Search results for: outpatient treatment efficiency

Authors: Md. Shoffikul Islam, Hongqing Hu

Abstract:

Reducing trace elements' mobility and bioavailability through amendment addition, especially biochar (BC), is a cost-effective and efficient method to address their toxicity in the soil environment. However, the low molecular weight organic acids (LMWOAs) in the rhizosphere could affect BC's efficiency to stabilize trace metals as the LMWOAs could either mobilize or fix metals in the soils. Therefore, understanding the BC's and LMWOAs' interaction mechanisms on metals stabilization in the rhizosphere is crucial. The present study explored the impact of BC derived from rice husk and citric acid (CA) and the combination of BC and CA on the redistribution of cadmium (Cd), lead (Pb), and zinc (Zn) among their geochemical forms through incubation experiment. The changes of zeta potential and X-ray diffraction (XRD) pattern of BC and BC-amended soils to investigate the probable mechanisms of trace elements' immobilization by BC under the CA attack were also examined. The rice husk BC at 5% (w/w) was mixed with the air-dry soil (an Anthrosols) contaminated with Cd, Pb, and Zn in the plastic pot. The 2, 5, 10, and 20 mM kg-1 (w/v) of CA were added separately into the pot. All the ingredients were mixed thoroughly with the soil. A control (CK) treatment was also prepared without BC and CA addition. After 7, 15, and 60 days of incubation with 60% (w/v) moisture level at 25 °C, the incubated soils were determined for pH and EC and were sequentially extracted to assess the metals' transformation in soil. The electronegative charges and XRD peaks of BC and BC-amended soils were also measured. Compared to CK, the application of BC, low level of CA (2 mM kg-1 soil) (CA2), and BC plus the low concentration of CA (BC-CA2) considerably declined the acid-soluble Cd, Pb, and Zn in which BC-CA2 was found to be the most effective treatment. The reversed trends were observed concerning the high levels of CA (>5-20 mM kg-1 soil) and the BC plus high concentrations of CA treatments. BC-CA2 changed the highest amounts of acid-soluble and reducible metals to the oxidizable and residual forms with time. The most increased electronegative charges of BC-CA2 indicate its (BC-CA2) highest Cd, Pb, and Zn immobilizing efficiency, probably through metals adsorption and fixation with the negative charge sites. The XRD study revealed the presence of P, O, CO32-, and Cl1- in BC, which might be responsible for the precipitation of CdCO3, pyromorphite, and hopeite in the case of Cd, Pb, and Zn immobilization, respectively. The findings depicted that the low concentration of CA increased metals' stabilization, whereas the high levels of CA enhanced their mobilization. The BC-CA2 emerged as the best amendment among treatments for metals stabilization in contaminated soils.

Keywords: Biochar, citric acid, immobilization, trace elements contaminated soil

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Authors: Sh. Sousani, Z. Shadrokh, M. Hofbauerová, J. Kollár, M. Jergel, P. Nádaždy, M. Omastová, E. Majková

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Perovskite quantum dots (PQDs) have the potential to increase the performance of the perovskite solar cell (PSCs). The integration of PQDs into PSCs can extend the absorption range and enhance photon harvesting and device efficiency. In addition, PQDs can stabilize the device structure by passivating surface defects and traps in the perovskite layer and enhance its stability. The integration of PQDs into PSCs is strongly affected by the type of ligands on the surface of PQDs. The ligands affect the charge transport properties of PQDs, as well as the formation of well-defined interfaces and stability of PSCs. In this work, the CsPbBr₃ QDs were synthesized by the conventional hot-injection method using cesium oleate, PbBr₂ and two different ligands, namely oleic acid (OA) oleylamine (OAm) and didodecyldimethylammonium bromide (DDAB). The STEM confirmed regular shape and relatively monodisperse cubic structure with an average size of about 10-14 nm of the prepared CsPbBr₃ QDs. Further, the photoluminescent (PL) properties of the PQDs/perovskite bilayer with the ligand OA, OAm and DDAB were studied. For this purpose, ITO/PQDs as well as ITO/PQDs/MAPI perovskite structures were prepared by spin coating and the effect of the ligand and oxygen plasma treatment was analyzed. The plasma treatment of the PQDs layer could be beneficial for the deposition of the MAPI perovskite layer and the formation of a well-defined PQDs/MAPI interface. The absorption edge in UV-Vis absorption spectra for OA, OAm CsPbBr₃ QDs is placed around 513 nm (the band gap 2.38 eV); for DDAB CsPbBr₃ QDs, it is located at 490 nm (the band gap 2.33 eV). The photoluminescence (PL) spectra of CsPbBr₃ QDs show two peaks located around 514 nm (503 nm) and 718 nm (708 nm) for OA, OAm (DDAB). The peak around 500 nm corresponds to the PL of PQDs, and the peak close to 710 nm belongs to the surface states of PQDs for both types of ligands. These surface states are strongly affected by the O₃ plasma treatment. For PQDs with DDAB ligand, the O₃ exposure (5, 10, 15 s) results in the blue shift of the PQDs peak and a non-monotonous change of the amplitude of the surface states' peak. For OA, OAm ligand, the O₃ exposition did not cause any shift of the PQDs peak, and the intensity of the PL peak related to the surface states is lower by one order of magnitude in comparison with DDAB, being affected by O₃ plasma treatment. The PL results indicate the possibility of tuning the position of the PL maximum by the ligand of the PQDs. Similar behavior of the PQDs layer was observed for the ITO/QDs/MAPI samples, where an additional strong PL peak at 770 nm coming from the perovskite layer was observed; for the sample with PQDs with DDAB ligands, a small blue shift of the perovskite PL maximum was observed independently of the plasma treatment. These results suggest the possibility of affecting the PL maximum position and the surface states of the PQDs by the combination of a suitable ligand and the O₃ plasma treatment.

