Search results for: vascular emergency

Authors: Lotfollah Rezagholizadeh

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Background and Aim: Diabetes mellitus is related to high mortality and morbidity caused by the early development of atherosclerosis correlated to diabetic macroangiopathy. The endothelium-derived vasodilator, nitric oxide (NO) has been implicated in the development of vascular complications via the regulation of blood flow, and various antiatherosclerotic actions. Patients with type 2 diabetes (T2D) have a decreased level of endothelial nitric oxide release. In this study we aimed to examine the effect of aquatic seed extract of Cichorium intybus L. (chicory) and metformin (a known prescription drug for diabetes) on NO levels in T2D rats. Methods: Five groups of adult male Wistar rats were used (n=6): Non-diabetic controls without extract treatment (Control), Non-diabetic controls with extract treatment (Chicory-control), T2D rats without extract treatment (NIA/STZ), T2D rats treated with the extract (Chicory-NIA/STZ), and T2D groups that received metformin (100 mg/kg) but no extract (Metformin-NIA/STZ). T2D was induced with intraperitoneal (i.p) injection of niacinamide (NIA, 200 mg/kg), 15 min after an i.p administration of streptozotocin (STZ, 55 mg/kg). Lyophilized chicory extract (125 mg/kg) was dissolved in 0.2 ml normal saline and administered one dose a day. The experiments lasted for 3 weeks after the diabetes induction. NO analysis was performed by assay based on the Griess reaction. Data were reported as the mean ± SD and statistical analysis was performed by ANOVA. Results: Serum nitric oxide levels decreased significantly in NIA/STZ group compared with Control and Chicory-control. Treatment with chicory extract caused a significant increase in serum levels of NO in Chicory-NIA/STZ group compare to NIA/STZ group (p<05). Metformin-NIA/STZ group did not show considerable difference when compared with NIA/STZ, with respect to NO levels. In a group of rats made diabetic by STZ alone (type 1 diabetic rats, T1D), chicory did not have a significant ameliorating effect. Conclusion: In this study, we clearly showed a relationship between low serum nitric oxide levels and diabetes mellitus in rats. The increase in serum nitric oxide by chicory extract is an indication of antiatherogenic effect of this plant. Chicory seed extract was more efficient than metformin in improving the NO levels in NO-deficient T2D diabetic rats.

Keywords: type 2 diabetes mellitus, nitric oxide, chicory, metformin

Procedia PDF Downloads 334

Authors: Laura Zizka, Gaby Probst

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The Covid-19 pandemic has affected the way Higher Education Institutions (HEIs) have given their courses. From emergency remote where all students and faculty were immediately confined to home teaching and learning, the continuing evolving sanitary situation obliged HEIs to adopt other methods of teaching and learning from blended courses that included both synchronous and asynchronous courses and activities to hy-flex models where some students were on campus while others followed the course simultaneously online. Each semester brought new challenges for HEIs and, subsequently, additional emotional reactions. This paper investigates the affective side of teaching and learning in various online modalities and its toll on students and faculty members over the past three semesters. The findings confirm that students and faculty who have more self-efficacy, flexibility, and resilience reported positive emotions and embraced the opportunities that these past semesters have offered. While HEIs have begun a new semester in an attempt to return to ‘normal’ face-to-face courses, this paper posits that there are lessons to be learned from these past three semesters. The opportunities that arose from the challenge of the pandemic should be considered when moving forward by focusing on a greater emphasis on the affective aspect of teaching and learning in HEIs worldwide.

Keywords: effective teaching and learning, higher education, engagement, interaction, motivation

Procedia PDF Downloads 117

Authors: Mumtaz Mooncey, Alexander Jolly, Megan Fisher, Kerry Robinson, Robert Lloyd, Dave Fielding

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Introduction: The integration of the WingFactors in-situ simulation programme has transformed the education landscape at the Whittington Health NHS Trust. To date, there have been a total of 90 simulations - 19 aimed at Paediatric trainees, including 2 Child and Adolescent Mental Health (CAMHS) scenarios. The opportunity for joint debriefs provided by clinical faculty and airline pilots, has created a new exciting avenue to explore human factors within psychiatry. Through the use of real clinical environments and primed actors; the benefits of high fidelity simulation, interdisciplinary and interprofessional learning has been highlighted. The use of in-situ simulation within Psychiatry is a newly emerging concept and its success here has been recognised by unanimously positive feedback from participants and acknowledgement through nomination for the Health Service Journal (HSJ) Award (Best Education Programme 2021). Methodology: The first CAMHS simulation featured a collapsed patient in the toilet with a ligature tied around her neck, accompanied by a distressed parent. This required participants to consider:; emergency physical management of the case, alongside helping to contain the mother and maintaining situational awareness when transferring the patient to an appropriate clinical area. The second simulation was based on a 17- year- old girl attempting to leave the ward after presenting with an overdose, posing potential risk to herself. The safe learning environment enabled participants to explore techniques to engage the young person and understand their concerns, and consider the involvement of other members of the multidisciplinary team. The scenarios were followed by an immediate ‘hot’ debrief, combining technical feedback with Human Factors feedback from uniformed airline pilots and clinicians. The importance of psychological safety was paramount, encouraging open and honest contributions from all participants. Key learning points were summarized into written documents and circulated. Findings: The in-situ simulations demonstrated the need for practical changes both in the Emergency Department and on the Paediatric ward. The presence of airline pilots provided a novel way to debrief on Human Factors. The following key themes were identified: -Team-briefing (‘Golden 5 minutes’) - Taking a few moments to establish experience, initial roles and strategies amongst the team can reduce the need for conversations in front of a distressed patient or anxious relative. -Use of checklists / guidelines - Principles associated with checklist usage (control of pace, rigor, team situational awareness), instead of reliance on accurate memory recall when under pressure. -Read-back - Immediate repetition of safety critical instructions (e.g. drug / dosage) to mitigate the risks associated with miscommunication. -Distraction management - Balancing the risk of losing a team member to manage a distressed relative, versus it impacting on the care of the young person. -Task allocation - The value of the implementation of ‘The 5A’s’ (Availability, Address, Allocate, Ask, Advise), for effective task allocation. Conclusion: 100% of participants have requested more simulation training. Involvement of airline pilots has led to a shift in hospital culture, bringing to the forefront the value of Human Factors focused training and multidisciplinary simulation. This has been of significant value in not only physical health, but also mental health simulation.

