Search results for: medical technology

Authors: Titir Bhattacharya, Tanika Chakraborty, Prabal K. De

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Maternal and child health continue to be a significant policy focus in developing countries, including India. An emerging model in health care is the creation of public and private partnerships. Since the construction of physical infrastructure is costly, governments at various levels have tried to implement social health insurance schemes where a trust calculates insurance premiums and medical payments. Typically, qualifying families get full subsidization of the premium and get access to private hospitals, in addition to low cost public hospitals, for their tertiary care needs. We analyze one such pioneering social insurance scheme in the Indian state of Andhra Pradesh (AP). The Rajiv Aarogyasri program (RA) was introduced by the Government of AP on a pilot basis in 2007 and implemented in 2008. In this paper, we first examine the extent to which access to reproductive health care changed. For example, the RA scheme reimburses hospital deliveries leading us to expect an increase in institutional deliveries, particularly in private hospitals. Second, we expect an increase in institutional deliveries to also improve child health outcomes. Hence, we estimate if the program improved infant and child mortality. We use District Level Health Survey data to create annual birth cohorts from 2000-2015. Since AP was the only state in which such a state insurance program was implemented, the neighboring states constituted a plausible control group. Combined with the policy timing, and the year of birth, we employ a difference-indifference strategy to identify the effects of RA on the residents of AP. We perform several checks against threats to identification, including testing for pre-treatment trends between the treatment and control states. We find that the policy significantly lowered infant and child mortality in AP. We also find that deliveries in private hospitals increased, and government hospitals decreased, showing a substitution effect of the relative price change. Finally, as expected, out-of-pocket costs declined for the treatment group. However, we do not find any significant effects for usual preventive care such as vaccination, showing that benefits of insurance schemes targeted at the tertiary level may not trickle down to the primary care level.

Keywords: public health insurance, maternal and child health, public-private choice

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Authors: Angelis P. Barlampas

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Objective: The confusion of terms is a common practice in many situations of the everyday life. But, in some circumstances, such as in medicine, the precise meaning of a word curries a critical role for the health of the patient. Fahr disease and Fahr syndrome are often falsely used interchangeably, but they are two different conditions with different physical histories of different etiology and different medical management. A case of the seldom Fahr disease is presented, and a comparison with the more common Fahr syndrome follows. Materials and method: A 72 years old patient came to the emergency department, complaining of some kind of non specific medal disturbances, like anxiety, difficulty of concentrating, and tremor. The problems had a long course, but he had the impression of getting worse lately, so he decided to check them. Past history and laboratory tests were unremarkable. Then, a computed tomography examination was ordered. Results: The CT exam showed bilateral, hyperattenuating areas of heavy, dense calcium type deposits in basal ganglia, striatum, pallidum, thalami, the dentate nucleus, and the cerebral white matter of frontal, parietal and iniac lobes, as well as small areas of the pons. Taking into account the absence of any known preexisting illness and the fact that the emergency laboratory tests were without findings, a hypothesis of the rare Fahr disease was supposed. The suspicion was confirmed with further, more specific tests, which showed the lack of any other conditions which could probably share the same radiological image. Differentiating between Fahr disease and Fahr syndrome. Fahr disease: Primarily autosomal dominant Symmetrical and bilateral intracranial calcifications The patient is healthy until the middle age Absence of biochemical abnormalities. Family history consistent with autosomal dominant Fahr syndrome :Earlier between 30 to 40 years old. Symmetrical and bilateral intracranial calcifications Endocrinopathies: Idiopathic hypoparathyroidism, secondary hypoparathyroidism, hyperparathyroidism, pseudohypoparathyroidism ,pseudopseudohypoparathyroidism, e.t.c The disease appears at any age There are abnormal laboratory or imaging findings. Conclusion: Fahr disease and Fahr syndrome are not the same illness, although this is not well known to the inexperienced doctors. As clinical radiologists, we have to inform our colleagues that a radiological image, along with the patient's history, probably implies a rare condition and not something more usual and prompt the investigation to the right route. In our case, a genetic test could be done earlier and reveal the problem, and thus avoiding unnecessary and specific tests which cost in time and are uncomfortable to the patient.

Keywords: fahr disease, fahr syndrome, CT, brain calcifications

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Authors: Matthias Stange

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Building Information Modelling (BIM) is one of the most promising methods in the building design process and plays an important role in the digitalization of the Architectural, Engineering, and Construction (AEC) Industry. The application of BIM is seen as the key enabler for increasing productivity in the construction industry. The model-based collaboration using the BIM method is intended to significantly reduce cost increases, schedule delays, and quality problems in the planning and construction of buildings. Numerous qualitative studies based on expert interviews support this theory and report perceived benefits from the use of BIM in terms of achieving project objectives related to cost, schedule, and quality. However, there is a large research gap in analysing quantitative data collected from real construction projects regarding the actual benefits of applying BIM based on representative sample size and different application regions as well as different project typologies. In particular, the influence of the project-related BIM maturity level is completely unexplored. This research project examines primary data from 105 construction projects worldwide using quantitative research methods. Projects from the areas of residential, commercial, and industrial construction as well as infrastructure and hydraulic engineering were examined in application regions North America, Australia, Europe, Asia, MENA region, and South America. First, a descriptive data analysis of 6 independent project variables (BIM maturity level, application region, project category, project type, project size, and BIM level) were carried out using statistical methods. With the help of statisticaldata analyses, the influence of the project-related BIM maturity level on 6 dependent project variables (deviation in planning time, deviation in construction time, number of planning collisions, frequency of rework, number of RFIand number of changes) was investigated. The study revealed that most of the benefits of using BIM perceived through numerous qualitative studies have not been confirmed. The results of the examined sample show that the application of BIM did not have an improving influence on the dependent project variables, especially regarding the quality of the planning itself and the adherence to the schedule targets. The quantitative research suggests the conclusion that the BIM planning method in its current application has not (yet) become a recognizable increase in productivity within the planning and construction process. The empirical findings indicate that this is due to the overall low level of BIM maturity in the projects of the examined sample. As a quintessence, the author suggests that the further implementation of BIM should primarily focus on an application-oriented and consistent development of the project-related BIM maturity level instead of implementing BIM for its own sake. Apparently, there are still significant difficulties in the interweaving of people, processes, and technology.

Keywords: AEC-process, building information modeling, BIM maturity level, project results, productivity of the construction industry

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Authors: Tuula Nygard

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This study contributes to the pedagogical discussion on how to promote adolescents’ multiliteracies with the emphasis on information seeking and evaluation skills in contemporary media environments. The study is conducted in the school environment utilizing perspectives of educational sciences and information studies to health communication and teaching. The research focus is on the teacher role as a trusted person, who guides students to choose and use credible information sources. Evaluating the credibility of information may often be challenging. Specifically, children and adolescents may find it difficult to know what to believe and who to trust, for instance, in health and well-being communication. Thus, advanced multiliteracy skills are needed. In the school environment, trust is based on the teacher’s subject content knowledge, but also the teacher’s character and caring. Teacher’s benevolence and approachability generate trustworthiness, which lays the foundation for good interaction with students and further, for the teacher’s pedagogical authority. The study explores teachers’ perceptions of their pedagogical authority and the role of a trustee. In addition, the study examines what kind of multiliteracy practices teachers utilize in their teaching. The data will be collected by interviewing secondary school health education teachers during Spring 2019. The analysis method is a nexus analysis, which is an ethnographic research orientation. Classroom interaction as the interviewed teachers see it is scrutinized through a nexus analysis lens in order to expound a social action, where people, places, discourses, and objects are intertwined. The crucial social actions in this study are information seeking and evaluation situations, where the teacher and the students together assess the credibility of the information sources. The study is based on the hypothesis that a trustee’s opinions of credible sources and guidance in information seeking and evaluation affect students’, that is, trustors’ choices. In the school context, the teacher’s own experiences and perceptions of health-related issues cannot be brushed aside. Furthermore, adolescents are used to utilize digital technology for day-to-day information seeking, but the chosen information sources are often not very high quality. In the school, teachers are inclined to recommend familiar sources, such as health education textbook and web pages of well-known health authorities. Students, in turn, rely on the teacher’s guidance of credible information sources without using their own judgment. In terms of students’ multiliteracy competences, information seeking and evaluation tasks in health education are excellent opportunities to practice and enhance these skills. To distinguish the right information from a wrong one is particularly important in health communication because experts by experience are easy to find and their opinions are convincing. This can be addressed by employing the ideas of multiliteracy in the school subject health education and in teacher education and training.