Keywords: perovskite quantum dots, photoluminescence, O₃ plasma., Perovskite Solar Cells

Procedia PDF Downloads 57

Authors: Sh. Sousani, Z. Shadrokh, M. Hofbauerová, J. Kollár, M. Jergel, P. Nádaždy, M. Omastová, E. Majková

Abstract:

Perovskite quantum dots (PQDs) have the potential to increase the performance of the perovskite solar cells (PSCs). The integration of PQDs into PSCs can extend the absorption range and enhance photon harvesting and device efficiency. In addition, PQDs can stabilize the device structure by passivating surface defects and traps in the perovskite layer and enhance its stability. The integration of PQDs into PSCs is strongly affected by the type of ligands on the surface of PQDs. The ligands affect the charge transport properties of PQDs, as well as the formation of well-defined interfaces and stability of PSCs. In this work, the CsPbBr₃ QDs were synthesized by the conventional hot-injection method using cesium oleate, PbBr₂, and two different ligands, namely oleic acid (OA)@oleylamine (OAm) and didodecyldimethylammonium bromide (DDAB). The STEM confirmed regular shape and relatively monodisperse cubic structure with an average size of about 10-14 nm of the prepared CsPbBr₃ QDs. Further, the photoluminescent (PL) properties of the PQDs/perovskite bilayer with the ligand OA@OAm and DDAB were studied. For this purpose, ITO/PQDs, as well as ITO/PQDs/MAPI perovskite structures, were prepared by spin coating, and the effect of the ligand and oxygen plasma treatment was analysed. The plasma treatment of the PQDs layer could be beneficial for the deposition of the MAPI perovskite layer and the formation of a well-defined PQDs/MAPI interface. The absorption edge in UV-Vis absorption spectra for OA@OAm CsPbBr₃ QDs is placed around 513 nm (the band gap 2.38 eV); for DDAB CsPbBr₃ QDs, it is located at 490 nm (the band gap 2.33 eV). The photoluminescence (PL) spectra of CsPbBr₃ QDs show two peaks located around 514 nm (503 nm) and 718 nm (708 nm) for OA@OAm (DDAB). The peak around 500 nm corresponds to the PL of PQDs, and the peak close to 710 nm belongs to the surface states of PQDs for both types of ligands. These surface states are strongly affected by the O₃ plasma treatment. For PQDs with DDAB ligand, the O₃ exposure (5, 10, 15 s) results in the blue shift of the PQDs peak and a non-monotonous change of the amplitude of the surface states' peak. For OA@OAm ligand, the O₃ exposition did not cause any shift of the PQDs peak, and the intensity of the PL peak related to the surface states is lower by one order of magnitude in comparison with DDAB, being affected by O₃ plasma treatment. The PL results indicate the possibility of tuning the position of the PL maximum by the ligand of the PQDs. Similar behaviour of the PQDs layer was observed for the ITO/QDs/MAPI samples, where an additional strong PL peak at 770 nm coming from the perovskite layer was observed; for the sample with PQDs with DDAB ligands, a small blue shift of the perovskite PL maximum was observed independently of the plasma treatment. These results suggest the possibility of affecting the PL maximum position and the surface states of the PQDs by the combination of a suitable ligand and the O₃ plasma treatment.

Keywords: perovskite quantum dots, photoluminescence, O₃ plasma., perovskite solar cells

Procedia PDF Downloads 64

Authors: Sang-Wook Lee, So-Yeon Jeon, Min-Gi Cho, Dae-Young Shin, Sung-Ho Hwang

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Hydraulic system of excavator gets working energy from hydraulic pump which is connected to output shaft of engine. Recently, main control valve (MCV) which is composed of several independent metering valve (IMV) has been introduced for better energy efficiency of the hydraulic system so that fuel efficiency of the excavator can be improved. Excavator with IMV has 5 operating modes depending on the quantity of regeneration flow. In this system, the hydraulic pump is controlled to supply demanded flow which is needed to operate each mode. Because the regenerated flow supply energy to actuators, the hydraulic pump consumes less energy to make same motion than one that does not regenerate flow. The horse power control is applied to the hydraulic pump of excavator for maintaining engine start under a heavy load and this control makes the flow of hydraulic pump reduced. When excavator is in complex operation such as loading or unloading soil, the hydraulic pump discharges small quantity of working fluid in high pressure. At this operation, the engine of excavator does not run at optimal operating line (OOL). The engine needs to be operated on OOL to improve fuel efficiency and by controlling hydraulic pump the engine can drive on OOL. By continuous mode changing of IMV, the hydraulic pump is controlled to make engine runs on OOL. The simulation result of this study shows that fuel efficiency of excavator with IMV can be improved by considering engine OOL and continuous mode changing algorithm.

Keywords: continuous mode changing, engine fuel consumption, excavator, fuel efficiency, IMV

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Authors: Narges Solaymani

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Definition of Nurse: Nurse: A person who is educated and skilled in the field of scientific principles and professional skills of health care, treatment, and medical training of patients. Nursing is a very important profession in the societies of the world. Although in the past, all caregivers of the sick and disabled were called nurses, nowadays, a nurse is a person who has a university education in this field. There are nurses in bachelor's, master's, and doctoral degrees in nursing. New courses have been launched in the master's degree based on duty-oriented nurses. A nurse cannot have an independent treatment center but is a member of the treatment team in established treatment centers such as hospitals, clinics, or offices. Nurses can establish counseling centers and provide nursing services at home. According to the standards, the number of nurses should be three times the number of doctors or twice the number of hospital beds, or there should be three nurses for every thousand people. Also, international standards show that in the internal and surgical department, every 4 to 6 patients should have a nurse.

Keywords: nurse, intensive care, CPR, bandage

Procedia PDF Downloads 60

Authors: J. D. García Espinel, Paula Pérez Sánchez, Carlos Egea Ruiz, Carlos Lardín Mifsut, Andrés López-Aranguren Oliver

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This paper shortly describes three main actuations over a Waste Water Treatment Plant (WWTP) for reducing its energy consumption: Optimization of the biological reactor in the aeration stage by including new control algorithms and introducing new efficient equipment, the installation of an innovative hybrid system with zero Grid injection (formed by 100kW of PV energy and 5 kW of mini-wind energy generation) and an intelligent management system for load consumption and energy generation control in the most optimum way. This project called RENEWAT, involved in the European Commission call LIFE 2013, has the main objective of reducing the energy consumptions through different actions on the processes which take place in a WWTP and introducing renewable energies on these treatment plants, with the purpose of promoting the usage of treated waste water for irrigation and decreasing the C02 gas emissions. WWTP is always required before waste water can be reused for irrigation or discharged in water bodies. However, the energetic demand of the treatment process is high enough for making the price of treated water to exceed the one for drinkable water. This makes any policy very difficult to encourage the re-use of treated water, with a great impact on the water cycle, particularly in those areas suffering hydric stress or deficiency. The cost of treating waste water involves another climate-change related burden: the energy necessary for the process is obtained mainly from the electric network, which is, in most of the cases in Europe, energy obtained from the burning of fossil fuels. The innovative part of this project is based on the implementation, adaptation and integration of solutions for this problem, together with a new concept of the integration of energy input and operative energy demand. Moreover, there is an important qualitative jump between the technologies used and the alleged technologies to use in the project which give it an innovative character, due to the fact that there are no similar previous experiences of a WWTP including an intelligent discrimination of energy sources, integrating renewable ones (PV and Wind) and the grid.

