India

Authors: Vidhya Venugopal, Jeremiah Chinnadurai, Rebekah A. I. Lucas, Tord Kjellstrom, Bruno Lemke

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Introduction: The effects of climate change (CC) are largely discussed across the globe in terms of impacts on the environment and the general population, but the impacts on workers remain largely unexplored. The predicted rise in temperatures and heat events in the CC scenario have health implications on millions of workers in physically exerting jobs. The current health and productivity risks associated with heat exposures are characterized, future risk estimates as temperature rises and recommendations towards developing protective and preventive occupational health and safety guidelines for India are discussed. Methodology: Cross-sectional studies were conducted in several occupational sectors with workers engaged in moderate to heavy labor (n=1580). Quantitative data on heat exposures (WBGT°C), physiological heat strain indicators viz., Core temperature (CBT), Urine specific gravity (USG), Sweat rate (SwR) and qualitative data on heat-related health symptoms and productivity losses were collected. Data were analyzed for associations between heat exposures, health and productivity outcomes related to heat stress. Findings: Heat conditions exceeded the Threshold Limit Value (TLV) for safe manual work in 66% of the workers across several sectors (Avg.WBGT of 28.7°C±3.1°C). Widespread concerns about heat-related health outcomes (86%) were prevalent among workers exposed to high TLVs, with excessive sweating, fatigue and tiredness being commonly reported by workers. The heat stress indicators, core temperature (14%), Sweat rate (8%) and USG (9%), were above normal levels in the study population. A significant association was found between rise in Core Temperatures and WBGT exposures (p=0.000179) Elevated USG and SwR in the worker population indicate moderate dehydration, with potential risks of developing heat-related illnesses. In a steel industry with high heat exposures, an alarming 9% prevalence of kidney/urogenital anomalies was observed in a young workforce. Heat exposures above TLVs were associated with significantly increased odds of various adverse health outcomes (OR=2.43, 95% CI 1.88 to 3.13, p-value = <0.0001) and productivity losses (OR=1.79, 95% CI 1.32 to 2.4, p-value = 0.0002). Rough estimates for the number of workers who would be subjected to higher than TLV levels in the various RCP scenarios are RCP2.6 =79%, RCP4.5 & RCP6 = 81% and at RCP 8.5 = 85%. Rising temperatures due to CC has the capacity to further reduce already compromised health and productivity by subjecting the workers to increased heat exposures in the RCP scenarios are of concern for the country’s occupational health and economy. Conclusion: The findings of this study clearly identify that health protection from hot weather will become increasingly necessary in the Indian subcontinent and understanding the various adaptation techniques needs urgent attention. Further research with a multi-targeted approach to develop strategies for implementing interventions to protect the millions of workers is imperative. Approaches to include health aspects of climate change within sectoral and climate change specific policies should be encouraged, via a number of mechanisms, such as the “Health in All Policies” approach to avert adverse health and productivity consequences as climate change proceeds.

Keywords: heat stress, occupational health, productivity loss, heat strain, adverse health outcomes

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121 Severe Post Operative Gas Gangrene of the Liver: Off-Label Treatment by Percutaneous Radiofrequency Ablation

Authors: Luciano Tarantino

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Gas gangrene is a rare, severe infection with a very high mortality rate caused by Clostridium species. The infection causes a non-suppurative localized producing gas lesion from which harmful toxins that impair the inflammatory response cause vessel damage and multiple organ failure. Gas gangrene of the liver is very rare and develops suddenly, often as a complication of abdominal surgery and liver transplantation. The present paper deals with a case of gas gangrene of the liver that occurred after percutaneous MW ablation of hepatocellular carcinoma, resulting in progressive liver necrosis and multi-organ failure in spite of specific antibiotics administration. The patient was successfully treated with percutaneous Radiofrequency ablation. Case report: Female, 76 years old, Child A class cirrhosis, treated with synchronous insertion of 3 MW antennae for large HCC (5.5 cm) in the VIII segment. 24 hours after treatment, the patient was asymptomatic and left the hospital . 2 days later, she complained of fever, weakness, abdominal swelling, and pain. Abdominal US detected a 2.3 cm in size gas-containing area, eccentric within the large (7 cm) ablated area. The patient was promptly hospitalized with the diagnosis of anaerobic liver abscess and started antibiotic therapy with Imipenem/cilastatine+metronidazole+teicoplanine. On the fourth day, the patient was moved to the ICU because of dyspnea, congestive heart failure, atrial fibrillation, right pleural effusion, ascites, and renal failure. Blood tests demonstrated severe leukopenia and neutropenia, anemia, increased creatinine and blood nitrogen, high-level FDP, and high INR. Blood cultures were negative. At US, unenhanced CT, and CEUS, a progressive enlargement of the infected liver lesion was observed. Percutaneous drainage was attempted, but only drops of non-suppurative brownish material could be obtained. Pleural and peritoneal drainages gave serosanguineous muddy fluid. The Surgeon and the Anesthesiologist excluded any indication of surgical resection because of the high perioperative mortality risk. Therefore, we asked for the informed consent of the patient and her relatives to treat the gangrenous liver lesion by percutaneous Ablation. Under conscious sedation, percutaneous RFA of GG was performed by double insertion of 3 cool-tip needles (Covidien LDT, USA ) into the infected area. The procedure was well tolerated by the patient. A dramatic improvement in the patient's condition was observed in the subsequent 24 hours and thereafter. Fever and dyspnea disappeared. Normalization of blood tests, including creatinine, was observed within 4 days. Heart performance improved, 10 days after the RFA the patient left the hospital and was followed-up with weekly as an outpatient for 2 months and every two months thereafter. At 18 months follow-up, the patient is well compensated (Child-Pugh class B7), without any peritoneal or pleural effusion and without any HCC recurrence at imaging (US every 3 months, CT every 6 months). Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients non-responder to antibiotics and when surgery and liver transplantation are not feasible. A fast and early indication is needed in case of rapid worsening of patient's conditions.

Keywords: liver tumor ablation, interventional ultrasound, liver infection, gas gangrene, radiofrequency ablation

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120 Relationship between Illegal Wildlife Trade and Community Conservation: A Case Study of the Chepang Community in Nepal

Authors: Vasundhara H. Krishnani, Ajay Saini, Dibesh Karmacharya, Salit Kark

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Illegal Wildlife Trade is one of the most pressing global conservation challenges. Unregulated wildlife trade can threaten biodiversity, contribute to habitat loss, limit sustainable development efforts, and expedite species declines and extinctions. In low-income and middle-income countries, such as Nepal and other countries in Asia and Africa, many of the people engaged in the early stages of illegal wildlife trade, which includes the hunting and transportation of wildlife, belong to Indigenous tribes and local communities.These countries primarily rely on punitive measures to prevent and suppress Illegal Wildlife Trade. For example, in Nepal, people involved in wildlife crimes can often be sentenced to incarceration and a hefty fine and serve up to 15 years in prison. Despite these harsh punitive measures, illegal wildlife trade remains a significant conservation challenge in many countries. The aim of this study was to examine factors affecting the participation of Indigenous communities in Illegal Wildlife Trade while recording the experiences of members of the Indigenous Chepang community, some of whom were imprisoned for their alleged involvement in rhino poaching. Chepangs, belonging to traditionally a hunter-gatherer community, are often considered an isolated and marginalized Indigenous community, some of whom live around the Chitwan National Park in Nepal. Established in 1973, Chitwan National Park is situated in the Chitwan Valley of Nepal and was one of the first regions that was declared as a protected area in Nepal, aiming to protect the one-horned rhinoceros as a flagship species. Conducted over a period of three years, this study used semi-structured interviews and focus group discussions to collect data from Illegal Wildlife Trade offenders, family members of offenders, community Elders, NGO personnel, community forest representatives, Chepang community representatives, and Government school teachers from the region surrounding Chitwan National Park. The study also examined the social, cultural, health, and financial impacts that the imprisonment of offenders had on the families of the community members, especially women and children. The results suggest that involvement of the members of the Chepang community living around Chitwan National Park in the poaching of the one-horned rhinoceros (Rhinoceros unicornis) can be attributed to a range of factors, some of which include: lack of livelihood opportunities, lack of awareness regarding wildlife rules and regulations and poverty.This work emphasises the need for raising awareness and building programs to enhance alternative livelihood training and empower indigenous and marginalised communities that provide sustainable alternatives. Furthermore, the issue needs to be addressed as a community solution which includes all community members. We suggest this multi-pronged approach can benefit wildlife conservation by reducing illegal poaching and wildlife trade, as well as community conservation in regions with similar challenges. By actively involving and empowering local communities, the communities become key stakeholders in the conservation process. This involvement contributes to protecting wildlife and natural ecosystems while simultaneously providing sustainable livelihood options for local communities.