Keywords: multiliteracies, nexus analysis, pedagogical authority, trust

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Authors: J. I. Corcoles, J. D. Moya-Rico, A. Molina, J. F. Belmonte, J. A. Almendros-Ibanez

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One of the most common heat exchangers technology in engineering processes is the use of double-pipe heat exchangers (DPHx), mainly in the food industry. To improve the heat transfer performance, several passive geometrical devices can be used, such as the wall corrugation of tubes, which increases the wet perimeter maintaining a constant cross-section area, increasing consequently the convective surface area. It contributes to enhance heat transfer in forced convection, promoting secondary recirculating flows. One of the most extended tools to analyse heat exchangers' efficiency is the use of computational fluid dynamic techniques (CFD), a complementary activity to the experimental studies as well as a previous step for the design of heat exchangers. In this study, a double pipe heat exchanger behaviour with two different inner tubes, smooth and spirally corrugated tube, have been analysed. Hence, experimental analysis and steady 3-D numerical simulations using the commercial code ANSYS Workbench v. 17.0 are carried out to analyse the influence of geometrical parameters for spirally corrugated tubes at turbulent flow. To validate the numerical results, an experimental setup has been used. To heat up or cool down the cold fluid as it passes through the heat exchanger, the installation includes heating and cooling loops served by an electric boiler with a heating capacity of 72 kW and a chiller, with a cooling capacity of 48 kW. Two tests have been carried out for the smooth tube and for the corrugated one. In all the tests, the hot fluid has a constant flowrate of 50 l/min and inlet temperature of 59.5°C. For the cold fluid, the flowrate range from 25 l/min (Test 1) and 30 l/min (Test 2) with an inlet temperature of 22.1°C. The heat exchanger is made of stainless steel, with an external diameter of 35 mm and wall thickness of 1.5 mm. Both inner tubes have an external diameter of 24 mm and 1 mm thickness of stainless steel with a length of 2.8 m. The corrugated tube has a corrugation height (H) of 1.1 mm and helical pitch (P) of 25 mm. It is characterized using three non-dimensional parameters, the ratio of the corrugation shape and the diameter (H/D), the helical pitch (P/D) and the severity index (SI = H²/P x D). The results showed good agreement between the numerical and the experimental results. Hence, the lowest differences were shown for the fluid temperatures. In all the analysed tests and for both analysed tubes, the temperature obtained numerically was slightly higher than the experimental results, with values ranged between 0.1% and 0.7%. Regarding the pressure drop, the maximum differences between the values obtained numerically, and the experimental values were close to 16%. Based on the experimental and the numerical results, for the corrugated tube, it can be highlighted that the temperature difference between the inlet and the outlet of the cold fluid is 42%, higher than the smooth tube.

Keywords: corrugated tube, heat exchanger, heat transfer, numerical simulation

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Authors: D. Signore, M. Ferraiuolo, P. Caramuta, O. Petrella, C. Toscano

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The Digital Image Correlation (DIC) is a newly developed optical technique that is spreading in all engineering sectors because it allows the non-destructive estimation of the entire surface deformation without any contact with the component under analysis. These characteristics make the DIC very appealing in all the cases the global deformation state is to be known without using strain gages, which are the most used measuring device. The DIC is applicable to any material subjected to distortion caused by either thermal or mechanical load, allowing to obtain high-definition mapping of displacements and deformations. That is why in the civil and the transportation industry, DIC is very useful for studying the behavior of metallic materials as well as of composite materials. DIC is also used in the medical field for the characterization of the local strain field of the vascular tissues surface subjected to uniaxial tensile loading. DIC can be carried out in the two dimension mode (2D DIC) if a single camera is used or in a three dimension mode (3D DIC) if two cameras are involved. Each point of the test surface framed by the cameras can be associated with a specific pixel of the image, and the coordinates of each point are calculated knowing the relative distance between the two cameras together with their orientation. In both arrangements, when a component is subjected to a load, several images related to different deformation states can be are acquired through the cameras. A specific software analyzes the images via the mutual correlation between the reference image (obtained without any applied load) and those acquired during the deformation giving the relative displacements. In this paper, a metrological characterization of the digital image correlation is performed on aluminum and composite targets both in static and dynamic loading conditions by comparison between DIC and strain gauges measures. In the static test, interesting results have been obtained thanks to an excellent agreement between the two measuring techniques. In addition, the deformation detected by the DIC is compliant with the result of a FEM simulation. In the dynamic test, the DIC was able to follow with a good accuracy the periodic deformation of the specimen giving results coherent with the ones given by FEM simulation. In both situations, it was seen that the DIC measurement accuracy depends on several parameters such as the optical focusing, the parameters chosen to perform the mutual correlation between the images and, finally, the reference points on image to be analyzed. In the future, the influence of these parameters will be studied, and a method to increase the accuracy of the measurements will be developed in accordance with the requirements of the industries especially of the aerospace one.

Keywords: accuracy, deformation, image correlation, mechanical analysis

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Authors: Venkata Madhusudana Rao Kapavarapu

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The Intermediate Slug Catcher (ISC) facility was built to process nominally 234 MSCFD of export gas from the booster station on a day-to-day basis and to receive liquid slugs up to 1600 m³ (10,000 BBLS) in volume when the incoming 24” gas pipelines are pigged following upsets or production of non-dew-pointed gas from gathering centers. The maximum slug sizes expected are 812 m³ (5100 BBLS) in winter and 542 m³ (3400 BBLS) in summer after operating for a month or more at 100 MMSCFD of wet gas, being 60 MMSCFD of treated gas from the booster station, combined with 40 MMSCFD of untreated gas from gathering center. The water content is approximately 60% but may be higher if the line is not pigged for an extended period, owing to the relative volatility of the condensate compared to water. In addition to its primary function as a slug catcher, the ISC facility will receive pigged liquids from the upstream and downstream segments of the 14” condensate pipeline, returned liquids from the AGRP, pigged through the 8” pipeline, and blown-down fluids from the 14” condensate pipeline prior to maintenance. These fluids will be received in the condensate flash vessel or the condensate separator, depending on the specific operation, for the separation of water and condensate and settlement of solids scraped from the pipelines. Condensate meeting the colour and 200 ppm water specifications will be dispatched to the AGRP through the 14” pipeline, while off-spec material will be returned to BS-171 via the existing 10” condensate pipeline. When they are not in operation, the existing 24” export gas pipeline and the 10” condensate pipeline will be maintained under export gas pressure, ready for operation. The gas manifold area contains the interconnecting piping and valves needed to align the slug catcher with either of the 24” export gas pipelines from the booster station and to direct the gas to the downstream segment of either of these pipelines. The manifold enables the slug catcher to be bypassed if it needs to be maintained or if through-pigging of the gas pipelines is to be performed. All gas, whether bypassing the slug catcher or returning to the gas pipelines from it, passes through black powder filters to reduce the level of particulates in the stream. These items are connected to the closed drain vessel to drain the liquid collected. Condensate from the booster station is transported to AGRP through 14” condensate pipeline. The existing 10” condensate pipeline will be used as a standby and for utility functions such as returning condensate from AGRP to the ISC or booster station or for transporting off-spec fluids from the ISC back to booster station. The manifold contains block valves that allow the two condensate export lines to be segmented at the ISC, thus facilitating bi-directional flow independently in the upstream and downstream segments, which ensures complete pipeline integrity and facility integrity. Pipeline failures will be attended to with the latest technologies by remote techno plug techniques, and repair activities will be carried out as needed. Pipeline integrity will be evaluated with ili pigging to estimate the pipeline conditions.

Keywords: integrity, oil & gas, innovation, new technology

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Authors: Maris Eugênia Dela Rosa, Ana Luiza Menegatti Pavan, Marcela De Oliveira, Diana Rodrigues De Pina, Luis Carlos Vulcano

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In medical veterinary as well as in human medicine, radiological study is essential for a safe diagnosis in clinical practice. Thus, the quality of radiographic image is crucial. In last year’s there has been an increasing substitution of image acquisition screen-film systems for computed radiology equipment (CR) without technical charts adequacy. Furthermore, to carry out a radiographic examination in veterinary patient is required human assistance for restraint this, which can compromise image quality by generating dose increasing to the animal, for Occupationally Exposed and also the increased cost to the institution. The image optimization procedure and construction of radiographic techniques are performed with the use of homogeneous phantoms. In this study, we sought to develop a homogeneous phantom of canine chest to be applied to the optimization of these images for the CR system. In carrying out the simulator was created a database with retrospectives chest images of computed tomography (CT) of the Veterinary Hospital of the Faculty of Veterinary Medicine and Animal Science - UNESP (FMVZ / Botucatu). Images were divided into four groups according to the animal weight employing classification by sizes proposed by Hoskins & Goldston. The thickness of biological tissues were quantified in a 80 animals, separated in groups of 20 animals according to their weights: (S) Small - equal to or less than 9.0 kg, (M) Medium - between 9.0 and 23.0 kg, (L) Large – between 23.1 and 40.0kg and (G) Giant – over 40.1 kg. Mean weight for group (S) was 6.5±2.0 kg, (M) 15.0±5.0 kg, (L) 32.0±5.5 kg and (G) 50.0 ±12.0 kg. An algorithm was developed in Matlab in order to classify and quantify biological tissues present in CT images and convert them in simulator materials. To classify tissues presents, the membership functions were created from the retrospective CT scans according to the type of tissue (adipose, muscle, bone trabecular or cortical and lung tissue). After conversion of the biologic tissue thickness in equivalent material thicknesses (acrylic simulating soft tissues, bone tissues simulated by aluminum and air to the lung) were obtained four different homogeneous phantoms, with (S) 5 cm of acrylic, 0,14 cm of aluminum and 1,8 cm of air; (M) 8,7 cm of acrylic, 0,2 cm of aluminum and 2,4 cm of air; (L) 10,6 cm of acrylic, 0,27 cm of aluminum and 3,1 cm of air and (G) 14,8 cm of acrylic, 0,33 cm of aluminum and 3,8 cm of air. The developed canine homogeneous phantom is a practical tool, which will be employed in future, works to optimize veterinary X-ray procedures.

