Search results for: improvement of properties

Authors: Oliver Chunho Ma, Tszying Chang

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Background: Traditional Chinese Medicine (TCM) has been widely used in the treatment of eczema. However, there is currently a lack of comprehensive research on the overall effectiveness of TCM in treating eczema, particularly using the Eczema Area and Severity Index (EASI) score as an evaluation tool. Meta-analysis can integrate the results of multiple studies to provide more convincing evidence. Objective: To conduct a systematic review and meta-analysis based on the EASI score to evaluate the overall effectiveness of TCM in the treatment of eczema. Specifically, the study will review and analyze published clinical studies that investigate TCM treatments for eczema and use the EASI score as an outcome measure, comparing the differences in improving the severity of eczema between TCM and other treatment modalities, such as conventional Western medicine treatments. Methods: Relevant studies, including randomized controlled trials (RCTs) and non-randomized controlled trials, that involve TCM treatment for eczema and use the EASI score as an outcome measure will be searched in medical literature databases such as PubMed, CNKI, etc. Relevant data will be extracted from the selected studies, including study design, sample size, treatment methods, improvement in EASI score, etc. The methodological quality and risk of bias of the included studies will be assessed using appropriate evaluation tools (such as the Cochrane Handbook). The results of the selected studies will be statistically analyzed, including pooling effect sizes (such as standardized mean differences, relative risks, etc.), subgroup analysis (e.g., different TCM syndromes, different treatment modalities), and sensitivity analysis (e.g., excluding low-quality studies). Based on the results of the statistical analysis and quality assessment, the overall effectiveness of TCM in improving the severity of eczema will be interpreted. Expected outcomes: By integrating the results of multiple studies, we expect to provide more convincing evidence regarding the specific effects of TCM in improving the severity of eczema. Additionally, subgroup analysis and sensitivity analysis can further elucidate whether the effectiveness of TCM treatment is influenced by different factors. Besides, we will compare the results of the meta-analysis with the clinical data from our clinic. For both the clinical data and the meta-analysis results, we will perform descriptive statistics such as means, standard deviations, percentages, etc. and compare the differences between the two using statistical tests such as independent samples t-test or non-parametric tests to assess the statistical differences between them.

Keywords: Eczema, traditional Chinese medicine, EASI, systematic review, meta-analysis

Procedia PDF Downloads 52

Authors: Panupong Lohrattanarungrot, Falan Srisuriyachai

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Polymer flooding is a well-known technique used for controlling mobility ratio in heterogeneous reservoirs, leading to improvement of sweep efficiency as well as wellbore profile. However, low injectivity of viscous polymer solution attenuates oil recovery rate and consecutively adds extra operating cost. An attempt of this study is to improve injectivity of polymer solution while maintaining recovery factor, enhancing effectiveness of polymer flooding method. This study is performed by using reservoir simulation program to modify conventional single polymer slug into sequential polymer flooding, emphasizing on increasing of injectivity and also reduction of polymer amount. Selection of operating conditions for single slug polymer including pre-injected water, polymer concentration and polymer slug size is firstly performed for a layered-heterogeneous reservoir with Lorenz coefficient (Lk) of 0.32. A selected single slug polymer flooding scheme is modified into sequential polymer flooding with reduction of polymer concentration in two different modes: Constant polymer mass and reduction of polymer mass. Effects of Residual Resistance Factor (RRF) is also evaluated. From simulation results, it is observed that first polymer slug with the highest concentration has the main function to buffer between displacing phase and reservoir oil. Moreover, part of polymer from this slug is also sacrificed for adsorption. Reduction of polymer concentration in the following slug prevents bypassing due to unfavorable mobility ratio. At the same time, following slugs with lower viscosity can be injected easily through formation, improving injectivity of the whole process. A sequential polymer flooding with reduction of polymer mass shows great benefit by reducing total production time and amount of polymer consumed up to 10% without any downside effect. The only advantage of using constant polymer mass is slightly increment of recovery factor (up to 1.4%) while total production time is almost the same. Increasing of residual resistance factor of polymer solution yields a benefit on mobility control by reducing effective permeability to water. Nevertheless, higher adsorption results in low injectivity, extending total production time. Modifying single polymer slug into sequence of reduced polymer concentration yields major benefits on reducing production time as well as polymer mass. With certain design of polymer flooding scheme, recovery factor can even be further increased. This study shows that application of sequential polymer flooding can be certainly applied to reservoir with high value of heterogeneity since it requires nothing complex for real implementation but just a proper design of polymer slug size and concentration.

Keywords: polymer flooding, sequential, heterogeneous reservoir, residual resistance factor

Procedia PDF Downloads 473

Authors: Wajid Rehman, Sirajul Haq, Bakhtiar Muhammad, Syed Fahad Hassan, Amin Badshah, Muhammad Waseem, Fazal Rahim, Obaid-Ur-Rahman Abid, Farzana Latif Ansari, Umer Rashid

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Five novel triorganotin (IV) compounds have been synthesized and characterized. The tin atom is penta-coordinated to assume trigonal-bipyramidal geometry. Using in silico derived parameters; the objective of our study is to design and synthesize promiscuous antibacterials potent enough to combat resistance. Among various synthesized organotin (IV) complexes, compound 5 was found as potent antibacterial agent against various bacterial strains. Further lead optimization of drug-like properties was evaluated through in silico predictions. Data mining and computational analysis were utilized to derive compound promiscuity phenomenon to avoid drug attrition rate in designing antibacterials. Xanthine oxidase and human glucose- 6-phosphatase were found as only true positive off-target hits by ChEMBL database and others utilizing similarity ensemble approach. Propensity towards a-3 receptor, human macrophage migration factor and thiazolidinedione were found as false positive off targets with E-value 1/4> 10^-4 for compound 1, 3, and 4. Further, displaying positive drug-drug interaction of compound 1 as uricosuric was validated by all databases and docked protein targets with sequence similarity and compositional matrix alignment via BLAST software. Promiscuity of the compound 5 was further confirmed by in silico binding to different antibacterial targets.