Keywords: human factors, in-situ simulation, inter-professional, multidisciplinary

Procedia PDF Downloads 108

Authors: H. Malachova, A. Oulehlova, D. Rezac

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Crisis preparedness training is the best possible strategy for identifying weak points, understanding vulnerability, and finding possible strategies for mitigation of blackout consequences. Training represents an effective tool for developing abilities and skills to cope with crisis situations. This article builds on the results of the research carried out in the field of preparation, realization, process, and impacts of training on subjects of energy sector critical infrastructure as a part of crisis preparedness. The research has revealed that the subjects of energy sector critical infrastructure have not realized training and therefore are not prepared for the restoration of the energy supply and black start after blackout regardless of the fact that most subjects state blackout and subsequent black start as key dangers. Training, together with mutual communication and processed crisis documentation, represent a basis for successful solutions for dealing with emergency situations. This text presents the suggested model of SIMEX simulator as a tool which supports managing crisis situations, containing training environment. Training models, possibilities of constructive simulation making use of non-aggregated as well as aggregated entities and tools of communication channels of individual simulator nodes have been introduced by the article.

Keywords: communication, energetic critical infrastructure, training, simulation

Procedia PDF Downloads 383

Authors: Abdelkadir Muzey Mohammed, Habtu Alemayehu Atsbaha, Yohannes Yirga Kefela, Woldegebriel Assefa Woldegerima, Kiros Tedla Gebrehiwot

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The circumstances of war and conflict have long been associated with concerns about heightening HIV infection due to the use of sexual violence and rape as a weapon of war and lack of health services access to the patients with HIV as well as sexual violence and rape victims. This paper examines the impact of war related mass rape on HIV incidence and prevalence in the war ravaged Tigray, Ethiopia. Risk equation model and uncertainty analyses with sampled ranges of parameters were employed using data from WHO, Ethiopian Public Health Institute and Ethiopian Central Statistical Agency was used. Our analysis indicated that the mass rape committed in Tigray could cause an increase of incidence and prevalence by a median of 63.01% and 1.14% respectively. The significant increase in HIV incidence and prevalence due to mass rape demands a special attention including region wide improved surveillance and tracing of rape survivors. Furthermore, HIV prevention and treatment strategies such as delivery of emergency health service, providing pre and post exposure treatments on the basis of human rights should priority of governmental and nongovernmental organizations in a conflict situation.

Keywords: conflict situation, mass rape, HIV, mathematical model, uncertainty analysis

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Authors: Naraporn Taemaitree, Pruet Areesawangvong, Satchachon Changthom, Tanin Titipungul

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Adult intussusception, unlike childhood intussusception, is rare. Approximately 5-15% of cases are idiopathic without a lead point lesion. Secondary intussusception is caused by pathological conditions such as inflammatory bowel disease, postoperative adhesions, Meckel’s diverticulum, benign and malignant lesions, metastatic neoplasms, or even iatrogenically due to the presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms. Computed tomography is the most sensitive diagnostic modality and can help distinguish between intussusceptions with and without a lead point and lesion localization. This report presents the case of a 49-year-old man presented with increasing abdominal pain over the past three days, loss of appetite, constipation, and frequent vomiting. Computed tomography revealed distal small bowel obstruction at the right lower quadrant with thickened outer wall and internal non-dilated small bowel loop. Emergency exploratory laparotomy was performed to clear the obstruction, which upon inspection was caused by extremely long Taenia solium parasites.

Keywords: intussusception, tape worm, Taenia solium, abdominal pain

Procedia PDF Downloads 134

Authors: Shammael Selorfia

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The Quality improvement project aimed to improve junior doctors and nurses’ knowledge and confidence in diagnosing and managing delirium on inpatient surgical wards in a tertiary hospital. The study aimed to develop a standardised assessment and management checklist for all staff working with patients who were presenting with signs of delirium. The aim of the study was to increase confidence of staff at dealing with delirium and improve the quality of referrals that were being sent to the Mental Health Liaison team over a 6-month period. A significant proportion of time was being spent by the Mental Health Liaison triage nurses on referrals for delirium. Data showed 28% of all delirium referrals from surgical teams were being closed at triage reflecting a poor standard of quality of those referrals. A qualitative survey of junior doctors in 6 surgical specialties in a UK tertiary hospital was conducted. These specialties include general surgery, vascular, plastic, urology, neurosurgery, and orthopaedics. The standardised checklist was distributed to all surgical wards. A comparison was made between the Mental health team caseload of delirium before intervention was compared and after. A Qualitative survey at end of 3-month cycle and compare overall caseload on Mental Health Liaison team to pre-QIP data with aim to improve quality of referrals and reduce workload on Mental Health Liaison team. At the end of the project cycle, we demonstrated an improvement in the quality of referrals with a decrease in the percentage of referrals being closed at triage by 8%. Our surveys also indicated an increase in the knowledge of official trust delirium guidelines and confidence at managing the patients. This project highlights that a new approach to delirium using multi-component interventions is needed, where the diagnosis of delirium is shared amongst medical and nursing staff, and everyone plays role in management. The key is improving awareness of delirium and encouraging the use of recognized diagnostic tools and official guidelines. Recommendations were made to the trust on how to implement a long-lasting change.