Keywords: radiation protection, phantom, veterinary radiology, computed radiography

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Authors: Alan N. A. Heberle, Salatiel W. Da Silva, Valentin Perez-Herranz, Andrea M. Bernardes

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Contaminants of emerging concern are substances widely used, such as pharmaceutical products. These compounds represent risk for both wild and human life since they are not completely removed from wastewater by conventional wastewater treatment plants. In the environment, they can be harm even in low concentration (µ or ng/L), causing bacterial resistance, endocrine disruption, cancer, among other harmful effects. One of the most common taken medicine to treat cardiocirculatory diseases is the Atenolol (ATL), a β-Blocker, which is toxic to aquatic life. In this way, it is necessary to implement a methodology, which is capable to promote the degradation of the ATL, to avoid the environmental detriment. A very promising technology is the advanced electrochemical oxidation (AEO), which mechanisms are based on the electrogeneration of reactive radicals (mediated oxidation) and/or on the direct substance discharge by electron transfer from contaminant to electrode surface (direct oxidation). The hydroxyl (HO•) and sulfate (SO₄•⁻) radicals can be generated, depending on the reactional medium. Besides that, at some condition, the peroxydisulfate (S₂O₈²⁻) ion is also generated from the SO₄• reaction in pairs. Both radicals, ion, and the direct contaminant discharge can break down the molecule, resulting in the degradation and/or mineralization. However, ATL molecule and byproducts can still remain in the treated solution. On this wise, some efforts can be done to implement the AEO process, being one of them the use of a cationic membrane to separate the cathodic (reduction) from the anodic (oxidation) reactor compartment. The aim of this study is investigate the influence of the implementation of a cationic membrane (Nafion®-117) to separate both cathodic and anodic, AEO reactor compartments. The studied reactor was a filter-press, with bath recirculation mode, flow 60 L/h. The anode was an Nb/BDD2500 and the cathode a stainless steel, both bidimensional, geometric surface area 100 cm². The solution feeding the anodic compartment was prepared with ATL 100 mg/L using Na₂SO₄ 4 g/L as support electrolyte. In the cathodic compartment, it was used a solution containing Na₂SO₄ 71 g/L. Between both solutions was placed the membrane. The applied currents densities (iₐₚₚ) of 5, 20 and 40 mA/cm² were studied over 240 minutes treatment time. Besides that, the ATL decay was analyzed by ultraviolet spectroscopy (UV/Vis). The mineralization was determined performing total organic carbon (TOC) in TOC-L CPH Shimadzu. In the cases without membrane, the iₐₚₚ 5, 20 and 40 mA/cm² resulted in 55, 87 and 98 % ATL degradation at the end of treatment time, respectively. However, with membrane, the degradation, for the same iₐₚₚ, was 90, 100 and 100 %, spending 240, 120, 40 min for the maximum degradation, respectively. The mineralization, without membrane, for the same studied iₐₚₚ, was 40, 55 and 72 %, respectively at 240 min, but with membrane, all tested iₐₚₚ reached 80 % of mineralization, differing only in the time spent, 240, 150 and 120 min, for the maximum mineralization, respectively. The membrane increased the ATL oxidation, probably due to avoid oxidant ions (S₂O₈²⁻) reduction on the cathode surface.

Keywords: contaminants of emerging concern, advanced electrochemical oxidation, atenolol, cationic membrane, double compartment reactor

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Authors: Mohamed Mamdouh Al-Banna, Warda Youssef Mohamed Morsy, Hanaa Ali El-Feky, Ashraf Hussein Abdelmohsen

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Background: The mechanically ventilated patients need a special nursing care with continuous closed observation. The patients’ body mass index may affect their prognosis or outcomes. Aim of the study: to investigate the relationship between BMI and selected outcomes of critically ill mechanically ventilated patients. Research Design: A descriptive correlational research design was utilized Research questions: a) what is the BMI profile of mechanically ventilated patients admitted to critical care units over a period of six months? b) What is the relationship between body mass index and frequency of organ dysfunction, length of ICU stay, weaning from mechanical ventilation, and the mortality rate among adult critically ill mechanically ventilated patients? Setting: different intensive care units of Cairo University Hospitals. Sample: A convenience sample of 30 mechanically ventilated patients for at least 72 hours. Tools of data collection: Three tools were utilized to collect data pertinent to the current study: tool 1: patients’ sociodemographic and medical data sheet, tool 2: BURNS Wean Assessment Program (BWAP) checklist, tool 3: Sequential organ failure assessment (SOFA score) sheet. Results: The majority of the studied sample (77%) was males, and (26.7 %) of the studied sample were in the age group of 18-28 years old, and (26.7 %) were in the age group of 40-50 years old. Moreover, two thirds (66.7%) of the studied sample were within normal BMI. No significant statistical relationship between BMI category and ICU length of stay or the mortality rate among the studied sample, (X² = 11.31, P value = 0.79), (X² = 0.15, P value = 0.928) respectively. No significant statistical relationship between BMI category and the weaning trials from mechanical ventilation among the studied sample, (X² = 0.15, P value = 0.928). No significant statistical relationship was found between BMI category and the occurrence of organ dysfunction among the studied sample, (X² = 2.54, P value = 0.637). Conclusion: No relationship between the BMI categories and the selected patients’ outcomes (weaning from MV, length of ICU stay, occurrence of organ dysfunction, mortality rate). Recommendations: Replication of this study on a larger sample from different geographical locations in Arab Republic of Egypt, conducting farther studies to assess the effect of the quality of nursing care on the mechanically ventilated patients’ outcomes.

Keywords: mechanical ventilation, body mass index, outcomes of mechanically ventilated patient, organ failure

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Authors: Ankush Raina, Ankush Anand

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Plyometric training is a form of specialised strength training that uses fast muscular contractions to improve power and speed in sports conditioning by coaches and athletes. Despite its useful role in sports conditioning programme, the information about plyometric training on the athletes cardiovascular health especially Electrocardiogram (ECG) has not been established in the literature. The purpose of the study was to determine the effects of lower and upper body plyometric training on ECG of athletes. The study was guided by three null hypotheses. Quasi–experimental research design was adopted for the study. Seventy-two university male athletes constituted the population of the study. Thirty male athletes aged 18 to 24 years volunteered to participate in the study, but only twenty-three completed the study. The volunteered athletes were apparently healthy, physically active and free of any lower and upper extremity bone injuries for past one year and they had no medical or orthopedic injuries that may affect their participation in the study. Ten subjects were purposively assigned to one of the three groups: lower body plyometric training (LBPT), upper body plyometric training (UBPT), and control (C). Training consisted of six plyometric exercises: lower (ankle hops, squat jumps, tuck jumps) and upper body plyometric training (push-ups, medicine ball-chest throws and side throws) with moderate intensity. The general data were collated and analysed using Statistical Package for Social Science (SPSS version 22.0). The research questions were answered using mean and standard deviation, while paired samples t-test was also used to test for the hypotheses. The results revealed that athletes who were trained using LBPT had reduced ECG parameters better than those in the control group. The results also revealed that athletes who were trained using both LBPT and UBPT indicated lack of significant differences following ten weeks plyometric training than those in the control group in the ECG parameters except in Q wave, R wave and S wave (QRS) complex. Based on the findings of the study, it was recommended among others that coaches should include both LBPT and UBPT as part of athletes’ overall training programme from primary to tertiary institution to optimise performance as well as reduce the risk of cardiovascular diseases and promotes good healthy lifestyle.