Keywords: antibacterial activity, drug promiscuity, ADMET prediction, metallo-pharmaceutical, antimicrobial resistance

Procedia PDF Downloads 500

Authors: Alexandru Achim, Tamás Szűcsborus, Viktor Sasi, Ferenc Nagy, Zoltán Jambrik, Attila Nemes, Albert Varga, Călin Homorodean, Olivier F. Bertrand, Zoltán Ruzsa

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Aim: Our study aimed to establish the safety and the technical success of distal radial access for balloon aortic valvuloplasty (DR-BAV). The secondary objective was to determine the effectiveness and appropriate role of DR-BAV within half year follow-up. Methods: Clinical and angiographic data from 32 consecutive patients with symptomatic aortic stenosis were evaluated in a prospective pilot single-center study. Between 2020 and 2021, the patients were treated utilizing dual distal radial access with 6-10F compatible balloons. The efficacy endpoint was divided into technical success (successful valvuloplasty balloon inflation at the aortic valve and absence of intra- or periprocedural major complications), hemodynamic success (a reduction of the mean invasive gradient >30%), and clinical success (an improvement of at least one clinical category in the NYHA classification). The safety endpoints were vascular complications (major and minor Valve Academic Research Consortium (VARC)-2 bleeding, diminished or lost arterial pulse or the presence of any pseudo-aneurysm or arteriovenous fistula during the clinical follow-up) and major adverse events, MAEs (the composite of death, stroke, myocardial infarction, and urgent major aortic valve replacement or implantation during the hospital stay and or at one-month follow-up). Results: 32 patients (40 % male, mean age 80 ± 8,5) with severe aortic valve stenosis were included in the study and 4 patients were excluded. Technical success was achieved in all patients (100%). Hemodynamic success was achieved in 30 patients (93,75%). Invasive max and mean gradients were reduced from 73±22 mm Hg and 49±22 mm Hg to 49±19 mm Hg and 20±13 mm Hg, respectively (p = <.001). Clinical success was achieved in 29 patients (90,6%). In total, no major adverse cardiac or cerebrovascular event nor vascular complications (according to VARC 2 criteria) occurred during the intervention. All-cause death at 6 months was 12%. Conclusion: According to our study, dual distal radial artery access is a safe and effective option for balloon aortic valvuloplasty in patients with severe aortic valve stenosis and can be performed in all patients with sufficient lumen diameter. Future randomized studies are warranted to investigate whether this technique is superior to other approaches.

Keywords: mean invasive gradient, distal radial access for balloon aortic valvuloplasty (DR-BAV), aortic valve stenosis, pseudo-aneurysm, arteriovenous fistula, valve academic research consortium (VARC)-2

Procedia PDF Downloads 91

Authors: E. Yarar, E. A. Guven, S. Karabay

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In this study, a comprehensive simulation was made for the cold tube drawing with fixed plug. The cold tube drawing process is preferred due to its high surface quality and the high mechanical properties. In drawing processes applied to materials with low plastic deformability, cracks can occur on the surfaces and the process efficiency decreases. The aim of the work is to investigate the effects of different drawing parameters on drawing forces and stresses. In the simulations, optimum conditions were investigated for four different materials, Ti64Al4V, AA5052, AISI4140, and C365. One of the most important parameters for the cold drawing process is the die angle. Three dies were designed for the analysis with semi die angles of 5°, 10°, and 15°. Three different parameters were used for the friction coefficient between die and the material. In the simulations, reduction of area and the drawing speed is kept constant. Drawing is done in one pass. According to the simulation results, the highest drawing forces were obtained in Ti64Al4V. As the semi die angle increases, the drawing forces decrease. The change in semi die angle was most effective on Ti64Al4V. Increasing the coefficient of friction is another effect that increases the drawing forces. The increase in the friction coefficient has also increased in drawing stresses. The increase in die angle also increased the drawing stress distribution for the other three materials outside C365. According to the results of the analysis, it is found that the designed drawing die is suitable for drawing. The lowest drawing stress distribution and drawing forces were obtained for AA5052. Drawing die parameters have a direct effect on the results. In addition, lubricants used for drawing have a significant effect on drawing forces.

Keywords: cold tube drawing, drawing force, drawing stress, semi die angle

Procedia PDF Downloads 164

Authors: Wenqian Zhang, Xuelin Wang, Yujin Hu, Siyang Wang

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The subsurface layer of a component plays a significant role in its service performance. Any surface mechanical process during fabrication can introduce a deformed layer near the surface, which can be related to the microstructure alteration and strain hardening, and affects the mechanical properties and corrosion resistance of the material. However, there exists a great difficulty in determining the subsurface deformation induced by surface machining. In this study, electron backscatter diffraction (EBSD) was used to study the deformed layer of surface milled 316 stainless steel. The microstructure change was displayed by the EBSD maps and characterized by misorientation variation. The results revealed that the surface milling resulted in heavily nonuniform deformations in the subsurface layer and even in individual grains. The direction of the predominant grain deformation was about 30-60 deg to the machined surface. Moreover, a local deformation rate (LDR) was proposed to quantitatively evaluate the local deformation degree. Both of the average and maximum LDRs were utilized to characterize the deformation trend along the depth direction. It was revealed that the LDR had a strong correlation with the development of grain and sub-grain boundaries. In this work, a scan step size of 1.2 μm was chosen for the EBSD measurement. A LDR higher than 18 deg/μm indicated a newly developed grain boundary, while a LDR ranged from 2.4 to 18 deg/μm implied the generation of a sub-grain boundary. And a lower LDR than 2.4 deg/μm could only introduce a slighter deformation and no sub-grain boundary was produced. According to the LDR analysis with the evolution of grain or sub grain boundaries, the deformed layer could be classified into four zones: grain broken layer, seriously deformed layer, slightly deformed layer and non-deformed layer.

Keywords: surface machining, EBSD, subsurface layer, local deformation

Procedia PDF Downloads 330

Authors: Ahmed Z. Mazen, Nejat Rahmanian, Iqbal Mujtaba, Ali Hassanpour

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In oil and gas well drilling, the drill bit is an important part of the Bottom Hole Assembly (BHA), which is installed and designed to drill and produce a hole by several mechanisms. The efficiency of the bit depends on many drilling parameters such as weight on bit, rotary speed, and mud properties. When the bit is pulled out of the hole, the evaluation of the bit damage must be recorded very carefully to guide engineers in order to select the bits for further planned wells. Having a worn bit for hole drilling may cause severe damage to bit leading to cutter or cone losses in the bottom of hole, where a fishing job will have to take place, and all of these will increase the operating cost. The main factor to reduce the cost of drilling operation is to maximize the rate of penetration by analyzing real-time data to predict the drill bit wear while drilling. There are numerous models in the literature for prediction of the rate of penetration based on drilling parameters, mostly based on empirical approaches. One of the most commonly used approaches is Bourgoyne and Young model, where the rate of penetration can be estimated by the drilling parameters as well as a wear index using an empirical correlation, provided all the constants and coefficients are accurately determined. This paper introduces a new methodology to estimate the eight coefficients for Bourgoyne and Young model using the gPROMS parameters estimation GPE (Version 4.2.0). Real data collected form similar formations (12 ¼’ sections) in two different fields in Libya are used to estimate the coefficients. The estimated coefficients are then used in the equations and applied to nearby wells in the same field to predict the bit wear.

