Search results for: total and partial densities of states
3935 Coarse-Grained Molecular Simulations to Estimate Thermophysical Properties of Phase Equilibria
Authors: Hai Hoang, Thanh Xuan Nguyen Thi, Guillaume Galliero
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Coarse-Grained (CG) molecular simulations have shown to be an efficient way to estimate thermophysical (static and dynamic) properties of fluids. Several strategies have been developed and reported in the literature for defining CG molecular models. Among them, those based on a top-down strategy (i.e. CG molecular models related to macroscopic observables), despite being heuristic, have increasingly gained attention. This is probably due to its simplicity in implementation and its ability to provide reasonable results for not only simple but also complex systems. Regarding simple Force-Fields associated with these CG molecular models, it has been found that the four parameters Mie chain model is one of the best compromises to describe thermophysical static properties (e.g. phase diagram, saturation pressure). However, parameterization procedures of these Mie-chain GC molecular models given in literature are generally insufficient to simultaneously provide static and dynamic (e.g. viscosity) properties. To deal with such situations, we have extended the corresponding states by using a quantity associated with the liquid viscosity. Results obtained from molecular simulations have shown that our approach is able to yield good estimates for both static and dynamic thermophysical properties for various real non-associating fluids. In addition, we will show that on simple (e.g. phase diagram, saturation pressure) and complex (e.g. thermodynamic response functions, thermodynamic energy potentials) static properties, results of our scheme generally provides improved results compared to existing approaches.Keywords: coarse-grained model, mie potential, molecular simulations, thermophysical properties, phase equilibria
Procedia PDF Downloads 3363934 Robust Segmentation of Salient Features in Automatic Breast Ultrasound (ABUS) Images
Authors: Lamees Nasser, Yago Diez, Robert Martí, Joan Martí, Ibrahim Sadek
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Automated 3D breast ultrasound (ABUS) screening is a novel modality in medical imaging because of its common characteristics shared with other ultrasound modalities in addition to the three orthogonal planes (i.e., axial, sagittal, and coronal) that are useful in analysis of tumors. In the literature, few automatic approaches exist for typical tasks such as segmentation or registration. In this work, we deal with two problems concerning ABUS images: nipple and rib detection. Nipple and ribs are the most visible and salient features in ABUS images. Determining the nipple position plays a key role in some applications for example evaluation of registration results or lesion follow-up. We present a nipple detection algorithm based on color and shape of the nipple, besides an automatic approach to detect the ribs. In point of fact, rib detection is considered as one of the main stages in chest wall segmentation. This approach consists of four steps. First, images are normalized in order to minimize the intensity variability for a given set of regions within the same image or a set of images. Second, the normalized images are smoothed by using anisotropic diffusion filter. Next, the ribs are detected in each slice by analyzing the eigenvalues of the 3D Hessian matrix. Finally, a breast mask and a probability map of regions detected as ribs are used to remove false positives (FP). Qualitative and quantitative evaluation obtained from a total of 22 cases is performed. For all cases, the average and standard deviation of the root mean square error (RMSE) between manually annotated points placed on the rib surface and detected points on rib borders are 15.1188 mm and 14.7184 mm respectively.Keywords: Automated 3D Breast Ultrasound, Eigenvalues of Hessian matrix, Nipple detection, Rib detection
Procedia PDF Downloads 3303933 Risk Assessment of Heavy Metals in Soils at Electronic Waste Activity Sites within the Vicinity of Alaba International Market, Nigeria
Authors: A. A. Adebayo, A. O. Ogunkeyede, A. O. Adeigbe
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Digital globalisation and yarn of Nigeria society to overcome the digital divide have resulted in contamination of soil by heavy metals (HMs) from e-waste activities at Alaba international market, Lagos, Nigeria. The aim of this research was to determine the concentration of various metals {Cadmium (Cd), Chromium (Cr), Copper (Cu), and Lead (Pb)} and identify their ecological and health risks for the people within the study area. A total of 60 soil samples were collected at Alaba market study area. Two types of samples were collected from each sampling points: topsoil (0-15 cm), subsoil (15 -30 cm). The metal concentration results showed that the soils were heavily contaminated by HMs at topsoil and subsoil. The geoaccummulation and ecological risk indices revealed high pollution level from all studied site. The health risk assessment results suggested that there is high possibility of carcinogenic risk to humans because the carcinogenic risk via corresponding exposure pathways exceeded the safety limit of 10-6 (the acceptable level of carcinogenic risk for human). Furthermore, inhalation of soil particles is the main exposure pathway for Cr to enter the human body for all ages. Children in the vicinity are exposed more to ingestion of Pb since they tend to eat earth (pica) and repeatedly suck their fingers. This study provides basic information to create awareness for a need to introduce pollution control measures and the need to protect the ecosystem and human health within the study area at Alaba international market.Keywords: contaminated soil, ecological risk, hazard index, risk factor, exposure pathways, heavy metals
Procedia PDF Downloads 2533932 Ilizarov's External Fixator. A Bone Regeneration Method Little Used in Africa. Our Experience of 20 Years in Cameroon.