Keywords: boundary lubrication, copper oxide, friction, nano diamond

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Authors: Luke Miller

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This paper develops an options pricing methodology to value strategic pricing strategies in the services sector. More specifically, this study provides a unifying taxonomy of current service sector pricing practices, frames these pricing decisions as strategic real options, demonstrates accepted option valuation techniques to assess service sector pricing decisions, and suggests future research areas where pricing decisions and real options overlap. Enhancing revenue in the service sector requires proactive decision making in a world of uncertainty. In an effort to strategically price service products, revenue enhancement necessitates a careful study of the service costs, customer base, competition, legalities, and shared economies with the market. Pricing decisions involve the quality of inputs, manpower, and best practices to maintain superior service. These decisions further hinge on identifying relevant pricing strategies and understanding how these strategies impact a firm’s value. A relatively new area of research applies option pricing theory to investments in real assets and is commonly known as real options. The real options approach is based on the premise that many corporate decisions to invest or divest in assets are simply an option wherein the firm has the right to make an investment without any obligation to act. The decision maker, therefore, has more flexibility and the value of this operating flexibility should be taken into consideration. The real options framework has already been applied to numerous areas including manufacturing, inventory, natural resources, research and development, strategic decisions, technology, and stock valuation. Additionally, numerous surveys have identified a growing need for the real options decision framework within all areas of corporate decision-making. Despite the wide applicability of real options, no study has been carried out linking service sector pricing decisions and real options. This is surprising given the service sector comprises 80% of the US employment and Gross Domestic Product (GDP). Identifying real options as a practical tool to value different service sector pricing strategies is believed to have a significant impact on firm decisions. This paper identifies and discusses four distinct pricing strategies available to the service sector from an options’ perspective: (1) Cost-based profit margin, (2) Increased customer base, (3) Platform pricing, and (4) Buffet pricing. Within each strategy lie several pricing tactics available to the service firm. These tactics can be viewed as options the decision maker has to best manage a strategic position in the market. To demonstrate the effectiveness of including flexibility in the pricing decision, a series of pricing strategies were developed and valued using a real options binomial lattice structure. The options pricing approach discussed in this study allows service firms to directly incorporate market-driven perspectives into the decision process and thus synchronizing service operations with organizational economic goals.

Keywords: option pricing theory, real options, service sector, valuation

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Authors: Ming-Yeh Lu, Shiao-Shing Chen, Saikat Sinha Ray, Hung-Te Hsu

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Recently, anaerobic membrane bioreactors (AnMBRs) has been widely utilized, which combines anaerobic biological treatment process and membrane filtration, that can be present an attractive option for wastewater treatment and water reuse. Conventional AnMBR is having several advantages, such as improving effluent quality, compact space usage, lower sludge yield, without aeration and production of energy. However, the removal of nitrogen and phosphorus in the AnMBR permeate was negligible which become the biggest disadvantage. In recent years, forward osmosis (FO) is an emerging technology that utilizes osmotic pressure as driving force to extract clean water without additional external pressure. The pore size of FO membrane is kindly mentioned the pore size, so nitrogen or phosphorus could effectively improve removal of nitrogen or phosphorus. Anaerobic bioreactor with FO membrane (AnOMBR) can retain the concentrate organic matters and nutrients. However, phosphorus is a non-renewable resource. Due to the high rejection property of FO membrane, the high amount of phosphorus could be recovered from the combination of AnMBR and FO. In this study, development of novel submerged anaerobic osmotic membrane bioreactor integrated with periodic microfiltration (MF) extraction for simultaneous phosphorus and clean water recovery from wastewater was evaluated. A laboratory-scale AnOMBR utilizes cellulose triacetate (CTA) membranes with effective membrane area of 130 cm² was fully submerged into a 5.5 L bioreactor at 30-35℃. Active layer-facing feed stream orientation was utilized, for minimizing fouling and scaling. Additionally, a peristaltic pump was used to circulate draw solution (DS) at a cross flow velocity of 0.7 cm/s. Magnesium sulphate (MgSO₄) solution was used as DS. Microfiltration membrane periodically extracted about 1 L solution when the TDS reaches to 5 g/L to recover phosphorus and simultaneous control the salt accumulation in the bioreactor. During experiment progressed, the average water flux was achieved around 1.6 LMH. The AnOMBR process show greater than 95% removal of soluble chemical oxygen demand (sCOD), nearly 100% of total phosphorous whereas only partial removal of ammonia, and finally average methane production of 0.22 L/g sCOD was obtained. Therefore, AnOMBR system periodically utilizes MF membrane extracted for phosphorus recovery with simultaneous pH adjustment. The overall performance demonstrates that a novel submerged AnOMBR system is having potential for simultaneous wastewater treatment and resource recovery from wastewater, and hence, the new concept of this system can be used to replace for conventional AnMBR in the future.

Keywords: anaerobic treatment, forward osmosis, phosphorus recovery, membrane bioreactor

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Authors: C. S. Chen, F. Y. Hui, B. S. Farhana, J. De Leon

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Introduction: Stroke can lead to long-term disability, affecting one’s quality of life. Providing stroke education to patient and family members is essential to optimize stroke recovery and prevent recurrent stroke. Currently, nurses conduct stroke education by handing out pamphlets and explaining their contents to patients. However, this is not always effective as nurses have varying levels of knowledge and depth of content discussed with the patient may not be consistent. With the advancement of information technology, health education is increasingly being disseminated via electronic software and studies have shown this to have benefitted patients. Hence, a multi-disciplinary team consisting of doctors, nurses and allied health professionals was formed to create the stroke journey map software to deliver consistent and concise stroke education. Research Objectives: To evaluate the effectiveness of using a stroke journey map software in improving patients’ perceived knowledge in the acute stroke unit during hospitalization. Methods: Patients admitted to the acute stroke unit were given stroke journey map software during patient education. The software consists of 31 interactive slides that are brightly coloured and 4 videos, based on input provided by the multi-disciplinary team. Participants were then assessed with pre-and-post survey questionnaires before and after viewing the software. The questionnaire consists of 10 questions with a 5-point Likert scale which sums up to a total score of 50. The inclusion criteria are patients diagnosed with ischemic stroke and are cognitively alert and oriented. This study was conducted between May 2017 to October 2017. Participation was voluntary. Results: A total of 33 participants participated in the study. The results demonstrated that the use of a stroke journey map as a stroke education medium was effective in improving patients’ perceived knowledge. A comparison of pre- and post-implementation data of stroke journey map revealed an overall mean increase in patients’ perceived knowledge from 24.06 to 40.06. The data is further broken down to evaluate patients’ perceived knowledge in 3 domains: (1) Understanding of disease process; (2) Management and treatment plans; (3) Post-discharge care. Each domain saw an increase in mean score from 10.7 to 16.2, 6.9 to 11.9 and 6.6 to 11.7 respectively. Project Impact: The implementation of stroke journey map has a positive impact in terms of (1) Increasing patient’s perceived knowledge which could contribute to greater empowerment of health; (2) Reducing need for stroke education material printouts making it environmentally friendly; (3) Decreasing time nurses spent on giving education resulting in more time to attend to patients’ needs. Conclusion: This study has demonstrated the benefit of using stroke journey map as a platform for stroke education. Overall, it has increased patients’ perceived knowledge in understanding their disease process, the management and treatment plans as well as the discharge process.

Keywords: acute stroke, education, ischemic stroke, knowledge, stroke

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Authors: Bander Alzahrani, Mohammed Alreshoodi

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Information-centric networking (ICN) using architectures such as the Publish-Subscribe Internet Technology (PURSUIT) has been proposed as a new networking model that aims at replacing the current used end-centric networking model of the Internet. This emerged model focuses on what is being exchanged rather than which network entities are exchanging information, which gives the control plane functions such as routing and host location the ability to be specified according to the content items. The forwarding plane of the PURSUIT ICN architecture uses a simple and light mechanism based on Bloom filter technologies to forward the packets. Although this forwarding scheme solve many problems of the today’s Internet such as the growth of the routing table and the scalability issues, it is vulnerable to brute force attacks which are starting point to distributed- denial-of-service (DDoS) attacks. In this work, we design and analyze a novel source-routing and information delivery technique that keeps the simplicity of using Bloom filter-based forwarding while being able to deter different attacks such as denial of service attacks at the ingress of the network. To achieve this, special forwarding nodes called Edge-FW are directly attached to end user nodes and used to perform a security test for malicious injected random packets at the ingress of the path to prevent any possible attack brute force attacks at early stage. In this technique, a core entity of the PURSUIT ICN architecture called topology manager, that is responsible for finding shortest path and creating a forwarding identifiers (FId), uses a cryptographically secure hash function to create a 64-bit hash, h, over the formed FId for authentication purpose to be included in the packet. Our proposal restricts the attacker from injecting packets carrying random FIds with a high amount of filling factor ρ, by optimizing and reducing the maximum allowed filling factor ρm in the network. We optimize the FId to the minimum possible filling factor where ρ ≤ ρm, while it supports longer delivery trees, so the network scalability is not affected by the chosen ρm. With this scheme, the filling factor of any legitimate FId never exceeds the ρm while the filling factor of illegitimate FIds cannot exceed the chosen small value of ρm. Therefore, injecting a packet containing an FId with a large value of filling factor, to achieve higher attack probability, is not possible anymore. The preliminary analysis of this proposal indicates that with the designed scheme, the forwarding function can detect and prevent malicious activities such DDoS attacks at early stage and with very high probability.