Keywords: Bourgoyne and Young model, bit wear, gPROMS, rate of penetration

Procedia PDF Downloads 151

Authors: Julius Denafas, Irina Kliopova, Gintaras Denafas

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Three opportunities for implementation of industrial ecology principles in the real industrial production of c-Si solar cells and modules are presented in this study. It includes: material flow dematerialisation, product modification and industrial symbiosis. Firstly, it is shown how the collaboration between R&D institutes and industry helps to achieve significant reduction of material consumption by a) refuse from phosphor silicate glass cleaning process and b) shortening of silicon nitride coating production step. Secondly, it was shown how the modification of solar module design can reduce the CO2 footprint for this product and enhance waste prevention. It was achieved by implementing a frameless glass/glass solar module design instead of glass/backsheet with aluminium frame. Such a design change is possible without purchasing new equipment and without loss of main product properties like efficiency, rigidity and longevity. Thirdly, industrial symbiosis in the solar cell production is possible in such case when manufacturing waste (silicon wafer and solar cell breakage) also used solar modules are collected, sorted and supplied as raw-materials to other companies involved in the production chain of c-Si solar cells. The obtained results showed that solar cells produced from recycled silicon can have a comparable electrical parameters like produced from standard, commercial silicon wafers. The above mentioned work was performed at solar cell producer Soli Tek R&D in the frame of H2020 projects CABRISS and Eco-Solar.

Keywords: manufacturing, process optimisation, recycling, solar cells, solar modules, waste prevention

Procedia PDF Downloads 136

Authors: Esma Hande Alıcı, Gülnur Arabacı

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Antioxidants are compounds or systems that can safely interact with free radicals and terminate the chain reaction before vital molecules are damaged. The anti-oxidative effectiveness of these compounds depends on their chemical characteristics and physical location within a food (proximity to membrane phospholipids, emulsion interfaces, or in the aqueous phase). Antioxidants (e.g., flavonoids, phenolic acids, tannins, vitamin C, vitamin E) have diverse biological properties, such as antiinflammatory, anti-carcinogenic and anti-atherosclerotic effects, reduce the incidence of coronary diseases and contribute to the maintenance of gut health by the modulation of the gut microbial balance. Plants are excellent sources of antioxidants especially with their high content of phenolic compounds. Raphanus raphanistrum L., the wild radish, is a flowering plant in the family Brassicaceae. It grows in Asia and Mediterranean region. It has been introduced into most parts of the world. It spreads rapidly, and is often found growing on roadsides or in other places where the ground has been disturbed. It is an edible plant, in Turkey its fresh aerial parts are mostly consumed as a salad with olive oil and lemon juice after boiled. The leaves of the plant are also used as anti-rheumatic in traditional medicine. In this study, we determined the antioxidant capacity of two different solvent fractions (methanol and ethyl acetate) obtained from Raphanus raphanistrum L. plant leaves. Antioxidant capacity of the plant was introduced by using three different methods: DPPH radical scavenging activity, CUPRAC (Cupric Ion Reducing Antioxidant Capacity) activity and Reducing power activity.

Keywords: antioxidant activity, antioxidant capacity, Raphanis raphanistrum L., wild radish

Procedia PDF Downloads 274

Authors: Ke Zhang, Yongli Zhu

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Due to rapid load growths in today’s highly electrified societies and the requirement for green energy sources, large-scale wind farm power transmission system is constantly developing. This system is a typical multi-terminal power supply system, whose structure of the network topology of transmission lines is complex. What’s more, it locates in the complex terrain of mountains and grasslands, thus increasing the possibility of transmission line faults and finding the fault location with difficulty after the faults and resulting in an extremely serious phenomenon of abandoning the wind. In order to solve these problems, a fault location method for multi-terminal transmission line based on wind farm characteristics and improved single-ended traveling wave positioning method is proposed. Through studying the zero sequence current characteristics by using the characteristics of the grounding transformer(GT) in the existing large-scale wind farms, it is obtained that the criterion for judging the fault interval of the multi-terminal transmission line. When a ground short-circuit fault occurs, there is only zero sequence current on the path between GT and the fault point. Therefore, the interval where the fault point exists is obtained by determining the path of the zero sequence current. After determining the fault interval, The location of the short-circuit fault point is calculated by the traveling wave method. However, this article uses an improved traveling wave method. It makes the positioning accuracy more accurate by combining the single-ended traveling wave method with double-ended electrical data. What’s more, a method of calculating the traveling wave velocity is deduced according to the above improvements (it is the actual wave velocity in theory). The improvement of the traveling wave velocity calculation method further improves the positioning accuracy. Compared with the traditional positioning method, the average positioning error of this method is reduced by 30%.This method overcomes the shortcomings of the traditional method in poor fault location of wind farm transmission lines. In addition, it is more accurate than the traditional fixed wave velocity method in the calculation of the traveling wave velocity. It can calculate the wave velocity in real time according to the scene and solve the traveling wave velocity can’t be updated with the environment and real-time update. The method is verified in PSCAD/EMTDC.

Keywords: grounding transformer, multi-terminal transmission line, short circuit fault location, traveling wave velocity, wind farm

Procedia PDF Downloads 261

Authors: Sarra Boughaba

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The α-aminophosphonates have received considerable attention in organic and medicinal chemistry because of their structural resemblance with α-amino acids. They are used as antitumor agents, anti-inflammatory and antibiotics. As a result, a number of procedures have been developed for their synthesis. However, many of these methods suffer from some disadvantages such as long reaction times, environmental pollution caused by utilization of organic solvents, and expensive catalyst. On the other hand, thiazole components, particularly 2-aminothiazole is an important class of heterocyclic compounds. They appear in the structure of natural products and biologically actives compounds, thiamine (vitamin-B), and some antibiotics drugs (penicillin, micrococcin). In the past few years, heteropolyacids have received great attention as environmentally benign catalysts for organic synthetic processes, they possess unique physicochemical properties, such as super-acidity, high thermal and chemical stability, ability to accept and release electrons and high proton mobility, and the possibility of varying their acidity and oxidizing potential. In this study, an efficient and eco-friendly process has been developed for the synthesis of α-aminophosphonates containing aminothiazole moiety via Kabachnik-Field reaction catalyzed by H₆P₂W₁₈O₆₂.14H₂O as reusable catalyst, by condensation of aromatic aldehydes, 2-aminothiazole and triethylphosphite under free conditions. The X-ray crystallographic data of obtained compounds were provided. The main advantages of our protocol include the absence of solvent in the reaction, easy work-up, short reaction time, atom-economy and reusability of catalyst without significant loss of its activity.