Keywords: aeration system, biological reactor, CO2 emissions, energy efficiency, hybrid systems, LIFE 2013 call, process optimization, renewable energy sources, wasted water treatment plants

Procedia PDF Downloads 348

Authors: Mohammad Ali Oghabian, Reza Reiazi, Esmaeel Parsai, Mehdi Aghili, Ramin Jaberi

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In this project a new procedure has been introduced for utilizing digitally reconstructed radiograph from MRI images in Brachytherapy treatment planning. This procedure enables us to localize the tumor volume and delineate the extent of critical structures in vicinity of tumor volume. The aim of this project was to improve the accuracy of dose delivered to targets of interest in 2D treatment planning system.

Keywords: brachytherapy, cervix, digitally reconstructed radiographs, lymph node

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Authors: Jihuai Wu, Zeyu Song, Zhang Lan, Liuxue Sun

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Solar energy is clean, open, and infinite, but solar radiation on the earth is fluctuating, intermittent, and unstable. So, the sustainable utilization of solar energy requires a combination of high-efficient energy conversion and low-loss energy storage technologies. Hence, a photo capacitor integrated with photo-electrical conversion and electric-chemical storage functions in single device is a cost-effective, volume-effective and functional-effective optimal choice. However, owing to the multiple components, multi-dimensional structure and multiple functions in one device, especially the mismatch of the functional modules, the overall conversion and storage efficiency of the photocapacitors is less than 13%, which seriously limits the development of the integrated system of solar conversion and energy storage. To this end, two typical photocapacitors were studied. A three-terminal photocapacitor was integrated by using perovskite solar cell as solar conversion module and symmetrical supercapacitor as energy storage module. A function portfolio management concept was proposed the relationship among various efficiencies during photovoltaic conversion and energy storage process were clarified. By harmonizing the energy matching between conversion and storage modules and seeking the maximum power points coincide and the maximum efficiency points synchronize, the overall efficiency of the photocapacitor surpassed 18 %, and Joule efficiency was closed to 90%. A voltage adjustable hybrid supercapacitor (VAHSC) was designed as energy storage module, and two Si wafers in series as solar conversion module, a three-terminal photocapacitor was fabricated. The VAHSC effectively harmonizes the energy harvest and storage modules, resulting in the current, voltage, power, and energy match between both modules. The optimal photocapacitor achieved an overall efficiency of 15.49% and Joule efficiency of 86.01%, along with excellent charge/discharge cycle stability. In addition, the Joule efficiency (ηJoule) was defined as the energy ratio of discharge/charge of the devices for the first time.

Keywords: joule efficiency, perovskite solar cell, photocapacitor, silicon solar cell, supercapacitor

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Authors: Kubra Dogan, Fatih Tornuk

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Due to increasing consumer demand for the high-quality food products and awareness regarding the health benefits of different nutrients in food minimal processing becomes more popular in modern food preservation. To date, heat treatment is often used for inactivation of spoilage microorganisms in foods. However, it may cause significant changes in the quality and nutritional properties of food. In order to overcome the detrimental effects of heat treatment, several alternatives of non-thermal microbial inactivation processes have been investigated. Ultraviolet (UV) inactivation is a promising and feasible method for better quality and longer shelf life as an alternative to heat treatment, which aims to inhibit spoilage and pathogenic microorganisms and to inactivate the enzymes in vegetable juice production. UV-C is a sub-class of UV treatment which shows the highest microcidal effect between 250-270 nm. The wavelength of 254 nm is used for the surface disinfection of certain liquid food products such as vegetable juice. Effects of UV-C treatment on microbiological load and quality parameter of vegetable juice which is a mix of celery, carrot, lemon and orange was investigated. Our results showed that storing of UV-C applied vegetable juice for three months, reduced the count of TMAB by 3.5 log cfu/g and yeast-mold by 2 log cfu/g compared to control sample. Total phenolic content was found to be 514.3 ± 0.6 mg gallic acid equivalent/L, and there wasn’t a significant difference compared to control. The present work suggests that UV-C treatment is an alternative method for disinfection of vegetable juice since it enables adequate microbial inactivation, longer shelf life and has minimal effect on degradation of quality parameters of vegetable juice.

Keywords: heat treatment, phenolic content, shelf life, ultraviolet (UV-C), vegetable juice

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Authors: Francois Defay

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Uses of Unmanned aerial vehicle (UAV) are increasing for many applicative cases. Long endurance UAVs are required for inspection or transportation in some deserted places. The global optimization of the efficiency is the aim of the works in ISAE-SUPAERO. From the propulsive part until the motor control, the global optimization can increase significantly the global efficiency. This paper deals with the global improvement of the efficiency of the electrical propulsion for the aerial vehicle. The application case of study is a small airplane of 2kg. A global modelization is presented in order to validate the electrical engine in a complete simulation from aerodynamics to battery. The classical control of the synchronous permanent drive is compared to the field-oriented control which is not yet applied for UAVs. The experimental results presented show an increase of more than 10 percent of the efficiency. A complete modelization and simulation based on Matlab/ Simulink are presented in this paper and compared to the experimental study. Finally this paper presents solutions to increase the endurance of the electrical aerial vehicle and provide models to optimize the global consumption for a specific mission. The next step is to use this model and the control to work with distributed propulsion which is the future for small distance plane.

