Search results for: reverse circulation drilling

Authors: Oktay Celenk, Ugur Karanfil, Iskender Demir, Samir Lamrini, Jorg Neumann, Arif Demir

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Due to its favourable material characteristics, fiber reinforced plastics are amongst the main topics of all actual lightweight construction megatrends. Especially in transportation trends ranging from aeronautics over the automotive industry to naval transportation (yachts, cruise liners) the expected economic and environmental impact is huge. In naval transportation components like yacht bodies, antenna masts, decorative structures like deck lamps, light houses and pool areas represent cheap and robust solutions. Commercially available laser tools like carbon dioxide gas lasers (CO₂), frequency tripled solid state UV lasers, and Neodymium-YAG (Nd:YAG) lasers can be used. These tools have emission wavelengths of 10 µm, 0.355 µm, and 1.064 µm, respectively. The scientific goal is first of all the generation of a parameter matrix for laser processing of each used material for a Tm-fiber laser system (wavelength 2 µm). These parameters are the heat affected zone, process gas pressure, work piece feed velocity, intensity, irradiation time etc. The results are compared with results obtained with well-known material processing lasers, such as a Yb-fiber lasers (wavelength 1 µm). Compared to the CO₂-laser, the Tm-laser offers essential advantages for future laser processes like cutting, welding, ablating for repair and drilling in composite part manufacturing (components of cruise liners, marine pipelines). Some of these are the possibility of beam delivery in a standard fused silica fiber which enables hand guided processing, eye safety which results from the wavelength, excellent beam quality and brilliance due to the fiber nature. There is one more feature that is economically absolutely important for boat, automotive and military projects manufacturing that the wavelength of 2 µm is highly absorbed by the plastic matrix and thus enables selective removal of it for repair procedures.

Keywords: Thulium (Tm) fiber laser, laser processing of fiber-reinforced plastics (FRP), composite, heat affected zone

Procedia PDF Downloads 179

Authors: Sudip Kumar Kundu, Charu Singh

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As a great physiographic divide, the Himalayas affecting a large system of water and air circulation which helps to determine the climatic condition in the Indian subcontinent to the south and mid-Asian highlands to the north. It creates obstacles by defending chill continental air from north side into India in winter and also defends rain-bearing southwesterly monsoon to give up maximum precipitation in that area in monsoon season. Nowadays extreme weather conditions such as heavy precipitation, cloudburst, flash flood, landslide and extreme avalanches are the regular happening incidents in the region of North Western Himalayan (NWH). The present study has been planned to investigate the suitable model(s) to find out the rainfall pattern over that region. For this investigation, selected models from Coordinated Regional Climate Downscaling Experiment (CORDEX) and Coupled Model Intercomparison Project Phase 5 (CMIP5) has been utilized in a consistent framework for the period of 1976 to 2000 (historical). The ability of these driving models from CORDEX domain and CMIP5 has been examined according to their capability of the spatial distribution as well as time series plot of rainfall over NWH in the rainy season and compared with the ground-based Indian Meteorological Department (IMD) gridded rainfall data set. It is noted from the analysis that the models like MIROC5 and MPI-ESM-LR from the both CORDEX and CMIP5 provide the best spatial distribution of rainfall over NWH region. But the driving models from CORDEX underestimates the daily rainfall amount as compared to CMIP5 driving models as it is unable to capture daily rainfall data properly when it has been plotted for time series (TS) individually for the state of Uttarakhand (UK) and Himachal Pradesh (HP). So finally it can be said that the driving models from CMIP5 are better than CORDEX domain models to investigate the rainfall pattern over NWH region.

Keywords: global warming, rainfall, CMIP5, CORDEX, NWH

Procedia PDF Downloads 152

Authors: Mohamed Khiatine, Amal Medjnoun, Ramdane Bahar

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The North Algeria is a highly seismic zone, as evidenced by the historical seismicity. During the past two decades, it has experienced several moderate to strong earthquakes. Therefore, the geotechnical engineering problems that involve dynamic loading of soils and soil-structure interaction system requires, in the presence of saturated loose sand formations, liquefaction studies. Bejaia city, located in North-East of Algiers, Algeria, is a part of the alluvial plain which covers an area of approximately 750 hectares. According to the Algerian seismic code, it is classified as moderate seismicity zone. This area had not experienced in the past urban development because of the different hazards identified by hydraulic and geotechnical studies conducted in the region. The low bearing capacity of the soil, its high compressibility and the risk of liquefaction and flooding are among these risks and are a constraint on urbanization. In this area, several cases of structures founded on shallow foundations have suffered damages. Hence, the soils need treatment to reduce the risk. Many field and laboratory investigations, core drilling, pressuremeter test, standard penetration test (SPT), cone penetrometer test (CPT) and geophysical down hole test, were performed in different locations of the area. The major part of the area consists of silty fine sand , sometimes heterogeneous, has not yet reached a sufficient degree of consolidation. The ground water depth changes between 1.5 and 4 m. These investigations show that the liquefaction phenomenon is one of the critical problems for geotechnical engineers and one of the obstacles found in design phase of projects. This paper presents an analysis to evaluate the liquefaction potential, using the empirical methods based on Standard Penetration Test (SPT), Cone Penetration Test (CPT) and shear wave velocity and numerical analysis. These liquefaction assessment procedures indicate that liquefaction can occur to considerable depths in silty sand of harbor zone of Bejaia.

Keywords: earthquake, modeling, liquefaction potential, laboratory investigations

Procedia PDF Downloads 339

Authors: Hillary Mwongyera

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The Semliki basin has become a frontier for petroleum exploration in recent years. Exploration efforts have resulted into extensive seismic data acquisition and drilling of three wells namely; Turaco 1, Turaco 2 and Turaco 3. A petrophysical analysis of the Turaco 1 well was carried out to identify two reservoir zones on which AVO modeling was performed. A combination of seismic modeling and rock physics modeling was applied during reservoir characterization and monitoring to determine variations of seismic responses with amplitude characteristics. AVO intercept gradient analysis applied on AVO synthetic CDP gathers classified AVO anomalies associated with both reservoir zones as Class 1 AVO anomalies. Fluid replacement modeling was carried out on both reservoir zones using homogeneous mixing and patchy saturation patterns to determine effects of fluid substitution on rock property interactions. For both homogeneous mixing and saturation patterns, density (ρ) showed an increasing trend with increasing brine substitution while Shear wave velocity (Vs) decreased with increasing brine substitution. A study of compressional wave velocity (Vp) with increasing brine substitution for both homogeneous mixing and patchy saturation gave quite interesting results. During patchy saturation, Vp increased with increasing brine substitution. During homogeneous mixing however, Vp showed a slightly decreasing trend with increasing brine substitution but increased tremendously towards and at full brine saturation. A sensitivity analysis carried out showed that density was a very sensitive rock property responding to brine saturation except at full brine saturation during homogeneous mixing where Vp showed greater sensitivity with brine saturation. Rock physics modeling was performed to predict diagnostics of reservoir quality using an inverse deterministic approach which showed low shale content and a high degree of shale stiffness within reservoir zones.