Authors: Ibrahima Farikou, Kolontchang Gatchou Alberic Lionel, Tsiagadgui Jean Gustave, Ngo Yamben Marie-Ange, Handy Eone Daniel
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Introduction: It was in 1956 that Ilizarov pioneered the concept of osteogenesis in distraction by the device that bears his name to help produce bone and soft tissue regeneration and bone consolidation. This technique is not widely used in Africa where, however, its applications are numerous (loss of bone substances, congenital or acquired malformations). Our goal is to bring the indications of Ilizarov's device back to our practice conditions. Methods: Our study was conducted in 2 hospitals over a period of 20 years. For the retrospective phase, this study included all complete usable records of patients operated on in the Ilizarov external fixator department, and for the prospective phase, all patients operated on in the departments with complete usable records. Our sample was consecutive and not exhaustive. Data were analyzed by SPSS software version 23.0. Results: A total of 52 patients were reviewed. The average age of our patients was 14.7 years. The sex ratio was 1.6 in favor of men. The lower limb was the most affected (49), with a predominance of the tibia (62.4%). The average elongation was 6.4 cm. Traumatic acquired pathologies (delayed union, malunion) represented 60.6%. The mean time to union was seven months. Correction of the limb length discrepancy or filling of loss of bone substance was obtained in 75% of cases. Functionally, 80.8% of the patients treated had regained autonomy at the end of treatment, but in 17.3% of the patients, pain and limping persisted. Conclusion: This technique should be popularized in Africa because the benefit that would accrue to patients is invaluable and would be an attractive alternative to many amputations sometimes carried out in Africa by despair.Keywords: ilizarov, external fixator, limb lengthening, bone regeneration, africa
Procedia PDF Downloads 1013931 An Online Master's Degree Program for the Preparation of Adapted Physical Education Teachers for Children with Significant Developmental Disabilities
Authors: Jiabei Zhang
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Online programs developed for preparing qualified teachers have significantly increased over the years in the United States of America (USA). However, no online graduate programs for training adapted physical education (APE) teachers for children with significant developmental disabilities are currently available in the USA. The purpose of this study was to develop an online master’s degree program for the preparation of APE teachers to serve children with significant developmental disabilities. The characteristics demonstrated by children with significant developmental disabilities, the competencies required for certified APE teachers, and the evidence-based positive behavioral interventions (PBI) documented for teaching children with significant developmental disabilities were fully reviewed in this study. An online graduate program with 14 courses for 42 credit hours (3 credit hours per course) was then developed for training APE teachers to serve children with significant developmental disabilities. Included in this online program are five components: (a) 2 capstone courses, (b) 4 APE courses, (c) 4 PBI course, (d) 2 elective courses, and (e) 2 capstone courses. All courses will be delivered online through Desire2Learn administered by the Extended University Programs at Western Michigan University (WMU). An applicant who has a bachelor’s degree in physical education or special education is eligible for this proposed program. A student enrolled in this program is expected to complete all courses in 2.5 years while staying in their local area. This program will be submitted to the WMU curriculum committee for approval in the fall of 2018.Keywords: adapted physical education, online program, teacher preparation, and significant disabilities
Procedia PDF Downloads 1483930 Effect of 8 Weeks of Intervention on Physical Fitness, Hepatokines, and Insulin Resistance in Obese Subjects
Authors: Adela Penesova, Zofia Radikova, Boris Bajer, Andrea Havranova, Miroslav Vlcek
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Background: The aim of our study was to compare the effect of intensified lifestyle intervention on insulin resistance (HOMA-IR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and Fibroblast growth factor (FGF) 21 after 8 weeks of lifestyle intervention. Methods: A group of 43 obese patients (13M/30F; 43.0±12.4 years; BMI (body mass index) 31.2±6.3 kg/m2 participated in a weight loss interventional program (NCT02325804) following an 8-week hypocaloric diet (-30% energy expenditure) and physical activity 150 minutes/week. Insulin sensitivity was evaluated according to the homeostasis model assessment of insulin resistance (HOMA-IR) and insulin sensitivity indices according to Matsuda and Cederholm were calculated (ISImat and ISIced). Plasma ALT, AST, Fetuin-A, FGF 21, and physical fitness were measured. Results: The average reduction of body weight was 6.8±4.9 kg (0-15 kg; p=0.0006), accompanied with a significant reduction of body fat amount of fat mass (p=0.03), and waist circumference (p=0.02). Insulin sensitivity has been improved (IR HOMA 2.71±3.90 vs 1.24±0.83; p=0.01; ISIMat 6.64±4.38 vs 8.93±5.36 p ≤ 0.001). Total, LDL cholesterol, and triglycerides decreased (p=0.05, p=0.04, p=0.04, respectively). Physical fitness significantly improved after intervention (as measure VO2 max (maximal oxygen uptake) (p ≤ 0.001). ALT decreased significantly (0.44±0.26 vs post 0.33±0.18 ukat/l, p=0.004); however, AST not (pre 0.40±0.15 vs 0.35±0.09 ukat/l, p=0.07). Hepatokine Fetuin-A significantly decreased after intervention (43.1±10.8 vs 32.6±8.6 ng/ml, p < 0.001); however, FGF 21 levels tended to decrease (146±152 vs 132±164 pg/ml, p=0.07). Conclusion: 8-weeks of diet and physical activity intervention program in obese otherwise healthy subjects led to an improvement of insulin resistance parameters and liver marker profiles, as well as increased physical fitness. This study was supported by grants APVV 15-0228; VEGA 2/0161/16.Keywords: obesity, diet, exercice, insulin sensitivity
Procedia PDF Downloads 2013929 The Current Crisis of Refugees and Contemporary Ethics
Authors: Leila Angélica de O. Castro, Thiago R. Pereira
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The number of refugees currently is alarming, having overcome the numbers of World War II. The objective of this research will be to examine this refugee crisis the light of the main contemporary ethical theories, mainly by analyzing whether there is an ethical obligation to assist these refugees. Among the many existing theories like virtue ethics, Kantian ethics, utilitarian ethics, ethical egoism and psychological egoism, will be the ethical theories used to analyze the current refugee crisis. The ethics of virtue is the oldest of theories, an action can be considered correct if we are acting virtuously if we predisposition to act that virtuously, where the goal is always the eudaimonia, a good life, a happy life. The Kantian ethics of the works of the philosopher Immanuel Kant, where we apply the hypothetical and categorical imperatives to find universal truths, actions that we consider to be universally correct. Utilitarian ethics believes that action will be considered as correct to bring happiness to the greatest possible number of people, even if they somehow have to bring unhappiness to any number of people. Ethical egoism should be concerned first with our individual happiness, and then we can worry about the happiness of others, so long as it causes us some happiness. Thus, action is correct since it is causing us a greater degree of happiness than unhappiness. Finally, the psychological egoism does not seek to determine whether an action is right or not, but claims that all our actions, even if they seem altruistic, actually has another motivation, which will always be a selfish motivation, that is, concerned with the our well-being. From these initial concepts, the issue of refugees, especially the question of whether states and their citizens have or not any ethical obligation to help them and receive them in their territories will be analyzed .Keywords: refugees, ethics, obligation to help, contemporary theories
Procedia PDF Downloads 3773928 The Severity of Electric Bicycle Injuries Compared to Classic Bicycle Injuries in Children: A Retrospective Review
Authors: Tali Capua, Karin Hermon, Miguel Glatstein, Oren Tavor, Ayelet Rimon
