Search results for: total load demand
3358 The Influence of Caregivers’ Preparedness and Role Burden on Quality of Life among Stroke Patients
Authors: Yeaji Seok, Myung Kyung Lee
Abstract:
Background: Even if patients survive after a stroke, stroke patients may experience disability in mobility, sensation, cognition, and speech and language. Stroke patients require rehabilitation for functional recovery and daily life for a considerable time. During rehabilitation, the role of caregivers is important. However, the stroke patients’ quality of life may deteriorate due to family caregivers’ non-preparedness and increased role burden. Purpose: To investigate the prediction of caregivers' preparedness and role burden on stroke patients’ quality of life. Methods: The target population was stroke patients who were hospitalized for rehabilitation and their family care providers. A total of 153 patient-family caregiver dyads were recruited from June to August 2021. Data were collected from self-reported questionnaires and analyzed using descriptive statistics, t-tests, chi-squared test, one-way analysis of variance, Pearson’s correlation coefficients, and multiple regression with SPSS statistics 28 programs. Results: Family caregivers’ preparedness affected stroke patients’ mobility (β = .20, p < 0.05) and character (β = -.084, p < 0.05) and production activities (β = -.197, p < 0.05) in quality of life. The role burden of family caregivers affected language skills (β = .310, p<0.05), visual functions (β=-.357, p < 0.05), thinking skills (β = 0.443, p = 0.05), mood conditions (β = 0.565, p < 0.001), family roles (β = -0.361, p < 0.001), and social roles (β = -0.304, p < 0.001), while the caregivers’ burden of performing self-protection negatively affected patients’ social roles (β = .180, p=.048). In addition, caregivers’ role burden of personal life sacrifice affected patients’ mobility (β = .311, p < 0.05), self-care (β =.232, p < 0.05) and energy (β = .239, p < 0.05). Conclusion: This study indicated that family caregivers' preparedness and role burden affected stroke patients’ quality of life. The results of this study suggested that intervention to improve family caregivers’ preparedness and to reduce role burden should be required for quality of life in stroke patients.Keywords: quality of life, preparedness, role burden, caregivers, stroke
Procedia PDF Downloads 2163357 International Tourists’ Travel Motivation by Push-Pull Factors and Decision Making for Selecting Thailand as Destination Choice
Authors: Siripen Yiamjanya, Kevin Wongleedee
Abstract:
This research paper aims to identify travel motivation by push and pull factors that affected decision making of international tourists in selecting Thailand as their destination choice. A total of 200 international tourists who traveled to Thailand during January and February, 2014 were used as the sample in this study. A questionnaire was employed as a tool in collecting the data, conducted in Bangkok. The list consisted of 30 attributes representing both psychological factors as “push- based factors” and destination factors as “pull-based factors”. Mean and standard deviation were used in order to find the top ten travel motives that were important determinants in the respondents’ decision making process to select Thailand as their destination choice. The finding revealed the top ten travel motivations influencing international tourists to select Thailand as their destination choice included [i] getting experience in foreign land; [ii] Thai food; [iii] learning new culture; [iv] relaxing in foreign land; [v] wanting to learn new things; [vi] being interested in Thai culture, and traditional markets; [vii] escaping from same daily life; [viii] enjoying activities; [ix] adventure; and [x] good weather. Classification of push- based and pull- based motives suggested that getting experience in foreign land was the most important push motive for international tourists to travel, while Thai food portrayed its highest significance as pull motive. Discussion and suggestions were also made for tourism industry of Thailand.Keywords: decision making, destination choice, international tourist, pull factor, push factor, Thailand, travel motivation
Procedia PDF Downloads 3973356 Formal Stress Management Teaching Incorporated into the First Year of a Doctor's Practice: A Career Transition Study of British Foundation Year 1 Doctors
Authors: Edward Ridyard, Vinary Varadarajan
Abstract:
Background and Aims: The first year as a doctor in any country represents a major career transition in any physician's life. During this period, many physicians concentrate on obtaining clinical skills but may not obtain the important skills necessary to cope with stress. In this study we elucidate stress levels amongst FY1 doctors regarding the transitioning into specialty career choices, working in the NHS and anxiety about future career success. Methods: A prospective single blinded analysis of Foundation Year one (FY1) trainees using a non-mandatory online questionnaire was distributed. No exclusion criteria were applied. The only inclusion criteria was the doctor was in a full-time FY1 post and this was their first job in the UK. A total of n= 22 doctors were included in the study. After data collection, statistical analysis using chi-squared testing was applied. Results: The large majority of FY1 doctors (72.7%) already knew what specialty they wished to pursue (p=0.0001). With regards to their future careers 45.5% of FY1 doctors stated "above average" stress levels. The majority of FY1 doctors (64.3%) stated their stress levels working in the NHS were either "above average" or "high". Finally, 81.8% of respondents know colleagues who have been put off from pursuing specialties due to the stress of competition. Conclusions: A large majority of FY1 doctors already know at this early stage what area they would like to specialise in. With this in mind, a large proportion have above "average" levels of stress with regards to securing this future career path. The most worrying finding is that 64.3% of FY1s stated they had "above average" or "high" stress levels working in the NHS. We therefore recommend formal stress management education to be incorporated into the foundation programme curriculum.Keywords: stress, anxiety, junior doctor, education
Procedia PDF Downloads 3753355 Re-Evaluation of Functional Assessment of Anorexia/Cachexia Therapy (Appetite Scale) with Nutritional Intake of Cancer Patients
Authors: Amena Omer Syeda, Harita Shyam
Abstract:
Background: Anorexia a common symptom among patients with prolonged illness leading to anorexia-cachexia syndrome with a prevalence rate of 70%. In order to provide effective health care and better response to treatment, appetite should be assessed on admission and then periodically for earlier nutrition intervention. Functional Assessment of Anorexia/Cachexia Therapy (FAACT) appetite scale is 12 questions, patient-rated, symptom specific measure for appetite, and distress from anorexia. It assigns a score ranging from 0 (worst response) to 4 (best response). Therefore, proposing a total score of ≤24 may be sufficient to make a diagnosis of anorexia. Objectives: To assess the FAACT scale by co-relating the scores with the Nutritional intake and BMI of Cancer Patients. Methods: The FAACT scores of 100 cancer in-patients receiving chemotherapy or radiation as treatment, their 24-hour calorie and protein intake and BMI were recorded. The data was then statistically analyzed. Results: The calorie and protein intake and FAACT scores both showed a significant positive co-relation (p<0.001), inferring that the patients with a FAACT score of ≤24 where not meeting their calorie as well as protein requirements, hence rightly categorizing them as anorexic. The co-relation between BMI and FAACT scores showed a weak co-relation and was not statistically significant (p > 0.05).The FAACT scale thus is not sensitive to distinguish patients being under-weight, normal weight or obese. Conclusion: The FAACT scale helps in providing better palliative and nutritional care as it correctly assessed anorexia /cachexia in cancer patients and co-related significantly with their nutrient intake.Keywords: appetite, cachexia, cancer, malnutrition
Procedia PDF Downloads 2503354 The Influence of Service Quality on Customer Satisfaction and Customer Loyalty at a Telecommunication Company in Malaysia
Authors: Noor Azlina Mohamed Yunus, Baharom Abd Rahman, Abdul Kadir Othman, Narehan Hassan, Rohana Mat Som, Ibhrahim Zakaria
Abstract:
Customer satisfaction and customer loyalty are the most important outcomes of marketing in which both elements serve various stages of consumer buying behavior. Excellent service quality has become a major corporate goal as more companies gradually struggle for quality for their products and services. Therefore, the main purpose of this study is to investigate the influence of service quality on customer satisfaction and customer loyalty at one telecommunication company in Malaysia which is Telekom Malaysia. The scope of this research is to evaluate satisfaction on the products or services at TMpoint Bukit Raja, Malaysia. The data are gathered through the distribution of questionnaires to a total of 306 respondents who visited and used the products or services. By using