Keywords: Amplitude Versus Offset (AVO), fluid replacement modelling, reservoir characterization, AVO attributes, rock physics modelling, reservoir monitoring

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Authors: Samir Chawdhury, Guido Morgenthal

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The paper presents a novel extension of Vortex Particle Methods (VPM) where the study aims to reproduce a template simulation of complex flow field that is generated from impulsively started flow past an upstream bluff body at certain Reynolds number Re-Vibration of a structural system under upstream wake flow is often considered its governing design criteria. Therefore, the attention is given in this study especially for the reproduction of wake flow simulation. The basic methodology for the implementation of the flow reproduction requires the downstream velocity sampling from the template flow simulation; therefore, at particular distances from the upstream section the instantaneous velocity components are sampled using a series of square sampling-cells arranged vertically where each of the cell contains four velocity sampling points at its corner. Since the grid free Lagrangian VPM algorithm discretises vorticity on particle elements, the method requires transformation of the velocity components into vortex circulation, and finally the simulation of the reproduction of the template flow field by seeding these vortex circulations or particles into a free stream flow. It is noteworthy that the vortex particles have to be released into the free stream exactly at same rate of velocity sampling. Studies have been done, specifically, in terms of different sampling rates and velocity sampling positions to find their effects on flow reproduction quality. The quality assessments are mainly done, using a downstream flow monitoring profile, by comparing the characteristic wind flow profiles using several statistical turbulence measures. Additionally, the comparisons are performed using velocity time histories, snapshots of the flow fields, and the vibration of a downstream bluff section by performing wake buffeting analyses of the section under the original and reproduced wake flows. Convergence study is performed for the validation of the method. The study also describes the possibilities how to achieve flow reproductions with less computational effort.

Keywords: vortex particle method, wake flow, flow reproduction, wake buffeting analysis

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Authors: Shu-Jen Chen, Yi-Chien Wan, Ruey-Chi Wang

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Hydroxyapatite (Ca10(PO4)6(OH)2, HAp) can be applied to the fabrication of bone replacement materials, the composite of dental filling, and the adsorption of biomolecules and dyes. The integration of HAp and magnetic materials would offer several advantages for bio-separation process because the magnetic adsorbents is capable of recovered by applied magnetic field. C-phycocyanin (C-PC) and Allophycocyanin (APC), isolated from Spirulina platensis, can be used in fluorescent labeling probes, health care foods and clinical diagnostic reagents. Although the purification of C-PC and APC are reported by HAp adsorption, the adsorption of C-PC and APC by magnetic HAp composites was not reported yet. Therefore, the fabrication of HAp with magnetic silica nanoparticles for proteins adsorption was investigated in this work. First, the magnetic silica particles were prepared by covering silica layer on Fe3O4 nanoparticles with a reverse micelle method. Then, the Fe3O4@SiO2 nanoparticles were mixed with calcium carbonate to obtain magnetic silica/calcium carbonate composites (Fe3O4@SiO2/CaCO3). The Fe3O4@SiO2/CaCO3 was further reacted with K2HPO4 for preparing the magnetic silica/hydroxyapatite composites (Fe3O4@SiO2/HAp). The adsorption experiments indicated that the adsorption capacity of Fe3O4@SiO2/HAp toward C-PC and APC were highest at pH 6. The adsorption of C-PC and APC by Fe3O4@SiO2/HAp could be correlated by the pseudo-second-order model, indicating chemical adsorption dominating the adsorption process. Furthermore, the adsorption data showed that the adsorption of Fe3O4@SiO2/HAp toward C-PC and APC followed the Langmuir isotherm. The isoelectric points of C-PC and APC were around 5.0. Additionally, the zeta potential data showed the Fe3O4@SiO2/HAp composite was negative charged at pH 6. Accordingly, the adsorption mechanism of Fe3O4@SiO2/HAp toward C-PC and APC should be governed by hydrogen bonding rather than electrostatic interaction. On the other hand, as compared to C-PC, the Fe3O4@SiO2/HAp shows higher adsorption affinity toward APC. Although the Fe3O4@SiO2/HAp cannot recover C-PC and APC from Spirulina platensis homogenate, the Fe3O4@SiO2/HAp can be applied to separate C-PC and APC.

Keywords: hydroxyapatite, magnetic, C-phycocyanin, allophycocyanin

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Authors: Emery Jr. Coppola

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Water resources are being depleted and degraded at an alarming and non-sustainable rate worldwide. In some areas, it is progressing more slowly. In other areas, irreversible damage has already occurred, rendering regions largely unsuitable for human existence with destruction of the environment and the economy. Today, 2.5 billion people or 36 percent of the world population live in water-stressed areas. The convergence of factors that created this global water crisis includes local, regional, and global failures. In this paper, a survey of some of these factors is presented. They include abuse of political power and regulatory acquiescence, improper planning and design, ignoring good science and models, systemic failures, and division between the powerful and the powerless. Increasing water demand imposed by exploding human populations and growing economies with short-falls exacerbated by climate change and continuing water quality degradation will accelerate this growing water crisis in many areas. Without regional measures to improve water efficiencies and protect dwindling and vulnerable water resources, environmental and economic displacement of populations and conflict over water resources will only grow. Perhaps more challenging, a global commitment is necessary to curtail if not reverse the devastating effects of climate change. Factors will be illustrated by real-world examples, followed by some partial solutions offered by water experts for helping to mitigate the growing water crisis. These solutions include more water efficient technologies, education and incentivization for water conservation, wastewater treatment for reuse, and improved data collection and utilization.