Keywords: alternative livelihoods, chepang community, illegal wildlife trade, low-and middle-income countries, nepal, one-horned rhinoceros

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119 Risk Factors Associated to Low Back Pain among Active Adults: Cross-Sectional Study among Workers in Tunisian Public Hospital

Authors: Lamia Bouzgarrou, Irtyah Merchaoui, Amira Omrane, Salma Kammoun, Amine Daafa, Neila Chaari

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Backgrounds: Currently, low back pain (LBP) is one of the most prevalent public health problems, which caused severe morbidity among a large portion of the adult population. It is also associated with heavy direct and indirect costs, in particular, related to absenteeism and early retirement. Health care workers are one of most occupational groups concerned by LBP, especially because of biomechanical and psycho-organizational risk factors. Our current study aims to investigate risk factors associated with chronic low back pain among Tunisian caregivers in university-hospitals. Methods: Cross-sectional study conducted over a period of 14 months, with a representative sample of caregivers, matched according to age, sex and work department, in two university-hospitals in Tunisia. Data collection included items related to socio-professional characteristics, the evaluation of the working capacity index (WAI), the occupational stress (Karazek job strain questionnaire); the quality of life (SF12), the musculoskeletal disorders Nordic questionnaire, and the examination of the spine flexibility (distance finger-ground, sit-stand maneuver and equilibrium test). Results: Totally, 293 caregivers were included with a mean age equal to 42.64 ± 11.65 years. A body mass index (BMI) exceeding 30, was noted in 20.82% of cases. Moreover, no regular physical activity was practiced in 51.9% of cases. In contrast, domestic activity equal or exceeding 20 hours per week, was reported by 38.22%. Job strain was noted in 19.79 % of cases and the work capacity was 'low' to 'average' among 27.64% of subjects. During the 12 months previous to the investigation, 65% of caregivers complained of LBP, with pain rated as 'severe' or 'extremely severe' in 54.4% of cases and with a frequency of discomfort exceeding one episode per week in 58.52% of cases. During physical examination, the mean distance finger-ground was 7.10 ± 7.5cm. Caregivers assigned to 'high workload' services had the highest prevalence of LBP (77.4%) compared to other categories of hospital services, with no statistically significant relationship (P = 0.125). LBP prevalence was statistically correlated with female gender (p = 0.01) and impaired work capacity (p < 10⁻³). Moreover, the increase of the distance finger-ground was statistically associated with LBP (p = 0.05), advanced age (p < 10⁻³), professional seniority (p < 10⁻³) and the BMI ≥ 25 (p = 0.001). Furthermore, others physical tests of spine flexibility were underperformed among LBP suffering workers with a statistically significant difference (sit-stand maneuver (p = 0.03); equilibrium test (p = 0.01)). According to the multivariate analysis, only the domestic activity exceeding 20H/week, the degraded quality of physical life, and the presence of neck pain were significantly corelated to LBP. The final model explains 36.7% of the variability of this complaint. Conclusion: Our results highlighted the elevate prevalence of LBP among caregivers in Tunisian public hospital and identified both professional and individual predisposing factors. The preliminary analysis supports the necessity of a multidimensional approach to prevent this critical occupational and public health problem. The preventive strategy should be based both on the improvement of working conditions, and also on lifestyle modifications, and reinforcement of healthy behaviors in these active populations.

Keywords: health care workers, low back pain, prevention, risk factor

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118 A Computational Investigation of Potential Drugs for Cholesterol Regulation to Treat Alzheimer’s Disease

Authors: Marina Passero, Tianhua Zhai, Zuyi (Jacky) Huang

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Alzheimer’s disease has become a major public health issue, as indicated by the increasing populations of Americans living with Alzheimer’s disease. After decades of extensive research in Alzheimer’s disease, only seven drugs have been approved by Food and Drug Administration (FDA) to treat Alzheimer’s disease. Five of these drugs were designed to treat the dementia symptoms, and only two drugs (i.e., Aducanumab and Lecanemab) target the progression of Alzheimer’s disease, especially the accumulation of amyloid-b plaques. However, controversial comments were raised for the accelerated approvals of either Aducanumab or Lecanemab, especially with concerns on safety and side effects of these two drugs. There is still an urgent need for further drug discovery to target the biological processes involved in the progression of Alzheimer’s disease. Excessive cholesterol has been found to accumulate in the brain of those with Alzheimer’s disease. Cholesterol can be synthesized in both the blood and the brain, but the majority of biosynthesis in the adult brain takes place in astrocytes and is then transported to the neurons via ApoE. The blood brain barrier separates cholesterol metabolism in the brain from the rest of the body. Various proteins contribute to the metabolism of cholesterol in the brain, which offer potential targets for Alzheimer’s treatment. In the astrocytes, SREBP cleavage-activating protein (SCAP) binds to Sterol Regulatory Element-binding Protein 2 (SREBP2) in order to transport the complex from the endoplasmic reticulum to the Golgi apparatus. Cholesterol is secreted out of the astrocytes by ATP-Binding Cassette A1 (ABCA1) transporter. Lipoprotein receptors such as triggering receptor expressed on myeloid cells 2 (TREM2) internalize cholesterol into the microglia, while lipoprotein receptors such as Low-density lipoprotein receptor-related protein 1 (LRP1) internalize cholesterol into the neuron. Cytochrome P450 Family 46 Subfamily A Member 1 (CYP46A1) converts excess cholesterol to 24S-hydroxycholesterol (24S-OHC). Cholesterol has been approved for its direct effect on the production of amyloid-beta and tau proteins. The addition of cholesterol to the brain promotes the activity of beta-site amyloid precursor protein cleaving enzyme 1 (BACE1), secretase, and amyloid precursor protein (APP), which all aid in amyloid-beta production. The reduction of cholesterol esters in the brain have been found to reduce phosphorylated tau levels in mice. In this work, a computational pipeline was developed to identify the protein targets involved in cholesterol regulation in brain and further to identify chemical compounds as the inhibitors of a selected protein target. Since extensive evidence shows the strong correlation between brain cholesterol regulation and Alzheimer’s disease, a detailed literature review on genes or pathways related to the brain cholesterol synthesis and regulation was first conducted in this work. An interaction network was then built for those genes so that the top gene targets were identified. The involvement of these genes in Alzheimer’s disease progression was discussed, which was followed by the investigation of existing clinical trials for those targets. A ligand-protein docking program was finally developed to screen 1.5 million chemical compounds for the selected protein target. A machine learning program was developed to evaluate and predict the binding interaction between chemical compounds and the protein target. The results from this work pave the way for further drug discovery to regulate brain cholesterol to combat Alzheimer’s disease.

Keywords: Alzheimer’s disease, drug discovery, ligand-protein docking, gene-network analysis, cholesterol regulation

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117 Effect of a Nutritional Supplement Containing Euterpe oleracea Mart., Inulin, Phaseolus vulgaris and Caralluma fimbriata in Persons with Metabolic Syndrome

Authors: Eduardo Cabrera-Rode, Janet Rodriguez, Aimee Alvarez, Ragmila Echevarria, Antonio D. Reyes, Ileana Cubas-Duenas, Silvia E. Turcios, Oscar Diaz-Diaz

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Obex is a nutritional supplement to help weight loss naturally. In addition, this supplement has a satiating effect that helps control the craving to eat between meals. The purpose of this study was to evaluate the effect of Obex in the metabolic syndrome (MS). This was an open label pilot study conducted in 30 patients with MS and ages between 29 and 60 years old. Participants received Obex, at a dose of one sachet before (30 to 45 minutes) the two main meals (lunch and dinner) daily (mean two sachets per day) for 3 months. The content of the sachets was dissolved in a glass of water or fruit juice. Obex ingredients: Açai (Euterpe oleracea Mart.) berry, inulin, Phaseolus vulgaris, Caralluma fimbriata, inositol, choline, arginine, ornitine, zinc sulfate, carnitine fumarate, methionine, calcium pantothenate, pyridoxine and folic acid. In addition to anthropometric measures and blood pressure, fasting plasma glucose, total cholesterol, triglycerides and HDL-cholesterol and insulin were determined. Insulin resistance was assessed by HOMA-IR index. Three indirect indexes were used to calculate insulin sensitivity [QUICKI index (Quantitative insulin sensitivity check index), Bennett index and Raynaud index]. Metabolic syndrome was defined according to the Joint Interim Statement (JIS) criteria. The JIS criteria require at least three of the following components: (1) abdominal obesity (waist circumference major or equal major or equal 94 cm for men or 80 cm for women), (2) triglycerides major or equal 1.7 mmol/L, (3) HDL cholesterol minor 1.03 mmol/L for men or minor 1.30 mmol/L for women, (4) systolic/diastolic blood pressure major or equal 130/85mmHg or use antihypertensive drugs, and (5) fasting plasma glucose major or equal 5.6 mmol/L or known treatment for diabetes. This study was approved by the Ethical and Research Committee of the National Institute of Endocrinology, Cuba and conducted according to the Declaration of Helsinki. Obex is registered as a food supplement in the National Institute of Nutrition and Food, Havana, Cuba. Written consent was obtained from all patients before the study. The clinical trial had been registered at ClinicalTrials.gov. After three months of treatment, 43.3% (13/30) of participants decreased the frequency of MS. Compared to baseline, Obex significantly reduced body weight, BMI, waist circumference, and waist/hip ratio and improved HDL-c (p<0.0001) and in addition to lowering blood pressure (p<0.05). After Obex intake, subjects also have shown a reduction in fasting plasma glucose (p<0.0001) and insulin sensitivity was enhanced (p=0.001). No adverse effects were seen in any of the participants during the study. In this pilot study, consumption of Obex decreased the prevalence of MS due to the improved selected components of the metabolic syndrome, indicating that further studies are warranted. Obex emerges as an effective and well tolerated treatment for preventing or delaying MS and therefore potential reduction of cardiovascular risk.