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Background: Electric bicycles (E-bikes) are one of a wide range of light electric vehicles that provide convenient local transportation and attractive recreational opportunities. Along with their growing use worldwide, the E-bike related injury rate increases. To the best of our knowledge, this study is the first to specifically compare E-bike with classic bicycle related injuries in children. Methods: Data of all pediatric ( < 16 years of age) bicycle related injuries presenting to an urban level I trauma center between 2014 and 2015 were collected and analyzed. The recorded data included age, gender, details of the accident, as well severity of injury, medical diagnosis, and the outcome. Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) were calculated for each patient. Data of E-bike related injuries and classic bicycle were then compared. Results: A total of 124 bicycle related injuries and 97 E-bike related injuries presented to the emergency department. Once pedestrians and bicycle passengers were removed, the groups of riders consisted of 111 bikers and 85 E-bikers. The mean age of bikers was 9.9 years (range 3-16 years) and of E-bikers was 13.7 years (range 7.5-16 years). Injuries to the head and the extremities were common in both groups. Compared to bikers, E-bikers had significantly more injuries to intra-abdominal organs (p = 0.04). Twenty patients (16%) with bicycle related injuries were admitted, and 13 (15%) patients with E-bike related injuries, of the latter group four underwent surgical intervention. ISS scores were low overall, but the injuries of higher severity (ISS > 9) were among the E-bikers. Conclusions: This study provides unique information which suggests that injuries in E-bikers tend to be more severe than in classic bikers. There is a need for regulation regarding the use of E-bikes to enhance the safety of both bikers and other road and pavement users.Keywords: bicycle, electric bicycle, injury, pediatric, trauma
Procedia PDF Downloads 1903927 Technological Characterization of Lactic Acid Bacteria Isolated from Algerian's Goat's Milk
Authors: A. Cheriguene, F. Chougrani
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A total of 153 wild lactic acid bacteria were isolated from goat’s milk collected from different areas in Western Algeria. The strains were identified using phenotypical, biochemical and physiological properties. API system and SDS-PAGE technique was also used in identification of the strains. Six genera were found Enterococcus (41.83%), Lactobacillus (29.40%), Lactococcus (19.60%), Leuconostoc (4.57%), Streptococcus thermophilus (3.26%) and Pediococcus (1.30%). The most abundant species were Enterococcus faecium (24 isolates), Enterococcus durans (22 isolates), Lactococcus lactis subsp. lactis (25 isolates), Lactobacillus rhamnosus (09 isolates) and Lactobacillus delbrueckii subsp. bulgaricus (07 isolates). The strains were screened for production and technological properties such as acid production, aminopeptidase activity, autolytic properties, antimicrobial activity and exopolysaccharide production. In general most tested isolates showed a good biomass separation when collected by centrifugation; as for the production of the lactic acid, results revealed that our strains are weakly acidifying; nevertheless, lactococci showed a best acidifying activity compared to lactobacilli. Aminopeptidase activity was also weak in most strains; but, it was generally higher for lactobacilli compared to lactococci, where we recorded 30 units for Lactobacillus delbrueckii subsp. bulgaricus M14. Autolytic activity was generally higher for most strains, more particularly lactobacilli where we recorded values of 71.13% and 70% of autolysis rate respectively in Lactobacillus rhamnosus strains 9S10 and 9S7. Antimicrobial activity was detected in 50% of the isolates, particularly in lactobacilli where 80% of strains tested were able to inhibit the growth of other strains. Two strains could produce exopolysaccharides, E. faecium 8M6 and E. durans 7S8. Some strains were able to maintain two or three technological characteristics together.Keywords: lactic acid bacteria, technological properties, acidification, aminopeptidase acivity (AP), autolysis
Procedia PDF Downloads 4323926 A Multi-Science Study of Modern Synergetic War and Its Information Security Component
Authors: Alexander G. Yushchenko
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From a multi-science point of view, we analyze threats to security resulting from globalization of international information space and information and communication aggression of Russia. A definition of Ruschism is formulated as an ideology supporting aggressive actions of modern Russia against the Euro-Atlantic community. Stages of the hybrid war Russia is leading against Ukraine are described, including the elements of subversive activity of the special services, the activation of the military phase and the gradual shift of the focus of confrontation to the realm of information and communication technologies. We reveal an emergence of a threat for democratic states resulting from the destabilizing impact of a target state’s mass media and social networks being exploited by Russian secret services under freedom-of-speech disguise. Thus, we underline the vulnerability of cyber- and information security of the network society in regard of hybrid war. We propose to define the latter a synergetic war. Our analysis is supported with a long-term qualitative monitoring of representation of top state officials on popular TV channels and Facebook. From the memetics point of view, we have detected a destructive psycho-information technology used by the Kremlin, a kind of information catastrophe, the essence of which is explained in detail. In the conclusion, a comprehensive plan for information protection of the public consciousness and mentality of Euro-Atlantic citizens from the aggression of the enemy is proposed.Keywords: cyber and information security, hybrid war, psycho-information technology, synergetic war, Ruschism
Procedia PDF Downloads 1343925 Mindfulness and Mental Resilience Training for Pilots: Enhancing Cognitive Performance and Stress Management
Authors: Nargiza Nuralieva
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The study delves into assessing the influence of mindfulness and mental resilience training on the cognitive performance and stress management of pilots. Employing a meticulous literature search across databases such as Medline and Google Scholar, the study used specific keywords to target a wide array of studies. Inclusion criteria were stringent, focusing on peer-reviewed studies in English that utilized designs like randomized controlled trials, with a specific interest in interventions related to mindfulness or mental resilience training for pilots and measured outcomes pertaining to cognitive performance and stress management. The initial literature search identified a pool of 123 articles, with subsequent screening resulting in the exclusion of 77 based on title and abstract. The remaining 54 articles underwent a more rigorous full-text screening, leading to the exclusion of 41. Additionally, five studies were selected from the World Health Organization's clinical trials database. A total of 11 articles from meta-analyses were retained for examination, underscoring the study's dedication to a meticulous and robust inclusion process. The interventions varied widely, incorporating mixed approaches, Cognitive behavioral Therapy (CBT)-based, and mindfulness-based techniques. The analysis uncovered positive effects across these interventions. Specifically, mixed interventions demonstrated a Standardized Mean Difference (SMD) of 0.54, CBT-based interventions showed an SMD of 0.29, and mindfulness-based interventions exhibited an SMD of 0.43. Long-term effects at a 6-month follow-up suggested sustained impacts for both mindfulness-based (SMD: 0.63) and CBT-based interventions (SMD: 0.73), albeit with notable heterogeneity.Keywords: mindfulness, mental resilience, pilots, cognitive performance, stress management
Procedia PDF Downloads 553924 Municipal Solid Waste (MSW) Composition and Generation in Nablus City, Palestine
Authors: Issam A. Al-Khatib
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In order to achieve a significant reduction of waste amount flowing into landfills, it is important to first understand the composition of the solid municipal waste generated. Hence a detailed analysis of municipal solid waste composition has been conducted in Nablus city. The aim is to provide data on the potential recyclable fractions in the actual waste stream, with a focus on the plastic fraction. Hence, waste-sorting campaigns were conducted on mixed waste containers from five districts in Nablus city. The districts vary in terms of infrastructure and average income. The target is to obtain representative data about the potential quantity and quality of household plastic waste. The study has measured the composition of municipal solid waste collected/ transported by Nablus municipality. The analysis was done by categorizing the samples into eight primary fractions (organic and food waste, paper and cardboard, glass, metals, textiles, plastic, a fine fraction (<10 mm), and others). The study results reveal that the MSW stream in Nablus city has a significant bio- and organic waste fraction (about 68% of the total MSW). The second largest fraction is paper and cardboard (13.6%), followed by plastics (10.1%), textiles (3.2%), glass (1.9%), metals (1.8%), a fine fraction (0.5%), and other waste (0.3%). After this complete and detailed characterization of MSW collected in Nablus and taking into account the content of biodegradable organic matter, the composting could be a solution for the city of Nablus where the surrounding areas of Nablus city have agricultural activities and could be a natural outlet to the compost product. Different waste management options could be practiced in the future in addition to composting, such as energy recovery and recycling, which result in a greater possibility of reducing substantial amounts that are disposed of at landfills.Keywords: developing countries, composition, management, recyclable, waste.