Keywords: climate change, water conservation, water crisis, water technologies

Procedia PDF Downloads 219

Authors: Elhem Zaatir, Taher Hamza

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Several governments seek to implement gender parity on boards, but the results of doing so are not clear and could harm corporations and economies. The present paper aims to investigate the relationship between women’s presence on boards and firms’ performance in the context of the French listed firms during the quota period. A dynamic panel generalized method of moment estimation is applied to control the endogenous effect of board structure and reverse the causality impact of the financial performance. Our results show that the impact of gender diversity manifests in conflicting directions, positively affecting accounting performance and negatively influencing market performance. These results suggest that female directors create economic value, but the market discounts their impact. Apparently, they are subject to a biased evaluation by the market, which undervalues their presence on boards. Added to that, our results confirm a twofold nature of female representation in the French market. The effect of female directorship on firm performance varies with the affiliation of the directors. In other words, the positive impact of gender diversity on return on assets primarily originates from the positive effect of non-family-affiliated women directors on market performance rather than on the effect of family-affiliated women directors on ROA. Finally, according to our results, women’s demographic attributes namely the level of education and multiple directorships strongly and positively impact firm performance as measured by return on assets (ROA). Obviously, women directors seem to be appointed to the business case rather than as token directors.

Keywords: corporate governance, board of directors, women, gender diversity, demographic attributes, firm performance

Procedia PDF Downloads 108

Authors: Leila Najafian

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Sarcoplasmic protein hydrolysates (SPHs) and myofibrillar protein hydrolysates (MPHs) from patin (Pangasius sutchi) were produced using two types of proteases: Papain and Alcalase. 1,1-diphenyl-2-picrylhydrazyl (DPPH), 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) diammonium salt (ABTS) radical scavenging activities and metal chelating activity assays for antioxidant activities were carried out on the SPHs and MPHs. The hydrolysates were isolated and purified by ultrafiltration, gel filtration and reverse phase high-performance liquid chromatography (RP-HPLC) and liquid chromatography with tandem mass spectrometry detection (LC-MS/MS) was used in identifying peptide sequences. The results showed that when the DH of MPHs increased, the protein solubility increased, while the highest amount of the protein solubility of SPHs was after 60 min incubation. The effect of DH on antioxidant activities of SPHs and MPHs was investigated. Among the hydrolysates, papain-MPH and Alcalase-SPH, which had the highest antioxidant activities, were purified. The potent fractions obtained from RP-HPLC of sarcoplasmic (SI 3 fraction) and myofibrillar (MI 4 fraction) hydrolysates showed the highest DPPH radical scavenging activity. The FVNQPYLLYSVHMK peptide for MPH and the LVVDIPAALQHA peptide for SPH exhibited the highest antioxidant activity. The presence of hydrophobic and hydrophilic amino acids, namely leucine (L), valine (V), phenylalanine (F), histidine (H) and proline (P), in the peptide sequences of SPH and MPH are believed to contribute to high antioxidant activity. Hence, SPH and MPH from patin have the potential as a natural functional ingredient in food and pharmaceutical industry.

Keywords: patin (Pangasius sutchi), protein hydrolysates, antioxidative peptides, mass spectrometry

Procedia PDF Downloads 245

Authors: Sema Kayapinar, Ismail Karaoglan, Turan Paksoy, Hadi Gokcen

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Green Supply Chain Management is gaining growing interest among researchers and supply chain management. The concept of Green Supply Chain Management is to integrate environmental thinking into the Supply Chain Management. It is the systematic concept emphasis on environmental problems such as reduction of greenhouse gas emissions, energy efficiency, recycling end of life products, generation of solid and hazardous waste. This study is to present a green supply chain network model integrated Internet of Things applications. Internet of Things provides to get precise and accurate information of end-of-life product with sensors and systems devices. The forward direction consists of suppliers, plants, distributions centres and sales and collect centres while, the reverse flow includes the sales and collects centres, disassembled centre, recycling and disposal centre. The sales and collection centre sells the new products are transhipped from factory via distribution centre and also receive the end-of life product according their value level. We describe green logistics activities by presenting specific examples including “recycling of the returned products and “reduction of CO2 gas emissions”. The different transportation choices are illustrated between echelons according to their CO2 gas emissions. This problem is formulated as a mixed integer linear programming model to solve the green supply chain problems which are emerged from the environmental awareness and responsibilities. This model is solved by using Gams package program. Numerical examples are suggested to illustrate the efficiency of the proposed model.

Keywords: green supply chain optimization, internet of things, greenhouse gas emission, recycling

Procedia PDF Downloads 316

Authors: Hamzeh Awad

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Disability is considered to be a worldwide complex phenomenon which rising at a phenomenal rate and caused by many different factors. Chronic diseases such as cardiovascular disease and diabetes can lead to mobility disability in particular and disability in general. The ICF is an integrative bio-psycho-social model of functioning and disability and considered by the World Health Organization (WHO) to be a reference for disability classification using its categories and core set to classify disorder’s functional limitations. Specialist programs at Sultan Bin Abdul Aziz Humanitarian City (SBAHC) are providing both inpatient and outpatient services have started to implement the ICF and use it as a problem solving tool in Rehab. Diabetes is leading contributing factor for disability and considered epidemic in several Gulf countries including the Kingdom of Saudi Arabia (KSA), where its prevalence continues to increase dramatically. Metabolic disorders, mainly diabetes are not well covered in Rehab field. The purpose of this study is present to research and clinical rehabilitation field of DREAM and ICF as a framework in clinical and research setting in Rehab service. Also, shed the light on using the ICF as problem solving tool at SBAHC. There are synergies between disability causes and wider public health priorities in relation to both chronic disease and disability prevention. Therefore, there is a need for strong advocacy and understanding of the role of ICF as a reference in Rehab settings in Middle East if we wish to seize the opportunity to reverse current trends of acquired disability in the region.

Keywords: international classification of functioning, disability and health (ICF), prototype, rehabilitation and diabetes

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Authors: Julia Zimmerman, Gaurav Savant

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This study aims to evaluate the efficacy of the U.S. Army Corp of Engineers’ River Analysis System (HEC-RAS) application to modeling the hydraulics of estuaries. HEC-RAS has been broadly used for a variety of riverine applications. However, it has not been widely applied to the study of circulation in estuaries. This report details the model development and validation of a combined 1D/2D unsteady flow hydraulic model using HEC-RAS for estuaries and they are associated with tidally influenced rivers. Two estuaries, Galveston Bay and Delaware Bay, were used as case studies. Galveston Bay, a bar-built, vertically mixed estuary, was modeled for the 2005 calendar year. Delaware Bay, a drowned river valley estuary, was modeled from October 22, 2019, to November 5, 2019. Water surface elevation was used to validate both models by comparing simulation results to NOAA’s Center for Operational Oceanographic Products and Services (CO-OPS) gauge data. Simulations were run using the Diffusion Wave Equations (DW), the Shallow Water Equations, Eulerian-Lagrangian Method (SWE-ELM), and the Shallow Water Equations Eulerian Method (SWE-EM) and compared for both accuracy and computational resources required. In general, the Diffusion Wave Equations results were found to be comparable to the two Shallow Water equations sets while requiring less computational power. The 1D/2D combined approach was valid for study areas within the 2D flow area, with the 1D flow serving mainly as an inflow boundary condition. Within the Delaware Bay estuary, the HEC-RAS DW model ran in 22 minutes and had an average R² value of 0.94 within the 2-D mesh. The Galveston Bay HEC-RAS DW ran in 6 hours and 47 minutes and had an average R² value of 0.83 within the 2-D mesh. The longer run time and lower R² for Galveston Bay can be attributed to the increased length of the time frame modeled and the greater complexity of the estuarine system. The models did not accurately capture tidal effects within the 1D flow area.