Keywords: electrical propulsion, endurance, field-oriented control, UAV

Procedia PDF Downloads 229

Authors: Elisa K. Schoenell, Cristiano De Oliveira, Luiz R. H. Dos Santos, Alexandre Giacobbo, Andréa M. Bernardes, Marco A. S. Rodrigues

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Water is an indispensable natural resource, which must be preserved to human activities as well the ecosystems. However, the sewage discharge has been contaminating water resources. Conventional treatment, such as physicochemical treatment followed by biological processes, has not been efficient to the complete degradation of persistent organic compounds, such as medicines and hormones. Therefore, the use of advanced technologies to sewage treatment has become urgent and necessary. The aim of this study was to apply Reverse Osmosis (RO) on sewage tertiary treatment from a Waste Water Treatment Plant (WWTP) in south Brazil. It was collected 200 L of sewage pre-treated by wetland with aquatic macrophytes. The sewage was treated in a RO pilot plant, using a polyamide membrane BW30-4040 model (DOW FILMTEC), with 7.2 m² membrane area. In order to avoid damage to the equipment, this system contains a pleated polyester filter with 5 µm pore size. It was applied 8 bar until achieve 5 times of concentration, obtaining 80% of recovery of permeate, with 10 L.min-1 of concentrate flow rate. Samples of sewage pre-treated on WWTP, permeate and concentrate generated on RO was analyzed for physicochemical parameters and by gas chromatography (GC) to qualitative analysis of organic compounds. The results proved that the sewage treated on WWTP does not comply with the limit of phosphorus and nitrogen of Brazilian legislation. Besides this, it was found many organic compounds in this sewage, such as benzene, which is carcinogenic. Analyzing permeate results, it was verified that the RO as sewage tertiary treatment was efficient to remove of physicochemical parameters, achieving 100% of iron, copper, zinc and phosphorus removal, 98% of color removal, 91% of BOD and 62% of ammoniacal nitrogen. RO was capable of removing organic compounds, however, it was verified the presence of some organic compounds on de RO permeate, showing that RO did not have the capacity of removal all organic compounds of sewage. It has to be considered that permeate showed lower intensity of peaks in chromatogram in comparison to the sewage of WWTP. It is important to note that the concentrate generate on RO needs a treatment before its disposal in environment.

Keywords: organic compounds, reverse osmosis, sewage treatment, tertiary treatment

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Authors: Anton Serov, Alan Maslani, Michal Hlina, Vladimir Kopecky, Milan Hrabovsky

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Recycling of organic waste is an increasingly hot topic in recent years. This issue becomes even more interesting if the raw material for the fuel production can be obtained as the result of that recycling. A process of high-temperature decomposition of a lignite (a non-hydrolysable complex organic compound) was studied on the plasma gasification reactor PLASGAS, where water-stabilized plasma torch was used as a source of high enthalpy plasma. The plasma torch power was 120 kW and allowed heating of the reactor to more than 1000 °C. The material feeding rate in the gasification reactor was selected 30 and 60 kg per hour that could be compared with small industrial production. An efficiency estimation of the thermal decomposition process was done. A balance of the torch energy distribution was studied as well as an influence of the lignite particle size and an addition of methane (CH4) in a reaction volume on the syngas composition (H2+CO). It was found that the ratio H2:CO had values in the range of 1,5 to 2,5 depending on the experimental conditions. The recycling process occurred at atmospheric pressure that was one of the important benefits because of the lack of expensive vacuum pump systems. The work was supported by the Grant Agency of the Czech Republic under the project GA15-19444S.

Keywords: atmospheric pressure, lignite, plasma treatment, water-stabilized plasma torch

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Authors: Charles Amoo, Joshua New, Bill Eckman

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Buildings in the United States account for a significant proportion of energy consumption and greenhouse gas (GHG) emissions, and this trend is expected to continue as well as rise in the near future. Low-income households, in particular, bear a disproportionate burden of high building energy consumption and spending due to high energy costs. Energy efficiency improvements need to reach an average of 4% per year in this decade in order to meet global net zero emissions target by 2050, but less than 1 % of U.S. buildings are improved each year. The government has recognized the importance of technology in addressing this issue, and energy efficiency programs have been developed to tackle the problem. The Weatherization Assistance Program (WAP), the largest residential whole-house energy efficiency program in the U.S., is specifically designed to reduce energy costs for low-income households. Under the WAP, energy auditors must follow specific audit procedures and use Department of Energy (DOE) approved energy audit tools or software. This article proposes an expanded framework of factors that should be considered in energy audit software that is approved for use in energy efficiency programs, particularly for low-income households. The framework includes more than 50 factors organized under 14 assessment criteria and can be used to qualitatively and quantitatively score different energy audit software to determine their suitability for specific energy efficiency programs. While the tool can be useful for developers to build new tools and improve existing software, as well as for energy efficiency program administrators to approve or certify tools for use, there are limitations to the model, such as the lack of flexibility that allows continuous scoring to accommodate variability and subjectivity. These limitations can be addressed by using aggregate scores of each criterion as weights that could be combined with value function and direct rating scores in a multicriteria decision analysis for a more flexible scoring.

Keywords: buildings, energy efficiency, energy audit, software

Procedia PDF Downloads 71

Authors: Kiurski S. Jelena, Oros B. Ivana, Kecić S. Vesna, Kovačević M. Ilija, Aksentijević M. Snežana

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The adsorption efficiency of various adsorbents for the removal of Zn(II) ions from the waste printing developer was studied in laboratory batch mode. The maximum adsorption efficiency of 94.1% was achieved with unfired clay pellets size (d≈15 mm). The obtained values of adsorption efficiency was subjected to the independent samples t-test in order to investigate the statistically significant differences of the investigated adsorbents for the effective removal of Zn(II) ions from the waste printing developer. The most statistically significant differences of adsorption efficiencies for Zn(II) ions removal were obtained between unfired clay pellets size (d≈15 mm) and activated carbon (|t|= 6.909), natural zeolite (|t|= 10.380), mixture of activated carbon and natural zeolite (|t|= 9.865), bentonite (|t|= 6.159), fired clay (|t|= 6.641), fired clay pellets size (d≈5 mm) (|t|= 6.678), fired clay pellets size (d≈8 mm) (|t|= 3.422), respectively.

Keywords: Adsorption efficiency, adsorbent, statistical analysis, zinc ion.