Keywords: aminophosphonates, green synthesis, H₆P₂W₁₈O₆₂.14H₂O catalyst, x-ray study

Procedia PDF Downloads 111

Authors: P. Selva, B. Lorraina, J. Alexis, A. Seror, A. Longuet, C. Mary, F. Denard

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Over the past four decades, the fatigue behavior of nickel-based alloys has been widely studied. However, in recent years, significant advances in the fabrication process leading to grain size reduction have been made in order to improve fatigue properties of aircraft turbine discs. Indeed, a change in particle size affects the initiation mode of fatigue cracks as well as the fatigue life of the material. The present study aims to investigate the fatigue behavior of a newly developed nickel-based superalloy under biaxial-planar loading. Low Cycle Fatigue (LCF) tests are performed at different stress ratios so as to study the influence of the multiaxial stress state on the fatigue life of the material. Full-field displacement and strain measurements as well as crack initiation detection are obtained using Digital Image Correlation (DIC) techniques. The aim of this presentation is first to provide an in-depth description of both the experimental set-up and protocol: the multiaxial testing machine, the specific design of the cruciform specimen and performances of the DIC code are introduced. Second, results for sixteen specimens related to different load ratios are presented. Crack detection, strain amplitude and number of cycles to crack initiation vs. triaxial stress ratio for each loading case are given. Third, from fractographic investigations by scanning electron microscopy it is found that the mechanism of fatigue crack initiation does not depend on the triaxial stress ratio and that most fatigue cracks initiate from subsurface carbides.

Keywords: cruciform specimen, multiaxial fatigue, nickel-based superalloy

Procedia PDF Downloads 289

Authors: L. Mercier, D. Beladjine, K. Beddiar

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The digital transition of building in France brings many changes which some have been able to face very quickly, while others are struggling to find their place and the interest that BIM can bring in their profession. BIM today is already adopted or initiated by construction professionals. However, this change, which can be drastic for some, prevents them from integrating it definitively. This is the case with architects. The profession is shared on the practice of BIM in its exercise. The risk of not adopting this new working method now and of not wanting to switch to its new digital tools leads us to question the future of the profession in view of the gap that is likely to be created within project management. In order to deal with the subject efficiently, our work was based on a documentary watch on BIM and then on the profession of architect, which allowed us to establish links on these two subjects. The observation of the economic model towards which the agencies tend and the trend of the sought after profiles made it possible to develop the opportunities and the brakes likely to impact the future of the profession of architect. The centralization of research directs work towards the conclusion that the model implemented by companies does not allow to integrate BIM within their structure. A solution hypothesis was then issued, focusing on the development of agencies through the diversity of profiles, skills to be integrated internally with the aim of diversifying their skills, and their business practices. In order to address this hypothesis of a multidisciplinary agency model, we conducted a survey of architectural firms. It is built on the model of Anglo-Saxon countries, which do not have the same functioning in comparison to the French model. The results obtained showed a risk of gradual disappearance on the market from small agencies in favor of those who will have and could take this BIM working method. This is why the architectural profession must, first of all, look at what is happening within its training before absolutely wanting to diversify the profiles to integrate into its structure. This directs the study on the training of architects. The schools of French architects are generally behind schedule if we allow the comparison to the schools of engineers. The latter is currently experiencing a slight improvement with the emergence of masters and BIM options during the university course. If the training of architects develops towards learning BIM and the agencies have the desire to integrate different but complementary profiles, then they will develop their skills internally and therefore open their profession to new functions. The place of BIM Management on projects will allow the architect to remain in control of the project because of their overall vision of the project. In addition, the integration of BIM and more generally of the life cycle analysis of the structure will make it possible to guarantee eco-design or eco-construction by approaching the constraints of sustainable development omnipresent on the planet.

Keywords: building information modelling, BIM, BIM management, BIM manager, BIM architect

Procedia PDF Downloads 110

Authors: Redouane Krini, Lutz Nuhn, Hicham El Mard Cheol Woo Ha, Yoondeok Han, Kwang-Sup Lee, Dong-Yol Yang, Jinsoo Joo, Rudolf Zentel

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To use Quantum Dots (QDs) in the two photon initiated polymerization technique (TPIP) for 3D patternings, QDs were modified on the surface with photosensitive end groups which are able to undergo a photopolymerization. We were able to fabricate fluorescent 3D lattice structures using photopatternable QDs by TPIP for photonic devices such as photonic crystals and metamaterials. The QDs in different diameter have different emission colors and through mixing of RGB QDs white light fluorescent from the polymeric structures has been created. Metamaterials are capable for unique interaction with the electrical and magnetic components of the electromagnetic radiation and for manipulating light it is crucial to have a negative refractive index. In combination with QDs via TPIP technique polymeric structures can be designed with properties which cannot be found in nature. This makes these artificial materials gaining a huge importance for real-life applications in photonic and optoelectronic. Understanding of interactions between nanoparticles and biological systems is of a huge interest in the biomedical research field. We developed a synthetic strategy of polymer functionalized nanoparticles for biomedical studies to obtain hybrid systems of QDs and copolymers with a strong binding network in an inner shell and which can be modified in the end through their poly(ethylene glycol) functionalized outer shell. These hybrid systems can be used as models for investigation of cell penetration and drug delivery by using measurements combination between CryoTEM and fluorescence studies.

Keywords: biomedical study models, lithography, photo induced polymerization, quantum dots

Procedia PDF Downloads 520

Authors: Orod Zarrin, Mohesn Ramezan Shirazi, Hassan Moniri

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The use of pile foundations technique is developed to support structures and buildings on soft soil. The most important dynamic load that can affect the pile structure is earthquake vibrations. Pile foundations during earthquake excitation indicate that piles are subject to damage by affecting the superstructure integrity and serviceability. During an earthquake, two types of stresses can damage the pile head, inertial load that is caused by superstructure and deformation which caused by the surrounding soil. Soil deformation and inertial load are associated with the acceleration developed in an earthquake. The acceleration amplitude at the ground surface depends on the magnitude of earthquakes, soil properties and seismic source distance. According to the investigation, the damage is between the liquefiable and non-liquefiable layers and also soft and stiff layers. This damage crushes the pile head by increasing the inertial load which is applied by the superstructure. On the other hand, the cracks on the piles due to the surrounding soil are directly related to the soil profile and causes cracks from small to large. However, the large cracks reason have been listed such as liquefaction, lateral spreading, and inertial load. In the field of designing, elastic response of piles is always a challenge for designer in liquefaction soil, by allowing deflection at top of piles. Moreover, absence of plastic hinges in piles should be insured, because the damage in the piles is not observed directly. In this study, the performance and behavior of pile foundations during liquefaction and lateral spreading are investigated. In addition, emphasize on the soil behavior in the liquefiable and non-liquefiable layers by different aspect of piles damage such as ranking, location and degree of damage are going to discuss.