Keywords: Delaware bay, estuarine hydraulics, Galveston bay, HEC-RAS, one-dimensional modeling, two-dimensional modeling

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Authors: Yi Sun, George Ed Rainger, Steve P. Watson

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Background: Beyond the classical roles in haemostasis and thrombosis, platelets are important in the initiation and development of various thrombo-inflammatory diseases. In atherosclerosis and deep vein thrombosis, for example, platelets bridge monocytes with endothelium and form heterotypic aggregates with monocytes in the circulation. This can alter monocyte phenotype by inducing their activation, stimulating adhesion and migration. These interactions involve cell surface receptor-ligand pairs on both cells. This list is likely incomplete as new interactions of importance to platelet biology are continuing to be discovered as illustrated by our discovery of PEAR-1 binding to FcεR1α. Results: We have developed a highly sensitive avidity-based assay to identify novel extracellular interactions among 126 recombinantly-expressed platelet cell surface and secreted proteins involved in platelet aggregation. In this study, we will use this method to identify novel platelet-monocyte interactions. We aim to identify ligands for orphan receptors and novel partners of well-known proteins. Identified interactions will be studied in preliminary functional assays to demonstrate relevance to the inflammatory processes supporting atherogenesis. Conclusions: Platelet-monocyte interactions are essential for the development of thromboinflammatory disease. Up until relatively recently, technologies only allow us to limit our studies on each individual protein interaction at a single time. These studies propose for the first time to study the cell surface platelet-monocyte interactions in a systematic large-scale approach using a reliable screening method we have developed. If successful, this will likely to identify previously unknown ligands for important receptors that will be investigated in details and also provide a list of novel interactions for the field. This should stimulate studies on developing alternative therapeutic strategies to treat vascular inflammatory disorders such as atherosclerosis, DVT and sepsis and other clinically important inflammatory conditions.

Keywords: membrane proteins, large-scale screening, platelets, recombinant expression

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Authors: Carlos Rios Llamas

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Urban health challenges, like the obesity epidemic, need to be studied from a dialogue between different disciplines and geographical conditions. Public health uses quantitative analysis and local samples, but qualitative data and multisite analysis would help to better understand how obesity has become a health problem. In the last decades, obesity rates have increased in most of the countries, especially in the Western World. Concerned about the problem, the American Medical Association has recently voted obesity as a disease. Suddenly, a ‘war on obesity’ attracted scientists from different disciplines to explore various ways to control and even reverse the trends. Medical sciences have taken the advance with quantitative methodologies focused on individual behaviors. Only a few scientist have extended their studies to the environment where obesity is produced as social risk, and less of them have taken into consideration the political and cultural aspects. This paper presents a multisite ethnography in South Bronx, USA, La Courneuve, France, and Lomas del Sur, Mexico, where obesity rates are as relevant as urban degradation. The comparative ethnography offers a possibility to unveil the mechanisms producing health risks from the urban tissue. The analysis considers three main categories: 1) built environment and access to food and physical activity, 2) biocultural construction of the healthy body, 3) urban inequalities related to health and body size. Major findings from a comparative ethnography on obesogenic environments, refer to the anthropological values related to food and body image, as well as the multidimensional oppression expressed in fat people who live in stigmatized urban zones. At the end, obesity, like many other diseases, is the result of political and cultural constructions structured in urbanization processes.

Keywords: comparative ethnography, urban health, obesogenic cities, biopolitics

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Authors: Prem, Norhaya, Vwrene C., Mohammad Harris A., Amarjit, Fazir M.

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Upper limb surgery is a common orthopedic procedure. After surgery, it is necessary to raise the patient's arm to reduce limb swelling and promote recovery. After an injury or surgery, swelling (edema) in the limbs is common. This swelling can be painful, cause stiffness, and affect movement and ability to do daily activities. One of the easiest ways to manage swelling is to elevate the swollen limb. The goal is to elevate the swollen limb slightly above the level of the heart. This helps the extra fluid move back towards the heart for circulation to the rest of the body. Conventional arm sling or pillows are usually placed under the arm to raise it, but in this way the arm cannot be fixed well and easily slide down, without ideal raising effect. Conventional arm sling need experience to tie the sling and this delay in the application process. To reduce the waiting time and cost, modified Norhaya upper limb elevation sling was designed and made readily available. The sling is made from calico fabric, readily available in the ward. Measurements of patients’ arm lengths are obtained, and fabric sizes are cut into the average arm lengths, as well as 1 size above and below. The cut calico fabric is then sewn together with thick sewing threads. Its application is easy and junior most staff or doctor will be able to apply it on patient. The time taken to set up the sling is also reduced. Feedback gathered from ground staff regarding ease of setting up the sling was tremendous and patient also feel comfort in the modified Norhaya sling. The device can freely adjust the raising height of the affected limb and effectively fix the affected limb to reduce its swelling, thus promoting recovery. This device is worthy to be clinically popularized and applied. The Modified Norhaya upper limb elevation sling is the quickest to set up and the delay in elevating the patient’s hand is significantly reduced. Moreover, it is reproducible and there is also significant cost savings.