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Authors: Mariam Fishere

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The proposed research study aims at developing an Internet-based transdiagnostic treatment and evaluating its efficacy. Based on the Common Elements Treatment Approach (CETA), a combined low-intensity and technology supported transdiagnostic treatment protocol will be culturally adapted for usage by nonprofessional therapists in Arabic-speaking countries. This Internet-based CETA intervention will target individuals suffering from one or more of the following disorders: depression, anxiety and posttraumatic stress disorder (PTSD), which are all major contributors to the global burden of mental illness. The growing body of research in the area of transdiagnostic treatment has proven to be effective in high-income countries (HICs), but there remain questions about its efficacy, cultural appropriateness, and validity for low- to middle-income countries (LMICs). The aim of this dissertation project is to investigate the efficacy of a newly developed Internet-delivery of an evidence-based transdiagnostic treatment – CETA – for a sample of Arabic-speaking individuals suffering from at least one of the following disorders; depression, anxiety, and PTSD.

Keywords: transdiagnostic, internet-based interventions, mental health, Arab world

Procedia PDF Downloads 220

Authors: Sunday Olufemi Adesogan

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The supply of potable water at least is a very important index in national development. Water tariffs depend on the treatment cost which carries the highest percentage of the total operation cost in any water supply scheme. In order to keep water tariffs as low as possible, treatment costs have to be minimized. The University of Ibadan, Nigeria, water supply scheme consists of a treatment plant with three distribution stations (Amina way, Kurumi and Lander) and two raw water supply sources (Awba dam and Eleyele dam). An operational study of the scheme was carried out to ascertain the efficiency of the supply of potable water on the campus to justify the need for water supply schemes in tertiary institutions. The study involved regular collection, processing and analysis of periodic operational data. Data collected include supply reading (water production on daily basis) and consumers metered reading for a period of 22 months (October 2013 - July 2015), and also collected, were the operating hours of both plants and human beings. Applying the required mathematical equations, total loss was determined for the distribution system, which was translated into monetary terms. Adequacies of the operational functions were also determined. The study revealed that water supply scheme is justified in tertiary institutions. It was also found that approximately 10.7 million Nigerian naira (N) is lost to leakages during the 22-month study period; the system’s storage capacity is no longer adequate, especially for peak water production. The capacity of the system as a whole is insufficient for the present university population and that the existing water supply system is not being operated in an optimal manner especially due to personnel, power and system ageing constraints.

Keywords: development, panacea, supply, water

Procedia PDF Downloads 203

Authors: M. M. Wickramasinghe

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Cholesterol and triglycerides are lipids, mainly essential to maintain the cellular structure of the human body. Cholesterol is also important for hormone production, vitamin D production, proper digestion functions, and strengthening the immune system. Excess fats in the blood circulation, known as hyperlipidemia, become harmful leading to arterial clogging and causing atherosclerosis. Aim of this research is to develop a treatment protocol to efficiently break down and maintain circulatory lipids by improving blood circulation without strenuous physical exercises while immersed in a tub of water. To achieve the target of strong exercise effect, this method involves generating powerful ozone bubbles to spin, collide, and burst in the water. Powerful emission of air into water is capable of transferring locked energy of the water molecules and releasing energy. This method involves water and air-based impact generated by pumping ozone at the speed of 46 lts/sec with a concentration of 0.03-0.05 ppt according to safety standards of The Federal Institute for Drugs and Medical Devices, BfArM, Germany. The direct impact of ozone bubbles on the muscular system and skin becomes the main target and is capable of increasing the heart rate while immersed in water. A total time duration of 20 minutes is adequate to exert a strong exercise effect, improve blood circulation, and stimulate the nervous and endocrine systems. Unstable ozone breakdown into oxygen release onto the surface of the water giving additional benefits and supplying high-quality air rich in oxygen required to maintain efficient metabolic functions. The breathing technique was introduced to improve the efficiency of lung functions and benefit the air exchange mechanism. The temperature of the water is maintained at 39c to 40c to support arterial dilation and enzyme functions and efficiently improve blood circulation to the vital organs. The buoyancy of water and natural hydrostatic pressure release the tension of the body weight and relax the mind and body. Sufficient hydration (3lts of water per day) is an essential requirement to transport nutrients and remove waste byproducts to process through the liver, kidney, and skin. Proper nutritional intake is an added advantage to optimize the efficiency of this method which aids in a fast recovery process. Within 20-30 days of daily treatment, triglycerides, low-density lipoproteins (LDL), and total cholesterol reduction were observed in patients with abnormal levels of lipid profile. Borderline patients were cleared within 10–15 days of treatment. This is a highly efficient system that provides many benefits and is able to achieve a successful reduction of triglycerides, LDL, and total cholesterol within a short period of time. Supported by proper hydration and nutritional balance, this system of natural treatment maintains healthy levels of lipids in the blood and avoids the risk of cerebral stroke, high blood pressure, and heart attacks.

Keywords: atherosclerosis, cholesterol, hydrotherapy, hyperlipidemia, lipid management, ozone therapy, triglycerides

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Authors: Herviyanti, Gusnidar, M. Harianti

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The objective of this research were: a) using low-rank coal (subbituminous) as main humate material sources because this material will not be anthracite, and cannot using to be an energy sources b) to examine residual effects of humic matter from subbituminous which was combined with P fertilizers to adsorp Al and Fe metal, improving soil fertility, and increasing P fertilizing efficiency and Oxisol productivity. Therefore, optimalization crop productivity of upland rice can be achieved. The experiment was designed using a 3 x 4 factorial with 3 replications in randomly groups design. The 1st factor was 3 ways incubating humate material with P-fertilizer, which are: I1 = Incubation of humate material 1 week, then incubation P-fertilizers 1 week; I2 = Incubation of humate materials and P fertilizers directly into the soil for 2 weeks; and I3 = humate material and P fertilizer mixed for 1 week, then incubation to the soil for 1 week. The 2nd factor was residual effects of humate material and P-fertilizer combination which are 4 doses H1 = 400 ppm (0.8 Mg/ha) + 100% R; H2 = 400 ppm + 75% R; H3 = 800 ppm (1.6 Mg/ha) + 100% R,; and H4 = 800 ppm + 75% R. The 2nd year research results showed that the best treatment was founded residue effect of 800 ppm humate material and 100% R P-fertilizer doses in I3 way incubation that is equal to 6.19 t ha-1 upland rice yield. However, this result is almost the same as residual effects of 800 ppm humate material + 75% R P-fertilizer doses and upland rice yield the 1st year. It was concluded that addition of humate material can given the efficiency of P-fertilizer using up to 25% until the 2nd season planted.