Keywords: forwarding identifier, filling factor, information centric network, topology manager

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Authors: Takashi Mitsuishi

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Fuzzy logic has gained acceptance in the recent years in the fields of social sciences and humanities such as psychology and linguistics because it can manage the fuzziness of words and human subjectivity in a logical manner. However, the major field of application of the fuzzy logic is control engineering as it is a part of the set theory and mathematical logic. Mamdani method, which is the most popular technique for approximate reasoning in the field of fuzzy control, is one of the ways to numerically represent the control afforded by human language and sensitivity and has been applied in various practical control plants. Fuzzy logic has been gradually developing as an artificial intelligence in different applications such as neural networks, expert systems, and operations research. The objects of inference vary for different application fields. Some of these include time, angle, color, symptom and medical condition whose fuzzy membership function is a periodic function. In the defuzzification stage, the domain of the membership function should be unique to obtain uniqueness its defuzzified value. However, if the domain of the periodic membership function is determined as unique, an unintuitive defuzzified value may be obtained as the inference result using the center of gravity method. Therefore, the authors propose a method of circular-polar-coordinates transformation and defuzzification of the periodic membership functions in this study. The transformation to circular polar coordinates simplifies the domain of the periodic membership function. Defuzzified value in circular polar coordinates is an argument. Furthermore, it is required that the argument is calculated from a closed plane figure which is a periodic membership function on the circular polar coordinates. If the closed plane figure is continuous with the continuity of the membership function, a significant amount of computation is required. Therefore, to simplify the practice example and significantly reduce the computational complexity, we have discretized the continuous interval and the membership function in this study. In this study, the following three methods are proposed to decide the argument from the discrete polygon which the continuous plane figure is transformed into. The first method provides an argument of a straight line passing through the origin and through the coordinate of the arithmetic mean of each coordinate of the polygon (physical center of gravity). The second one provides an argument of a straight line passing through the origin and the coordinate of the geometric center of gravity of the polygon. The third one provides an argument of a straight line passing through the origin bisecting the perimeter of the polygon (or the closed continuous plane figure).

Keywords: defuzzification, fuzzy membership function, periodic function, polar coordinates transformation

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Authors: José Ramón López-Mínguez, Estrella Suárez-Corchuelo, Sergio López-Tejero, Luis Nombela-Franco, Xavier Freixa-Rofastes, Guillermo Bastos-Fernández, Xavier Millán-Álvarez, Raúl Moreno-Gómez, José Antonio Fernández-Díaz, Ignacio Amat-Santos, Tomás Benito-González, Fernando Alfonso-Manterola, Pablo Salinas-Sanguino, Pedro Cepas-Guillén, Dabit Arzamendi, Ignacio Cruz-González, Juan Manuel Nogales-Asensio

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Background and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To this end, we studied the impact of LAAO plus antiplatelet drugs vs oral anticoagulants (OAC) (including direct OAC) plus antiplatelet drugs in these patients’ long-term outcomes. Methods: The results of 207 consecutive patients with NVAF who underwent coronary stenting were analyzed. A total of 146 patients were treated with OAC (75 with acenocoumarol, 71 with direct OAC) while 61 underwent LAAO. The median follow-up was 35 months. Patients also received antiplatelet therapy as prescribed by their cardiologist. The study received the proper ethical oversight. Results: Age (mean 75.7 years), and the past medical history of stroke were similar in both groups. However, the LAAO group had more unfavorable characteristics (history of coronary artery disease [CHA2DS2-VASc], and significant bleeding [BARC ≥ 2] and HAS-BLED). The occurrence of major adverse events (death, stroke/transient ischemic events, major bleeding) and major cardiovascular events (cardiac death, stroke/transient ischemic attack, and myocardial infarction) were significantly higher in the OAC group compared to the LAAO group: 19.75% vs 9.06% (HR, 2.18; P = .008) and 6.37% vs 1.91% (HR, 3.34; P = .037), respectively. Conclusions: In patients with NVAF undergoing coronary stenting, LAAO plus antiplatelet therapy produced better long-term outcomes compared to treatment with OAC plus antiplatelet therapy despite the unfavorable baseline characteristics of the LAAO group.

Keywords: stents, atrial fibrillation, anticoagulants, left atrial appendage occlusion

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Authors: Adonis Menezes, J. C. Passos

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The current panorama of technology in heat transfer and the scarcity of information about the convective boiling of CO₂ and hydrocarbon in small diameter channels motivated the development of this work. Among non-halogenated refrigerants, CO₂/ R744 has distinct thermodynamic properties compared to other fluids. The R744 presents significant differences in operating pressures and temperatures, operating at higher values compared to other refrigerants, and this represents a challenge for the design of new evaporators, as the original systems must normally be resized to meet the specific characteristics of the R744, which creates the need for a new design and optimization criteria. To carry out the convective boiling tests of CO₂, an experimental apparatus capable of storing (m= 10kg) of saturated CO₂ at (T = -30 ° C) in an accumulator tank was used, later this fluid was pumped using a positive displacement pump with three pistons, and the outlet pressure was controlled and could reach up to (P = 110bar). This high-pressure saturated fluid passed through a Coriolis type flow meter, and the mass velocities varied between (G = 20 kg/m².s) up to (G = 1000 kg/m².s). After that, the fluid was sent to the first test section of circular cross-section in diameter (D = 4.57mm), where the inlet and outlet temperatures and pressures, were controlled and the heating was promoted by the Joule effect using a source of direct current with a maximum heat flow of (q = 100 kW/m²). The second test section used a cross-section with multi-channels (seven parallel channels) with a square cross-section of (D = 2mm) each; this second test section has also control of temperature and pressure at the inlet and outlet as well as for heating a direct current source was used, with a maximum heat flow of (q = 20 kW/m²). The fluid in a biphasic situation was directed to a parallel plate heat exchanger so that it returns to the liquid state, thus being able to return to the accumulator tank, continuing the cycle. The multi-channel test section has a viewing section; a high-speed CMOS camera was used for image acquisition, where it was possible to view the flow patterns. The experiments carried out and presented in this report were conducted in a rigorous manner, enabling the development of a database on the convective boiling of the R744 in macro and micro channels. The analysis prioritized the processes from the beginning of the convective boiling until the drying of the wall in a subcritical regime. The R744 resurfaces as an excellent alternative to chlorofluorocarbon refrigerants due to its negligible ODP (Ozone Depletion Potential) and GWP (Global Warming Potential) rates, among other advantages. The results found in the experimental tests were very promising for the use of CO₂ in micro-channels in convective boiling and served as a basis for determining the flow pattern map and correlation for determining the heat transfer coefficient in the convective boiling of CO₂.

Keywords: convective boiling, CO₂/R744, macro-channels, micro-channels

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Authors: Annisa Ulfah Pristya, Andi Setiawan

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Electricity is the primary requirement today's world, including Indonesia. This is because electricity is a source of electrical energy that is flexible to use. Fossil energy sources are the major energy source that is used as a source of energy power plants. Unfortunately, this conversion process impacts on the depletion of fossil fuel reserves and causes an increase in the amount of CO2 in the atmosphere, disrupting health, ozone depletion, and the greenhouse effect. Solutions have been applied are solar cells, ocean wave power, the wind, water, and so forth. However, low efficiency and complicated treatment led to most people and industry in Indonesia still using fossil fuels. Referring to this Fuel Cell was developed. Fuel Cells are electrochemical technology that continuously converts chemical energy into electrical energy for the fuel and oxidizer are the efficiency is considerably higher than the previous natural source of electrical energy, which is 40-60%. However, Fuel Cells still have some weaknesses in terms of the use of an expensive platinum catalyst which is limited and not environmentally friendly. Because of it, required the simultaneous source of electrical energy and environmentally friendly. On the other hand, Indonesia is a rich country in marine sediments and organic content that is never exhausted. Stacking the organic component can be an alternative energy source continued development of fuel cell is A Microbial Fuel Cell. Microbial Fuel Cells (MFC) is a tool that uses bacteria to generate electricity from organic and non-organic compounds. MFC same tools as usual fuel cell composed of an anode, cathode and electrolyte. Its main advantage is the catalyst in the microbial fuel cell is a microorganism and working conditions carried out in neutral solution, low temperatures, and environmentally friendly than previous fuel cells (Chemistry Fuel Cell). However, when compared to Chemistry Fuel Cell, MFC only have an efficiency of 40%. Therefore, the authors provide a solution in the form of Nano-MFC (Nano Microbial Fuel Cell): Utilization of Carbon Nano Tube to Increase Efficiency of Microbial Fuel Cell Power as an Effective, Efficient and Environmentally Friendly Alternative Energy Source. Nano-MFC has the advantage of an effective, high efficiency, cheap and environmental friendly. Related stakeholders that helped are government ministers, especially Energy Minister, the Institute for Research, as well as the industry as a production executive facilitator. strategic steps undertaken to achieve that begin from conduct preliminary research, then lab scale testing, and dissemination and build cooperation with related parties (MOU), conduct last research and its applications in the field, then do the licensing and production of Nano-MFC on an industrial scale and publications to the public.