Keywords: nutritional supplement, metabolic syndrome, weight loss, insulin resistance

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116 Making the Right Call for Falls: Evaluating the Efficacy of a Multi-Faceted Trust Wide Approach to Improving Patient Safety Post Falls

Authors: Jawaad Saleem, Hannah Wright, Peter Sommerville, Adrian Hopper

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Introduction: Inpatient falls are the most commonly reported patient safety incidents, and carry a significant burden on resources, morbidity, and mortality. Ensuring adequate post falls management of patients by staff is therefore paramount to maintaining patient safety especially in out of hours and resource stretched settings. Aims: This quality improvement project aims to improve the current practice of falls management at Guys St Thomas Hospital, London as compared to our 2016 Quality Improvement Project findings. Furthermore, it looks to increase current junior doctors confidence in managing falls and their use of new guidance protocols. Methods: Multifaceted Interventions implemented included: the development of new trust wide guidelines detailing management pathways for patients post falls, available for intranet access. Furthermore, the production of 2000 lanyard cards distributed amongst junior doctors and staff which summarised these guidelines. Additionally, a ‘safety signal’ email was sent from the Trust chief medical officer to all staff raising awareness of falls and the guidelines. Formal falls teaching was also implemented for new doctors at induction. Using an established incident database, 189 consecutive falls in 2017were retrospectively analysed electronically to assess and compared to the variables measured in 2016 post interventions. A separate serious incident database was used to analyse 50 falls from May 2015 to March 2018 to ascertain the statistical significance of the impact of our interventions on serious incidents. A similar questionnaire for the 2017 cohort of foundation year one (FY1) doctors was performed and compared to 2016 results. Results: Questionnaire data demonstrated improved awareness and utility of guidelines and increased confidence as well as an increase in training. 97% of FY1 trainees felt that the interventions had increased their awareness of the impact of falls on patients in the trust. Data from the incident database demonstrated the time to review patients post fall had decreased from an average of 130 to 86 minutes. Improvement was also demonstrated in the reduced time to order and schedule X-ray and CT imaging, 3 and 5 hours respectively. Data from the serious incident database show that ‘the time from fall until harm was detected’ was statistically significantly lower (P = 0.044) post intervention. We also showed the incidence of significant delays in detecting harm ( > 10 hours) reduced post intervention. Conclusions: Our interventions have helped to significantly reduce the average time to assess, order and schedule appropriate imaging post falls. Delays of over ten hours to detect serious injuries after falls were commonplace; since the intervention, their frequency has markedly reduced. We suggest this will lead to identifying patient harm sooner, reduced clinical incidents relating to falls and thus improve overall patient safety. Our interventions have also helped increase clinical staff confidence, management, and awareness of falls in the trust. Next steps include expanding teaching sessions, improving multidisciplinary team involvement to aid this improvement.

Keywords: patient safety, quality improvement, serious incidents, falls, clinical care

Procedia PDF Downloads 113
115 Pathophysiological Implications in Immersion Treatment Methods of Icthyophthiriasis Disease in African Catfish (Clarias gariepinus) Using Moringa oleifera Extract

Authors: Ikele Chika Bright, Mgbenka Bernard Obialo, Ikele Chioma Faith

Abstract:

Icthyophthiriasis is a prevalent protozoan (ectoparasite) mostly affecting cultured and aquarium fishes. The majority of the chemotherapeutants lack efficacy for completely eliminating Ich parasite without affecting the environment and they are not safe for human health. The present work is focused on the evaluating different immersion treatments of African catfish (Clarias gariepinus) infected with ichthyophthiriasis and treated with a non-chemical and environmental friendly parasiticides Moringa oleifera. A total number of 800 apparently healthy parasites free (examined) post juvenile catfish were obtained from a reputable farm, disinfected with potassium permanganate in a quarantine tank to remove any possible external parasites. The fish were further challenged with approximately 44,000 infective stages of theronts which were obtained through serial passages by cohabitation. Seven groups (A-G) of post Juvenile were used for the experiment which was carried out into three stages; Dips (60minutes), short term treatment (24-96h) and prolong bath treatment (0-15 days). The concentrations selected were dependent on the outcome of the LC50 of the plant material from which dose-dependent factors were used to select various concentrations of the treatment. In Dips treatment, group D-G were treated with 1,500mg/L, 2500mg/L., 3500mg/L and 4500mg/L, short-term treatment was treated with 150mg/L, 250mg/L, 350mg/L and 450mg/L and prolong bath was treated with 15mg/L, 25mg/L, 35mg/L and 45mg/L of the plant extract whereas group A, B and C were normal control, Ich- infested not treated and Ich- infested treated with standard drug (Acriflavin), respectively. The various types of treatment applied with corresponding concentrations showed almost complete elimination of the adult parasites (trophonts) both in the gills and the body smear, thereby making M. oleifera a potential parasiticides. There were serious pathological alterations in the skin and gills which are usually the main point for Ich parasites invasion but no significant morphological characteristics was noted among the treated groups subjected to different immersion treatment patterns. Epitheliocystis, aneurysm, oedema, hemorrhage, and localization of the adult parasite in the gills were the overall common observations made in the gills whereas degeneration of muscle fibre, dermatitis, hemorrhage, oedema, abscess formation and keratinisation were observed in the skin. However, there are no pathological changes in the control group. Moreover, biochemical parameters such as urea, creatinine, albumin., globulin, total protein, ALT, AST), blood chemistry (sodium, chloride, potassium, bicarbonate), antioxidants (CAT, SOD, GPx, LPO), enzymatic activities (myeloperoxidase, thioreadoxin reductase), Inflammatory response (C-reactive protein), Stress markers (lactate dehydrogenase), heamatological parameters (RBC, PCV, WBC, HB and differential count), lipid profile (total cholesterol, tryglycerides , high density lipoprotein and low density lipoprotein) all showed various significant (P<0.05) and no significant (P>0.05) responses among the Ich-infested fish treated under three immersion treatments. It is suggested that M. oleifera may serve as an alternatives to chemotherapeutants for control of Ichthyophthiriasis in African catfish Clarias gariepinus.

Keywords: Icthyophthirius multifilis, immersion treatment, pathophysiology, African catfish

Procedia PDF Downloads 368
114 Calpoly Autonomous Transportation Experience: Software for Driverless Vehicle Operating on Campus

Authors: F. Tang, S. Boskovich, A. Raheja, Z. Aliyazicioglu, S. Bhandari, N. Tsuchiya

Abstract:

Calpoly Autonomous Transportation Experience (CATE) is a driverless vehicle that we are developing to provide safe, accessible, and efficient transportation of passengers throughout the Cal Poly Pomona campus for events such as orientation tours. Unlike the other self-driving vehicles that are usually developed to operate with other vehicles and reside only on the road networks, CATE will operate exclusively on walk-paths of the campus (potentially narrow passages) with pedestrians traveling from multiple locations. Safety becomes paramount as CATE operates within the same environment as pedestrians. As driverless vehicles assume greater roles in today’s transportation, this project will contribute to autonomous driving with pedestrian traffic in a highly dynamic environment. The CATE project requires significant interdisciplinary work. Researchers from mechanical engineering, electrical engineering and computer science are working together to attack the problem from different perspectives (hardware, software and system). In this abstract, we describe the software aspects of the project, with a focus on the requirements and the major components. CATE shall provide a GUI interface for the average user to interact with the car and access its available functionalities, such as selecting a destination from any origin on campus. We have developed an interface that provides an aerial view of the campus map, the current car location, routes, and the goal location. Users can interact with CATE through audio or manual inputs. CATE shall plan routes from the origin to the selected destination for the vehicle to travel. We will use an existing aerial map for the campus and convert it to a spatial graph configuration where the vertices represent the landmarks and edges represent paths that the car should follow with some designated behaviors (such as stay on the right side of the lane or follow an edge). Graph search algorithms such as A* will be implemented as the default path planning algorithm. D* Lite will be explored to efficiently recompute the path when there are any changes to the map. CATE shall avoid any static obstacles and walking pedestrians within some safe distance. Unlike traveling along traditional roadways, CATE’s route directly coexists with pedestrians. To ensure the safety of the pedestrians, we will use sensor fusion techniques that combine data from both lidar and stereo vision for obstacle avoidance while also allowing CATE to operate along its intended route. We will also build prediction models for pedestrian traffic patterns. CATE shall improve its location and work under a GPS-denied situation. CATE relies on its GPS to give its current location, which has a precision of a few meters. We have implemented an Unscented Kalman Filter (UKF) that allows the fusion of data from multiple sensors (such as GPS, IMU, odometry) in order to increase the confidence of localization. We also noticed that GPS signals can easily get degraded or blocked on campus due to high-rise buildings or trees. UKF can also help here to generate a better state estimate. In summary, CATE will provide on-campus transportation experience that coexists with dynamic pedestrian traffic. In future work, we will extend it to multi-vehicle scenarios.

Keywords: driverless vehicle, path planning, sensor fusion, state estimate

Procedia PDF Downloads 123
113 Guard@Lis: Birdwatching Augmented Reality Mobile Application

Authors: Jose A. C. Venancio, Alexandrino J. M. Goncalves, Anabela Marto, Nuno C. S. Rodrigues, Rita M. T. Ascenso

Abstract:

Nowadays, it is common to find people who are concerned about getting away from the everyday life routine, looking forward to outcome well-being and pleasant emotions. Trying to disconnect themselves from the usual places of work and residence, they pursue different places, such as tourist destinations, aiming to have unexpected experiences. In order to make this exploration process easier, cities and tourism agencies seek new opportunities and solutions, creating routes with diverse cultural landmarks, including natural landscapes and historic buildings. These offers frequently aspire to the preservation of the local patrimony. In nature and wildlife, birdwatching is an activity that has been increasing, both in cities and in the countryside. This activity seeks to find, observe and identify the diversity of birds that live permanently or temporarily in these places, and it is usually supported by birdwatching guides. Leiria (Portugal) is a well-known city, presenting several historical and natural landmarks, like the Lis river and the castle where King D. Dinis lived in the 13th century. Along the Lis River, a conservation process was carried out and a pedestrian route was created (Polis project). This is considered an excellent spot for birdwatching, especially for the gray heron (Ardea cinerea) and for the kingfisher (Alcedo atthis). There is also a route through the city, from the riverside to the castle, which encloses a characterized variety of species, such as the barn swallow (Hirundo rustica), known for passing through different seasons of the year. Birdwatching is sometimes a difficult task since it is not always possible to see all bird species that inhabit a given place. For this reason, a need to create a technological solution was found to ease this activity. This project aims to encourage people to learn about the various species of birds that live along the Lis River and to promote the preservation of nature in a conscious way. This work is being conducted in collaboration with Leiria Municipal Council and with the Environmental Interpretation Centre. It intends to show the majesty of the Lis River, a place visited daily by several people, such as children and families, who use it for didactic and recreational activities. We are developing a mobile multi-platform application (Guard@Lis) that allows bird species to be observed along a given route, using representative digital 3D models through the integration of augmented reality technologies. Guard@Lis displays a route with points of interest for birdwatching and a list of species for each point of interest, along with scientific information, images and sounds for every species. For some birds, to ensure their observation, the user can watch them in loco, in their real and natural environment, with their mobile device by means of augmented reality, giving the sensation of presence of these birds, even if they cannot be seen in that place at that moment. The augmented reality feature is being developed with Vuforia SDK, using a hybrid approach to recognition and tracking processes, combining marks and geolocation techniques. This application proposes routes and notifies users with alerts for the possibility of viewing models of augmented reality birds. The final Guard@Lis prototype will be tested by volunteers in-situ.