Keywords: delirium, surgery, quality, improvement

Procedia PDF Downloads 81

Authors: Aleksandra Ristic

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The Coronavirus Disease – 2019 hit Europe in February 2020, and infections took place in four waves. It left consequences and demanded changes for the future. More than half of European countries responded quickly by declaring a state of emergency and introducing various containment measures that have had a major impact on individuals’ lives in recent years. Closing public lives was largely achieved by limited access and/or closing public institutions and services, including the closure of educational institutions. Teaching in classrooms converted to distance learning. In the research, we used a quantitative study to analyze various factors of distance learning that influenced pupils in different segments: teachers’ availability, family support, entire online conference learning, successful distance learning, time for themselves, reliable sources, teachers’ feedback, successful distance learning, online participation classes, motivation and teachers’ communication and theoretical review of the importance of digital skills, e-learning Index, World comparison of e-learning in the past, digital education plans for the field of Europe. We have gathered recommendations and distance learning solutions to improve the learning process by strengthening teachers and creating more tiered strategies for setting and achieving learning goals by the children.

Keywords: availability, digital skills, distance learning, resources

Procedia PDF Downloads 102

Authors: Pelin Sonmez

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Health services provided to refugees and asylum seekers are very important and of priority due to their physical damages during the war and conflict situation, possible diseases in migration journey and negative psychological mood. However, there are very poor international standards in regards to providing health services to these people, which in return cause each country to differ their regulations. United Nations Sustainable Development Goals that are in effect as of 2016 assure that attention should be provided to non-citizen vulnerable groups in terms of health policies and they should be included in the global development, thereby aims to decrease the problems arising from providing health services to refugees. Though, we should not forget that these are the recent and yet uncertain attempts, mostly, as a result of Syrian War's forced migration wave. As an attempt to reveal different attitudes of international actors, this study compares/analyzes health services provided to refugees and asylum seekers on the basis of Turkey-EU policy implementations. While doing so, two research data will be focused upon. In this globe, results of the focus group interviews and a field study in a specific work (from its health related section) which was done in 2017 to 5000 Syrian women living in Turkey and presented to Republic of Turkey Disaster and Emergency Management Presidency will be utilized.

Keywords: European Union, health policies, refugee, Syrian women, Turkey

Procedia PDF Downloads 185

Authors: Mohiuddin Ahsanul Kabir Chowdhury, Nafisa Lira Huq, Afroza Khanom, Rafiqul Islam, Abdullah Nurus Salam Khan, Farhana Karim, Nabila Zaka, Shams El Arifeen, Sk. Masum Billah

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After having astounding achievements in reducing maternal mortality and achieving the target for Millennium Development Goal (MDG) 5, the Government of Bangladesh has set new target to reduce Maternal Mortality Ratio (MMR) to 70 per 100,000 live births aligning with targets of Sustainable Development Goals (SDGs). Aversion of deaths from maternal complication by ensuring quality health care could be an important path to accelerate the rate of reduction of MMR. This formative research was aimed at exploring the provision of quality maternal health services at different level of health facilities. The study was conducted in 1 district hospital (DH) and 4 Upazila health complexes (UHC) of Kurigram district of Bangladesh, utilizing both quantitative and qualitative research methods. We conducted 14 key informant interviews with facility managers and 20 in-depth interviews with health care providers and support staff. Besides, we observed 387 normal deliveries from which we found 17 cases of post partum haemorrhage (PPH) and 2 cases of eclampsia during the data collection period extended from July-September 2016. The quantitative data were analyzed by using descriptive statistics, and the qualitative component underwent thematic analysis with the broad themes of facility readiness for maternal complication management, and management of complications. Inadequacy in human resources has been identified as the most important bottleneck to provide quality care to manage maternal complications. The DH had a particular paucity of human resources in medical officer cadre where about 61% posts were unfilled. On the other hand, in the UHCs the positions mostly empty were obstetricians (75%, paediatricians (75%), staff nurses (65%), and anaesthetists (100%). The workload on the existing staff is increased because of the persistence of vacant posts. Unavailability of anesthetists and consultants does not permit the health care providers (HCP) of lower cadres to perform emergency operative procedures and forces them to refer the patients although referral system is not well organized in rural Bangladesh. Insufficient bed capacity, inadequate training, shortage of emergency medicines etc. are other hindrance factors for facility readiness. Among the 387 observed delivery case, 17 (4.4%) were identified as PPH cases, and only 2 cases were found as eclampsia/pre-eclampsia. The majority of the patients were treated with uterine message (16 out of 17, 94.1%) and injectable Oxytocin (14 out of 17, 82.4%). The providers of DH mentioned that they can manage the PPH because of having provision for diagnostic and blood transfusion services, although not as 24/7 services. Regarding management of eclampsia/pre-eclampsia, HCPs provided Diazepam, MgSO4, and other anti-hypertensives. The UHCs did not have MgSO4 at stock even, and one facility manager admitted that they treat eclampsia with Diazepam only. The nurses of the UHCs were found to be afraid to handle eclampsia cases. The upcoming interventions must ensure refresher training of service providers, continuous availability of essential medicine and equipment needed for complication management, availability of skilled health workforce, availability of functioning blood transfusion unit and pairing of consultants and anaesthetists to reach the newly set targets altogether.

Keywords: Bangladesh, health facilities, maternal complications, quality of care

Procedia PDF Downloads 235

Authors: Iyabode A. Kehinde, Joshua O. Oyekanmi, Jumoke T. Abimbola, Olajumoke E. Ayanda

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African yam bean (AYB), (Sphenostylis stenocarpa) is a leguminous crop that provides nutritionally rich seeds, tubers and leaves for human consumption. AYB potentials as an important food security crop is yet to be realized and thus classified as underutilized crop. Underutilization of the crop has been partly associated with scarce information on the incidence and characterization of fungal endophytes infecting vascular parts of AYB. Accurate and robust detection of these endophytic fungi is essential for diagnosis, modeling, surveillance and protection of germplasm (seed) health. This work aimed at isolating and identifying fungal endophytes associated with leaves, stems and roots of AYB in Ogun State, Nigeria. This study investigated both cultural and molecular properties of endophytic fungi in AYB for its characterization and diversity. Fungal endophytes were isolated and culturally identified. DNA extraction, PCR amplification using ITS primers and analyses of nucleotide sequences of ribosomal DNA fragments were conducted on selected isolates. BLAST analysis was conducted on consensus nucleotide sequences of 28 out of 30 isolates and results showed similar homology with genera of Rhizopus, Cunninghamella, Fusarium, Aspergillus, Penicillium, Alternaria, Diaporthe, Nigrospora, Purpureocillium, Corynespora, Magnaporthe, Macrophomina, Curvularia, Acrocalymma, Talaromyces and Simplicillium. Slight similarity was found with endophytes associated with soybean. Phylogenetic analysis by maximum likelihood method showed high diversity among the general. These organisms have high economic importance in crop improvement. For an instance, Purpureocillium lilacinum showed high potential in control of root rot caused by nematodes in tomatoes. Though some can be pathogens, but many of the fungal endophytes have beneficial attributes to plant in host health, uptake of nutrients, disease suppression, and host immunity.