Keywords: pile, earthquake, liquefaction, non-liquefiable, damage

Procedia PDF Downloads 297

Authors: Andrei Tiberiu Cucuruz, Ecaterina Andronescu, Cristina Daniela Ghitulica, Andreia Cucuruz

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In modern dentistry, the application of resin-based composites continues to increase and in the majority of countries has completely replaced mercury amalgams. Alumina (Al2O3) is a representative bioinert ceramic with a variety of applications in industry as well as in medicine. Alumina has the potential to improve electrical resistivity and thermal conductivity of polymers. The application of poly(methacrylic acid) (PMAA) in medicine was poorly investigated in the past but can lead to good results by the incorporation of alumina particles that can bring bioinertness to the composite. However, because of the differences related to chemical bonding of these materials, the interaction is very weak at the interface leading to no significant values in practical situations. The aim of this work was to modify the structure of alumina with silane coupling agents and to study the influence of silanization on the physicomechanical properties of the resulting composite materials. Two silanes were used in this study: 3-aminopropyl-trimethoxysilane (APTMS) and dichlorodimethylsilane (DCDMS). Both silanes proved to have a significant effect on the overall performance of composites by establishing bonds with the polymer matrix and the filler. All these improvements in dental adhesive systems made for bonding resin composites to tooth structure have enhanced the clinical application of polymeric restorative materials to the position that they are now considered the material of choice for esthetic restoration.

Keywords: alumina, compressive strength, dental materials, silane coupling agents, poly(methacrylic acid)

Procedia PDF Downloads 346

Authors: Panasbodee Thachaopas, Duangdorm Gamnerdsap, Waraporn Inthip, Arissara Pungpa

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LDD’s IM Farm or Land Development Department’s Integrated Management Farm is the agricultural simulation application developed by Land Development Department relies on actual data in simulation game to grow 12 cash crops which are rice, corn, cassava, sugarcane, soybean, rubber tree, oil palm, pineapple, longan, rambutan, durian, and mangosteen. Launching in simulation game, players could select preferable areas for cropping from base map or Orthophoto map scale 1:4,000. Farm management is simulated from field preparation to harvesting. The system uses soil group, and present land use database to facilitate player to know whether what kind of crop is suitable to grow in each soil groups and integrate LDD’s data with other agencies which are soil types, soil properties, soil problems, climate, cultivation cost, fertilizer use, fertilizer price, socio-economic data, plant diseases, weed, pest, interest rate for taking on loan from Bank for Agriculture and Agricultural Cooperatives (BAAC), labor cost, market prices. These mentioned data affect the cost and yield differently to each crop. After completing, the player will know the yield, income and expense, profit/loss. The player could change to other crops that are more suitable to soil groups for optimal yields and profits.

Keywords: agricultural simulation, smart farmer, web application, factors of agricultural production

Procedia PDF Downloads 195

Authors: Igor P. Maximkin, Arkady A. Yukhimchuk, Victor V. Baluev, Igor L. Malkov, Rafael K. Musyaev, Damir T. Sitdikov, Alexey V. Buchirin, Vasily V. Tikhonov

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Minimization of tritium diffusion leakage when developing devices handling tritium-containing media is key problems whose solution will at least allow essential enhancement of radiation safety and minimization of diffusion losses of expensive tritium. One of the ways to solve this problem is to use Al₂O₃ high-strength non-porous ceramics as a structural material of the bed body. This alumina ceramics offers high strength characteristics, but its main advantages are low hydrogen permeability (as against the used structural material) and high dielectric properties. The latter enables direct induction heating of an hydride-forming metal without essential heating of the pressure and containment vessel. The use of alumina ceramics and induction heating allows: - essential reduction of tritium extraction time; - several orders reduction of tritium diffusion leakage; - more complete extraction of tritium from metal hydrides due to its higher heating up to melting in the event of final disposal of the device. The paper presents computational and experimental results for the tritium bed designed to absorb 6 liters of tritium. Titanium was used as hydrogen isotope sorbent. Results of hydrogen realize kinetic from hydride-forming metal, strength and cyclic service life tests are reported. Recommendations are also provided for the practical use of the given bed type.

Keywords: aluminum oxide ceramic, hydrogen pressure, hydrogen isotope storage, titanium hydride

Procedia PDF Downloads 400

Authors: T. Poppendieker

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A new innovative tool for self-myofascial release is widely and increasingly used among athletes of various sports. The application of the foam roll is suggested to improve muscle performance and flexibility. Attempts to examine acute and somewhat long term effects of either have been conducted over the past ten years. However, the results of muscle performance have been inconsistent. It is suggested that regular use over a long period of time results in a different, muscle performance improving outcome. This study examines long-term effects of regular foam rolling combined with a short plyometric routine vs. solely the same plyometric routine on muscle performance and flexibility over a period of six weeks. Results of counter movement jump (CMJ), squat jump (SJ), and isometric maximal force (IMF) of a 90° horizontal squat in a leg-press will serve as parameters for muscle performance. Data on the range of motion (ROM) of the sit and reach test will be used as a parameter for the flexibility assessment. Muscle activation will be measured throughout all tests. Twenty male and twenty female members of a Frankfurt area fitness center chain (7.11) with an average age of 25 years will be recruited. Women and men will be randomly assigned to a foam roll (FR) and a control group. All participants will practice their assigned routine three times a week over the period of six weeks. Tests on CMJ, SJ, IMF, and ROM will be taken before and after the intervention period. The statistic software program SPSS 22 will be used to analyze the data of CMJ, SJ, IMF, and ROM under consideration of muscle activation by a 2 x 2 x 2 (time of measurement x gender x group) analysis of variance with repeated measures and dependent t-test analysis of pre- and post-test. The alpha level for statistic significance will be set at p ≤ 0.05. It is hypothesized that a significant difference in outcome based on gender differences in all four tests will be observed. It is further hypothesized that both groups may show significant improvements in their performance in the CMJ and SJ after the six-week period. However, the FR group is hypothesized to achieve a higher improvement in the two jump tests. Moreover, the FR group may increase IMF as well as flexibility, whereas the control group may not show likewise progress. The results of this study are crucial for the understanding of long-term effects of regular foam roll application. The collected information on the matter may help to motivate the incorporation of foam rolling into training routines, in order to improve athletic performances.