Keywords: augmented reality, birdwatching route, mobile application, nature tourism, watch birds using augmented reality

Procedia PDF Downloads 151
112 Differential Survival Rates of Pseudomonas aeruginosa Strains on the Wings of Pantala flavescens

Authors: Banu Pradheepa Kamarajan, Muthusamy Ananthasubramanian

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Biofilm forming Pseudomonads occupy the top third position in causing hospital acquired infections. P. aeruginosa is notoriously known for its tendency to develop drug resistance. Major classes of drug such as β-lactams, aminoglycosides, quinolones, and polymyxins are found ineffective against multi-drug resistance Pseudomonas. To combat the infections, rather than administration of a single antibiotic, use of combinations (tobramycin and essential oils from plants and/or silver nanoparticles, chitosan, nitric oxide, cis-2-decenoic acid) in single formulation are suggested to control P. aeruginosa biofilms. Conventional techniques to prevent hospital-acquired implant infections such as coatings with antibiotics, controlled release of antibiotics from the implant material, contact-killing surfaces, coating the implants with functional DNase I and, coating with glycoside hydrolase are being followed. Coatings with bioactive components besides having limited shelf-life, require cold-chain and, are likely to fail when bacteria develop resistance. Recently identified nano-scale physical architectures on the insect wings are expected to have potential bactericidal property. Nanopillars are bactericidal to Staphylococcus aureus, Bacillus subtilis, K. pnuemoniae and few species of Pseudomonas. Our study aims to investigate the survival rate of biofilm forming Pseudomonas aeruginosa strain over non-biofilm forming strain on the nanopillar architecture of dragonfly (Pantala flavescens) wing. Dragonflies were collected near house-hold areas and, insect identification was carried out by the Department of Entomology, Tamilnadu Agricultural University, Coimbatore, India. Two strains of P. aeruginosa such as PAO1 (potent biofilm former) and MTCC 1688 (non-weak biofilm former) were tested against the glass coverslip (control) and wings of dragonfly (test) for 48 h. The wings/glass coverslips were incubated with bacterial suspension in 48-well plate. The plates were incubated at 37 °C under static condition. Bacterial attachment on the nanopillar architecture of the wing surface was visualized using FESEM. The survival rate of P. aeruginosa was tested using colony counting technique and flow cytometry at 0.5 h, 1 h, 2 h, 7 h, 24 h, and 48 h post-incubation. Cell death was analyzed using propidium iodide staining and DNA quantification. The results indicated that the survival rate of non-biofilm forming P. aeruginosa is 0.2 %, whilst that of biofilm former is 45 % on the dragonfly wings at the end of 48 h. The reduction in the survival rate of biofilm and non-biofilm forming P. aeruginosa was 20% and 40% respectively on the wings compared to the glass coverslip. In addition, Fourier Transformed Infrared Radiation was used to study the modification in the surface chemical composition of the wing during bacterial attachment and, post-sonication. This result indicated that the chemical moieties are not involved in the bactericidal property of nanopillars by the conserved characteristic peaks of chitin pre and post-sonication. The nanopillar architecture of the dragonfly wing efficiently deters the survival of non-biofilm forming P. aeruginosa, but not the biofilm forming strain. The study highlights the ability of biofilm formers to survive on wing architecture. Understanding this survival strategy will help in designing the architecture that combats the colonization of biofilm forming pathogens.

Keywords: biofilm, nanopillars, Pseudomonas aeruginosa, survival rate

Procedia PDF Downloads 160
111 The Relationship between Fight-Flight-Freeze System, Level of Expressed Emotion in Family, and Emotion Regulation Difficulties of University Students: Comparison Experienced to Inexperienced Non-Suicidal Self-Injury Students (NSSI)

Authors: Hyojung Shin, Munhee Kweon

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Non-suicide Self Injuri (NSSI) can be defined as the act of an individual who does not intend to die directly and intentionally damaging his or her body tissues. According to a study conducted by the Korean Ministry of Education in 2018, the NSSI is widely spreading among teenagers, with 7.9 percent of all middle school students and 6.4 percent of high school students reporting experience in NSSI. As such, it is understood that the first time of the NSSI is in adolescence. However, the NSSI may not start and stop at a certain time, but may last longer. However, despite the widespread prevalence of NSSI among teenagers, little is known about the process and maintenance of NSSI college students on a continuous development basis. Korea's NSSI research trends are mainly focused on individual internal vulnerabilities (high levels of painful emotions/awareness, lack of pain tolerance) and interpersonal vulnerabilities (poor communication skills and social problem solving), and little studies have been done on individuals' unique characteristics and environmental factors such as substrate or environmental vulnerability factors. In particular, environmental factors are associated with the occurrence of NSSI by acting as a vulnerability factor that can interfere with the emotional control of individuals, whereas individual factors play a more direct role by contributing to the maintenance of NSSI, so it is more important to consider this for personal environmental involvement in NSSI. This study focused on the Fight-Flight-Freeze System as a factor in the defensive avoidance system of Reward Sensitivity in individual factors. Also, Environmental factors include the level of expressed emotion in family. Wedig and Nock (2007) said that if parents with a self-critical cognitive style take the form of criticizing their children, the experience of NSSI increases. The high level of parental criticism is related to the increasing frequency of NSSI acts as well as to serious levels of NSSI. If the normal coping mechanism fails to control emotions, people want to overcome emotional difficulties even through NSSI, and emotional disturbances experienced by individuals within an unsupported social relationship increase vulnerability to NSSI. Based on these theories, this study is to find ways to prevent NSSI and intervene in counseling effectively by verifying the differences between the characteristics experienced NSSI persons and non-experienced NSSI persons. Therefore, the purpose of this research was to examine the relationship of Fight-Flight-Freeze System (FFFS), level of expressed emotion in family and emotion regulation difficulties, comparing those who experienced Non-Suicidal Self-Injury (NSSI) with those who did not experienced Non-Suicidal Self-Injury (NSSI). The data were collected from university students in Seoul Korea and Gyeonggi-do province. 99 subjects were experienced student of NSSI, while 375 were non- experienced student of NSSI. The results of this study are as follows. First, the result of t-test indicated that NSSI attempters showed a significant difference in fight-flight-freeze system, level of expressed emotion and emotion regulation difficulties, compared with non-attempters. Second, fight-flight-freeze system, level of expressed emotion in family and emotion regulation difficulties of NSSI attempters showed a significant difference in correlation. The correlation was significant only freeze system of fight-flight-freeze system, Level of expressed emotion in family and emotion regulation difficulties. Third, freeze system and level of expressed emotion in family predicted emotion regulation difficulties of NSSI attempters. Fight-freeze system and level of expressed emotion in family predicted emotion regulation difficulties of non-NSSI attempters. Lastly, Practical implications for counselors and limitations of this study are discussed.

Keywords: fight-flight-freeze system, level of expressed emotion in family, emotion regulation difficulty, non-suicidal self injury

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110 Medical Workforce Knowledge of Adrenaline (Epinephrine) Administration in Anaphylaxis in Adults Considerably Improved with Training in an UK Hospital from 2010 to 2017

Authors: Jan C. Droste, Justine Burns, Nithin Narayan

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Introduction: Life-threatening detrimental effects of inappropriate adrenaline (epinephrine) administration, e.g., by giving the wrong dose, in the context of anaphylaxis management is well documented in the medical literature. Half of the fatal anaphylactic reactions in the UK are iatrogenic, and the median time to a cardio-respiratory arrest can be as short as 5 minutes. It is therefore imperative that hospital doctors of all grades have active and accurate knowledge of the correct route, site, and dosage of administration of adrenaline. Given this time constraint and the potential fatal outcome with inappropriate management of anaphylaxis, it is alarming that surveys over the last 15 years have repeatedly shown only a minority of doctors to have accurate knowledge of adrenaline administration as recommended by the UK Resuscitation Council guidelines (2008 updated 2012). This comparison of survey results of the medical workforce over several years in a small NHS District General Hospital was conducted in order to establish the effect of the employment of multiple educational methods regarding adrenaline administration in anaphylaxis in adults. Methods: Between 2010 and 2017, several education methods and tools were used to repeatedly inform the medical workforce (doctors and advanced clinical practitioners) in a single district general hospital regarding the treatment of anaphylaxis in adults. Whilst the senior staff remained largely the same cohort, junior staff had changed fully in every survey. Examples included: (i) Formal teaching -in Grand Rounds; during the junior doctors’ induction process; advanced life support courses (ii) In-situ simulation training performed by the clinical skills simulation team –several ad hoc sessions and one 3-day event in 2017 visiting 16 separate clinical areas performing an acute anaphylaxis scenario using actors- around 100 individuals from multi-disciplinary teams were involved (iii) Hospital-wide distribution of the simulation event via the Trust’s Simulation Newsletter (iv) Laminated algorithms were attached to the 'crash trolleys' (v) A short email 'alert' was sent to all medical staff 3 weeks prior to the survey detailing the emergency treatment of anaphylaxis (vi) In addition, the performance of the surveys themselves represented a teaching opportunity when gaps in knowledge could be addressed. Face to face surveys were carried out in 2010 ('pre-intervention), 2015, and 2017, in the latter two occasions including advanced clinical practitioners (ACP). All surveys consisted of convenience samples. If verbal consent to conduct the survey was obtained, the medical practitioners' answers were recorded immediately on a data collection sheet. Results: There was a sustained improvement in the knowledge of the medical workforce from 2010 to 2017: Answers improved regarding correct drug by 11% (84%, 95%, and 95%); the correct route by 20% (76%, 90%, and 96%); correct site by 40% (43%, 83%, and 83%) and the correct dose by 45% (27%, 54%, and 72%). Overall, knowledge of all components -correct drug, route, site, and dose-improved from 13% in 2010 to 62% in 2017. Conclusion: This survey comparison shows knowledge of the medical workforce regarding adrenaline administration for treatment of anaphylaxis in adults can be considerably improved by employing a variety of educational methods.