Keywords: molecular characterization, African Yam Bean, fungal endophyte, plant parts

Procedia PDF Downloads 215

Authors: Nermin A. Morsy, Amany N. Beshay

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The tourism industry has seen considerable transformations due to the emergency of e-commerce. For instance, airlines are increasingly dependent on achieving online sales instead of their traditional platform. Online travel agencies’ (OTAs) websites have been able to reach a broader range of customers and generate more revenue. Therefore, website quality plays an important role in attaining website effectiveness. It is now considered as a critical factor in attracting customers' attention and build loyalty. Customers are more likely to visit and purchase at websites that exhibit highly desirable qualities. A user-friendly website can help tourists find their target information easily and make decisions quickly. This research focuses on analyzing the impact of airline and OTAs’ websites quality on the actual customer usage and purchase intentions. An online survey was distributed among internet users to assess the various dimensions of website quality in the context of online booking and their effect on customer’s usage and purchase intentions. The data from the survey was analyzed statistically using correlation, t-tests and other statistical tests. Results revealed the direct impact of website quality on customer usage and purchase intentions.

Keywords: airlines, OTAs, purchasing intention, website quality

Procedia PDF Downloads 179

Authors: Yijun Shao, Yan Cheng, Rashmee U. Shah, Charlene R. Weir, Bruce E. Bray, Qing Zeng-Treitler

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Deep neural network (DNN) models are being explored in the clinical domain, following the recent success in other domains such as image recognition. For clinical adoption, outcome prediction models require explanation, but due to the multiple non-linear inner transformations, DNN models are viewed by many as a black box. In this study, we developed a deep neural network model for predicting 1-year mortality of patients who underwent major cardio vascular procedures (MCVPs), using temporal image representation of past medical history as input. The dataset was obtained from the electronic medical data warehouse administered by Veteran Affairs Information and Computing Infrastructure (VINCI). We identified 21,355 veterans who had their first MCVP in 2014. Features for prediction included demographics, diagnoses, procedures, medication orders, hospitalizations, and frailty measures extracted from clinical notes. Temporal variables were created based on the patient history data in the 2-year window prior to the index MCVP. A temporal image was created based on these variables for each individual patient. To generate the explanation for the DNN model, we defined a new concept called impact score, based on the presence/value of clinical conditions’ impact on the predicted outcome. Like (log) odds ratio reported by the logistic regression (LR) model, impact scores are continuous variables intended to shed light on the black box model. For comparison, a logistic regression model was fitted on the same dataset. In our cohort, about 6.8% of patients died within one year. The prediction of the DNN model achieved an area under the curve (AUC) of 78.5% while the LR model achieved an AUC of 74.6%. A strong but not perfect correlation was found between the aggregated impact scores and the log odds ratios (Spearman’s rho = 0.74), which helped validate our explanation.

Keywords: deep neural network, temporal data, prediction, frailty, logistic regression model

Procedia PDF Downloads 153

Authors: Qasem Qananwah, Ahmad Dagamseh, Hiam AlQuran, Khalid Shaker Ibrahim

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Blood pressure helps the physicians greatly to have a deep insight into the cardiovascular system. The determination of individual blood pressure is a standard clinical procedure considered for cardiovascular system problems. The conventional techniques to measure blood pressure (e.g. cuff method) allows a limited number of readings for a certain period (e.g. every 5-10 minutes). Additionally, these systems cause turbulence to blood flow; impeding continuous blood pressure monitoring, especially in emergency cases or critically ill persons. In this paper, the most important statistical features in the photoplethysmogram (PPG) signals were extracted to estimate the blood pressure noninvasively. PPG signals from more than 40 subjects were measured and analyzed and 12 features were extracted. The features were fed to principal component analysis (PCA) to find the most important independent features that have the highest correlation with blood pressure. The results show that the stiffness index means and standard deviation for the beat-to-beat heart rate were the most important features. A model representing both features for Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) was obtained using a statistical regression technique. Surface fitting is used to best fit the series of data and the results show that the error value in estimating the SBP is 4.95% and in estimating the DBP is 3.99%.

Keywords: blood pressure, noninvasive optical system, principal component analysis, PCA, continuous monitoring

Procedia PDF Downloads 161

Authors: M. Manohari, Himanshu Gupta, S. Priyadharshini, R. Santhanam, S. Chandrasekaran, B. Venkatraman

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Injection is one of the potential routes of intake in a radioactive facility. The internal dose due to this intake is monitored at the radiation emergency medical centre, IGCAR using a portable planar HPGe detector. The contaminated wound may be having different shapes. In a reprocessing potential of wound contamination with actinide is more. Efficiency is one of the input parameters for estimation of internal dose. Estimating these efficiencies experimentally would be tedious and cumbersome. Numerical estimation can be a supplement to experiment. As an initial step in this study 241Am contamination of different shapes are studied. In this study portable planar HPGe detector was modeled using Monte Carlo code FLUKA and the effect of different parameters like distance of the contamination from the detector, radius of the circular contamination were studied. Efficiency values for point and surface contamination located at different distances were estimated. The effect of efficiency on the radius of the surface source was more predominant when the source is at 1 cm distance compared to when the source to detector distance is 10 cm. At 1 cm the efficiency decreased quadratically as the radius increased and at 10 cm it decreased linearly. The point source efficiency varied exponentially with source to detector distance.