Procedia PDF Downloads 903923 Decision Support: How Explainable A.I. Can Improve Transparency and Trust with Human Users
Authors: Devon Brown, Liu Chunmei
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This paper will present an analysis as part of the researchers dissertation topic focusing on the intersection of affective and analytical directed acyclic graphs (DAGs) in the context of Decision Support Systems (DSS). The researcher’s work involves analyzing decision theory models like Affective and Bayesian Decision theory models and how they could be implemented under an Affective Computing Framework using Information Fusion and Human-Centered Design. Additionally, the researcher is beginning research on an Affective-Analytic Decision Framework (AADF) model for their dissertation research and are looking to merge logic and analytic models with empathetic insights into affective DAGs. Data-collection efforts begin Fall 2024 and in preparation for the efforts this paper looks to analyze previous research in this area and introduce the AADF framework and propose conceptual models for consideration. For this paper, the research emphasis is placed on analyzing Bayesian networks and Markov models which offer probabilistic techniques during uncertainty in decision-making. Ideally, including affect into analytic models will ensure algorithms can increase user trust with algorithms by including emotional states and the user’s experience with the goal of developing emotionally intelligent A.I. systems that can start to navigate the complex fabric of human emotion during decision-making.Keywords: decision support systems, explainable AI, HCAI techniques, affective-analytical decision framework
Procedia PDF Downloads 213922 Anatomy of the Challenges, Problems and Prospects of Polytechnic Administration in North-Central Nigeria
Authors: A. O. Osabo
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Polytechnic education is often described as the only sustainable academic institution that can propel massive industrial and technological growth and development in all sectors of the Nigerian economy. Because of its emphasis on science and technology, practical demonstration of skills and pivotal role in the training of low-and-high-cadre technologists and technocrats to man critical sectors of the economy, the administration of polytechnics needs to be run according to global best standards and practices in order to achieve their goals and objectives. Besides, the polytechnics need to be headed by seasoned and academically sound professionals to pursue the goals and objectives of the schools as centres of technology, learning and academic excellence. Over the years, however, polytechnics in Nigeria have suffered a wide myriad of administrative problems and challenges which have prevented them from achieving their basic goals and objectives. Apart from regulatory problems and challenges, some heads of polytechnics do not demonstrate leadership and management skills in bringing the desired innovations in the management of the polytechnics under them. These have resulted, in most cases, to the polytechnics not performing optimally in its mandate. This paper examines the administrative problems, challenges and prospects of polytechnics education in north-central Nigeria. Using a total of 97 questionnaires consisting of semi-structured interviews of yes-or-no questions shared among staff and students of the selected polytechnics and a descriptive statistical method of analysis, the study found that the inability of the polytechnics to meet their goals and objectives is caused by administrative and organizational problems and challenges, bordering on funding, accreditation, manpower, corruption and maladministration, among others. The paper thus suggests that the leadership of the polytechnics must rise up to the demands of the time in order to deal with the administrative problems and challenges affecting them and fulfill the goals and objectives for which the schools were established.Keywords: education, administration, polytechnic, accreditation, Nigerian
Procedia PDF Downloads 2643921 Comparison of Efficacy between Low-Residue Diet and Clear-Liquid Diet in Colonoscopic Bowel Preparation at a Surgical Clinic: A Randomized Controlled Trial
Authors: Sopana Wongtawee
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Purpose: Adequate bowel cleansing is essential for a high quality, effective and safe colonoscopy. The aims of this study were to compare the efficacy of bowel preparation based on a low-residue diet before 8:00 followed by a clear-liquid diet, and a low-residue diet until 16:00 one day before colonoscopy using sodium phosphate solution (Xubil ®), the side effects of the two protocols and the patient satisfaction with them. Method: This was an endoscopist-blinded, prospective, randomized, controlled trial. A total of 224 patients (112 in each group) scheduled for outpatient colonoscopy met the criteria.They were randomized to either a low-residue diet consisting of white rice porridge with either fish, chicken or eggs before 8:00 followed by a clear-liquid diet (Group 1) or a low-residue diet consisting of the same food and drink, until 16:00 the day before colonoscopy(Group 2). All of them received 45 ml of sodium phosphate solution (Xubil ®) and three glasses of water (300 ml/glass) the evening before and the morning of the procedure. The cleansing efficacy of bowel preparation was rated according to the modified Rajawithi hospital bowel preparation score scale, patient satisfaction with bowel preparation was rated using Likert scale, and side effects of the 2 protocols was assessed using a patient questionnaire. Results: The cleansing efficacy between the two groups was significantly different (p=0.02). Satisfaction with bowel preparation and side effects were not different, except for the feeling of hunger in the first group (p=0.001). Conclusion: The low-residue diet consisting of white rice porridge with fish, chicken or eggs until 16:00 one day before colonoscopy achieved a better bowel-cleansing efficacy than the protocol consisting of clear liquid all day and rice porridge only before 8:00 one day before colonoscopy.Keywords: bowel preparation, colonoscopy, sodium phosphate solution, nursing management
Procedia PDF Downloads 3933920 The Moderating Roles of Bedtime Activities and Anxiety and Depression in the Relationship between Attention-Deficit/Hyperactivity Disorder and Sleep Problems in Children
Authors: Lian Tong, Yan Ye, Qiong Yan
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Background: Children with attention-deficit/hyperactivity disorder (ADHD) often experience sleep problems, but the comorbidity mechanism has not been sufficiently studied. This study aimed to determine the comorbidity of ADHD and sleep problems as well as the moderating effects of bedtime activities and depression/anxiety symptoms on the relationship between ADHD and sleep problems. Methods: We recruited 934 primary students from third to fifth grade and their parents by stratified random sampling from three primary schools in Shanghai, China. This study used parent-reported versions of the ADHD Rating Scale-IV, Children’s Sleep Habits Questionnaire, and Achenbach Child Behavior Checklist. We used hierarchical linear regression analysis to clarify the moderating effects of bedtime activities and depression/anxiety symptoms. Results: We found that children with more ADHD symptoms had shorter sleep durations and more sleep problems on weekdays. Screen time before bedtime strengthened the relationship between ADHD and sleep-disordered breathing. Children with more screen time were more likely to have sleep onset delay, while those with less screen time had more sleep onset problems with increasing ADHD symptoms. The high bedtime eating group experienced more night waking with increasing ADHD symptoms compared with the low bedtime eating group. Anxiety/depression exacerbated total sleep problems and further interacted with ADHD symptoms to predict sleep length and sleep duration problems. Conclusions: Bedtime activities and emotional problems had important moderating effects on the relationship between ADHD and sleep problems. These findings indicate that appropriate bedtime management and emotional management may reduce sleep problems and improve sleep duration for children with ADHD symptoms.Keywords: ADHD, sleep problems, anxiety/depression, bedtime activities, children