Keywords: adrenaline, anaphylaxis, epinephrine, medical education, patient safety

Procedia PDF Downloads 112
109 Heterotopic Ossification: DISH and Myositis Ossificans in Human Remains Identification

Authors: Patricia Shirley Almeida Prado, Liz Brito, Selma Paixão Argollo, Gracie Moreira, Leticia Matos Sobrinho

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Diffuse idiopathic skeletal hyperostosis (DISH) is a degenerative bone disease also known as Forestier´s disease and ankylosing hyperostosis of the spine is characterized by a tendency toward ossification of half the anterior longitudinal spinal ligament without intervertebral disc disease. DISH is not considered to be osteoarthritis, although the two conditions commonly occur together. Diagnostic criteria include fusion of at least four vertebrae by bony bridges arising from the anterolateral aspect of the vertebral bodies. These vertebral bodies have a 'dripping candle wax' appearance, also can be seen periosteal new bone formation on the anterior surface of the vertebral bodies and there is no ankylosis at zygoapophyseal facet joint. Clinically, patients with DISH tend to be asymptomatic some patients mention moderate pain and stiffness in upper back. This disease is more common in man, uncommon in patients younger than 50 years and rare in patients under 40 years old. In modern populations, DISH is found in association with obesity, (type II) diabetes; abnormal vitamin A metabolism and also associated with higher levels of serum uric acid. There is also some association between the increase of risk of stroke or other cerebrovascular disease. The DISH condition can be confused with Heterotopic Ossification, what is the bone formation in the soft tissues as the result of trauma, wounding, surgery, burnings, prolonged immobility and some central nervous system disorder. All these conditions have been described extensively as myositis ossificans which can be confused with the fibrodysplasia (myositis) ossificans progressive. As in the DISH symptomatology it can be asymptomatic or extensive enough to impair joint function. A third confusion osteoarthritis disease that can bring confusion are the enthesopathies that occur in the entire skeleton being common on the ischial tuberosities, iliac crests, patellae, and calcaneus. Ankylosis of the sacroiliac joint by bony bridges may also be found. CASE 1: this case is skeletal remains presenting skull, some vertebrae and scapulae. This case remains unidentified and due to lack of bone remains. Sex, age and ancestry profile was compromised, however the DISH pathognomonic findings and diagnostic helps to estimate sex and age characteristics. Moreover to presenting DISH these skeletal remains also showed some bone alterations and non-metrics as fusion of the first vertebrae with occipital bone, maxillae and palatine torus and scapular foramen on the right scapulae. CASE 2: this skeleton remains shows an extensive bone heterotopic ossification on the great trochanter area of left femur, right fibula showed a healed fracture in its body however in its inteosseous crest there is an extensive bone growth, also in the Ilium at the region of inferior gluteal line can be observed some pronounced bone growth and the skull presented a pronounced mandibular, maxillary and palatine torus. Despite all these pronounced heterotopic ossification the whole skeleton presents moderate bone overgrowth that is not linked with aging, since the skeleton belongs to a young unidentified individual. The appropriate osteopathological diagnosis support the human identification process through medical reports and also assist with epidemiological data that can strengthen vulnerable anthropological estimates.

Keywords: bone disease, DISH, human identification, human remains

Procedia PDF Downloads 321
108 Environmental Planning for Sustainable Utilization of Lake Chamo Biodiversity Resources: Geospatially Supported Approach, Ethiopia

Authors: Alemayehu Hailemicael Mezgebe, A. J. Solomon Raju

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Context: Lake Chamo is a significant lake in the Ethiopian Rift Valley, known for its diversity of wildlife and vegetation. However, the lake is facing various threats due to human activities and global effects. The poor management of resources could lead to food insecurity, ecological degradation, and loss of biodiversity. Research Aim: The aim of this study is to analyze the environmental implications of lake level changes using GIS and remote sensing. The research also aims to examine the floristic composition of the lakeside vegetation and propose spatially oriented environmental planning for the sustainable utilization of the biodiversity resources. Methodology: The study utilizes multi-temporal satellite images and aerial photographs to analyze the changes in the lake area over the past 45 years. Geospatial analysis techniques are employed to assess land use and land cover changes and change detection matrix. The composition and role of the lakeside vegetation in the ecological and hydrological functions are also examined. Findings: The analysis reveals that the lake has shrunk by 14.42% over the years, with significant modifications to its upstream segment. The study identifies various threats to the lake-wetland ecosystem, including changes in water chemistry, overfishing, and poor waste management. The study also highlights the impact of human activities on the lake's limnology, with an increase in conductivity, salinity, and alkalinity. Floristic composition analysis of the lake-wetland ecosystem showed definite pattern of the vegetation distribution. The vegetation composition can be generally categorized into three belts namely, the herbaceous belt, the legume belt and the bush-shrub-small trees belt. The vegetation belts collectively act as different-sized sieve screen system and calm down the pace of incoming foreign matter. This stratified vegetation provides vital information to decide the management interventions for the sustainability of lake-wetland ecosystem.Theoretical Importance: The study contributes to the understanding of the environmental changes and threats faced by Lake Chamo. It provides insights into the impact of human activities on the lake-wetland ecosystem and emphasizes the need for sustainable resource management. Data Collection and Analysis Procedures: The study utilizes aerial photographs, satellite imagery, and field observations to collect data. Geospatial analysis techniques are employed to process and analyze the data, including land use/land cover changes and change detection matrices. Floristic composition analysis is conducted to assess the vegetation patterns Question Addressed: The study addresses the question of how lake level changes and human activities impact the environmental health and biodiversity of Lake Chamo. It also explores the potential opportunities and threats related to water utilization and waste management. Conclusion: The study recommends the implementation of spatially oriented environmental planning to ensure the sustainable utilization and maintenance of Lake Chamo's biodiversity resources. It emphasizes the need for proper waste management, improved irrigation facilities, and a buffer zone with specific vegetation patterns to restore and protect the lake outskirt.

Keywords: buffer zone, geo-spatial, lake chamo, lake level changes, sustainable utilization

Procedia PDF Downloads 58
107 The Design of a Phase I/II Trial of Neoadjuvant RT with Interdigitated Multiple Fractions of Lattice RT for Large High-grade Soft-Tissue Sarcoma

Authors: Georges F. Hatoum, Thomas H. Temple, Silvio Garcia, Xiaodong Wu

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Soft Tissue Sarcomas (STS) represent a diverse group of malignancies with heterogeneous clinical and pathological features. The treatment of extremity STS aims to achieve optimal local tumor control, improved survival, and preservation of limb function. The National Comprehensive Cancer Network guidelines, based on the cumulated clinical data, recommend radiation therapy (RT) in conjunction with limb-sparing surgery for large, high-grade STS measuring greater than 5 cm in size. Such treatment strategy can offer a cure for patients. However, when recurrence occurs (in nearly half of patients), the prognosis is poor, with a median survival of 12 to 15 months and with only palliative treatment options available. The spatially-fractionated-radiotherapy (SFRT), with a long history of treating bulky tumors as a non-mainstream technique, has gained new attention in recent years due to its unconventional therapeutic effects, such as bystander/abscopal effects. Combining single fraction of GRID, the original form of SFRT, with conventional RT was shown to have marginally increased the rate of pathological necrosis, which has been recognized to have a positive correlation to overall survival. In an effort to consistently increase the pathological necrosis rate over 90%, multiple fractions of Lattice RT (LRT), a newer form of 3D SFRT, interdigitated with the standard RT as neoadjuvant therapy was conducted in a preliminary clinical setting. With favorable results of over 95% of necrosis rate in a small cohort of patients, a Phase I/II clinical study was proposed to exam the safety and feasibility of this new strategy. Herein the design of the clinical study is presented. In this single-arm, two-stage phase I/II clinical trial, the primary objectives are >80% of the patients achieving >90% tumor necrosis and to evaluation the toxicity; the secondary objectives are to evaluate the local control, disease free survival and overall survival (OS), as well as the correlation between clinical response and the relevant biomarkers. The study plans to accrue patients over a span of two years. All patient will be treated with the new neoadjuvant RT regimen, in which one of every five fractions of conventional RT is replaced by a LRT fraction with vertices receiving dose ≥10Gy while keeping the tumor periphery at or close to 2 Gy per fraction. Surgical removal of the tumor is planned to occur 6 to 8 weeks following the completion of radiation therapy. The study will employ a Pocock-style early stopping boundary to ensure patient safety. The patients will be followed and monitored for a period of five years. Despite much effort, the rarity of the disease has resulted in limited novel therapeutic breakthroughs. Although a higher rate of treatment-induced tumor necrosis has been associated with improved OS, with the current techniques, only 20% of patients with large, high-grade tumors achieve a tumor necrosis rate exceeding 50%. If this new neoadjuvant strategy is proven effective, an appreciable improvement in clinical outcome without added toxicity can be anticipated. Due to the rarity of the disease, it is hoped that such study could be orchestrated in a multi-institutional setting.