Keywords: humate materials, P-fertilizer, subbituminous, upland rice

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Authors: P. Charvin, R. Bourrou, F. Lemont, C. Lafon, A. Russello

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For nuclear waste treatment and confinement, a specific IN-CAN melting module based on low-frequency induction heating have been designed. The frequency of 50Hz has been chosen to improve penetration length through metal. In this design, the liquid metal, strongly stirred by electromagnetic effects, presents shape of a dome caused by strong Laplace forces developing in the bulk of bath. Because of a lower density, the glass phase is located above the metal phase and is heated and stirred by metal through interface. Electric parameters (Intensity, frequency) give precious information about metal load and composition (resistivity of alloy) through impedance modification. Then, power supply can be adapted to energy transfer efficiency for suitable process supervision. Modeling of this system allows prediction of metal dome shape (in agreement with experimental measurement with a specific device), glass and metal velocity, heat and motion transfer through interface. MHD modeling is achieved with COMSOL and Fluent. First, a simplified model is used to obtain the shape of the metal dome. Then the shape is fixed to calculate the fluid flow and the thermal part.

Keywords: electromagnetic stirring, induction heating, interface modeling, metal load

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Authors: Chen Zhang; Qiang Wang

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With the rapid development of the new generation of digital technology, various industries have created more and more value by using digital technology, accelerating the digital transformation of various industries. The economic form of human society has evolved with the progress of technology, and in this context, the power conversion, transformation and upgrading of the manufacturing industry in terms of quality, efficiency and energy change has become a top priority. Based on the digitalization background, this paper analyzes the transformation and upgrading efficiency of the manufacturing industry and evaluates the impact of the driving factors, which have very important theoretical and practical significance. This paper utilizes qualitative research methods, entropy methods, data envelopment analysis methods and econometric models to explore the transformation and upgrading efficiency of manufacturing enterprises and driving factors. The study shows that the transformation and upgrading efficiency of the manufacturing industry shows a steady increase, and regions rich in natural resources and social resources provide certain resources for transformation and upgrading. The ability of scientific and technological innovation has been improved, but there is still much room for progress in the transformation of scientific and technological innovation achievements. Most manufacturing industries pay more attention to green manufacturing and sustainable development. In addition, based on the existing problems, this paper puts forward suggestions for improving infrastructure construction, developing the technological innovation capacity of enterprises, green production and sustainable development.

Keywords: digitization, manufacturing firms, transformation and upgrading, efficiency, driving factors

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Authors: Vidit Mohan, Ashwin P. Ramesh, Anirudh Toshniwal

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Alkali-Surfactant-Alternate-Gas(ASAG) injection, a novel EOR process has the potential to improve displacement efficiency over Surfactant-Alternate-Gas(SAG) by addressing the problem of surfactant adsorption by clay minerals in rock matrix. A detailed laboratory investigation on ASAG injection process was carried out with encouraging results. To further enhance recovery over WAG injection process, SAG injection was investigated at laboratory scale. SAG injection yielded marginal incremental displacement efficiency over WAG process. On investigation, it was found that, clay minerals in rock matrix adsorbed the surfactants and were detrimental for SAG process. Hence, ASAG injection was conceptualized using alkali as a clay stabilizer. The experiment of ASAG injection with surfactant concentration of 5000 ppm and alkali concentration of 0.5 weight% yields incremental displacement efficiency of 5.42% over WAG process. The ASAG injection is a new process and has potential to enhance efficiency of WAG/SAG injection process.

Keywords: alkali surfactant alternate gas (ASAG), surfactant alternate gas (SAG), laboratory investigation, EOR process

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Authors: Mohd. A. M. Rahim, Yahaya Hassan, Mathumalar L. Fahrni

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Second line antiretroviral therapy (ART) regimen is used when patients fail their first line regimen. There are many factors such as non-adherence, drug resistance as well as virological and immunological failure that lead to second line highly active antiretroviral therapy (HAART) regimen treatment failure. This study was aimed at determining predictor factors to treatment failure with second line HAART and analyzing median survival time. An observational, retrospective study was conducted in Sungai Buloh Hospital (HSB) to assess current status of HIV patients treated with second line HAART regimen. Convenience sampling was used and 104 patients were included based on the study’s inclusion and exclusion criteria. Data was collected for six months i.e. from July until December 2013. Data was then analysed using SPSS version 18. Kaplan-Meier and Cox regression analyses were used to measure median survival times and predictor factors for treatment failure. The study population consisted mainly of male subjects, aged 30-45 years, who were heterosexual, and had HIV infection for less than 6 years. The most common second line HAART regimen given was lopinavir/ritonavir (LPV/r)-based combination. Kaplan-Meier analysis showed that patients on LPV/r demonstrated longer median survival times than patients on indinavir/ritonavir (IDV/r) based combination (p<0.001). The commonest reason for a treatment to fail with second line HAART was non-adherence. Based on Cox regression analysis, other predictor factors for treatment failure with second line HAART regimen were age and mode of HIV transmission.

Keywords: adherence, antiretroviral therapy, second line, treatment failure

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Authors: M. Szechynska-Hebda, M. Sobczak, E. Rozanska, J. Troczynska, Z. Banaszak, N. Hordyńska, M. Dyda, M. Wedzony

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Chloroplasts, as essential organelles for photosynthesis, play a critical role in plant development. However, disturbances in the proper functioning of chloroplasts, in the extreme case manifesting as albinism of tissues and whole plants, are a phenomenon often occurring in conditions deviating from natural (e.g., in vitro cultures applied in breeding programs). Using whole-transcriptome analysis (RNA-Seq) together with light, fluorescent and electron microscopy, it was shown, that development of chloroplasts and formation of green or albino plants in the androgenesis process are genotype-dependent; however, they could be modulated by sub-optimal temperature treatment. The reprogramming of the microspore development from gametophytic to sporophytic, and then regeneration of green plant can be positively regulated by cold stress (4 ⁰C). A high temperature stress (32 ⁰C) can induce androgenesis, but it is a factor negatively influencing green plant regeneration (promoting albinism). A similar effect on microspores, androgenesis, and subsequent chloroplast formation, is elicited as a result of postponing the date of spike collection from spring to summer in field conditions (natural temperature rise). It is determined in both environmental or genotypic manner. The delay of the sowing date (environmental effect) or growing of late genotypes (genotypic effect) result in spike maturation at higher temperatures and significantly enhance albino plant formation in androgenesis process. Such a temperature system (4 ⁰C vs. 32 ⁰C) was used to study the chloroplast biogenesis process in wheat and triticale. It was shown, that efficiency of physiological processes differentiates microspore development during cold reprograming in genotypes susceptible and resistant to androgenesis. Moreover, a great variation in developmental stages of the microspores in one anther is observed for susceptible genotypes. Microspores that are more physiologically active under cold conditions can activate signaling pathways and processes, which provide an appropriate supply of metabolites to cell compartments. This, in turn, fully correlates with the genotype-dependent efficiency of chloroplast formation (or different types of plastid) at particular steps of androgenesis. The effect obtained after applying a high temperature stress is different. High temperature causes a significant acceleration of microspore development and less variation in developmental stages at the end of the treatment. Therefore, the developmental diversity of the microspores in one anther seems to be a critical factor for subsequent cell and chloroplast differentiation. The work was financed by Ministry of Agriculture and Rural Development within Program: 'Biological Progress in Plant Production', project no HOR.hn.802.15.2018