Procedia PDF Downloads 2043919 A Sustainable Design Model by Integrated Evaluation of Closed-loop Design and Supply Chain Using a Mathematical Model
Authors: Yuan-Jye Tseng, Yi-Shiuan Chen
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The paper presented a sustainable design model for integrated evaluation of the design and supply chain of a product for the sustainable objectives. To design a product, there can be alternative ways to assign the detailed specifications to fulfill the same design objectives. In the design alternative cases, different material and manufacturing processes with various supply chain activities may be required for the production. Therefore, it is required to evaluate the different design cases based on the sustainable objectives. In this research, a closed-loop design model is developed by integrating the forward design model and reverse design model. From the supply chain point of view, the decisions in the forward design model are connected with the forward supply chain. The decisions in the reverse design model are connected with the reverse supply chain considering the sustainable objectives. The purpose of this research is to develop a mathematical model for analyzing the design cases by integrated evaluating the criteria in the closed-loop design and the closed-loop supply chain. The decision variables are built to represent the design cases of the forward design and reverse design. The cost parameters in a forward design include the costs of material and manufacturing processes. The cost parameters in a reverse design include the costs of recycling, disassembly, reusing, remanufacturing, and disposing. The mathematical model is formulated to minimize the total cost under the design constraints. In practical applications, the decisions of the mathematical model can be used for selecting a design case for the purpose of sustainable design of a product. An example product is demonstrated in the paper. The test result shows that the sustainable design model is useful for integrated evaluation of the design and the supply chain to achieve the sustainable objectives.Keywords: closed-loop design, closed-loop supply chain, design evaluation, supply chain management, sustainable design model
Procedia PDF Downloads 4263918 Distribution and Historical Trends of PAHs Deposition in Recent Sediment Cores of the Imo River, SE Nigeria
Authors: Miranda I. Dosunmu, Orok E. Oyo-Ita, Inyang O. Oyo-Ita
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Polycyclic aromatic hydrocarbons (PAHs) are a class of priority listed organic pollutants due to their carcinogenicity, mutagenity, acute toxicity and persistency in the environment. The distribution and historical changes of PAHs contamination in recent sediment cores from the Imo River were investigated using gas chromatography coupled with mass spectrometer. The concentrations of total PAHs (TPAHs) ranging from 402.37 ng/g dry weight (dw) at the surface layer of the Estuary zone (ESC6; 0-5 cm) to 92,388.59 ng/g dw at the near surface layer of the Afam zone (ASC5; 5-10 cm) indicate that PAHs contamination was localized not only between sample sites but also within the same cores. Sediment-depth profiles for the four (Afam, Mangrove, Estuary and illegal Petroleum refinery) cores revealed irregular distribution patterns in the TPAH concentrations except the fact that these levels became maximized at the near surface layers (5-10 cm) corresponding to a geological time-frame of about 1996-2004. This time scale coincided with the period of intensive bunkering and oil pipeline vandalization by the Niger Delta militant groups. Also a general slight decline was found in the TPAHs levels from near the surface layers (5-10 cm) to the most recent top layers (0-5 cm) of the cores, attributable to the recent effort by the Nigerian government in clamping down the illegal activity of the economic saboteurs. Therefore, the recent amnesty period granted to the militant groups should be extended. Although mechanism of perylene formation still remains enigmatic, examination of its distributions down cores indicates natural biogenic, pyrogenic and petrogenic origins for the compound at different zones. Thus, the characteristic features of the Imo River environment provide a means of tracing diverse origins for perylene.Keywords: perylene, historical trend, distribution, origin, Imo River
Procedia PDF Downloads 2513917 The Impact of Restricting Product Availability on the Purchasing of Lower Sugar Biscuits in UK Convenience Stores
Authors: Hannah S. Waldron
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Background: The government has proposed sugar reduction targets in an effort to tackle childhood obesity, focussing on those of low socioeconomic status (SES). Supermarkets are a key location for reducing the amount of sugar purchased, but success so far in this environment has been limited. Building on previous research, this study will assess the impact of restricting the availability of higher sugar biscuits as a strategy to encourage lower sugar biscuit purchasing, and whether the effects vary by customer SES. Method: 14 supermarket convenience stores were divided between control (n=7) and intervention (n=7) groups. In the intervention stores, biscuits with sugar above the government’s target (26.2g/100g) were removed from sale and replaced with lower sugar ( < 26.2g sugar/100g) alternatives. Sales and customer demographic information were collected using loyalty card data and point-of-sale transaction data for 8-weeks pre and post the intervention for lower sugar biscuits, total biscuits, alternative higher sugar products, and all products. Results were analysed using three-way and two-way mixed ANOVAs. Results: The intervention resulted in a significant increase in lower sugar biscuit purchasing (p < 0.001) and a significant decline in overall biscuit sales (p < 0.001) between the time periods compared to control stores. Sales of higher sugar products and all products increased significantly between the two time periods in both the intervention and control stores (p < 0.05). SES showed no significant effect on any of the reported outcomes (p > 0.05). Conclusion: Restricting the availability of higher sugar products may be a successful strategy for encouraging lower sugar purchasing across all SES groups. However, larger-scale interventions are required in additional categories to assess the long term implications for both consumers and retailers.Keywords: biscuits, nudging, sugar, supermarket
Procedia PDF Downloads 1053916 The Consumption of Sodium and Fat from Processed Foods
Authors: Pil Kyoo Jo, Jee Young Kim, Yu Jin Oh, Sohyun Park, Young Ha Joo, Hye Suk Kim, Semi Kang