Keywords: counter movement jump, foam rolling, isometric maximal force, long term effects, self-myofascial release, squat jump

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Authors: Didem Venus Yildiz, Murat Hocaoglu, Murat Dursun, Taner Akkan

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The shoulder joint is a more complex structure than the hip or knee joints. In addition to the overall complexity of the shoulder joint, two different factors influence the insufficient outcome of shoulder replacement: the shoulder prosthesis design is far from fully developed and it is difficult to place these shoulder prosthesis due to shoulder anatomy. The glenohumeral joint is the most complex joint of the human shoulder. There are various treatments for shoulder failures such as total shoulder arthroplasty, reverse total shoulder arthroplasty. Due to its reverse design than normal shoulder anatomy, reverse total shoulder arthroplasty has different physiological and biomechanical properties. Post-operative achievement of this arthroplasty is depend on improved design of reverse total shoulder prosthesis. Designation achievement can be increased by several biomechanical and computational analysis. In this study, data of human both shoulders with right side fracture was collected by 3D Computer Tomography (CT) machine in dicom format. This data transferred to 3D medical image processing software (Mimics Materilise, Leuven, Belgium) to reconstruct patient’s left and right shoulders’ bones geometry. Provided 3D geometry model of the fractured shoulder was used to constitute of reverse total shoulder prosthesis by 3-matic software. Finite element (FE) analysis was conducted for comparison of intact shoulder and prosthetic shoulder in terms of stress distribution and displacements. Body weight physiological reaction force of 800 N loads was applied. Resultant values of FE analysis was compared for both shoulders. The analysis of the performance of the reverse shoulder prosthesis could enhance the knowledge of the prosthetic design.

Keywords: reverse shoulder prosthesis, biomechanics, finite element analysis, 3D printing

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Authors: Tetsya Sok, Seong Jae Hong, Young Kyu Kim, Seung Woo Lee

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The temperature distribution for asphalt concrete (AC)-Concrete composite pavement is one of main influencing factor that affects to performance life of pavement. The temperature gradient in concrete slab underneath the AC layer results the critical curling stress and lead to causes de-bonding of AC-Concrete interface. These stresses, when enhanced by repetitive axial loadings, also contribute to the fatigue damage and eventual crack development within the slab. Moreover, the temperature change within concrete slab extremely causes the slab contracts and expands that significantly induces reflective cracking in AC layer. In this paper, the numerical prediction of pavement temperature was investigated using one-dimensional finite different method (FDM) in fully explicit scheme. The numerical predicted model provides a fundamental and clear understanding of heat energy balance including incoming and outgoing thermal energies in addition to dissipated heat in the system. By using the reliable meteorological data for daily air temperature, solar radiation, wind speech and variable pavement surface properties, the predicted pavement temperature profile was validated with the field measured data. Additionally, the effects of AC thickness and daily air temperature on the temperature profile in underlying concrete were also investigated. Based on obtained results, the numerical predicted temperature of AC-Concrete composite pavement using FDM provided a good accuracy compared to field measured data and thicker AC layer significantly insulates the temperature distribution in underlying concrete slab.

Keywords: asphalt concrete, finite different method (FDM), curling effect, heat transfer, solar radiation

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Authors: Gal Belsitzman, Rose Stamp, Atay Citron, Wendy Sandler

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Sign languages are considered endangered. The vitality of sign languages is compromised by its unique sociolinguistic situation, in which hearing parents that give birth to deaf children usually decide to cochlear implant their child. Therefore, these children don’t acquire their natural language – Sign Language. Despite this, many sign languages, such as Israeli Sign Language (ISL) are thriving. The continued survival of similar languages under threat has been associated with the remarkable resilience of the language community. In particular, deaf literary traditions are central in reminding the community of the importance of the language. One example of a deaf literary tradition which has received increased popularity in recent years is deaf theatre. The Ebisu Sign Language Theatre Laboratory, developed as part of the multidisciplinary Grammar of the Body Research Project, is the first deaf theatre company in Israel. Ebisu Theatre combines physical theatre and sign language research, to allow for a natural laboratory to analyze the creative use of the body. In this presentation, we focus on the recent theatre production called ‘Their language’ which tells of the struggle faced by the deaf community to use their own natural language in the education system. A thorough analysis unravels how linguistic properties are integrated with the use of poetic devices and physical theatre techniques in this performance, enabling wider access by both deaf and hearing audiences, without interpretation. Interviews with the audience illustrate the significance of this art form which serves a dual purpose, both as empowering for the deaf community and educational for the hearing and deaf audiences, by raising awareness of community-related issues.

Keywords: deaf theatre, empowerment, language revitalization, sign language

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Authors: Márcia Afonso, Marisa Dinis-Almeida, Cristina Fael

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Climate change, namely precipitation patterns alteration, has led to extreme conditions such as floods and droughts. In turn, excessive construction has led to the waterproofing of the soil, increasing the surface runoff and decreasing the groundwater recharge capacity. The permeable pavements used in areas with low traffic lead to a decrease in the probability of floods peaks occurrence and the sediments reduction and pollutants transport, ensuring rainwater quality improvement. This study aims to evaluate the porous asphalt performance, developed in the laboratory, with addition of cellulosic fibres. One of the main objectives of cellulosic fibres use is to stop binder drainage, preventing its loss during storage and transport. Comparing to the conventional porous asphalt the cellulosic fibres addition improved the porous asphalt performance. The cellulosic fibres allowed the bitumen content increase, enabling retention and better aggregates coating and, consequently, a greater mixture durability. With this solution, it is intended to develop better practices of resilience and adaptation to the extreme climate changes and respond to the sustainability current demands, through the eco-friendly materials use. The mix design was performed for different size aggregates (with fine aggregates – PA1 and with coarse aggregates – PA2). The percentage influence of the fibres to be used was studied. It was observed that overall, the binder drainage decreases as the cellulose fibres percentage increases. It was found that the PA2 mixture obtained most binder drainage relative to PA1 mixture, irrespective of the fibres percentage used. Subsequently, the performance was evaluated through laboratory tests of indirect tensile stiffness modulus, water sensitivity, permeability and permanent deformation. The stiffness modulus for the two mixtures groups (with and without cellulosic fibres) presented very similar values between them. For the water sensitivity test it was observed that porous asphalt containing more fine aggregates are more susceptible to the water presence than mixtures with coarse aggregates. The porous asphalt with coarse aggregates have more air voids which allow water to pass easily leading to ITSR higher values. In the permeability test was observed that asphalt porous without cellulosic fibres presented had lower permeability than asphalt porous with cellulosic fibres. The resistance to permanent deformation results indicates better behaviour of porous asphalt with cellulosic fibres, verifying a bigger rut depth in porous asphalt without cellulosic fibres. In this study, it was observed that porous asphalt with bitumen higher percentages improve the performance to permanent deformation. This fact was only possible due to the bitumen retention by the cellulosic fibres.