Keywords: elevate, effective, sling, timely

Procedia PDF Downloads 173

Authors: Abduladim Maitieg

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The oil manufacture is one of the main productive activities in Libya and has a massive infrastructure, including offshore drilling and exploration and wide oil export platform sites that located in coastal area. There is a threat to marine and coastal area of oil spills is greatest in those sites with a high spills comes from urban and industry, parallel to that, monitoring oil spills and risk emergency strategy is weakness, An approach for estimating a coastal resources vulnerability to oil spills is presented based on abundance, environmental and Scio-economic importance, distance to oil spill resources and oil risk likelihood. As many as 10 coastal resources were selected for oil spill assessment at the coast. This study aims to evaluate, determine and establish vulnerable coastal resource maps and estimating the rate of oil spill comes for different oil spill resources in Misratah marine environment. In the study area there are two type of oil spill resources, major oil resources come from offshore oil industries which are 96 km from the Coast and Loading/Uploading oil platform. However, the miner oil resources come from urban sewage pipes and fish ports. In order to analyse the collected database, the Geographic information system software has been used to identify oil spill location, to map oil tracks in front of study area, and developing seasonal vulnerable costal resources maps. This work shows that there is a differential distribution of the degree of vulnerability to oil spills along the coastline, with values ranging from high vulnerability and low vulnerability, and highlights the link between oil spill movement and coastal resources vulnerability. The results of assessment found most of costal freshwater spring sites are highly vulnerable to oil spill due to their location on the intertidal zone and their close to proximity to oil spills recourses such as Zreag coast. Furthermore, the Saltmarsh coastline is highly vulnerable to oil spill risk due to characterisation as it contains a nesting area of sea turtles and feeding places for migratory birds and the . Oil will reach the coast in winter season according to oil spill movement. Coastal tourist beaches in the north coast are considered as highly vulnerable to oil spill due to location and closeness to oil spill resources.

Keywords: coastal recourses vulnerability, oil spill trajectory, gnome software, Misratah coast- Libya, GIS

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Authors: Anish Shah, Steve A. Wakelin, Derrick Moot, Aurélie Laugraud, Hayley J. Ridgway

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A mixed pasture system of ryegrass-clover is used in New Zealand, where clovers are generally inoculated with commercially available strains of rhizobia. The community of rhizobia living in the soil and the way in which they interact with the plant are affected by different biotic and abiotic factors. In general, bacterial richness and diversity in soil varies by soil pH. pH also affects cell physiology and acts as a master variable that controls the wider soil physiochemical conditions such as P availability, Al release and micronutrient availability. As such, pH can have both primary and secondary effects on soil biology and processes. The aim of this work was to investigate the effect of soil pH on the genetic diversity and metabolic profile of Rhizobium leguminosarum strains nodulating clover. Soils were collected from 12 farms across New Zealand which had a pH(water) range of between 4.9 and 7.5, with four acidic (pH 4.9 – 5.5), four ‘neutral’ (5.8 – 6.1) and four alkaline (6.5 – 7.5) soils. Bacteria were recovered from nodules of Trifolium repens (white clover) and T. subterraneum (subterranean clover) grown in the soils. The strains were cultured and screened against a range of pH-amended media to demonstrate whether they were adapted to pH levels similar to their native soils. The strains which showed high relative growth at a given pH (~20% of those isolated) were selected for metabolic and taxonomic profiling. The Omnilog (Biolog Inc., Hayward, CA) phenotype array was used to perform assays on carbon (C) utilisation for selected strains. DNA was extracted from the strains which had differing C utilisation profiles and PCR products for both forward and reverse primers were sequenced for the following genes: 16S rRNA, recA, nodC, nodD and nifH (symbiotic).

Keywords: bacterial diversity, clover, metabolic and taxonomic profiling, pH adaptation, rhizobia

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Authors: Yuexin Liu, Gordon B. Mills, Russell R. Broaddus, John N. Weinstein

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The lethality of endometrioid endometrial cancer (EEC) is primarily attributable to the high-stage diseases. However, there are no available biomarkers that predict EEC patient staging at the time of diagnosis. We aim to develop a predictive scheme to help in this regards. Using reverse-phase protein array expression profiles for 210 EEC cases from The Cancer Genome Atlas (TCGA), we constructed a Protein Scoring of EEC Staging (PSES) scheme for surgical stage prediction. We validated and evaluated its diagnostic potential in an independent cohort of 184 EEC cases obtained at MD Anderson Cancer Center (MDACC) using receiver operating characteristic curve analyses. Kaplan-Meier survival analysis was used to examine the association of PSES score with patient outcome, and Ingenuity pathway analysis was used to identify relevant signaling pathways. Two-sided statistical tests were used. PSES robustly distinguished high- from low-stage tumors in the TCGA cohort (area under the ROC curve [AUC]=0.74; 95% confidence interval [CI], 0.68 to 0.82) and in the validation cohort (AUC=0.67; 95% CI, 0.58 to 0.76). Even among grade 1 or 2 tumors, PSES was significantly higher in high- than in low-stage tumors in both the TCGA (P = 0.005) and MDACC (P = 0.006) cohorts. Patients with positive PSES score had significantly shorter progression-free survival than those with negative PSES in the TCGA (hazard ratio [HR], 2.033; 95% CI, 1.031 to 3.809; P = 0.04) and validation (HR, 3.306; 95% CI, 1.836 to 9.436; P = 0.0007) cohorts. The ErbB signaling pathway was most significantly enriched in the PSES proteins and downregulated in high-stage tumors. PSES may provide clinically useful prediction of high-risk tumors and offer new insights into tumor biology in EEC.

Keywords: endometrial carcinoma, protein, protein scoring of EEC staging (PSES), stage

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Authors: Fanniyah Anis, Bram Kilapong

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Myocardial reperfusion injury is defined as the cellular damage that results from a period of ischemia, followed by the reestablishment of the blood supply to the infarcted tissue. Ventricular tachycardia is one of the most commonly encountered reperfusion arrhythmia as one of the types of myocardial perfusion injury. Prompt and early treatment can reduce mortality, despite limited resources of the hospital in high risk patients with history of triple vessel disease. Case report, Male 53 years old has been diagnosed with NSTEMI with 3VD and comorbid disease of Hypertension and has undergone revascularization management with Percutaneous coronary intervention. Ventricular tachycardia leading to cardiac arrest occurred right after the stent was inserted. Resuscitation was performed for almost 2 hours until spontaneous circulation returned. Patient admitted in ICU with refractory cardiac shock despite using combination of ionotropic and vasopressor agents under standard non-invasive monitoring due to the limitation of the hospital. Angiography was performed again 5 hours later to exclude other possibilities of blockage of coronary arteries and conclude diagnosis of myocardial reperfusion injury. Patient continually managed with combination of antiplatelet agents and maintenance dose of anti-arrhythmia agents. The handling of the patient was to focus more on supportive and preventive from further deteriorating of the condition. Patient showed clinically improvement and regained consciousness within 24 hours. Patient was successfully discharged from ICU within 3 days without any neurological sequela and was discharge from hospital after 3 days observation in general ward. Limited Resource of hospital did not refrain the physician from attaining a good outcome for this myocardial reperfusion injury case and angiography alone can be used to confirm the diagnosis of myocardial reperfusion injury.