Keywords: Planar HPGe, efficiency value, injection, surface source

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Authors: Hossam Shalabi, George Hadjisophocleous

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The Canadian Nuclear Power Plants (NPPs) use some portions of NUREG/CR-6850 in carrying out Fire Probabilistic Risk Assessment (PRA). An assessment for the applicability of NUREG/CR-6850 to CANDU reactors was performed and a CANDU Fire PRA was introduced. There are 19 operating CANDU reactors in Canada at five sites (Bruce A, Bruce B, Darlington, Pickering and Point Lepreau). A fire load density survey was done for all Fire Safe Shutdown Analysis (FSSA) fire zones in all CANDU sites in Canada. National Fire Protection Association (NFPA) Standard 557 proposes that a fire load survey must be conducted by either the weighing method or the inventory method or a combination of both. The combination method results in the most accurate values for fire loads. An updated CANDU Fire PRA model is demonstrated in this paper that includes the fuel survey in all Canadian CANDU stations. A qualitative screening step for the CANDU fire PRA is illustrated in this paper to include any fire events that can damage any part of the emergency power supply in addition to FSSA cables.

Keywords: fire safety, CANDU, nuclear, fuel densities, FDS, qualitative analysis, fire probabilistic risk assessment

Procedia PDF Downloads 137

Authors: Md. Shafiullah, M. Shafiul Alam, Bandar Suliman Alsharif

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Electrical quantities such as frequency, voltage, current are being fluctuated due to abnormalities in power system. Most of the abnormalities cause fluctuation in system frequency and sometimes extreme abnormalities lead to system blackout. To protect the system from complete blackout planned and proper islanding plays a very important role even in case of extreme abnormalities. Islanding operation not only helps stabilizing a faulted system but also supports power supplies to critical and important loads, in extreme emergency. But the islanding systems are weaker than integrated system so the stability of islands is the prime concern when an integrated system is disintegrated. In this paper, different impacts on a load rich island have been studied and a frequency based auto-load shedding scheme has been developed for sudden load addition, generation outage and combined effect of both to the island. The developed scheme has been applied to Khulna-Barisal Island to validate the effectiveness of the developed technique. Various types of abnormalities to the test system have been simulated and for the simulation purpose CYME PSAF (Power System Analysis Framework) has been used.

Keywords: auto load shedding, FS&FD relay, impact study, island, PSAF, ROCOF

Procedia PDF Downloads 457

Authors: Wisit Wichitkosoom

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Objectives: To find out the more effect of early cardiologist consultation using a simple technology on the diagnosis and early proper management of patients with Non-STEMI at emergency department of district hospitals without cardiologist on site before transferred. Methods: A cohort study was performed in Udonthani general hospital at Udonthani province. From 1 October 2012–30 September 2013 with 892 patients diagnosed with Non-STEMI. All patients mean aged 46.8 years of age who had been transferred because of Non-STEMI diagnosed, over a 12 week period of studied. Patients whose transferred, in addition to receiving proper care, were offered a cardiologist consultation with average time to Udonthani hospital 1.5 hour. The main outcome measure was length of hospital stay, mortality at 3 months, inpatient investigation, and transfer rate to the higher facilitated hospital were also studied. Results: Hospital stay was significantly shorter for those didn’t consult cardiologist (hazard ratio 1.19; approximate 95% CI 1.001 to 1.251; p = 0.039). The 136 cases were transferred to higher facilitated hospital. No statistically significant in overall mortality between the groups (p=0.068). Conclusions: Early cardiologist consultant can reduce length of hospital stay for patients with cardiovascular conditions outside of cardiac center. The new basic technology can apply for the safety patient.

Keywords: critical, telemedicine, safety, non STEMI

Procedia PDF Downloads 418

Authors: Amany Ragab, Nashwa Khairat Abousamra, Omayma Saleh, Asmaa Higazy

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Insulin resistance syndrome has been shown to be associated with many coagulation and fibrinolytic proteins and these associations suggest that some coagulation and fibrinolytic proteins have a role in atherothrombotic disorders. This study was conducted to determine the levels of some of the haemostatic parameters in subjects having metabolic syndrome and to correlate these values with the anthropometric and metabolic variables associated with this syndrome. The study included 46 obese non diabetic subjects of whom 28 subjects(group1) fulfilled the ATP III criteria of the metabolic syndrome and 18 subjects (group2) did not have metabolic syndrome as well as 14 lean subjects (group 3) of matched age and sex as a control group. Clinical and laboratory evaluation of the study groups stressed on anthropometric measurements (weight, height, body mass index, waist circumference, and sagittal abdominal diameter), blood pressure, and laboratory measurements of fasting plasma glucose, fasting insulin, serum lipids, tissue plasminogen activator (t-PA), antithrombin III activity (ATIII), protein C and von Willebrand factor (vWf) antigen. There was significant increase in the concentrations of t-PA and vWf antigens in subjects having metabolic syndrome (group 1) in comparison to the other groups while there were non-significant changes in the levels of protein C antigen and AT III activity. Both t-PA and vWf showed significant correlation with HOMA-IR as a measure of insulin sensitivity. The t-PA showed also significant correlation with most of the variables of metabolic syndrome including waist circumference, BMI, systolic blood pressure, fasting plasma glucose, fasting insulin, and HDL cholesterol. On the other hand, vWf showed significant correlations with fasting plasma glucose, fasting insulin and sagital abdominal diameter, with non-significant correlations with the other variables. Haemostatic and fibrinolytic parameters should be included in the features and characterization of the insulin resistance syndrome. t-PA and vWf antigens concentrations were increased in subjects with metabolic syndrome and correlated with the HOMA-IR measure of insulin sensitivity. Taking into consideration that both t-PA and vWf are mainly released from vascular endothelium, these findings could be an indicator of endothelial dysfunction in that group of subjects.