Keywords: binder drainage, cellulosic fibres, permanent deformation, porous asphalt

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Authors: Mewa Singh

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Nanomedicine, a fusion of nanotechnology and medicine, is an emerging technology ideally suited to the targeted therapies. Nanoparticles overcome the low selectivity of anti-cancer drugs toward the tumor as compared to normal tissue and hence result-in less severe side-effects. Our new technology, HYBRID-NANOENGINEERING™, uses a new molecule (MR007) in the creation of nanoparticles that not only helps in nanonizing the medicine but also provides synergy to the medicine. The simplified manufacturing process will result in reduced manufacturing costs. Treatment is made more convenient because hybrid nanomedicines can be produced in oral, injectable or transdermal formulations. The manufacturing process uses no protein, oil or detergents. The particle size is below 180 nm with a narrow distribution of size. Importantly, these properties confer great stability of the structure. The formulation does not aggregate in plasma and is stable over a wide range of pH. The final hybrid formulation is stable for at least 18 months as a powder. More than 97 drugs, including paclitaxel, docetaxel, tamoxifen, doxorubicinm prednisone, and artemisinin have been nanonized in water soluble formulations. Preclinical studies on cell cultures of tumors show promising results. Our HYBRID-NANOENGINEERING™ platform enables the design and development of hybrid nano-pharmaceuticals that combine efficacy with tolerability, giving patients hope for both extended overall survival and improved quality of life. This study would discuss or present this new discovery of HYBRID-NANOENGINEERING™ which targets drug delivery, synergistic, and potentiating effects, and barriers of drug delivery and advanced drug delivery systems.

Keywords: nano-medicine, nano-particles, drug delivery system, pharmaceuticals

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Authors: Nondumiso Lushozi, Busisani Lembede, Eliton Chivandi

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Consumption of fructose increases the risk of obesity, nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome in children. Zingerone which is found in ginger has antidiabetic and antiobesogenic properties. Therefore, the aim of the study was to investigate the potential of orally administered zingerone to protect growing Sprague-Dawley rats (mimicking growing children) against high-fructose diet-induced metabolic derangements. Forty, 21-day old female Sprague-Dawley rats were randomly allocated and administered the following four treatments for 12 weeks: group I: standard rat chow (SR) + plain water (PW) + plain gelatine cube (PC). group II: SR + 20% (w/v) fructose solution (FS) + PC. group III: SR + FS + 100 mg/kg/day of fenofibrate in gelatine cube. group IV: SR+ FS + 20 mg/kg/day of zingerone in gelatine cube. The rats’ triglyceride, cholesterol, insulin & adiponectin concentration, visceral fat liver lipid content, homoeostasis model assessment of insulin resistance (HOMA-IR) and ability to handle glucose were determined. Oral administration of zingerone significantly increased (P<0.001) visceral fat and liver lipid content (P<0.001), respectively. Results from the study revealed that administration of 20% fructose solution did not induce metabolic dysfunction, however the zingerone treatment increased visceral fat and liver lipid content, all these lipid abnormalities are typical features of the metabolic syndrome, therefore the current study suggests that zingerone has no effect on metabolic dysfunction in adolescent females.

Keywords: antidiabetic, metabolic syndrome, zingerone, antiobesogenic

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Authors: Pixiang Wang, Shaoyang Liu, Yucheng Peng

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Polypropylene (PP) is an essential material of numerous applications in different industrial sectors, including packaging, construction, and automotive. Because the application of homopolypropylene (HPP) is limited by its relatively low impact strength and high embrittlement temperature, various types of impact copolymer PP (ICPP) that incorporate elastomers/rubbers into HPP to increase impact strength have been successfully commercialized. Crystallization kinetics of an isotactic HPP, an ICPP, and their composites were studied in this work understand the composites’ behaviors better. The Avrami-Jeziorny model was used to describe the crystallization process. For most samples, the Avrami exponent, n, was greater than 3, indicating the crystal grew in three dimensions with spherical geometry. However, the n value could drop below 3 when the ICPP content was 80 wt.% or higher and the cooling rate was 7.5°C/min or lower, implying that the crystals could grow in two dimensions and some lamella structures could be formed under those conditions. The nucleation activity increased with the increase of the ICPP content, demonstrating that the rubber phase in the ICPP acted as a nucleation agent and facilitated the nucleation process. The decrease in crystallization rate after the ICPP content exceeded 60 wt.% might be caused by the excessive amount of crystal nuclei induced by the high ICPP content, which caused strong crystal-crystal interactions and limited the crystal growth space. The nucleation activity and the n value showed high correlations to the mechanical and thermal properties of the materials. The quantitative study of the kinetics of crystallization in this work could be a helpful reference for manufacturing ICPP and HPP/ICPP mixtures.

Keywords: polypropylene, crystallization kinetics, Avrami-Jeziorny model, crystallization activation energy, Nucleation activity