Keywords: limited resources hospital, myocardial reperfusion injury, prolonged resuscitation, refractory cardiogenic shock, reperfusion arrhythmia, revascularization, triple-vessel disease

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Authors: Arfan Ali, Idrees Ahmad Nasir

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The critical evaluation of tolerance in tomato plants against the induced saline soil were assessed by transcript analysis of genes coding for products potentially involved in stress tolerance. A reverse transcriptase PCR experiment was performed with Hsp90-1, MT2, and GR1like protein genes using RNA isolated from different tissues of tomato plants. Four strains of Bacillus magisterium were inoculated with 100 Mm & 200 Mm concentrations of salt. Eleven treatments each ten replica pots were installed in green house experiment and the parameters taken into account were morphological (length, weight, number of leaves, leaf surface area), chemical (anthocyanin, chlorophyll-a, chlorophyll-b, carotenoids) and biological (gene expression). Results bare a response i.e. highest response of MT2 like gene was at 24 hpi and the highest levels of GR1 like protein transcript accumulation were detected at 36 hpi. The chemical and morphological parameters at diverse salt concentrations bequeath superlative response amongst strains which candidly flank on Zm7 and Zm4. Therefore, Bacillus magisterium Zm7 strains and somehow Zm4 strain can be used in saline condition to make plants tolerant. The overall performance of strains Zm7, Zm6, and Zm4 was found better for all studied traits under salt stress conditions. Significant correlations among traits root length, shoot length, number of leaves, leaf surface area, carotenoids, anthocyanin, chlorophyll-a and chlorophyll-b were found and suggested that the salt tolerance in tomato may be improved through the use of PGPR strains.

Keywords: Bacillus magisterium, gene expression glutathione reductase, metallothionein, PGPR, Rhizobacteria, saline

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Authors: Faisal Nouroz, Mukaramin Mukaramin

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Of the transposable elements (TEs), the retrotransposons are the most copious elements identified from many sequenced genomes. They have played a major role in genome evolution, rearrangement, and expansions based on their copy and paste mode of proliferation. They are further divided into LTR and Non-LTR retrotransposons. The purpose of the current study was to identify the LTR REs in sequenced Phoenix dactylifera genome and to study their structural diversity. A total of 150 P. dactylifera BAC sequences with > 60kb sizes were randomly retrieved from National Center for Biotechnology Information (NCBI) database and screened for the presence of LTR retrotransposons. Seven bacterial artificial chromosomes (BAC) sequences showed full-length LTR Retrotransposons with 4 Copia and 3 Gypsy families having variable copy numbers in respective families. Reverse transcriptase (RT) domain was found as the most conserved domain among Copia and Gypsy superfamilies and was used to deduce evolutionary analysis. The amino acid residues among various RT sequences showed variability in their percentages indicating post divergence evolution. Amino acid Leucine was found in highest proportions followed by Lysine, while Methionine and Tryptophan were in lowest percentages. The phylogenetic analysis based on RT domains confirmed that although having most conserved RT regions, several evolutionary events occurred causing nucleotide polymorphisms and hence clustering of Gypsy and Copia superfamilies into their respective lineages. The study will be helpful in identification and annotation of these elements in other species and genera and their distribution patterns on chromosomes by fluorescent in situ hybridization techniques.

Keywords: transposable elements, Phoenix dactylifera, retrotransposons, phylogenetic analysis

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Authors: E.K.K. Agyeman, P. Mousseau, A. Sarda, D. Edelin

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The uniform and controlled cooling of hot metals by the circulation of water in canals remains a challenge due to the phase change of the water and the high heat fluxes associated with the phase change. This is because, during the cooling process, the phases are not uniformly distributed along the canals with the liquid phase dominating at the entrances of the canals and the gaseous phase dominating towards the exits. The difference in thermal properties between both phases leads to a heterogeneous temperature distribution in the part being cooled. Slowing down the cooling process is also a challenge due to the high heat fluxes associated with the phase change of water. This study investigates the use of multiple water jets for the controlled and homogenous cooling of hot metal parts and the effect of gravity on the effectiveness of the cooling process with a potential application in the cooling of composite forming moulds. A hole is bored at the centre of a steel block along its length. The jets are generated from the holes of a perforated steel pipe which is placed along the centre of the hole bored in the steel block. The evolution of the temperature with respect to time on the external surface of the steel block is measured simultaneously by thermocouples and an infrared camera. Different jet positions are tested in order to identify the jet placement configuration that ensures the most homogenous cooling of the block while the cooling speed is controlled by an intermittent impingement of the jets. In order to study the effect of gravity on the cooling process, a scenario where the jets are oriented in the opposite direction to that of gravity is compared to one where the jets are aligned in the same direction as gravity. It’s observed that orienting the jets in the direction of gravity reduces the effectiveness of the cooling process on the face of the block facing the impinging jets. This is due to the formation of a deeper pool of water due to the effect gravity and of the curved surface of the canal. This deeper pool of water influences the boiling regime characterized by a slower bubble evacuation when compared to the scenario where the jets are opposed to gravity.

Keywords: cooling speed, gravity, homogenous cooling, jet impingement

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Authors: Masome Moeni, Roya Abedizadeh, Elham Aram, Hamid Sadeghi-Abandansari, Davood Sabour, Robert Menzel, Ali Hassanpour

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Mitochondria- targeting immunogenic cell death inducers (MT-ICD) have been designed to trigger intrinsic apoptosis signalling pathway in malignant cells and revive the antitumour immune system. MT-ICD inducers have considered to be non-specific, which can deteriorate the ability to initiate mitochondria-selective oxidative stress, causing high toxicity. Iron oxide nanoparticles (IONPs) can be an ideal candidate as vehicles for utilizing in immunotherapy due to their biocompatibility, modifiable surface chemistry, magnetic characteristics and multi-functional applications in single platform. These types of NPs can facilitate a real time imaging which can provide an effective strategy to analyse pharmacokinetic parameters of nano-formula, including blood circulation time, targeted and controlled release at tumour microenvironment. To our knowledge, the conjugation of IONPs with MT-ICD and oxaliplatin (a chemotherapeutic agent used for the treatment of colorectal cancer) for immunotherapy have not been investigated. Herein, IONPs were generated via co-precipitation reaction at high temperatures, followed by coating the colloidal suspension with tetraethyl orthosilicate and 3-aminopropyltriethoxysilane to optimize their bio-compatibility, preventing aggregation and maintaining stability at physiological pH, then functionalized with (3-carboxypropyl) triphenyl phosphonium bromide for mitochondrial delivery. Analytical results demonstrated the successful process of IONPs functionalization. In particular, the colloidal particles of doped IONPs exhibited an excellent stability and dispersibility. The resultant particles were also successfully loaded with the oxaliplatin for an active mitochondrial targeting in immunotherapy, resulting in well-maintained super-paramagnetic characteristics and stable structure of the functionalized IONPs with nanoscale particle sizes.