Keywords: insulin resistance, obesity, metabolic syndrome, coagulation

Procedia PDF Downloads 137

Authors: Maryam Idris Bakori

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The level of poverty in our region (West Africa) is a severe problem. The statistics about it are scary and alarming. For example, Report on Economic and Social Conditions in West Africa by United Nations Economic Commission for Africa gives the following gloomy picture of social conditions in the region: In West Africa, approximately one person in three in the towns, and one in two in the rural areas, cannot afford the expenditure needed to cover their basic needs. The situation has reached emergency proportions and calls for urgent social action (Recent Economic and Social Developments in West Africa and Prospects for 2010). Many different policies and programs to combat the poverty in the region have been embarked upon by the government of various countries in West Africa, but yet the ugly face of poverty persists. However, to explore opportunities and avenues for making positive contributions to national and regional development, this paper sets out to examine the role of two Islamic institutions; Zakah and Waqf, in poverty alleviation and how Islam uses these two institutions among others to eradicate poverty. The paper suggests that the governments of various countries of West Africa should endeavor to integrate Zakah and Waqf into their poverty alleviation programs by borrowing a leaf from some countries in Africa and Asia that have integrated these Islamic institutions into their poverty reduction programs, and they have started to reap the positive result from the policy.

Keywords: waqf, poverty, zakah, Islamic economy, education

Procedia PDF Downloads 402

Authors: Nicolas Koslover, Tamara Levene

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Aims: Tonsilitis is one of the most common presentations to the A+E department. We aimed to assess whether patients presenting with tonsilitis are being managed in-line with current guidance. We then set out to educate A+E staff about tonsilitis management and then assessed for improvement in management. Methods: All patients presenting to A+E in one fortnight with a documented diagnosis of tonsilitis were included. We reviewed the notes to assess the choice of treatment in each case and whether a clinical score (CENTOR or FEVERPain score) was used to guide choice of treatment (in accordance with NICE guideline [NG84]). We designed and delivered an educational intervention for A+E staff covering tonsilitis guidelines. The audit was repeated two weeks later. Results: Over the study period, 49 patients were included; only 35% (n=17) had either a clinical score documented or had all components of a score recorded. In total, 39% (n=19) were treated with antibiotics. Of these, 63% (n=12) should not have been prescribed an antibiotic and 37% (n=7) were prescribed an inappropriate antibiotic. At re-audit, (n=50 cases), 58% (n=29) had a clinical score documented and 28% (n=14) were treated with antibiotics. Of these, 29% (n=4) should not have been prescribed antibiotics and 21% (n=3) were prescribed an inappropriate antibiotic. Thus, after this teaching session, there was a significant improvement in antibiotic prescribing practices (63% vs. 29%, p=0.026). Conclusions: A+E assessment and management of tonsilitis frequently deviated from guidelines, but a single teaching session vastly improved clinical scoring and antibiotic prescribing practices.

Keywords: tonsilitis, education, emergency medicine, ENT

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Authors: Nefzi Ahlem, Aydi Ben Abdallah Rania, Jabnoun-Khiareddine Hayfa, Ammar Nawaim, Mejda Daami-Remadi

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Fusarium Crown and Root Rot (FCRR) caused by Fusarium oxysporum f. sp. radicis-lycopersici (FORL) is a serious tomato (Solanum lycopersicum L.) disease in Tunisia. Its management is very difficult due to the long survival of its resting structures and to the luck of genetic resistance. In this work, we explored the wild Solanaceae species Withania somnifera, growing in the Tunisian Centre-East, as a potential source of biocontrol agents effective in FCRR suppression and tomato growth promotion. Seven fungal isolates were shown able to colonize tomato roots, crowns, and stems. Used as conidial suspensions or cell-free culture filtrates, all tested fungal treatments significantly enhanced tomato growth parameters by 21.5-90.3% over FORL-free control and by 27.6-93.5% over pathogen-inoculated control. All treatments significantly decreased the leaf and root damage index by 28.5-92.8 and the vascular browning extent 9.7-86.4% over FORL-inoculated and untreated control. The highest disease suppression ability (decrease by 86.4-92.8% in FCRR severity) over pathogen-inoculated control and by 81.3-88.8 over hymexazol-treated control) was expressed by I6 based treatments. This endophytic fungus was morphologically characterized and identified using rDNA sequencing gene as Fusarium sp. I6 (MG835371). This fungus was shown able to reduce FORL radial growth by 58.5–83.2% using its conidial suspension or cell-free culture filtrate. Fusarium sp. I6 showed chitinolytic, proteolytic and amylase activities. The current study clearly demonstrated that Fusarium sp. (I6) is a promising biocontrol candidate for suppressing FCRR severity and promoting tomato growth. Further investigations are required for elucidating its mechanism of action involved in disease suppression and plant growth promotion.

Keywords: antifungal activity, associated fungi, Fusarium oxysporum f. sp. radicis-lycopersici, Withania somnifera, tomato growth

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Authors: Mohammed Ali Faqeeh

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SCADA System Alarms Optimization Process has been introduced recently and applied accordingly in different implemented stages. First, MODBUS communication protocols between RTU/SCADA were improved at the level of I/O points scanning intervals. Then, some of the technical issues related to manufacturing limitations were resolved. Afterward, another approach was followed to take a decision on the configured alarms database. So, a couple of meetings and workshops were held among all system stakeholders, which resulted in an agreement of disabling unnecessary (Diagnostic) alarms. Moreover, a leap forward step was taken to segregate the SCADA Operator Graphics in a way to show only process-related alarms while some other graphics will ensure the availability of field alarms related to maintenance and engineering purposes. This overall system management and optimization have resulted in a huge effective impact on all operations, maintenance, and engineering. It has reduced unneeded open tickets for maintenance crews which led to reduce the driven mileages accordingly. Also, this practice has shown a good impression on the operation reactions and response to the emergency situations as the SCADA operators can be staying much vigilant on the real alarms rather than gets distracted by noisy ones. SCADA System Alarms Optimization process has been executed utilizing all applicable in-house resources among engineering, maintenance, and operations crews. The methodology of the entire enhanced scopes is performed through various stages.