Keywords: CNT, efficiency, electric, microorganisms, sediment

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Authors: Yasmeen Cheema, Parvinder Singh

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The evolution of Islamic State (acronym IS) has an ultimate goal of restoring the caliphate. IS threat to the global security is main concern of international community but has also raised a factual concern for India about the regular radicalization of IS ideology among Indian youth. The incident of joining Arif Ejaz Majeed, an Indian as ‘jihadist’ in IS has set strident alarm in law & enforcement agencies. On 07.03.2017, many people were injured in an Improvised Explosive Device (IED) blast on-board of Bhopal Ujjain Express. One perpetrator of this incident was killed in encounter with police. But, the biggest shock is that the conspiracy was pre-planned and the assailants who carried out the blast were influenced by the ideology perpetrated by the Islamic State. This is the first time name of IS has cropped up in a terror attack in India. It is a red indicator of violent presence of IS in India, which is spreading through social media. The IS have the capacity to influence the younger Muslim generation in India through its brutal and aggressive propaganda videos, social media apps and hatred speeches. It is a well known fact that India is on the radar of IS, as well on its ‘Caliphate Map’. IS uses Twitter, Facebook and other social media platforms constantly. Islamic State has used enticing videos, graphics, and articles on social media and try to influence persons from India & globally that their jihad is worthy. According to arrested perpetrator of IS in different cases in India, the most of Indian youths are victims to the daydreams which are fondly shown by IS. The dreams that the Muslim empire as it was before 1920 can come back with all its power and also that the Caliph and its caliphate can be re-established are shown by the IS. Indian Muslim Youth gets attracted towards these euphemistic ideologies. Islamic State has used social media for disseminating its poisonous ideology, recruitment, operational activities and for future direction of attacks. IS through social media inspired its recruits & lone wolfs to continue to rely on local networks to identify targets and access weaponry and explosives. Recently, a pro-IS media group on its Telegram platform shows Taj Mahal as the target and suggested mode of attack as a Vehicle Born Improvised Explosive Attack (VBIED). Islamic State definitely has the potential to destroy the Indian national security & peace, if timely steps are not taken. No doubt, IS has used social media as a critical mechanism for recruitment, planning and executing of terror attacks. This paper will therefore examine the specific characteristics of social media that have made it such a successful weapon for Islamic State. The rise of IS in India should be viewed as a national crisis and handled at the central level with efficient use of modern technology.

Keywords: ideology, India, Islamic State, national security, recruitment, social media, terror attack

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Authors: Min Han, Di Wu, Lin Yuan, Fei Liu

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Mechanical sensors have undergone a continuous evolution and have become an important part of many industries, ranging from manufacturing to process, chemicals, machinery, health-care, environmental monitoring, automotive, avionics, and household appliances. Concurrently, the microelectronics and microfabrication technology have provided us with the means of producing mechanical microsensors characterized by high sensitivity, small size, integrated electronics, on board calibration, and low cost. Here we report a new kind of mechanical sensors based on the quantum transport process of electrons in the closely spaced nanoparticle films covering a flexible polymer sheet. The nanoparticle films were fabricated by gas phase depositing of preformed metal nanoparticles with a controlled coverage on the electrodes. To amplify the conductance of the nanoparticle array, we fabricated silver interdigital electrodes on polyethylene terephthalate(PET) by mask evaporation deposition. The gaps of the electrodes ranged from 3 to 30μm. Metal nanoparticles were generated from a magnetron plasma gas aggregation cluster source and deposited on the interdigital electrodes. Closely spaced nanoparticle arrays with different coverage could be gained through real-time monitoring the conductance. In the film coulomb blockade and quantum, tunneling/hopping dominate the electronic conduction mechanism. The basic principle of the mechanical sensors relies on the mechanical deformation of the fabricated devices which are translated into electrical signals. Several kinds of sensing devices have been explored. As a strain sensor, the device showed a high sensitivity as well as a very wide dynamic range. A gauge factor as large as 100 or more was demonstrated, which can be at least one order of magnitude higher than that of the conventional metal foil gauges or even better than that of the semiconductor-based gauges with a workable maximum applied strain beyond 3%. And the strain sensors have a workable maximum applied strain larger than 3%. They provide the potential to be a new generation of strain sensors with performance superior to that of the currently existing strain sensors including metallic strain gauges and semiconductor strain gauges. When integrated into a pressure gauge, the devices demonstrated the ability to measure tiny pressure change as small as 20Pa near the atmospheric pressure. Quantitative vibration measurements were realized on a free-standing cantilever structure fabricated with closely-spaced nanoparticle array sensing element. What is more, the mechanical sensor elements can be easily scaled down, which is feasible for MEMS and NEMS applications.

Keywords: gas phase deposition, mechanical sensors, metallic nanoparticle arrays, quantum conductance

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Authors: C. Miranda, S. Cunha, R. Soares, M. Maia, G. Igrejas, F. Silva, P. Poeta

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The worldwide inappropriate use of antibiotics has increased the emergence of antimicrobial-resistant microorganisms isolated from animals, humans, food, and the environment. To combat this complex and multifaceted problem is essential to know the prevalence in livestock animals and possible ways of transmission among animals and between these and humans. Enterococci species, in particular E. faecalis and E. faecium, are the most common nosocomial bacteria, causing infections in animals and humans. Thus, the aim of this study was to characterize resistance and virulence factors genes among two enterococci species isolated from calf colostrums in Portuguese dairy farms. The 55 enterococci isolates (44 E. faecalis and 11 E. faecium) were tested for the presence of the resistance genes for the following antibiotics: erythromicyn (ermA, ermB, and ermC), tetracycline (tetL, tetM, tetK, and tetO), quinupristin/dalfopristin (vatD and vatE) and vancomycin (vanB). Of which, 25 isolates (15 E. faecalis and 10 E. faecium) were tested until now for 8 virulence factors genes (esp, ace, gelE, agg, cpd, cylA, cylB, and cylLL). The resistance and virulence genes were performed by PCR, using specific primers and conditions. Negative and positive controls were used in all PCR assays. All enterococci isolates showed resistance to erythromicyn and tetracycline through the presence of the genes: ermB (n=29, 53%), ermC (n=10, 18%), tetL (n=49, 89%), tetM (n=39, 71%) and tetK (n=33, 60%). Only two (4%) E. faecalis isolates showed the presence of tetO gene. No resistance genes for vancomycin were found. The virulence genes detected in both species were cpd (n=17, 68%), agg (n=16, 64%), ace (n=15, 60%), esp (n=13, 52%), gelE (n=13, 52%) and cylLL (n=8, 32%). In general, each isolate showed at least three virulence genes. In three E. faecalis isolates was not found virulence genes and only E. faecalis isolates showed virulence genes for cylA (n=4, 16%) and cylB (n=6, 24%). In conclusion, these colostrum samples that were consumed by calves demonstrated the presence of antibiotic-resistant enterococci harbored virulence genes. This genotypic characterization is crucial to control the antibiotic-resistant bacteria through the implementation of restricts measures safeguarding public health. Acknowledgements: This work was funded by the R&D Project CAREBIO2 (Comparative assessment of antimicrobial resistance in environmental biofilms through proteomics - towards innovative theragnostic biomarkers), with reference NORTE-01-0145-FEDER-030101 and PTDC/SAU-INF/30101/2017, financed by the European Regional Development Fund (ERDF) through the Northern Regional Operational Program (NORTE 2020) and the Foundation for Science and Technology (FCT). This work was supported by the Associate Laboratory for Green Chemistry - LAQV which is financed by national funds from FCT/MCTES (UIDB/50006/2020 and UIDP/50006/2020).