Keywords: Immunotherapy, mitochondria, cancer, iron oxide nanoparticle

Procedia PDF Downloads 56

Authors: Rai Friedman

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The recent migrant crisis has revealed an unmet demand for increased international protection and promotion of migrant rights. Europe has found itself at the centre of the migration crisis, being the recipient to the largest number of asylum-seekers since the conclusion of the second World War. Rather than impart a unified humanitarian lens of offering legal protections, the Schengen territory is devising new, preventative measures to confront the influx of asylum-seekers. This paper will focus on the refugee crisis in Europe as it relates to the Central Mediterranean route. To do so, it will outline the increased need for international protection for migrant rights through analyzing historic human rights treaties and conventions; the formation of the current composition of the Schengen area; the evolutionary changes in policies and legal landscapes throughout Europe and the Central Mediterranean route; the vernacular transformation surrounding refugees, migrants, and asylum-seekers; and expose the gaps in international protection. It will also discuss Europe’s critical position, both geographically and conceptually, critiquing the notion of European victimization. Lastly, it will discuss the increased harm of preventative border measures and argue for tangible sustainability solutions through economic programming models in highly vulnerable countries. To do so, this paper will observe a case study in Algeria that has conceded to an economic programming model for forced migrants. In 2017 amid worker shortages, Algeria announced it would grant African migrants’ legal status to become agriculturalists and construction workers. Algeria is one of the few countries along the Central Mediterranean route that has adopted a law to govern foreign nationals’ conditions of entry, stay and circulation. Thereafter, it will provide recommendations for solutions for forced migration along the Central Mediterranean route and advocate for strengthened protections under international law.

Keywords: refugees, migrants, human rights, middle east, Africa, mediterranean, international humanitarian law, policy

Procedia PDF Downloads 90

Authors: Ho Seong Shin

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Introduction: A research in relation to wound healing also showed that platelet-rich plasma (PRP) was effective on normal tissue regeneration. Nonetheless, there is no evidence that when platelet-rich plasma was applied on diabetic wound, it normalize diabetic wound healing process. In this study, we have analyzed matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9) expression to know the effect of PRP on diabetic wounds using Reverse transcription-polymerase chain reaction (RT-PCR) of MMP-2, MMP-9 mRNA. Materials and Methods: Platelet-rich plasma (PRP) was prepared from blood of 6 rats. The whole 120-mL was added immediately to an anticoagulant. Citrate phosphonate dextrose(CPD) buffer (0.15 mg CPDmL) in a ratio of 1 mL of CPD buffer to 5 mL of blood. The blood was then centrifuged at 220g for 20minutes. The supernatant was saved to produce fibrin glue. The participate containing PRP was used for second centrifugation at 480g for 20 minutes. The pellet from the second centrifugation was saved and diluted with supernatant until the platelet concentration became 900,000/μL. Twenty male, 4week-old OLETF rats were underwent operation; each rat had two wounds created on left and right sides. The each wound of left side was treated with PRP gel, the wound of right side was treated with physiologic saline gauze. Results: RT-PCR analysis; The levels of MMP-2 mRNA in PRP applied tissues were positively related to postwounding days, whereas MMP-2 mRNA expression in saline-applied tissues remained in 5day after treatment. MMP-9 mRNA was undetectable in saline-applied tissues for either tissue, except 3day after treatment. Following PRP-applied tissues, MMP-9 mRNA expression was detected, with maximal expression being seen at third day. The levels of MMP-9 mRNA in PRP applied tissues were reported high intensity of optical density related to saline applied tissues.

Keywords: diabetes, MMP-2, MMP-9, OLETF, PRP, wound healing MMP-9

Procedia PDF Downloads 255

Authors: Raviteja Chintala

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Water shortage in many areas of the world have predominantly increased the demand for efficient methods involved in the production of drinking water, So purification of water invoking cost effective and efficient methods is a challenging field of research. In this regard, Reverse osmosis membrane desalination of both seawater and inland brackish water is currently being deployed in various locations around the world. In the present work an attempt is made to integrate these existing technologies with novel method, Wherein carbon nanotubes at the lab scale are prepared which further replace activated carbon tubes being used traditionally. This has proven to enhance the efficiency of the water filter, Effectively neutralising most of the organic impurities. Furthermore, This ensures the reduction in TDS. Carbon nanotubes have wide range in scope of applications such as composite reinforcements, Field emitters, Sensors, Energy storage and energy conversion devices and catalysts support phases, Because of their unusual mechanical, Electrical, Thermal and structural properties. In particular, The large specific surface area, as well as the high chemical and thermal stability, Makes carbon nanotube an attractive adsorbent in waste water treatment. Carbon nanotubes are effective in eliminating these harmful media from water as an adsorbent. In this work, Candle soot method has been incorporated for the preparation of carbon nanotubes and mixed with activated charcoal in different compositions. The effect of composition change is monitored by using TDS measuring meter. As the composition of Nano carbon increases, The TDS of the water gradually decreases. In order to enhance the life time for carbon filter, Nano tubes are provided with larger surface area.

Keywords: TDS (Total Dissolved Solids), carbon nanotubes, water, candle soot

Procedia PDF Downloads 316

Authors: Fiorenza Misale

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The painful phenomenon of so-called white deaths and accidents at work, unfortunately, is always current. The key is to act on the culture of security through effective measures of attitudes and behaviors that go far beyond the knowledge and the know-how. It is necessary that there is an ‘introjection’ of safety culture through the conscious involvement of all workers. The legislation on work safety identifies the main tool to promote the culture of safety at work and prevention within the workplace. In law the term education is used to distinguish itself from the information with which they will simply theoretically transmit, and from the training with which they will provide the practical skills. The new decree fact fills several gaps in previous legislation and stresses the importance of training in the workplace, that is, the main activity through which it is possible to achieve the active participation of all workers in the company’s prevention system. This system is built only through the dissemination of risk information, the circulation of information, comparison and dialogue between all actors involved that are the necessary elements for a correct transmission of the culture of worker safety. Training activity should put the focus on work experience in order to bring out all the knowledge needed to identify and assess the risks in the work place, and especially the action to eliminate or control them, integrating, when necessary, the missing knowledge. In addition to traditional training and information systems can be utilized for the purpose of training that are able to affect both one emotionally and aesthetically, team-theatre is one of them. Among the methods of company theater that can be used in work safety we have: Lesson show, theater workshop, improvised theater, forum theater, theater playback. The theater can represent a complementary approach to traditional training and give information on safety measures, demonstrating that there are more engaging outreach tools. Team-theatre allows identification with the characters, a transmission of emotions and moods and it is through the staging of a story that the individual processes new information. It’ also s a means of experiential training that allows you to work with your mind, body, emotions.The aim of one work is the use of corporate theater on the personnel working in the health sector. Through a questionnaire we are able to analyze the knowledge of occupational safety and current risks; in particular in health care which is to be administered before and after the play.