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When convenience drives daily food choices, the increased consumption of processed foods may be associated with the increased intakes of sodium and fat and further with the onset of chronic diseases. The purpose of this study was to investigate the levels of sodium, saturated fat, and calories intakes through processed foods and the dietary patterns among adult populations in South Korea. We used the nationally representative data from the 5th Korea National Health and Nutrition Examination Survey (KNHANES, 2010-2012) and a cross-sectional survey on the eating behaviors among university students(N=893, 380 men, 513 women) aged from 20 to 24 years. Results showed that South Koreans consumed 43.5% of their total food consumption from processed foods. The 24-hour recalls data showed that 77% of sodium, 60% of fats, 59% of saturated fat, and 44% of calories were consumed from processed food. The intake of processed foods increased by 1.7% in average since 2008 annually. Only 33% of processed food that respondents consumed had nutrition labeling. The data from university students showed that students selected processed foods in convenience store when eating alone compared to eating with someone else. Given the convenience and lack of time, more people will consume processed foods and it may impact their overall dietary intake and further their health. In order to help people to make healthier food choices, regulations and policies to reduce the potentially unhealthy nutrients of processed foods should be strengthened. This research was supported by the National Research Foundation of Korea for 2011 Korea-Japan Basic Scientific Cooperation Program. This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2015S1A5B6037369).Keywords: sodium, fat, processed foods, diet trends
Procedia PDF Downloads 2563915 Reducing Ambulance Offload Delay: A Quality Improvement Project at Princess Royal University Hospital
Authors: Fergus Wade, Jasmine Makker, Matthew Jankinson, Aminah Qamar, Gemma Morrelli, Shayan Shah
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Background: Ambulance offload delays (AODs) affect patient outcomes. At baseline, the average AOD at Princess Royal University Hospital (PRUH) was 41 minutes, in breach of the 15-minute target. Aims: By February 2023, we aimed to reduce: the average AOD to 30 minutes percentage of AOD >30 minutes (PA30) to 25% and >60 minutes (PA60) to 10% Methods: Following a root-cause analysis, we implemented 2 Plan, Do, Study, Act (PDSA) cycles. PDSA-1 ‘Drop-and-run’: ambulances waiting >15 minutes for a handover left the patients in the Emergency Department (ED) and returned to the community. PDSA-2: Booking in the patients before the handover, allowing direct updates to online records, eliminating the need for handwritten notes. Outcome measures: AOD, PA30, and PA60, and process measures: total ambulances and patients in the ED were recorded for 16 weeks. Results: In PDSA-1, all parameters increased slightly despite unvarying ED crowding. In PDSA-2, two shifts in data were seen: initially, a sharp increase in the outcome measures consistent with increased ED crowding, followed by a downward shift when crowding returned to baseline (p<0.01). Within this interval, the AOD reduced to 29.9 minutes, and PA30 and PA60 were 31.2% and 9.2% respectively. Discussion/conclusion: PDSA-1 didn’t result in any significant changes; lack of compliance was a key cause. The initial upward shift in PDSA-2 is likely associated with NHS staff strikes. However, during the second interval, the AOD and the PA60 met our targets of 30 minutes and 10%, respectively, improving patient flow in the ED. This was sustained without further input and if maintained, saves 2 paramedic shifts every 3 days.Keywords: ambulance offload, district general hospital, handover, quality improvement
Procedia PDF Downloads 1063914 Energy Storage in the Future of Ethiopia Renewable Electricity Grid System
Authors: Dawit Abay Tesfamariam
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Ethiopia’s Climate- Resilient Green Economy strategy focuses mainly on generating and utilization of Renewable Energy (RE). The data collected in 2016 by Ethiopian Electric Power (EEP) indicates that the intermittent RE sources on the grid from solar and wind energy were only 8 % of the total energy produced. On the other hand, the EEP electricity generation plan in 2030 indicates that 36 % of the energy generation share will be covered by solar and wind sources. Thus, a case study was initiated to model and compute the balance and consumption of electricity in three different scenarios: 2016, 2025, and 2030 using the Energy PLAN Model (EPM). Initially, the model was validated using the 2016 annual power-generated data to conduct the EPM analysis for two predictive scenarios. The EPM simulation analysis using EPM for 2016 showed that there was no significant excess power generated. Hence, the model’s results are in line with the actual 2016 output. Thus, the EPM was applied to analyze the role of energy storage in RE in Ethiopian grid systems. The results of the EPM simulation analysis showed there will be excess production of 402 /7963 MW average and maximum, respectively, in 2025. The excess power was dominant in all months except in the three rainy months of the year (June, July, and August). Consequently, based on the validated outcomes of EPM indicates, there is a good reason to think about other alternatives for the utilization of excess energy and storage of RE. Thus, from the scenarios and model results obtained, it is realistic to infer that; if the excess power is utilized with a storage mechanism that can stabilize the grid system; as a result, the extra RE generated can be exported to support the economy. Therefore, researchers must continue to upgrade the current and upcoming energy storage system to synchronize with RE potentials that can be generated from RE.Keywords: renewable energy, storage, wind, energyplan
Procedia PDF Downloads 813913 The Effect of Malaria Parasitaemia on Serum Reproductive Hormonal Levels of Asymptomatic HIV Subjects in Nauth Nnewi, South Eastern Nigeria
Authors: Ezeugwunne Ifeoma Priscilla, Charles Chinedum Onyenekwe, Joseph Eberendu Ahaneku, Rosemary Adanma Analike, Adesuwa Peace Eidangbe
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This study was designed to assess the effect of malaria parasitaemia on serum reproductive hormone levels of asymptomatic HIV adult subjects. A total of 271 participants aged between 17 and 58 ears were conveniently recruited. 135 asymptomatic HIV-infected subjects participated in the study; 67 of them had malaria parasitaemia. 136 HIV seropositive control subjects, 68 of them had malaria parasitaemia. Blood samples were collected from the participants for the determination of HIV status by immunoassay and immunochromatography. Enzyme-linked immunosorbent assay (ELISA) was used to assay for serum LH, FSH, Estrogen, testosterone, progesterone, prolactin, and PSA levels, CD4+T cell counts by Cyflow method, thick and thin films determination of malaria parasitaemia count and density by WHO. Student's t-tests and ANOVA were used to compare means. P<0.05 was considered statistically significant. The results showed significant differences in serum levels of LH, FSH, PSA, estrogen, progesterone, and testosterone amongst the groups at P<0.05, respectively. The serum levels of LH, FSH, and PSA were significantly higher in malaria-infected asymptomatic HIV subjects than in asymptomatic HIV subjects with malaria parasitaemia (P<0.05 in each case). Also, the serum levels of LH, FSH, PSA, estrogen, and progesterone were significantly higher in malaria-infected asymptomatic HIV subjects compared with malaria-infected HIV seronegative subjects (P<0.05, respectively). The mean MP counts and MP density were significantly higher in asymptomatic HIV subjects compared to HIV seronegative subjects (P<0.05, in each case). The mean serum levels of testosterone were significantly lower in both malaria-infected and malaria uninfected HIV seronegative subjects (P<0.05, in each case). In conclusion, Malaria and HIV co-infection might increase the burden of hypogonadism as well as primary testicular failure, hyperprogesteronaemia, elevated levels of estrogen, and PSA in adult males asymptomatic HIV subjects.Keywords: malaria parasitaemia, HIV, CD4, reproductive hormones