Keywords: antimicrobial resistance, calf, colostrums, enterococci

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Authors: Ingrid Snustad, Asmund Ervik, Anders Austegard, Amy Brunsvold, Jianying He, Zhiliang Zhang

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CO₂ capture, transport and storage (CCS) is essential to mitigate global anthropogenic CO₂ emissions. To make CCS a widely implemented technology in, e.g. the power sector, the reduction of costs is crucial. For a large cost reduction, every part of the CCS chain must contribute. By increasing the heat transfer efficiency during liquefaction of CO₂, which is a necessary step, e.g. ship transportation, the costs associated with the process are reduced. Heat transfer rates during dropwise condensation are up to one order of magnitude higher than during filmwise condensation. Dropwise condensation usually occurs on a non-wetting surface (Superlyophobic surface). The vapour condenses in discrete droplets, and the non-wetting nature of the surface reduces the adhesion forces and results in shedding of condensed droplets. This, again, results in fresh nucleation sites for further droplet condensation, effectively increasing the liquefaction efficiency. In addition, the droplets in themselves have a smaller heat transfer resistance than a liquid film, resulting in increased heat transfer rates from vapour to solid. Surface tension is a crucial parameter for dropwise condensation, due to its impact on the solid-liquid contact angle. A low surface tension usually results in a low contact angle, and again to spreading of the condensed liquid on the surface. CO₂ has very low surface tension compared to water. However, at relevant temperatures and pressures for CO₂ condensation, the surface tension is comparable to organic compounds such as pentane, a dropwise condensation of CO₂ is a completely new field of research. Therefore, knowledge of several important parameters such as contact angle and drop size distribution must be gained in order to understand the nature of the condensation. A new setup has been built to measure these relevant parameters. The main parts of the experimental setup is a pressure chamber in which the condensation occurs, and a high- speed camera. The process of CO₂ condensation is visually monitored, and one can determine the contact angle, contact angle hysteresis and hence, the surface adhesion of the liquid. CO₂ condensation on different surfaces can be analysed, e.g. copper, aluminium and stainless steel. The experimental setup is built for accurate measurements of the temperature difference between the surface and the condensing vapour and accurate pressure measurements in the vapour. The temperature will be measured directly underneath the condensing surface. The next step of the project will be to fabricate nanostructured surfaces for inducing superlyophobicity. Roughness is a key feature to achieve contact angles above 150° (limit for superlyophobicity) and controlled, and periodical roughness on the nanoscale is beneficial. Surfaces that are non- wetting towards organic non-polar liquids are candidates surface structures for dropwise condensation of CO₂.

Keywords: CCS, dropwise condensation, low surface tension liquid, superlyophobic surfaces

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Authors: Aishvarya Gupta, Keerthana Anand, Sasirekha Rengaraj, Latha Chathurvedula

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Introduction: Advances in assisted reproductive technology and increase in the proportion of infertile couples have both contributed to the steep increase in the incidence of twin pregnancies in past decades. Maternal and perinatal complications are higher in twins than in singleton pregnancies. Studies comparing the maternal and perinatal outcomes of ART twin pregnancies versus spontaneously conceived twin pregnancies report heterogeneous results making it unclear whether the complications are due to twin gestation per se or because of assisted reproductive techniques. The present study aims to compare both maternal and perinatal outcomes in twin pregnancies which are spontaneously conceived and after assisted conception methods, so that targeted steps can be undertaken in order to improve maternal and perinatal outcome of twins. Objectives: To study perinatal and maternal outcome in twin pregnancies conceived spontaneously as well as with assisted methods and compare the outcomes between the two groups. Setting: Women delivering at JIPMER (tertiary care institute), Pondicherry. Population: 380 women with twin pregnancies who delivered in JIPMER between June 2015 and March 2017 were included in the study. Methods: The study population was divided into two cohorts – one conceived by spontaneous conception and other by assisted reproductive methods. Association of various maternal and perinatal outcomes with the method of conception was assessed using chi square test or Student's t test as appropriate. Multiple logistic regression analysis was done to assess the independent association of assisted conception with maternal outcomes after adjusting for age, parity and BMI. Multiple logistic regression analysis was done to assess the independent association of assisted conception with perinatal outcomes after adjusting for age, parity, BMI, chorionicity, gestational age at delivery and presence of hypertension or gestational diabetes in the mother. A p value of < 0.05 was considered as significant. Result: There was increased proportion of women with GDM (21% v/s 4.29%) and premature rupture of membranes (35% v/s 22.85%) in the assisted conception group and more anemic women in the spontaneous group (71.27% v/s 55.1%). However assisted conception per se increased the incidence of GDM among twin gestations (OR 3.39, 95% CI 1.34 – 8.61) and did not influence any of the other maternal outcomes. Among the perinatal outcomes, assisted conception per se increased the risk of having very preterm (<32 weeks) neonates (OR 3.013, 95% CI 1.432 – 6.337). The mean birth weight did not significantly differ between the two groups (p = 0.429). Though there were higher proportion of babies admitted to NICU in the assisted conception group (48.48% v/s 36.43%), assisted conception per se did not increase the risk of admission to NICU (OR 1.23, 95% CI 0.76 – 1.98). There was no significant difference in perinatal mortality rates between the two groups (p = 0.829). Conclusion: Assisted conception per se increases the risk of developing GDM in women with twin gestation and increases the risk of delivering very preterm babies. Hence measures should be taken to ensure appropriate screening methods for GDM and suitable neonatal care in such pregnancies.

Keywords: assisted conception, maternal outcomes, perinatal outcomes, twin gestation

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Authors: Rebecca Bach, Evgenia Kanli, Nihat Kiziltoprak, Linda Hildebrand, Ulrich Knaack, Jens Schneider

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The building industry has a high demand for resources and at the same time is responsible for a significant amount of waste created worldwide. Today's building components need to contribute to the protection of natural resources without creating waste. This is defined in the product development phase and impacts the product’s degree of being cycle-oriented. Paper-based materials show advantage due to their renewable origin and their ability to incorporate different functions. Besides the ecological aspects like renewable origin and recyclability the main advantages of paper materials are its light-weight but stiff structure, the optimized production processes and good insulation values. The main deficits from building technology’s perspective are the material's vulnerability to humidity and water as well as inflammability. On material level, those problems can be solved by coatings or through material modification. On construction level intelligent setup and layering of a building component can improve and also solve these issues. The target of the present work is to provide an overview of developed building components and construction typologies mainly made from paper materials. The research is structured in four parts: (1) functions and requirements, (2) preselection of paper-based materials, (3) development of building components and (4) evaluation. As part of the research methodology at first the needs of the building sector are analyzed with the aim to define the main areas of application and consequently the requirements. Various paper materials are tested in order to identify to what extent the requirements are satisfied and determine potential optimizations or modifications, also in combination with other construction materials. By making use of the material’s potentials and solving the deficits on material and on construction level, building components and construction typologies are developed. The evaluation and the calculation of the structural mechanics and structural principals will show that different construction typologies can be derived. Profiles like paper tubes can be used at best for skeleton constructions. Massive structures on the other hand can be formed by plate-shaped elements like solid board or honeycomb. For insulation purposes corrugated cardboard or cellulose flakes have the best properties, while layered solid board can be applied to prevent inner condensation. Enhancing these properties by material combinations for instance with mineral coatings functional constructions mainly out of paper materials were developed. In summary paper materials offer a huge variety of possible applications in the building sector. By these studies a general base of knowledge about how to build with paper was developed and is to be reinforced by further research.

Keywords: construction typologies, cycle-oriented construction, innovative building material, paper materials, renewable resources

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Authors: Joseph Ndegwa

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Changes are required if energy systems are to foster long-term growth. The main problems are increasing access to inexpensive, dependable, and sufficient energy supply while addressing environmental implications at all levels. Policies can help to promote sustainable development by providing adequate and inexpensive energy sources to underserved regions, such as liquid and gaseous fuels for cooking and electricity for household and commercial usage. Promoting energy efficiency. Increased utilization of new renewables. Spreading and implementing additional innovative energy technologies. Markets can achieve many of these goals with the correct policies, pricing, and regulations. However, if markets do not work or fail to preserve key public benefits, tailored government policies, programs, and regulations can achieve policy goals. The main strategies for promoting sustainable energy systems are simple. However, they need a broader recognition of the difficulties we confront, as well as a firmer commitment to specific measures. Making markets operate better by minimizing pricing distortions, boosting competition, and removing obstacles to energy efficiency are among the measures. Complementing the reform of the energy industry with policies that promote sustainable energy. Increasing investments in renewable energy. Increasing the rate of technical innovation at each level of the energy innovation chain. Fostering technical leadership in underdeveloped nations by transferring technology and enhancing institutional and human capabilities. promoting more international collaboration. Governments, international organizations, multilateral financial institutions, and civil society—including local communities, business and industry, non-governmental organizations (NGOs), and consumers—all have critical enabling roles to play in the problem of sustainable energy. Partnerships based on integrated and cooperative approaches and drawing on real-world experience will be necessary. Setting the required framework conditions and ensuring that public institutions collaborate effectively and efficiently with the rest of society are common themes across all industries and geographical areas in order to achieve sustainable development. Powerful tools for sustainable development include energy. However, significant policy adjustments within the larger enabling framework will be necessary to refocus its influence in order to achieve that aim. Many of the options currently accessible will be lost or the price of their ultimate realization (where viable) will grow significantly if such changes don't take place during the next several decades and aren't started right enough. In any case, it would seriously impair the capacity of future generations to satisfy their demands.