Keywords: theater, training, occupational health, safety

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Authors: Peter Collett, Mike Pynn, Haseeb Ur Rahman

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For the last few years across the UK there has been a push towards implementing treatment escalation plans (TEP) for every patient admitted to hospital. This is a paper form which is completed by a junior doctor then countersigned by the consultant responsible for the patient's care. It is designed to address what level of care is appropriate for the patient in question at point of entry to hospital. It helps decide whether the patient would benefit for ward based, high dependency or intensive care. They are completed to ensure the patient's best interests are maintained and aim to facilitate difficult decisions which may be required at a later date. For example, a frail patient with significant co-morbidities, unlikely to survive a pathology requiring an intensive care admission is admitted to hospital the decision can be made early to state the patient would not benefit from an ICU admission. This decision can be reversed depending on the clinical course of the patient's admission. It promotes discussions with the patient regarding their wishes to receive certain levels of healthcare. This poster describes the steps taken in the Aneurin Bevan University Health Board (ABUHB) when implementing the TEP form. The team implementing the TEP form campaigned for it's use to the board of directors. The directors were eager to hear of experiences of other health boards who had implemented the TEP form. The team presented the data produced in a number of health boards and demonstrated the proposed form. Concern was raised regarding the legalities of the form and that it could upset patients and relatives if the form was not explained properly. This delayed the effectuation of the TEP form and further research and discussion would be required. When COVID 19 reached the UK the National Institute for Health and Clinical Excellence issued guidance stating every patient admitted to hospital should be issued a TEP form. The TEP form was accelerated through the vetting process and was approved with immediate effect. The TEP form in ABUHB has now been in circulation for a month. An audit investigating it's uptake and a survey gathering opinions have been conducted.

Keywords: acute medicine, clinical governance, intensive care, patient centered decision making

Procedia PDF Downloads 156

Authors: Marcel Schneider, Nils Nießen

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Microscopic simulation programs enable the description of the two processes of railway operation and the previous timetabling. Occupation conflicts are often solved based on defined train priorities on both process levels. These conflict resolutions produce knock-on delays for the involved trains. The sum of knock-on delays is commonly used to evaluate the quality of railway operations. It is either compared to an acceptable level-of-service or the delays are evaluated economically by linearly monetary functions. It is impossible to properly evaluate dispatching decisions without a well-founded objective function. This paper presents a new approach for evaluation of dispatching decisions. It uses models of choice of transport and considers the behaviour of the end-costumers. These models evaluate the knock-on delays in more detail than linearly monetary functions and consider other competing modes of transport. The new approach pursues the coupling of a microscopic model of railway operation with the macroscopic model of choice of transport. First it will be implemented for the railway operations process, but it can also be used for timetabling. The evaluation considers the possibility to change over to other transport modes by the end-costumers. The new approach first looks at the rail-mounted and road transport, but it can also be extended to air transport. The split of the end-costumers is described by the modal-split. The reactions by the end-costumers have an effect on the revenues of the railway undertakings. Various travel purposes has different pavement reserves and tolerances towards delays. Longer journey times affect besides revenue changes also additional costs. The costs depend either on time or track and arise from circulation of workers and vehicles. Only the variable values are summarised in the contribution margin, which is the base for the monetary evaluation of the delays. The contribution margin is calculated for different resolution decisions of the same conflict. The conflict resolution is improved until the monetary loss becomes minimised. The iterative process therefore determines an optimum conflict resolution by observing the change of the contribution margin. Furthermore, a monetary value of each dispatching decision can also be determined.

Keywords: choice of transport, knock-on delays, monetary evaluation, railway operations

Procedia PDF Downloads 307

Authors: An-Yi Wang, Wei-Fong Kao, Shin-Han Tsai

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Introduction: Information as patient characteristics, resuscitation scene, resuscitation provider perspectives and families wish affects on resuscitation decision-making for out-of-hospital cardiac arrest (OHCA). There is no consistency consensus on how families and emergency physicians approach this decision. The main purpose of our study is to evaluate the characteristics of withholding resuscitation efforts arrival at the hospital. Methods: We retrospectively analyzed patients with OHCA without pre-hospital return-of-spontaneous circulation (ROSC) who was sent to our emergency department (ED) between January 2014 and December 2015. Baseline characteristics, pre-hospital course, and causes of the cardiopulmonary arrest among patients were compared. Results: In 2 years, total 155 arrest patients without pre-hospital ROSC was included. 33(21.3%) patients withhold the resuscitation efforts in ED with mean resuscitation duration 4.45 ± 7.04 minutes after ED arrival. In withholding group, the initial rhythm of arrests was all non-shockable. 9 of them received endotracheal intubation before decision-making. None of the patients in withhold resuscitation group survived to discharge. There was no significant difference among gender, underlying cardiovascular disease, malignancy, chronic renal disease, nor witness collapse between withhold and continue resuscitation groups. Univariate analysis showed there was lower percentage of bystander resuscitation (32.3% vs. 50.4%, p=0.071), and the lower percentage of transport via emergency medical service (EMS) (78.8% vs. 91.8%, p=0.054) in withholding group. Multivariate analysis showed old age (adjusted odds ratio=1.06, 95% C.I.=[1.02-1.11], p<0.05), with underlying respiratory insufficiency (adjusted odds ratio=12.16, 95% C.I.=[3.34-44.29], p<0.05), living at home compared with nursing home (adjusted odds ratio=37.75, 95% C.I.=[1.09-1110.70], p<0.05) were more likely to withhold resuscitation. Transport via EMS was more likely to continue resuscitation (adjusted odds ratio=0.11, 95% C.I.=[0.02-0.71], p<0.05). Conclusion: The decision-making for families and emergency physicians to withhold or continue resuscitation for out-of-hospital cardiac arrest is complex and multi-factorial. Continue resuscitation efforts in nursing home residents is high, and further study among this population is warranted.

Keywords: cardiopulmonary resuscitation, out-of-hospital cardiac arrest, termination resuscitation, withhold resuscitation

Procedia PDF Downloads 235