Procedia PDF Downloads 1423912 Comparative Study of Electronic and Optical Properties of Ammonium and Potassium Dinitramide Salts through Ab-Initio Calculations
Authors: J. Prathap Kumar, G. Vaitheeswaran
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The present study investigates the role of ammonium and potassium ion in the electronic, bonding and optical properties of dinitramide salts due to their stability and non-toxic nature. A detailed analysis of bonding between NH₄ and K with dinitramide, optical transitions from the valence band to the conduction band, absorption spectra, refractive indices, reflectivity, loss function are reported. These materials are well known as oxidizers in solid rocket propellants. In the present work, we use full potential linear augmented plane wave (FP-LAPW) method which is implemented in the Wien2k package within the framework of density functional theory. The standard DFT functional local density approximation (LDA) and generalized gradient approximation (GGA) always underestimate the band gap by 30-40% due to the lack of derivative discontinuities of the exchange-correlation potential with respect to an occupation number. In order to get reliable results, one must use hybrid functional (HSE-PBE), GW calculations and Tran-Blaha modified Becke-Johnson (TB-mBJ) potential. It is very well known that hybrid functionals GW calculations are very expensive, the later methods are computationally cheap. The new developed TB-mBJ functionals use information kinetic energy density along with the charge density employed in DFT. The TB-mBJ functionals cannot be used for total energy calculations but instead yield very much improved band gap. The obtained electronic band gap at gamma point for both the ammonium dinitramide and potassium dinitramide are found to be 2.78 eV and 3.014 eV with GGA functional, respectively. After the inclusion of TB-mBJ, the band gap improved by 4.162 eV for potassium dinitramide and 4.378 eV for ammonium dinitramide. The nature of the band gap is direct in ADN and indirect in KDN. The optical constants such as dielectric constant, absorption, and refractive indices, birefringence values are presented. Overall as there are no experimental studies we present the improved band gap with TB-mBJ functional following with optical properties.Keywords: ammonium dinitramide, potassium dinitramide, DFT, propellants
Procedia PDF Downloads 1573911 Drop Impact Study on Flexible Superhydrophobic Surface Containing Micro-Nano Hierarchical Structures
Authors: Abinash Tripathy, Girish Muralidharan, Amitava Pramanik, Prosenjit Sen
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Superhydrophobic surfaces are abundant in nature. Several surfaces such as wings of butterfly, legs of water strider, feet of gecko and the lotus leaf show extreme water repellence behaviour. Self-cleaning, stain-free fabrics, spill-resistant protective wears, drag reduction in micro-fluidic devices etc. are few applications of superhydrophobic surfaces. In order to design robust superhydrophobic surface, it is important to understand the interaction of water with superhydrophobic surface textures. In this work, we report a simple coating method for creating large-scale flexible superhydrophobic paper surface. The surface consists of multiple layers of silanized zirconia microparticles decorated with zirconia nanoparticles. Water contact angle as high as 159±10 and contact angle hysteresis less than 80 was observed. Drop impact studies on superhydrophobic paper surface were carried out by impinging water droplet and capturing its dynamics through high speed imaging. During the drop impact, the Weber number was varied from 20 to 80 by altering the impact velocity of the drop and the parameters such as contact time, normalized spread diameter were obtained. In contrast to earlier literature reports, we observed contact time to be dependent on impact velocity on superhydrophobic surface. Total contact time was split into two components as spread time and recoil time. The recoil time was found to be dependent on the impact velocity while the spread time on the surface did not show much variation with the impact velocity. Further, normalized spreading parameter was found to increase with increase in impact velocity.Keywords: contact angle, contact angle hysteresis, contact time, superhydrophobic
Procedia PDF Downloads 4263910 A Psychosocial Impact of the Covid-19 Pandemic Among Frontline Workers and General Populations in Kathmandu
Authors: Nabin Prasad Joshi
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A new variant of the coronavirus family found in the Wuhan city market of China is causing serious harm to human beings. After the WHO decided COVID-19 was a pandemic situation, everyone started to measure the prevention of infectious diseases according to WHO guidelines. It includes social distancing, isolation, quarantine, lockdown, sanitation, and masking, respectively. During this time, the researcher has observed the difficulties of cultivating the new normal in people in Nepal. People have perceived the single coronavirus differently; common populations and frontline workers have different perceptions of coronavirus. The researcher started to measure the psychosocial impact of the COVID-19 pandemic on frontline workers and general populations in Kathmandu valley. The total number of sample units for this research is 82; it includes 52 general populations and 30 frontline workers. These sample units are selected through convenient sampling and purposive sampling, respectively. This research is based on descriptive and exploratory design. DASS-21 of the Nepali version is a comprehensive data collection tool for depression, anxiety, and stress measurement in this research, and simultaneously the psychosocial checklist, key-informant interview, and case study have been done. Quantitative data are analyzed with the help of excel, and qualitative data are through thematic analysis. The study has shown that the occurrence of psychosocial issues among frontline workers is greater than in general populations. It is found that the informants with higher education status have greater psychosocial issues in comparison to low education status. In the context of a pandemic, family/friends’ support can function as a protective factor when at adequate levels.Keywords: anxiety, depression, isolation, lockdown
Procedia PDF Downloads 773909 Assessing the Feasibility of Incorporating Green Infrastructure into Colonial-Era Buildings in the Caribbean
Authors: Luz-Marina Roberts, Ancil Kirk, Aisha Donaldson, Anya Seepaul, Jade Lakhan, Shianna Tikasingh