Keywords: SCADA, RTU Communication, alarm management system, SCADA alarms, Modbus, DNP protocol

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Authors: F. Alaa Ali, S. A. Sherein Abdelgayed, S. Osama. EL-Tawil, M. Adel Bakeer

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Tartrazine is an organic azo dyes food additive widely used in foods, drugs, and cosmetics. The present study aimed to investigate the toxic effects of tartrazine on kidneys and liver biomarkers in addition to the investigation of oxidative stress and change of histopathological structure of liver and kidneys in 30 male rats. Tartrazine was orally administrated daily at dose 200 mg/ kg bw (1/ 10 LD₅₀) for sixty days. Serum and tissue samples were collected at the end of the experiment to investigate the underlying mechanism of tartrazine through assessment oxidative stress (Glutathione (GSH), Superoxide dismutase (SOD) and malondialdehyde (MDA) and biochemical markers (alanine aminotransferase (ALT), aspartate aminotransferase (AST), Total protein and Urea). Liver and kidneys tissue were collected and preserved in 10% formalin for histopathological examination. The obtained values were statistically analyzed by one way analysis of variance (ANOVA) followed by multiple comparison test. Biochemical analysis revealed that tartrazine induced significant increase in serum ALT, AST, total protein, urea level compared to control group. Tartrazine showed significant decrease in liver GSH and SOD where their values when compared to control group. Tartrazine induced increase in liver MDA compared to control group. Histopathology of the liver showed diffuse vacuolar degeneration in hepatic parenchyma, the portal area showed sever changes sever in hepatoportal blood vessels and in the bile ducts. The kidneys showed degenerated tubules at the cortex together with mononuclear leucocytes inflammatory cells infiltration. There is perivascular edema with inflammatory cell infiltration surrounding the congested and hyalinized vascular wall of blood vessel. The present study indicates that the subchronic effects of tartrazine have a toxic effect on the liver and kidneys together with induction of oxidative stress by formation of free radicals. Therefore, people should avoid the hazards of consuming tartrazine.

Keywords: albino rats, tartrazine, toxicity, pathology

Procedia PDF Downloads 358

Authors: Alan (Avi) Kirschenbaum, Carmit Rapaport

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The behavior of bystanders in emergencies and disasters have been examined for over 50 years. Such acts have been cited as contributing to saving lives in terms of providing first responder help until official emergency units can arrive. Several reasons have been suggested for this type of behavior but most focused on a broad segment of individual psychological decision-making processes. Recent theoretical evidence suggests that the external factors for such bystander decisions, mainly disaster community based social contexts factors, are also important. We aim to test these competing arguments. Specifically, we examine alternative explanatory perspectives by focusing on self-efficacy as a proxy for the accepted individual psychological case and contrast it with potential bystander characteristics of the individual as well factors as embedded in the social context of the disaster community. To do so, we will utilize a random sampling of the population from a field study of an urban community in Israel that experienced five years of continuous terror attacks. The results strongly suggest that self-efficacy, as well as external factors: preparedness and having skills for intervention during emergencies along with gender best, predict potential helping behaviors. These results broaden our view of bystander behavior and open a window for enhancing this phenomenon as another element in disaster and crisis management.

Keywords: bystander behavior, disasters emergencies, psychological motivation to help, social context for helping

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Authors: Maria Giovanna Lupo, Marina Camera, Marcello Rattazzi, Nicola Ferri

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A complex interplay among chronic kidney disease, lipid metabolism and aortic calcification has been recognized starting from results of many clinical and experimental studies. Here we investigated the influence of kidney function on PCSK9 levels, both in uremic rats and in clinical observation study, and its potential direct action on cultured smooth muscle cells (SMCs) calcification. In a cohort of 594 subjects enrolled in a single centre, observational, cross-sectional and longitudinal study, a negative association between GFR and plasma PCSK9 was found. Atherosclerotic cardiovascular disease (ASCVD), as co-morbidity, further increased PCSK9 plasma levels. Diet-induced uremic condition in rats, induced aortic calcification and increased total cholesterol and PCSK9 levels in plasma, livers and kidneys. Immunohistochemical analysis confirmed PCSK9 expression in aortic SMCs. SMCs overexpressing PCSK9 (SMCsPCSK9), cultured for 7-days in a pro-calcification environment (2.0mM or 2.4mM inorganic phosphate, Pi) showed a significantly higher extracellular calcium (Ca2+) deposition compared to mocked SMCs. Under the same experimental conditions, the addition of exogenous recombinant PCSK9 did not increase the extracellular calcification of SMCs. By flow cytometry analysis we showed that SMCsPCSK9, in response to 2.4mM Pi, released higher number of extracellular vesicles (EVs) positive for three tetraspanin molecules, such as CD63, CD9, and CD81. EVs derived from SMCsPCSK9 tended to be more enriched in calcium and alkaline phosphatase (ALPL), compared to EVs from mocks SMCs. In conclusion, our study reveals a direct role of PCSK9 on vascular calcification induced by higher inorganic phosphate levels associated to CKD condition. This effect appears to be mediated by a positive effect of endogenous PCSK9 on the release of EVs containing Ca2+ and ALP, which facilitate the deposition inorganic calcium phosphate crystals.