Keywords: androgenesis, chloroplast biogenesis, temperature stress, wheat

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Authors: N. R. N. Idris, S. Baharom

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A meta-analysis may be performed using aggregate data (AD) or an individual patient data (IPD). In practice, studies may be available at both IPD and AD level. In this situation, both the IPD and AD should be utilised in order to maximize the available information. Statistical advantages of combining the studies from different level have not been fully explored. This study aims to quantify the statistical benefits of including available IPD when conducting a conventional summary-level meta-analysis. Simulated meta-analysis were used to assess the influence of the levels of data on overall meta-analysis estimates based on IPD-only, AD-only and the combination of IPD and AD (mixed data, MD), under different study scenario. The percentage relative bias (PRB), root mean-square-error (RMSE) and coverage probability were used to assess the efficiency of the overall estimates. The results demonstrate that available IPD should always be included in a conventional meta-analysis using summary level data as they would significantly increased the accuracy of the estimates. On the other hand, if more than 80% of the available data are at IPD level, including the AD does not provide significant differences in terms of accuracy of the estimates. Additionally, combining the IPD and AD has moderating effects on the biasness of the estimates of the treatment effects as the IPD tends to overestimate the treatment effects, while the AD has the tendency to produce underestimated effect estimates. These results may provide some guide in deciding if significant benefit is gained by pooling the two levels of data when conducting meta-analysis.

Keywords: aggregate data, combined-level data, individual patient data, meta-analysis

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Authors: Yaxian Chen, Yeonhee Park

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Driven by evolving FDA recommendations, modern clinical trials demand innovative designs that strike a balance between statistical rigor and ethical considerations. Covariate-adjusted response-adaptive (CARA) designs bridge this gap by utilizing patient attributes and responses to skew treatment allocation in favor of the treatment that is best for an individual patient’s profile. However, existing CARA designs for survival outcomes often hinge on specific parametric models, constraining their applicability in clinical practice. In this article, we address this limitation by introducing a CARA design for survival outcomes (CARAS) based on the Cox model and a variance estimator. This method addresses issues of model misspecification and enhances the flexibility of the design. We also propose a group sequential overlapweighted log-rank test to preserve type I error rate in the context of group sequential trials using extensive simulation studies to demonstrate the clinical benefit, statistical efficiency, and robustness to model misspecification of the proposed method compared to traditional randomized controlled trial designs and response-adaptive randomization designs.

Keywords: cox model, log-rank test, optimal allocation ratio, overlap weight, survival outcome

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Authors: Mohamed Ghoz, Hala Alsabeh

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Context: Macroscopic Nose Macroneedling (MNM) is a new non-surgical procedure for lifting and tightening the nose. It is a tissue-non-invasive technique that uses a needle to create micro-injuries in the skin. These injuries stimulate the production of collagen and elastin, which results in the tightening and lifting of the skin. Research Aim: The research aim of this study was to investigate the efficacy and safety of MNM for the treatment of nasal deformities. Methodology A total of 100 patients with nasal deformities were included in this study. The patients were randomly assigned to either the MNM group or the control group. The MNM group received a single treatment of MNM, while the control group received no treatment. The patients were evaluated at baseline, 6 months, and 12 months after treatment. Findings: The results of this study showed that MNM was effective in improving the appearance of the nose in patients with nasal deformities. At 6 months after treatment, the patients in the MNM group had significantly improved nasal tip projection, nasal bridge height, and nasal width compared to the patients in the control group. The improvements in nasal appearance were maintained at 12 months after treatment. Theoretical Importance: The findings of this study provide support for the use of MNM as a safe and effective treatment for nasal deformities. MNM is a non-surgical procedure that is associated with minimal downtime and no risk of scarring. This makes it an attractive option for patients who are looking for a minimally invasive treatment for their nasal deformities. Data Collection: Data was collected from the patients using a variety of methods, including clinical assessments, photographic assessments, and patient-reported outcome measures. Analysis Procedures: The data was analyzed using a variety of statistical methods, including descriptive statistics, inferential statistics, and meta-analysis. Question Addressed: The research question addressed in this study was whether MNM is an effective and safe treatment for nasal deformities. Conclusion: The findings of this study suggest that MNM is an effective and safe treatment for nasal deformities. MNM is a non-surgical procedure that is associated with minimal downtime and no risk of scarring. This makes it an attractive option for patients who are looking for a minimally invasive treatment for their nasal deformities.

Keywords: nose, surgery, tie, suture

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Authors: Gianluca Castelnuovo, Gian Mauro Manzoni, Giada Pietrabissa, Stefania Corti, Emanuele Giusti, Roberto Cattivelli, Enrico Molinari, Susan Simpson

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Obesity is currently an important public health problem of epidemic proportions (globesity). Moreover Binge Eating Disorder (BED) is typically connected with obesity, even if not occurring exclusively in conjunction with overweight conditions. Typically obesity with BED requires a longer term treatment in comparison with simple obesity. Rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation, due to the growing costs of a limited inpatient approach. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach. The new m health (m-health, mobile health) paradigm, defined as clinical practices supported by up to date mobile communication devices, could increase compliance- engagement and contribute to a significant cost reduction in BED and obesity rehabilitation. Five psychological components need to be considered for successful m Health-based obesity rehabilitation in order to facilitate weight-loss.1) Self-monitoring. Portable body monitors, pedometers and smartphones are mobile and, therefore, can be easily used, resulting in continuous self-monitoring. 2) Counselor feedback and communication. A functional approach is to provide online weight-loss interventions with brief weekly or monthly counselor or psychologist visits. 3) Social support. A group treatment format is typically preferred for behavioral weight-loss interventions. 4) Structured program. Technology-based weight-loss programs incorporate principles of behavior therapy and change with structured weekly protocolos including nutrition, exercise, stimulus control, self-regulation strategies, goal-setting. 5) Individually tailored program. Interventions specifically designed around individual’s goals typically record higher rates of adherence and weight loss. Opportunities and limitations of m health approach in clinical psychology for obesity and BED are discussed, taking into account future research directions in this promising area.