Keywords: lattice RT, necrosis, SFRT, soft tissue sarcoma

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106 Investigating Links in Achievement and Deprivation (ILiAD): A Case Study Approach to Community Differences

Authors: Ruth Leitch, Joanne Hughes

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This paper presents the findings of a three-year government-funded study (ILiAD) that aimed to understand the reasons for differential educational achievement within and between socially and economically deprived areas in Northern Ireland. Previous international studies have concluded that there is a positive correlation between deprivation and underachievement. Our preliminary secondary data analysis suggested that the factors involved in educational achievement within multiple deprived areas may be more complex than this, with some areas of high multiple deprivation having high levels of student attainment, whereas other less deprived areas demonstrated much lower levels of student attainment, as measured by outcomes on high stakes national tests. The study proposed that no single explanation or disparate set of explanations could easily account for the linkage between levels of deprivation and patterns of educational achievement. Using a social capital perspective that centralizes the connections within and between individuals and social networks in a community as a valuable resource for educational achievement, the ILiAD study involved a multi-level case study analysis of seven community sites in Northern Ireland, selected on the basis of religious composition (housing areas are largely segregated by religious affiliation), measures of multiple deprivation and differentials in educational achievement. The case study approach involved three (interconnecting) levels of qualitative data collection and analysis - what we have termed Micro (or community/grassroots level) understandings, Meso (or school level) explanations and Macro (or policy/structural) factors. The analysis combines a statistical mapping of factors with qualitative, in-depth data interpretation which, together, allow for deeper understandings of the dynamics and contributory factors within and between the case study sites. Thematic analysis of the qualitative data reveals both cross-cutting factors (e.g. demographic shifts and loss of community, place of the school in the community, parental capacity) and analytic case studies of explanatory factors associated with each of the community sites also permit a comparative element. Issues arising from the qualitative analysis are classified either as drivers or inhibitors of educational achievement within and between communities. Key issues that are emerging as inhibitors/drivers to attainment include: the legacy of the community conflict in Northern Ireland, not least in terms of inter-generational stress, related with substance abuse and mental health issues; differing discourses on notions of ‘community’ and ‘achievement’ within/between community sites; inter-agency and intra-agency levels of collaboration and joined-up working; relationship between the home/school/community triad and; school leadership and school ethos. At this stage, the balance of these factors can be conceptualized in terms of bonding social capital (or lack of it) within families, within schools, within each community, within agencies and also bridging social capital between the home/school/community, between different communities and between key statutory and voluntary organisations. The presentation will outline the study rationale, its methodology, present some cross-cutting findings and use an illustrative case study of the findings from a community site to underscore the importance of attending to community differences when trying to engage in research to understand and improve educational attainment for all.

Keywords: educational achievement, multiple deprivation, community case studies, social capital

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105 Remote BioMonitoring of Mothers and Newborns for Temperature Surveillance Using a Smart Wearable Sensor: Techno-Feasibility Study and Clinical Trial in Southern India

Authors: Prem K. Mony, Bharadwaj Amrutur, Prashanth Thankachan, Swarnarekha Bhat, Suman Rao, Maryann Washington, Annamma Thomas, N. Sheela, Hiteshwar Rao, Sumi Antony

Abstract:

The disease burden among mothers and newborns is caused mostly by a handful of avoidable conditions occurring around the time of childbirth and within the first month following delivery. Real-time monitoring of vital parameters of mothers and neonates offers a potential opportunity to impact access as well as the quality of care in vulnerable populations. We describe the design, development and testing of an innovative wearable device for remote biomonitoring (RBM) of body temperatures in mothers and neonates in a hospital in southern India. The architecture consists of: [1] a low-cost, wearable sensor tag; [2] a gateway device for ‘real-time’ communication link; [3] piggy-backing on a commercial GSM communication network; and [4] an algorithm-based data analytics system. Requirements for the device were: long battery-life upto 28 days (with sampling frequency 5/hr); robustness; IP 68 hermetic sealing; and human-centric design. We undertook pre-clinical laboratory testing followed by clinical trial phases I & IIa for evaluation of safety and efficacy in the following sequence: seven healthy adult volunteers; 18 healthy mothers; and three sets of babies – 3 healthy babies; 10 stable babies in the Neonatal Intensive Care Unit (NICU) and 1 baby with hypoxic ischaemic encephalopathy (HIE). The 3-coin thickness, pebble-design sensor weighing about 8 gms was secured onto the abdomen for the baby and over the upper arm for adults. In the laboratory setting, the response-time of the sensor device to attain thermal equilibrium with the surroundings was 4 minutes vis-a-vis 3 minutes observed with a precision-grade digital thermometer used as a reference standard. The accuracy was ±0.1°C of the reference standard within the temperature range of 25-40°C. The adult volunteers, aged 20 to 45 years, contributed a total of 345 hours of readings over a 7-day period and the postnatal mothers provided a total of 403 paired readings. The mean skin temperatures measured in the adults by the sensor were about 2°C lower than the axillary temperature readings (sensor =34.1 vs digital = 36.1); this difference was statistically significant (t-test=13.8; p<0.001). The healthy neonates provided a total of 39 paired readings; the mean difference in temperature was 0.13°C (sensor =36.9 vs digital = 36.7; p=0.2). The neonates in the NICU provided a total of 130 paired readings. Their mean skin temperature measured by the sensor was 0.6°C lower than that measured by the radiant warmer probe (sensor =35.9 vs warmer probe = 36.5; p < 0.001). The neonate with HIE provided a total of 25 paired readings with the mean sensor reading being not different from the radian warmer probe reading (sensor =33.5 vs warmer probe = 33.5; p=0.8). No major adverse events were noted in both the adults and neonates; four adult volunteers reported mild sweating under the device/arm band and one volunteer developed mild skin allergy. This proof-of-concept study shows that real-time monitoring of temperatures is technically feasible and that this innovation appears to be promising in terms of both safety and accuracy (with appropriate calibration) for improved maternal and neonatal health.

Keywords: public health, remote biomonitoring, temperature surveillance, wearable sensors, mothers and newborns

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104 Strategy to Evaluate Health Risks of Short-Term Exposure of Air Pollution in Vulnerable Individuals

Authors: Sarah Nauwelaerts, Koen De Cremer, Alfred Bernard, Meredith Verlooy, Kristel Heremans, Natalia Bustos Sierra, Katrien Tersago, Tim Nawrot, Jordy Vercauteren, Christophe Stroobants, Sigrid C. J. De Keersmaecker, Nancy Roosens

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Projected climate changes could lead to exacerbation of respiratory disorders associated with reduced air quality. Air pollution and climate changes influence each other through complex interactions. The poor air quality in urban and rural areas includes high levels of particulate matter (PM), ozone (O3) and nitrogen oxides (NOx), representing a major threat to public health and especially for the most vulnerable population strata, and especially young children. In this study, we aim to develop generic standardized policy supporting tools and methods that allow evaluating in future follow-up larger scale epidemiological studies the risks of the combined short-term effects of O3 and PM on the cardiorespiratory system of children. We will use non-invasive indicators of airway damage/inflammation and of genetic or epigenetic variations by using urine or saliva as alternative to blood samples. Therefore, a multi-phase field study will be organized in order to assess the sensitivity and applicability of these tests in large cohorts of children during episodes of air pollution. A first test phase was planned in March 2018, not yet taking into account ‘critical’ pollution periods. Working with non-invasive samples, choosing the right set-up for the field work and the volunteer selection were parameters to consider, as they significantly influence the feasibility of this type of study. During this test phase, the selection of the volunteers was done in collaboration with medical doctors from the Centre for Student Assistance (CLB), by choosing a class of pre-pubertal children of 9-11 years old in a primary school in Flemish Brabant, Belgium. A questionnaire, collecting information on the health and background of children and an informed consent document were drawn up for the parents as well as a simplified cartoon-version of this document for the children. A detailed study protocol was established, giving clear information on the study objectives, the recruitment, the sample types, the medical examinations to be performed, the strategy to ensure anonymity, and finally on the sample processing. Furthermore, the protocol describes how this field study will be conducted in relation with the prevision and monitoring of air pollutants for the future phases. Potential protein, genetic and epigenetic biomarkers reflecting the respiratory function and the levels of air pollution will be measured in the collected samples using unconventional technologies. The test phase results will be used to address the most important bottlenecks before proceeding to the following phases of the study where the combined effect of O3 and PM during pollution peaks will be examined. This feasibility study will allow identifying possible bottlenecks and providing missing scientific knowledge, necessary for the preparation, implementation and evaluation of federal policies/strategies, based on the most appropriate epidemiological studies on the health effects of air pollution. The research leading to these results has been funded by the Belgian Science Policy Office through contract No.: BR/165/PI/PMOLLUGENIX-V2.