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Authors: Kristof Grätz

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Background: Coping with crisis situations (e.g., the identity crisis in adolescence) is omnipresent in today's socialization and should be encouraged as a child. For this reason, students should be given the opportunity to create, endure and manage these crisis situations in a sporting context within the project “Herausforderung.” They should prove themselves by working on a self-assigned task, accompanied by ‚coaches’ in a place outside of their hometown. The aim of the project is to observe this process from a resource-oriented perspective. Health promotion, as called for by the WHO in the Ottawa Charter since 1986, includes strengthening psychosocial resources. These include cognitive, emotional, and social potentials that contribute to improving the quality of life, provide favourable conditions for coping with health burdens and enable people to influence their physical performance and well-being self-confidently and actively. A systematic strengthening of psychosocial resources leads to an improvement in mental health and contributes decisively to the regular implementation and long-term maintenance of this health behavior. Previous studies have already shown significant increases in self-concept following experiential educational measures [Fengler, 2007; Eberle & Fengler, 2018] and positive effects of experience-based school trips on the social competence of students [Reuker, 2009]. Method: The research project examines the influence of the project “Herausforderung” on psychosocial resources such as self-efficacy, self-concept, social support, and group cohesion. The students participating in the project will be tested in a pre-post design in the context of the challenge. This test includes specific questions to capture the different psychosocial resources. For the measurement, modifications of existing scales with good item selectivity and reliability are used to a large extent, so that acceptable item and scale values can be expected. If necessary, the scales were adapted or shortened to the specific context in order to ensure a balanced relationship between reliability and test economy. Specifically, these are already tested scales such as FRKJ 8-16, FSKN, GEQ, and F-SozU. The aim is to achieve a sample size of n ≥ 100. Conclusion: The project will be reviewed with regard to its effectiveness, and implications for a resource-enhancing application in sports settings will be given. Conclusions are drawn as to which extent to specific experiential educational content in physical education can have a health-promoting effect on the participants.

Keywords: children, education, health promotion, psychosocial resources

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Authors: Samaneh Farokhirad, Fatemeh Ahmadpoor

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Biological membranes are constantly in contact with various filamentous soft nanostructures that either reside on their surface or are being transported between the cell and its environment. In particular, viral infections are determined by the interaction of viruses (such as filovirus) with cell membranes, membrane protein organization (such as cytoskeletal proteins and actin filament bundles) has been proposed to influence the mechanical properties of lipid membranes, and the adhesion of filamentous nanoparticles influence their delivery yield into target cells or tissues. The goal of this research is to integrate the rapidly increasing but still fragmented experimental observations on the adhesion and self-assembly of nanofilaments (including filoviruses, actin filaments, as well as natural and synthetic nanofilaments) on cell membranes into a general, rigorous, and unified knowledge framework. The global outbreak of the coronavirus disease in 2020, which has persisted for over three years, highlights the crucial role that nanofilamentbased delivery systems play in human health. This work will unravel the role of a unique property of all cell membranes, namely flexoelectricity, and the significance of nanofilaments’ flexibility in the adhesion and self-assembly of nanofilaments on cell membranes. This will be achieved utilizing a set of continuum mechanics, statistical mechanics, and molecular dynamics and Monte Carlo simulations. The findings will help address the societal needs to understand biophysical principles that govern the attachment of filoviruses and flexible nanofilaments onto the living cells and provide guidance on the development of nanofilament-based vaccines for a range of diseases, including infectious diseases and cancer.

Keywords: virus nanofilaments, cell mechanics, computational biophysics, statistical mechanics

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Authors: Mohd Yussni Hashim, Mohd Nazrul Roslan, Shahruddin Mahzan Mohd Zin, Saparudin Ariffin

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Fiber cross-sectional area value is a crucial factor in determining the strength properties of natural fiber. Furthermore, unlike synthetic fiber, a diameter and cross-sectional area of natural fiber has a large variation along and between the fibers. This study aims to determine the main and interaction effects of alkali treatment conditions that influence kenaf bast fiber mean cross-sectional area. Three alkali treatment conditions at two different levels were selected. The conditions setting were alkali concentrations at two and ten w/v %; fiber immersed temperature at room temperature and 1000C; and fiber immersed duration for 30 and 480 minute. Untreated kenaf fiber was used as a control unit. Kenaf bast fiber bundle mounting tab was prepared according to ASTM C1557-03. The cross-sectional area was measured using a Leica video analyzer. The study result showed that kenaf fiber bundle mean cross-sectional area was reduced 6.77% to 29.88% after alkali treatment. From the analysis of variance, it shows that the interaction of alkali concentration and immersed time has a higher magnitude at 0.1619 compared to alkali concentration and immersed temperature interaction that was 0.0896. For the main effect, alkali concentration factor contributes to the higher magnitude at 0.1372 which indicated the decrease pattern of variability when the level changed from lower to the higher level. Then, it was followed by immersed temperature at 0.1261 and immersed time at 0.0696 magnitudes.

Keywords: natural fiber, kenaf bast fiber bundles, alkali treatment, cross-sectional area

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Authors: R. Tariq, R. Lee

Abstract:

Background: Additional demands placed on senior clinical teams with ongoing COVID-19 management has accelerated the need to harness the wider healthcare professional resources and upskill them to take on greater clinical responsibility safely. The UK NHS Long Term Plan (2019)¹ emphasises the importance of expanding Advanced Practitioners’ (APs) roles to take on more clinical diagnostic responsibilities to cope with increased demand. In acute settings, APs are often the first point of care for patients and require training to take on initial triage responsibilities efficiently and safely. Critically, their roles include determining which onward services the patients may require, and assessing whether they can be treated at home, avoiding unnecessary admissions to the hospital. Dem Dx is a Clinical Reasoning Platform (CRP) that claims to help frontline healthcare professionals independently assess and triage patients. It guides the clinician from presenting complaints through associated symptoms to a running list of differential diagnoses, media, national and institutional guidelines. The objective of this study was to compare the clinical referral rates and guidelines adherence registered by the HMR Urgent Community Care Team (UCCT)² and Dem Dx recommendations using retrospective cases. Methodology: 192 cases seen by the UCCT were anonymised and reassessed using Dem Dx clinical pathways. We compared the UCCT’s performance with Dem Dx regarding the appropriateness of onward referrals. We also compared the clinical assessment regarding adherence to NICE guidelines recorded on the clinical notes and the presence of suitable guidance in each case. The cases were audited by two medical doctors. Results: Dem Dx demonstrated appropriate referrals in 85% of cases, compared to 47% in the UCCT team (p<0.001). Of particular note, Dem Dx demonstrated an almost 65% (p<0.001) improvement in the efficacy and appropriateness of referrals in a highly experienced clinical team. The effectiveness of Dem Dx is in part attributable to the relevant NICE and local guidelines found within the platform's pathways and was found to be suitable in 86% of cases. Conclusion: This study highlights the potential of clinical decision support, as Dem Dx, to improve the quality of onward clinical referrals delivered by a multidisciplinary team in primary care. It demonstrated that it could support healthcare professionals in making appropriate referrals, especially those that may be overlooked by providing suitable clinical guidelines directly embedded into cases and clear referral pathways. Further evaluation in the clinical setting has been planned to confirm those assumptions in a prospective study.

Keywords: advanced practitioner, clinical reasoning, clinical decision-making, management, multidisciplinary team, referrals, triage

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