Keywords: PCSK9, calcification, extracellular vesicles, chronic kidney disease

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Authors: Sarah Elsayed Mohammed, Lamiaa Ahmed Ahmed, Mahmoud Mohammed Khattab

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Aim: The aim of the present study was to investigate whether combined nicorandil and bone marrow-derived mesenchymal stem cells (BMDMSC) treatment could offer an additional benefit in ameliorating isoproterenol (ISO)-induced heart failure in rats. Methods: ISO (85 and 170 mg/kg/day) was injected subcutaneously for 2 successive days, respectively. By day 3, electrocardiographic changes were recorded and serum was separated for determination of CK-MB level for confirmation of myocardial damage. Nicorandil (3 mg/kg/day) was then given orally with or without a single i.v. BMDMSC administration. Electrocardiography and echocardiography were recorded 2 weeks after beginning of treatment. Rats were then sacrificed and ventricles were isolated for estimation of vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-α) and transforming growth factor-beta (TGF-β) contents, caspase-3 activity as well as inducible nitric oxide synthase (iNOS) and connexin-43 protein expressions. Moreover, histological analysis of myocardial fibrosis was performed and cryosections were done for estimation of homing of BMDMSC. Results: ISO induced a significant increase in ventricles/body weight ratio, left ventricular end diastolic (LVEDD) and systolic dimensions (LVESD), ST segment and QRS duration. Moreover, myocardial fibrosis as well as VEGF, TNF-α and TGF-β contents were significantly increased. On the other hand, connexin-43 protein expression was significantly decreased, while caspase-3 and iNOS protein expressions were significantly increased. Combined therapy provided additional improvement compared to cell treatment alone towards reducing cardiac hypertrophy, fibrosis and inflammation. Furthermore, combined therapy induced significant increase in angiogenesis and BMDMSC homing and prevented ISO induced changes in iNOS, connexin-43 and caspase-3 protein expressions. Conclusion: Combined nicorandil/BMDMSC treatment was superior to BMDMSC alone towards preventing ISO-induced heart failure in rats.

Keywords: fibrosis, isoproterenol, mesenchymal stem cells, nicorandil

Procedia PDF Downloads 532

Authors: A. Esra İdemen, Sinan M. Şener, Emrah Acar

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The technological paradigm of the disaster management field, especially in the case of governmental intervention strategies, is generally based on rapid and flexible accommodation solutions. From various technical solution patterns used to address the immediate housing needs of disaster victims, the adaptive re-use of existing buildings can be considered to be both low-cost and practical. However, there is a scarcity of analytical methods to screen, select and adapt buildings to help decision makers in cases of emergency. Following an extensive literature review, this paper aims to highlight key points and problem areas associated with the adaptive re-use of buildings within the disaster management context. In other disciplines such as real estate management, the adaptive re-use potential (ARP) of existing buildings is typically based on the prioritization of a set of technical and non-technical criteria which are then weighted to arrive at an economically viable investment decision. After a disaster, however, the assessment of the ARP of buildings requires consideration of different/additional layers of analysis which stem from general disaster management principles and the peculiarities of different types of disasters, as well as of their victims. In this paper, a discussion of the development of an adaptive re-use potential (ARP) assessment model is presented. It is thought that governmental and non-governmental decision makers who are required to take quick decisions to accommodate displaced masses following disasters are likely to benefit from the implementation of such a model.

Keywords: adaptive re-use of buildings, disaster management, temporary housing, assessment model

Procedia PDF Downloads 332

Authors: Christophe Spaas, Lies Pottel, Joke De Ceulaer, Johan Abeloos, Philippe Lamoral, Tom De Backer, Calix De Clercq

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We aimed to evaluate the accuracy of an in-house developed low-cost computer-assisted surgery (CAS) protocol for osseous free flap mandibular reconstruction. All patients who underwent primary or secondary mandibular reconstruction with a free (solely or composite) osseous flap, either a fibula free flap or iliac crest free flap, between January 2014 and December 2017 were evaluated. The low-cost protocol consisted out of a virtual surgical planning, a prebend custom reconstruction plate and an individualized free flap positioning guide. The accuracy of the protocol was evaluated through comparison of the postoperative outcome with the 3D virtual planning, based on measurement of the following parameters: intercondylar distance, mandibular angle (axial and sagittal), inner angular distance, anterior-posterior distance, length of the fibular/iliac crest segments and osteotomy angles. A statistical analysis of the obtained values was done. Virtual 3D surgical planning and cutting guide design were performed with Proplan CMF® software (Materialise, Leuven, Belgium) and IPS Gate (KLS Martin, Tuttlingen, Germany). Segmentation of the DICOM data as well as outcome analysis were done with BrainLab iPlan® Software (Brainlab AG, Feldkirchen, Germany). A cost analysis of the protocol was done. Twenty-two patients (11 fibula /11 iliac crest) were included and analyzed. Based on voxel-based registration on the cranial base, 3D virtual planning landmark parameters did not significantly differ from those measured on the actual treatment outcome (p-values >0.05). A cost evaluation of the in-house developed CAS protocol revealed a 1750 euro cost reduction in comparison with a standard CAS protocol with a patient-specific reconstruction plate. Our results indicate that an accurate transfer of the planning with our in-house developed low-cost CAS protocol is feasible at a significant lower cost.

Keywords: CAD/CAM, computer-assisted surgery, low-cost, mandibular reconstruction

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Authors: Sabah Mohammed, Jinan Fiaidhi, Darien Sawyer

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Data integration of health through connected services can save lives in the event of a medical emergency or provide efficient and effective interventions for the benefit of the patients through the integration of bedside and bench side clinical research. Such integration will support all wind of change in healthcare by being predictive, pre-emptive, personalized, problem-oriented and participatory. Prototyping a healthcare system that enables data integration has been a big challenge for healthcare for a long time. However, an innovative solution started to emerge by focusing on problem lists where everything can connect the problem list forming a growing graph. This notion was introduced by Dr. Lawrence Weed in early 70’s, but the enabling technologies weren’t mature enough to provide a successful implementation prototype. In this article, we are describing our efforts in prototyping Dr. Lawrence Weed's problem-oriented medical record (POMR) and his patient case schema (SOAP) to shape a prototype for connected health. For this, we are using the TypeGraphQL API and our enterprise-based QL4POMR to describe a Web-Based gateway for healthcare services connectivity. Our prototype has reported success in connecting to the HL7 FHIR medical record and the OpenTarget biomedical repositories.

Keywords: connected health, problem-oriented healthcare record, SOAP, QL4POMR, typegraphQL

Procedia PDF Downloads 97