Keywords: air pollution, biomarkers, children, field study, feasibility study, non-invasive

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103 Understanding Natural Resources Governance in Canada: The Role of Institutions, Interests, and Ideas in Alberta's Oil Sands Policy

Authors: Justine Salam

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As a federal state, Canada’s constitutional arrangements regarding the management of natural resources is unique because it gives complete ownership and control of natural resources to the provinces (subnational level). However, the province of Alberta—home to the third largest oil reserves in the world—lags behind comparable jurisdictions in levying royalties on oil corporations, especially oil sands royalties. While Albertans own the oil sands, scholars have argued that natural resource exploitation in Alberta benefits corporations and industry more than it does Albertans. This study provides a systematic understanding of the causal factors affecting royalties in Alberta to map dynamics of power and how they manifest themselves during policy-making. Mounting domestic and global public pressure led Alberta to review its oil sands royalties twice in less than a decade through public-commissioned Royalty Review Panels, first in 2007 and again in 2015. The Panels’ task was to research best practices and to provide policy recommendations to the Government through public consultations with Albertans, industry, non-governmental organizations, and First Nations peoples. Both times, the Panels recommended a relative increase to oil sands royalties. However, irrespective of the Reviews’ recommendations, neither the right-wing 2007 Progressive Conservative Party (PC) nor the left-wing 2015 New Democratic Party (NDP) government—both committed to increase oil sands royalties—increased royalty intake. Why did two consecutive political parties at opposite ends of the political spectrum fail to account for the recommendations put forward by the Panel? Through a qualitative case-study analysis, this study assesses domestic and global causal factors for Alberta’s inability to raise oil sands royalties significantly after the two Reviews through an institutions, interests, and ideas framework. Indeed, causal factors can be global (e.g. market and price fluctuation) or domestic (e.g. oil companies’ influence on the Alberta government). The institutions, interests, and ideas framework is at the intersection of public policy, comparative studies, and political economy literatures, and therefore draws multi-faceted insights into the analysis. To account for institutions, the study proposes to review international trade agreements documents such as the North American Free Trade Agreement (NAFTA) because they have embedded Alberta’s oil sands into American energy security policy and tied Canadian and Albertan oil policy in legal international nods. To account for interests, such as how the oil lobby or the environment lobby can penetrate governmental decision-making spheres, the study draws on the Oil Sands Oral History project, a database of interviews from government officials and oil industry leaders at a pivotal time in Alberta’s oil industry, 2011-2013. Finally, to account for ideas, such as how narratives of Canada as a global ‘energy superpower’ and the importance of ‘energy security’ have dominated and polarized public discourse, the study relies on content analysis of Alberta-based pro-industry newspapers to trace the prevalence of these narratives. By mapping systematically the nods and dynamics of power at play in Alberta, the study sheds light on the factors that influence royalty policy-making in one of the largest industries in Canada.

Keywords: Alberta Canada, natural resources governance, oil sands, political economy

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102 The Safe Introduction of Tocilizumab for the Treatment of SARS-CoV-2 Pneumonia at an East London District General Hospital

Authors: Andrew Read, Alice Parry, Kate Woods

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Since the advent of the SARS-CoV-2 pandemic, the search for medications that can reduce mortality and morbidity has been a global research priority. Several multi-center trials have recently demonstrated improved mortality associated with the use of Tocilizumab, an interleukin-6 receptor antagonist, in patients with severe SARS-CoV-2 pneumonia. Initial data supported the administration in patients requiring respiratory support (non-invasive or invasive ventilation), but more recent data has shown benefit in all hypoxic patients. At the height of the second wave of COVID-19 infections in London, our hospital introduced the use of Tocilizumab for patients with severe COVID-19. Tocilizumab is licensed for use in chronic inflammatory conditions and has been associated with an increased risk of severe bacterial and fungal infections, as well as reactivation of chronic viral infections (e.g., hepatitis B). It is a specialist drug that suppresses the formation of C-reactive protein (CRP) for 6 – 12 weeks. It is not widely used by the general medical community. We aimed to assess Tocilizumab use in our hospital and to implement changes to the protocol as required to ensure administration was safe and appropriate. A retrospective study design was used to assess prescriptions over an initial 3-week period in both intensive care and on the medical wards. This amounted to a total of 13 patients. The initial data collection identified four key areas of concern: adherence to national and local inclusion & exclusion criteria; a collection of appropriate screening blood prior to administration; documentation of informed consent or best interest decision and documentation of Tocilizumab administration on patient discharge information, to alert future healthcare providers that typical measures of inflammation and infection, such as CRP, are unreliable for up to 3-months. Data were collected from electronic notes, blood results and observation charts, and cross referenced with pharmacy data. Initial results showed that all four key areas were completed in approximately 50% of cases. Of particular concern was adherence to exclusion criteria, such as current evidence of bacterial infection, and ensuring the correct screening blood was sent to exclude infections such as hepatitis. To remedy this and improve patient safety, the initial data was presented to relevant healthcare professionals. Subsequently, three interventions were introduced and education on each provided to hospital staff. An electronic ‘order set’ collating the appropriate screening blood was created simplifying the screening process. Pre-formed electronic documentation which can be inserted into the notes was created to provide a framework for consent discussions and reduce the time needed for junior doctors to complete this task. Additionally, a ‘Tocilizumab’ administration card was created and administered via pharmacy. This was distributed to each patient on discharge to ensure future healthcare professionals were aware of the potential effects of Tocilizumab administration, including suppression of CRP. Following these changes, repeat data collection over two months illustrated that each of the 4 safety aspects was met with a 100% success rate in every patient. Although this demonstrates good progress and effective interventions the challenge will be to maintain this progress. The audit data collection is ongoing

Keywords: education, patient safety , SARS-CoV-2, Tocilizumab

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101 Improving the Utility of Social Media in Pharmacovigilance: A Mixed Methods Study

Authors: Amber Dhoot, Tarush Gupta, Andrea Gurr, William Jenkins, Sandro Pietrunti, Alexis Tang

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Background: The COVID-19 pandemic has driven pharmacovigilance towards a new paradigm. Nowadays, more people than ever before are recognising and reporting adverse reactions from medications, treatments, and vaccines. In the modern era, with over 3.8 billion users, social media has become the most accessible medium for people to voice their opinions and so provides an opportunity to engage with more patient-centric and accessible pharmacovigilance. However, the pharmaceutical industry has been slow to incorporate social media into its modern pharmacovigilance strategy. This project aims to make social media a more effective tool in pharmacovigilance, and so reduce drug costs, improve drug safety and improve patient outcomes. This will be achieved by firstly uncovering and categorising the barriers facing the widespread adoption of social media in pharmacovigilance. Following this, the potential opportunities of social media will be explored. We will then propose realistic, practical recommendations to make social media a more effective tool for pharmacovigilance. Methodology: A comprehensive systematic literature review was conducted to produce a categorised summary of these barriers. This was followed by conducting 11 semi-structured interviews with pharmacovigilance experts to confirm the literature review findings whilst also exploring the unpublished and real-life challenges faced by those in the pharmaceutical industry. Finally, a survey of the general public (n = 112) ascertained public knowledge, perception, and opinion regarding the use of their social media data for pharmacovigilance purposes. This project stands out by offering perspectives from the public and pharmaceutical industry that fill the research gaps identified in the literature review. Results: Our results gave rise to several key analysis points. Firstly, inadequacies of current Natural Language Processing algorithms hinder effective pharmacovigilance data extraction from social media, and where data extraction is possible, there are significant questions over its quality. Social media also contains a variety of biases towards common drugs, mild adverse drug reactions, and the younger generation. Additionally, outdated regulations for social media pharmacovigilance do not align with new, modern General Data Protection Regulations (GDPR), creating ethical ambiguity about data privacy and level of access. This leads to an underlying mindset of avoidance within the pharmaceutical industry, as firms are disincentivised by the legal, financial, and reputational risks associated with breaking ambiguous regulations. Conclusion: Our project uncovered several barriers that prevent effective pharmacovigilance on social media. As such, social media should be used to complement traditional sources of pharmacovigilance rather than as a sole source of pharmacovigilance data. However, this project adds further value by proposing five practical recommendations that improve the effectiveness of social media pharmacovigilance. These include: prioritising health-orientated social media; improving technical capabilities through investment and strategic partnerships; setting clear regulatory guidelines using multi-stakeholder processes; creating an adverse drug reaction reporting interface inbuilt into social media platforms; and, finally, developing educational campaigns to raise awareness of the use of social media in pharmacovigilance. Implementation of these recommendations would speed up the efficient, ethical, and systematic adoption of social media in pharmacovigilance.

Keywords: adverse drug reaction, drug safety, pharmacovigilance, social media

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100 The Negative Effects of Controlled Motivation on Mathematics Achievement

Authors: John E. Boberg, Steven J. Bourgeois

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The decline in student engagement and motivation through the middle years is well documented and clearly associated with a decline in mathematics achievement that persists through high school. To combat this trend and, very often, to meet high-stakes accountability standards, a growing number of parents, teachers, and schools have implemented various methods to incentivize learning. However, according to Self-Determination Theory, forms of incentivized learning such as public praise, tangible rewards, or threats of punishment tend to undermine intrinsic motivation and learning. By focusing on external forms of motivation that thwart autonomy in children, adults also potentially threaten relatedness measures such as trust and emotional engagement. Furthermore, these controlling motivational techniques tend to promote shallow forms of cognitive engagement at the expense of more effective deep processing strategies. Therefore, any short-term gains in apparent engagement or test scores are overshadowed by long-term diminished motivation, resulting in inauthentic approaches to learning and lower achievement. The current study focuses on the relationships between student trust, engagement, and motivation during these crucial years as students transition from elementary to middle school. In order to test the effects of controlled motivational techniques on achievement in mathematics, this quantitative study was conducted on a convenience sample of 22 elementary and middle schools from a single public charter school district in the south-central United States. The study employed multi-source data from students (N = 1,054), parents (N = 7,166), and teachers (N = 356), along with student achievement data and contextual campus variables. Cross-sectional questionnaires were used to measure the students’ self-regulated learning, emotional and cognitive engagement, and trust in teachers. Parents responded to a single item on incentivizing the academic performance of their child, and teachers responded to a series of questions about their acceptance of various incentive strategies. Structural equation modeling (SEM) was used to evaluate model fit and analyze the direct and indirect effects of the predictor variables on achievement. Although a student’s trust in teacher positively predicted both emotional and cognitive engagement, none of these three predictors accounted for any variance in achievement in mathematics. The parents’ use of incentives, on the other hand, predicted a student’s perception of his or her controlled motivation, and these two variables had significant negative effects on achievement. While controlled motivation had the greatest effects on achievement, parental incentives demonstrated both direct and indirect effects on achievement through the students’ self-reported controlled motivation. Comparing upper elementary student data with middle-school student data revealed that controlling forms of motivation may be taking their toll on student trust and engagement over time. While parental incentives positively predicted both cognitive and emotional engagement in the younger sub-group, such forms of controlling motivation negatively predicted both trust in teachers and emotional engagement in the middle-school sub-group. These findings support the claims, posited by Self-Determination Theory, about the dangers of incentivizing learning. Short-term gains belie the underlying damage to motivational processes that lead to decreased intrinsic motivation and achievement. Such practices also appear to thwart basic human needs such as relatedness.