Keywords: sustainable development, reliable, price, policy

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Authors: Vivek Rangarajan, Kim G. Clarke

Abstract:

Bacillus lipopeptides are biosurfactants with wide ranging applications in the medical, food, agricultural, environmental and cosmetic industries. They are produced as a mix of three families, surfactin, iturin and fengycin, each comprising a large number of homologues of varying functionalities. Consequently, the method and degree of purification of the lipopeptide cocktail becomes particularly important if the functionality of the lipopeptide end-product is to be maximized for the specific application. However, downstream processing of Bacillus lipopeptides is particularly challenging due to the subtle variations observed in the different lipopeptide homologues and isoforms. To date, the most frequently used lipopeptide purification operations have been acid precipitation, solvent extraction, membrane ultrafiltration, adsorption and size exclusion. RP-HPLC (reverse phase high pressure liquid chromatography) also has potential for fractionation of the lipopeptide homologues. In the studies presented here, membrane ultrafiltration and RP-HPLC were evaluated for lipopeptide purification to different degrees of purities for maximum functionality. Batch membrane ultrafiltration using 50 kDa polyether sulphone (PES) membranes resulted in lipopeptide recovery of about 68% for surfactin and 82 % for fengycin. The recovery was further improved to 95% by using size-conditioned lipopeptide micelles. The conditioning of lipopeptides with Ca2+ ions resulted in uniformly sized micelles with average size of 96.4 nm and a polydispersity index of 0.18. The size conditioning also facilitated removal of impurities (molecular weight ranging between 2335-3500 Da) through operation of the system under dia-filtration mode, in a way similar to salt removal from protein by dialysis. The resultant purified lipopeptide was devoid of macromolecular impurities and could ideally suit applications in the cosmetic and food industries. Enhanced purification using RP-HPLC was carried out in an analytical C18 column, with the aim to fractionate lipopeptides into their constituent homologues. The column was eluted with mobile phase comprising acetonitrile and water over an acetonitrile gradient, 35% - 80%, over 70 minutes. The gradient elution program resulted in as many as 41 fractions of individual lipopeptide homologues. The efficacy test of these fractions against fungal phytopathogens showed that first 21 fractions, identified to be homologues of iturins and fengycins, displayed maximum antifungal activities, suitable for biocontrol in the agricultural industry. Thus, in the current study, the downstream processing of lipopeptides leading to tailor-made products for selective applications was demonstrated using two major downstream unit operations.

Keywords: bacillus lipopeptides, membrane ultrafiltration, purification, RP-HPLC

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Authors: Scott Cavinder

Abstract:

Surgical site infections (SSI) are a known complication to any surgical procedure and are one of the most common nosocomial infections. Globally it is estimated 300 million surgical procedures take place annually, with an incidence of SSI’s estimated to be 11 of 100 surgical patients developing an infection within 30 days after surgery. The specific purpose of the project is to address the PICOT (Problem, Intervention, Comparison, Outcome, Time) question: In patients who have undergone cardiothoracic or vascular surgery (P), does implementation of a post-operative care bundle based on current EBP (I) as compared to current clinical agency practice standards (C) result in a decrease of SSI (O) over a 12-week period (T)? Synthesis of Supporting Evidence: A literature search of five databases, including citation chasing, was performed, which yielded fourteen pieces of evidence ranging from high to good quality. Four common themes were identified for the prevention of SSI’s including use and removal of surgical dressings; use of topical antibiotics and antiseptics; implementation of evidence-based care bundles, and implementation of surveillance through auditing and feedback. The Iowa Model was selected as the framework to help guide this project as it is a multiphase change process which encourages clinicians to recognize opportunities for improvement in healthcare practice. Practice/Implementation: The process for this project will include recruiting postsurgical participants who have undergone cardiovascular or thoracic surgery prior to discharge at a Northwest Indiana Hospital. The patients will receive education, verbal instruction, and return demonstration. The patients will be followed for 12 weeks, and wounds assessed utilizing the National Healthcare Safety Network//Centers for Disease Control (NHSN/CDC) assessment tool and compared to the SSI rate of 2021. Key stakeholders will include two cardiovascular surgeons, four physician assistants, two advance practice nurses, medical assistant and patients. Method of Evaluation: Chi Square analysis will be utilized to establish statistical significance and similarities between the two groups. Main Results/Outcomes: The proposed outcome is the prevention of SSIs in the post-op cardiothoracic and vascular patient. Implication/Recommendation(s): Implementation of standardized post operative care bundles in the prevention of SSI in cardiovascular and thoracic surgical patients.

Keywords: cardiovascular, evidence based practice, infection, post-operative, prevention, thoracic, surgery

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Authors: Mohammad Khatib, Salam Hadid

Abstract:

Introduction: Developing nurses' cultural competence begins in their basic training and requires them to participate in an array of activities which raise their awareness and stimulate their interest, desire and curiosity about different cultures, by creating opportunities for intercultural meetings promoting the concept of 'culture' and its components, including recognition of cultural diversity and the legitimacy of the other. Importantly, professionals need to acquire specific cultural knowledge and thorough understanding of the values, norms, customs, beliefs and symbols of different cultures. Similarly, they need to be given opportunities to practice the verbal and non-verbal communication skills of other cultures according to their cultural codes. Such a system is being implemented as part of nursing studies at Zefat Academic College in two study frameworks; firstly, a course integrating nursing theory and practice in multicultural nursing; secondly, a course in learning the languages spoken in Israel focusing on medical and nursing terminology. Methods: Students participating in the 'Transcultural Nursing' course come from a variety of backgrounds: Jews, or Arabs, religious, or secular; Muslim, Christian, new immigrants, Ethiopians or from other cultural affiliations. They are required to present and discuss cultural practices that affect health. In addition, as part of the language course, students learn and teach their friends 5 spoken languages (Arabic, Russian, Amharian, Yidish, and Sign language) focusing on therapeutic interaction and communication using the vocabulary and concepts necessary for the therapeutic encounter. An evaluation of the process and the results was done using a structured questionnaire which includes series of questions relating to the contributions of the courses to their cultural knowledge, awareness and skills. 155 students completed the questionnaire. Results: A preliminary assessment of this educational system points an increase in cultural awareness and knowledge among the students as well as in their willingness to recognize the other's difference. A positive atmosphere of multiculturalism is reflected in students' mutual interest and respect was created. Students showed a deep understanding of cultural issues relating to health and care (consanguinity and genetics, food customs; cultural events, reincarnation, traditional treatments etc.). Most of the students were willing to recommend the courses to others and suggest some changes relating learning methods (more simulations, role playing and activities).

Keywords: cultural competence, nursing education, culture, language

Procedia PDF Downloads 278

Authors: Yi-Fung Lin, Shiow-Ching Shun, Wen-Yu Hu

Abstract:

Background: A skill mix model is regarded as one of the most effective methods of reducing nursing shortages, as well as easing nursing staff workloads and labor costs. Although this model shows several benefits for the health workforce, the relationship between the optimal model of skill mix and the patient mortality rate remains to be discovered. Objectives: This review aimed to explore the relationship between the skill mix model and patient mortality rate in acute care hospitals. Data Sources: A systematic search of the PubMed, Web of Science, Embase, and Cochrane Library databases and researchers retrieved studies published between January 1986 and March 2022. Review methods: Two independent reviewers screened the titles and abstracts based on selection criteria, extracted the data, and performed critical appraisals using the STROBE checklist of each included study. The studies focused on adult patients in acute care hospitals, and the skill mix model and patient mortality rate were included in the analysis. Results: Six included studies were conducted in the USA, Canada, Italy, Taiwan, and European countries (Belgium, England, Finland, Ireland, Spain, and Switzerland), including patients in medical, surgical, and intensive care units. There were both nurses and nursing assistants in their skill mix team. This main finding is that three studies (324,592 participants) show evidence of fewer mortality rates associated with hospitals with a higher percentage of registered nurse staff (range percentage of registered nurse staff 36.1%-100%), but three articles (1,122,270 participants) did not find the same result (range of percentage of registered nurse staff 46%-96%). However, based on appraisal findings, those showing a significant association all meet good quality standards, but only one-third of their counterparts. Conclusions: In light of the limited amount and quality of published research in this review, it is prudent to treat the findings with caution. Although the evidence is not insufficient certainty to draw conclusions about the relationship between nurse staffing level and patients' mortality, this review lights the direction of relevant studies in the future. The limitation of this article is the variation in skill mix models among countries and institutions, making it impossible to do a meta-analysis to compare them further.

Keywords: nurse staffing level, nursing assistants, mortality, skill mix

Procedia PDF Downloads 118