Keywords: obesity, rehabilitation, out-patient, new technologies, tele medicine, tele care, m health, clinical psychology, psychotherapy, chronic care management

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Authors: Mamoun S. Ideis, Zein Salah

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Virtual Rehabilitation (VR) refers to using Virtual Reality’s hardware and simulations as means of exercising tools to rehabilitate patients in need. These patients will undergo their treatment exercises while playing different computer games, which helps achieve greater motivation for patients undergoing their therapeutic exercises. Virtual Rehabilitation systems adopt computer games as part of the treatment therapy. In this paper, we present a preliminary proposal to using adaptive computer games in Virtual Rehabilitation therapy. We also present some tips in designing those adaptive computer games by using different machine learning algorithms in order to create a personalized experience for each patient, which in turn, increases the potential benefits of the treatment that each patient receives. Furthermore, we propose a method of comparing the results of treatment using the adaptive computer games with the results of using static and classical computer games.

Keywords: virtual rehabilitation, physiotherapy, adaptive computer games, post-stroke, game design

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Authors: Teagan Fink, Lynn Chong, Michael Hii, Brett Knowles

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Background: Telemedicine is a rapidly advancing field providing healthcare to patients at a distance from their treating clinician. There is a paucity of high-quality evidence detailing the safety and acceptability of telemedicine for postoperative outpatient follow-up. This randomized controlled trial – conducted prior to the COVID 19 pandemic – aimed to assess patient satisfaction and safety (as determined by readmission, reoperation and complication rates) of telephone compared to face-to-face clinic follow-up after uncomplicated general surgical procedures. Methods: Patients following uncomplicated laparoscopic appendicectomy or cholecystectomy and laparoscopic or open umbilical or inguinal hernia repairs were randomized to a telephone or face-to-face outpatient clinic follow-up. Data points including patient demographics, perioperative details and postoperative outcomes (eg. wound healing complications, pain scores, unplanned readmission to hospital and return to daily activities) were compared between groups. Patients also completed a Likert patient satisfaction survey following their consultation. Results: 103 patients were recruited over a 12-month period (21 laparoscopic appendicectomies, 65 laparoscopic cholecystectomies, nine open umbilical hernia repairs, six laparoscopic inguinal hernia repairs and two laparoscopic umbilical hernia repairs). Baseline patient demographics and operative interventions were the same in both groups. Patient or clinician-reported concerns on postoperative pain, use of analgesia, wound healing complications and return to daily activities at clinic follow-up were not significantly different between the two groups. Of the 58 patients randomized to the telemedicine arm, 40% reported high and 60% reported very high patient satisfaction. Telemedicine clinic mean consultation times were significantly shorter than face-to-face consultation times (telemedicine 10.3 +/- 7.2 minutes, face-to-face 19.2 +/- 23.8 minutes, p-value = 0.014). Rates of failing to attend clinic were not significantly different (telemedicine 3%, control 6%). There was no increased rate of postoperative complications in patients followed up by telemedicine compared to in-person. There were no unplanned readmissions, return to theatre, or mortalities in this study. Conclusion: Telemedicine follow-up of patients undergoing uncomplicated general surgery is safe and does not result in any missed diagnosis or higher rates of complications. Telemedicine provides high patient satisfaction and steps to implement this modality in inpatient care should be undertaken.

Keywords: general surgery, telemedicine, patient satisfaction, patient safety

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Authors: Umair Shoukat Ali, Rashna Hoshang Sukhia, Mubassar Fida

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Introduction: The objective of the study was to compare outcomes in terms of Bleeding index (BI), Gingival Index (GI), and Orthodontic Plaque Index (OPI) with video graphics and plaque disclosing tablets (PDT) versus verbal instructions in adult orthodontic patients undergoing fixed appliance treatment (FAT). Materials and Methods: Adult orthodontic patients have recruited from outpatient orthodontic clinics who fulfilled the inclusion criteria and were randomly allocated to three groups i.e., video, PDT, and verbal groups. We included patients undergoing FAT for six months of both genders with all teeth bonded mesial to first molars having no co-morbid conditions such as rheumatic fever and diabetes mellitus. Subjects who had gingivitis as assessed by Bleeding Index (BI), Gingival Index (GI), and Orthodontic Plaque Index (OPI) were recruited. We excluded subjects having > 2 mm of clinical attachment loss, pregnant and lactating females, any history of periodontal therapy within the last six months, and any consumption of antibiotics or anti-inflammatory drugs within the last one month. Pre- and post-interventional measurements were taken at two intervals only for BI, GI, and OPI. The primary outcome of this trial was to evaluate the mean change in the BI, GI, and OPI in the three study groups. A computer-generated randomization list was used to allocate subjects to one of the three study groups using a random permuted block sampling of 6 and 9 to randomize the samples. No blinding of the investigator or the participants was performed. Results: A total of 99 subjects were assessed for eligibility, out of which 96 participants were randomized as three of the participants declined to be part of this trial. This resulted in an equal number of participants (32) that were analyzed in all three groups. The mean change in the oral hygiene indices score was assessed, and we found no statistically significant difference among the three interventional groups. Pre- and post-interventional results showed statistically significant improvement in the oral hygiene indices for the video and PDT groups. No statistically significant difference for age, gender, and education level on oral hygiene indices were found. Simple linear regression showed that the video group produced significantly higher mean OPI change as compared to other groups. No harm was observed during the trial. Conclusions: Visual aids performed better as compared to the verbal group. Gender, age, and education level had no statistically significant impact on the oral hygiene indices. Longer follow-ups will be required to see the long-term effects of these interventions. Trial Registration: NCT04386421 Funding: Aga Khan University and Hospital (URC 183022)

Keywords: oral hygiene, orthodontic treatment, adults, randomized clinical trial

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