Keywords: controlled motivation, student engagement, incentivized learning, mathematics achievement, self-determination theory, student trust

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99 Railway Composite Flooring Design: Numerical Simulation and Experimental Studies

Authors: O. Lopez, F. Pedro, A. Tadeu, J. Antonio, A. Coelho

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The future of the railway industry lies in the innovation of lighter, more efficient and more sustainable trains. Weight optimizations in railway vehicles allow reducing power consumption and CO₂ emissions, increasing the efficiency of the engines and the maximum speed reached. Additionally, they reduce wear of wheels and rails, increase the space available for passengers, etc. Among the various systems that integrate railway interiors, the flooring system is one which has greater impact both on passenger safety and comfort, as well as on the weight of the interior systems. Due to the high weight saving potential, relative high mechanical resistance, good acoustic and thermal performance, ease of modular design, cost-effectiveness and long life, the use of new sustainable composite materials and panels provide the latest innovations for competitive solutions in the development of flooring systems. However, one of the main drawbacks of the flooring systems is their relatively poor resistance to point loads. Point loads in railway interiors can be caused by passengers or by components fixed to the flooring system, such as seats and restraint systems, handrails, etc. In this way, they can originate higher fatigue solicitations under service loads or zones with high stress concentrations under exceptional loads (higher longitudinal, transverse and vertical accelerations), thus reducing its useful life. Therefore, to verify all the mechanical and functional requirements of the flooring systems, many physical prototypes would be created during the design phase, with all of the high costs associated with it. Nowadays, the use of virtual prototyping methods by computer-aided design (CAD) and computer-aided engineering (CAE) softwares allow validating a product before committing to making physical test prototypes. The scope of this work was to current computer tools and integrate the processes of innovation, development, and manufacturing to reduce the time from design to finished product and optimise the development of the product for higher levels of performance and reliability. In this case, the mechanical response of several sandwich panels with different cores, polystyrene foams, and composite corks, were assessed, to optimise the weight and the mechanical performance of a flooring solution for railways. Sandwich panels with aluminum face sheets were tested to characterise its mechanical performance and determine the polystyrene foam and cork properties when used as inner cores. Then, a railway flooring solution was fully modelled (including the elastomer pads to provide the required vibration isolation from the car body) and perform structural simulations using FEM analysis to comply all the technical product specifications for the supply of a flooring system. Zones with high stress concentrations are studied and tested. The influence of vibration modes on the comfort level and stability is discussed. The information obtained with the computer tools was then completed with several mechanical tests performed on some solutions, and on specific components. The results of the numerical simulations and experimental campaign carried out are presented in this paper. This research work was performed as part of the POCI-01-0247-FEDER-003474 (coMMUTe) Project funded by Portugal 2020 through COMPETE 2020.

Keywords: cork agglomerate core, mechanical performance, numerical simulation, railway flooring system

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98 i2kit: A Tool for Immutable Infrastructure Deployments

Authors: Pablo Chico De Guzman, Cesar Sanchez

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Microservice architectures are increasingly in distributed cloud applications due to the advantages on the software composition, development speed, release cycle frequency and the business logic time to market. On the other hand, these architectures also introduce some challenges on the testing and release phases of applications. Container technology solves some of these issues by providing reproducible environments, easy of software distribution and isolation of processes. However, there are other issues that remain unsolved in current container technology when dealing with multiple machines, such as networking for multi-host communication, service discovery, load balancing or data persistency (even though some of these challenges are already solved by traditional cloud vendors in a very mature and widespread manner). Container cluster management tools, such as Kubernetes, Mesos or Docker Swarm, attempt to solve these problems by introducing a new control layer where the unit of deployment is the container (or the pod — a set of strongly related containers that must be deployed on the same machine). These tools are complex to configure and manage and they do not follow a pure immutable infrastructure approach since servers are reused between deployments. Indeed, these tools introduce dependencies at execution time for solving networking or service discovery problems. If an error on the control layer occurs, which would affect running applications, specific expertise is required to perform ad-hoc troubleshooting. As a consequence, it is not surprising that container cluster support is becoming a source of revenue for consulting services. This paper presents i2kit, a deployment tool based on the immutable infrastructure pattern, where the virtual machine is the unit of deployment. The input for i2kit is a declarative definition of a set of microservices, where each microservice is defined as a pod of containers. Microservices are built into machine images using linuxkit —- a tool for creating minimal linux distributions specialized in running containers. These machine images are then deployed to one or more virtual machines, which are exposed through a cloud vendor load balancer. Finally, the load balancer endpoint is set into other microservices using an environment variable, providing service discovery. The toolkit i2kit reuses the best ideas from container technology to solve problems like reproducible environments, process isolation, and software distribution, and at the same time relies on mature, proven cloud vendor technology for networking, load balancing and persistency. The result is a more robust system with no learning curve for troubleshooting running applications. We have implemented an open source prototype that transforms i2kit definitions into AWS cloud formation templates, where each microservice AMI (Amazon Machine Image) is created on the fly using linuxkit. Even though container cluster management tools have more flexibility for resource allocation optimization, we defend that adding a new control layer implies more important disadvantages. Resource allocation is greatly improved by using linuxkit, which introduces a very small footprint (around 35MB). Also, the system is more secure since linuxkit installs the minimum set of dependencies to run containers. The toolkit i2kit is currently under development at the IMDEA Software Institute.

Keywords: container, deployment, immutable infrastructure, microservice

Procedia PDF Downloads 163
97 Post Liberal Perspective on Minorities Visibility in Contemporary Visual Culture: The Case of Mizrahi Jews

Authors: Merav Alush Levron, Sivan Rajuan Shtang

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From as early as their emergence in Europe and the US, postmodern and post-colonial paradigm have formed the backbone of the visual culture field of study. The self-representation project of political minorities is studied, described and explained within the premises and perspectives drawn from these paradigms, addressing the key issues they had raised: modernism’s crisis of representation. The struggle for self-representation, agency and multicultural visibility sought to challenge the liberal pretense of universality and equality, hitting at its different blind spots, on issues such as class, gender, race, sex, and nationality. This struggle yielded subversive identity and hybrid performances, including reclaiming, mimicry and masquerading. These performances sought to defy the uniform, universal self, which forms the basis for the liberal, rational, enlightened subject. The argument of this research runs that this politics of representation itself is confined within liberal thought. Alongside post-colonialism and multiculturalism’s contribution in undermining oppressive structures of power, generating diversity in cultural visibility, and exposing the failure of liberal colorblindness, this subversion is constituted in the visual field by way of confrontation, flying in the face of the universal law and relying on its ongoing comparison and attribution to this law. Relying on Deleuze and Guattari, this research set out to draw theoretic and empiric attention to an alternative, post-liberal occurrence which has been taking place in the visual field in parallel to the contra-hegemonic phase and as a product of political reality in the aftermath of the crisis of representation. It is no longer a counter-representation; rather, it is a motion of organic minor desire, progressing in the form of flows and generating what Deleuze and Guattari termed deterritorialization of social structures. This discussion shall have its focus on current post-liberal performances of ‘Mizrahim’ (Jewish Israelis of Arab and Muslim extraction) in the visual field in Israel. In television, video art and photography, these performances challenge the issue of representation and generate concrete peripheral Mizrahiness, realized in the visual organization of the photographic frame. Mizrahiness then transforms from ‘confrontational’ representation into a 'presence', flooding the visual sphere in our plain sight, in a process of 'becoming'. The Mizrahi desire is exerted on the plains of sound, spoken language, the body and the space where they appear. It removes from these plains the coding and stratification engendered by European dominance and rational, liberal enlightenment. This stratification, adhering to the hegemonic surface, is flooded not by way of resisting false consciousness or employing hybridity, but by way of the Mizrahi identity’s own productive, material immanent yearning. The Mizrahi desire reverberates with Mizrahi peripheral 'worlds of meaning', where post-colonial interpretation almost invariably identifies a product of internalized oppression, and a recurrence thereof, rather than a source in itself - an ‘offshoot, never a wellspring’, as Nissim Mizrachi clarifies in his recent pioneering work. The peripheral Mizrahi performance ‘unhook itself’, in Deleuze and Guattari words, from the point of subjectification and interpretation and does not correspond with the partialness, absence, and split that mark post-colonial identities.

Keywords: desire, minority, Mizrahi Jews, post-colonialism, post-liberalism, visibility, Deleuze and Guattari

Procedia PDF Downloads 306