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Climate change has produced a crisis that particularly threatens small island states in the Caribbean. Developers and climate enthusiasts alike are now forced to find new and sustainable ways of building. Focus on existing buildings is particularly needed in Trinidad and Tobago, like other islands, especially as these countries are vulnerable to climate threats and geographic locations with close proximity to a hurricane. Additionally, since many colonial-era style buildings still exist, the idea that they are energy inefficient is at the forefront of the work of policy-makers. The question that remains is can these buildings be retrofitted to reflect the modern era while considering climate resilience. This paper aims to investigate the energy efficiency of colonial-era buildings in Port of Spain and whether these buildings in Trinidad and Tobago, if found to be energy inefficient, can be more energy efficient and sustainable. This involves collecting surveys from building management in colonial-era buildings and researching literature on colonial architecture in the Caribbean and modern innovations in green building designs. Additionally, the data and experiences from the Town and Country Planning Division in the Ministry of Planning and Development of Trinidad and Tobago will inform the paper. This research will aid in re-envisioning how green infrastructure can be applied to urban environments with older buildings and help inform planning policy as it relates to sustainability and energy efficiency.Keywords: spatial planning, climate resilience, energy efficiency, sustainable development
Procedia PDF Downloads 683908 Counter-Terrorism Policies in the Wider Black Sea Region: Evaluating the Robustness of Constantza Port under Potential Terror Attacks
Authors: A. V. Popa, C. Barna, V. Mihalache
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Being the largest port at the Black Sea and functioning as a civil and military nodal point between Europe and Asia, Constantza Port has become a potential target on the terrorist international agenda. The authors use qualitative research based on both face-to-face and online semi-structured interviews with relevant stakeholders (top decision-makers in the Romanian Naval Authority, Romanian Maritime Training Centre, National Company "Maritime Ports Administration" and military staff) in order to detect potential vulnerabilities which might be exploited by terrorists in the case of Constantza Port. Likewise, this will enable bringing together the experts’ opinions on potential mitigation measures. Subsequently, this paper formulates various counter-terrorism policies to enhance the robustness of Constantza Port under potential terror attacks and connects them with the attributions in the field of critical infrastructure protection conferred by the law to the lead national authority for preventing and countering terrorism, namely the Romanian Intelligence Service. Extending the national counterterrorism efforts to an international level, the authors propose the establishment – among the experts of the NATO member states of the Wider Black Sea Region – of a platform for the exchange of know-how and best practices in the field of critical infrastructure protection.Keywords: Constantza Port, counter-terrorism policies, critical infrastructure protection, security, Wider Black Sea Region
Procedia PDF Downloads 2953907 Low Volume High Intensity Interval Training Effect on Liver Enzymes in Chronic Hepatitis C Patients
Authors: Aya Gamal Khattab
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Chronic infection with the hepatitis C virus (HCV) is now the leading cause of liver-related morbidity and mortality; Currently, alanine aminotransferase ALT measurement is not only widely used in detecting the incidence, development, and prognosis of liver disease with obvious clinical symptoms, but also provides reference on screening the overall health status during health check-ups. Exercise is a low-cost, reliable and sustainable therapy for many chronic diseases. Low-volume high intensity interval training HIT is time efficient while also having wider application to different populations including people at risk for chronic inflammatory diseases. Purpose of this study was to investigate the effect of low volume high intensity interval training on ALT, AST in HCV patients. All practical work was done in outpatient physiotherapy clinic of Suez Canal Authority Hospitals. Forty patients both gender (27 male, 13 female), age ranged (40-60) years old submitted to low volume high intensity interval training on treadmill for two months three sessions per week. Each session consisting of five min warming up, two bouts for 10 min each bout consisting of 30 sec - 1 min of high intensity (75%-85%) HRmax then two to four min active recovery at intensity (40%-60%) HRmax, so the sum of high intensity intervals was one to two min for each session and four to eight min active recovery, and ends with five min cooling down. ALT and AST were measured before starting exercise session and 2 months later after finishing the total exercise sessions through blood samples. Results showed significant decrease in ALT, AST with improvement percentage (18.85%), (23.87%) in the study, so the study concluded that low volume high intensity interval training had a significant effect in lowering the level of circulating liver enzymes (ALT, AST) which means protection of hepatic cells and restoration of its function.Keywords: alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatitis C (HCV), low volume high intensity interval training
Procedia PDF Downloads 2993906 Parasagittal Approach to Lumbar Epidural Steroid Injections: A Cost-Effectiveness Analysis
Authors: K. D. Candido, A. Lissounov, I. Knezevic, N. Knezevic
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Background: The most commonly performed pain procedures in the USA is Lumbar Epidural Steroid Injections (LESI). There are three main types of these procedures: transforaminal (TF), interlaminar (IL) and caudal injections. It is expected for TF injections to have better outcomes than IL injections, based on the recently published systematic review. The studies presented in that review used a midline IL approach, but those with parasagittal IL approach were not taken into consideration. Our aim is to emphasize the efficacy of the lateral parasagittal (paramedian) IL approach in this review. Methods: We included five studies in this systematic review, which compared Parasagittal-IL (PIL) with either Midline-IL (MIL) or TF LESI. Total of 296 patients who had undergone different types of LESI were observed across the five studies, and the average pain and functional improvements were calculated and compared among groups. Results: Pain and function improvements with PIL approach is superior on 12 months follow up to MIL approach (53.4% vs. 14.7%) and (55% vs. 27.7%), respectively. A 12 months follow-up results between PIL and TF shows a near equivalent effectiveness for pain (58.9% vs. 63.2%) and function improvement (47.3% vs. 48.1%). An average follow-up of 17.1 days have shown better short-term pain relief for PIL than TF approach (45.8% vs. 19.2%), respectively. Number of repeated injections is lower for PIL injections than MIL. Number of weeks between 1st and 2nd injections: PIL averaged 15.8 weeks and MIL averaged 9.7 weeks. Third LESI injection is more common in TF group (30%) than PIL group (18.8%). Conclusion: Higher complication rates are associated with TF injections for which FDA7 issued an official warning. We have recorded better outcomes in pain and function improvement of Parasagittal-IL LESI as compared to midline-IL injection, in the presented systematic review. Parasagittal and TF injections have equivalent efficacy in Pain and Function improvements thus we advocate for Parasagittal-IL approach consideration as an alternative for TF injections.Keywords: parasagital approach, lumbar, back pain, epidural steroid injection
Procedia PDF Downloads 174