correlation and multiple regression analyses, the result revealed that there was a positive and significant relationship between service quality and customer satisfaction. The most influential factor on customer satisfaction was empathy followed by reliability, assurance and tangibles. However, there was no significant influence between responsiveness and customer satisfaction. The result also showed there was a positive and significant relationship between service quality and customer loyalty. The most influential factor on customer loyalty was assurance followed by reliability and tangibles. TMpoint Bukit Raja is recommended to device excellent strategies to satisfy customers’ needs and to adopt action-oriented approach by focusing on what the customers wanted. It is also recommended that similar study can be carried out in other industries using different methodologies such as longitudinal method, enlarge the sample size and use a qualitative approach.Keywords: customer satisfaction, customer loyalty, service quality, telecommunication company
Procedia PDF Downloads 4583353 Functional Ingredients from Potato By-Products: Innovative Biocatalytic Processes
Authors: Salwa Karboune, Amanda Waglay
Abstract:
Recent studies indicate that health-promoting functional ingredients and nutraceuticals can help support and improve the overall public health, which is timely given the aging of the population and the increasing cost of health care. The development of novel ‘natural’ functional ingredients is increasingly challenging. Biocatalysis offers powerful approaches to achieve this goal. Our recent research has been focusing on the development of innovative biocatalytic approaches towards the isolation of protein isolates from potato by-products and the generation of peptides. Potato is a vegetable whose high-quality proteins are underestimated. In addition to their high proportion in the essential amino acids, potato proteins possess angiotensin-converting enzyme-inhibitory potency, an ability to reduce plasma triglycerides associated with a reduced risk of atherosclerosis, and stimulate the release of the appetite regulating hormone CCK. Potato proteins have long been considered not economically feasible due to the low protein content (27% dry matter) found in tuber (Solanum tuberosum). However, potatoes rank the second largest protein supplying crop grown per hectare following wheat. Potato proteins include patatin (40-45 kDa), protease inhibitors (5-25 kDa), and various high MW proteins. Non-destructive techniques for the extraction of proteins from potato pulp and for the generation of peptides are needed in order to minimize functional losses and enhance quality. A promising approach for isolating the potato proteins was developed, which involves the use of multi-enzymatic systems containing selected glycosyl hydrolase enzymes that synergistically work to open the plant cell wall network. This enzymatic approach is advantageous due to: (1) the use of milder reaction conditions, (2) the high selectivity and specificity of enzymes, (3) the low cost and (4) the ability to market natural ingredients. Another major benefit to this enzymatic approach is the elimination of a costly purification step; indeed, these multi-enzymatic systems have the ability to isolate proteins, while fractionating them due to their specificity and selectivity with minimal proteolytic activities. The isolated proteins were used for the enzymatic generation of active peptides. In addition, they were applied into a reduced gluten cookie formulation as consumers are putting a high demand for easy ready to eat snack foods, with high nutritional quality and limited to no gluten incorporation. The addition of potato protein significantly improved the textural hardness of reduced gluten cookies, more comparable to wheat flour alone. The presentation will focus on our recent ‘proof-of principle’ results illustrating the feasibility and the efficiency of new biocatalytic processes for the production of innovative functional food ingredients, from potato by-products, whose potential health benefits are increasingly being recognized.Keywords: biocatalytic approaches, functional ingredients, potato proteins, peptides
Procedia PDF Downloads 3833352 Enhancement in Bactericidal Activity of Hydantoin Based Microsphere from Smooth to Rough
Authors: Rajani Kant Rai, Jayakrishnan Athipet
Abstract:
There have been several attempts to prepare polymers with antimicrobial properties by doping with various N-halamines. Hydantoins (Cyclic N-halamine) is of importance due to their stability rechargeable chloroamide function, broad-spectrum anti-microbial action and ability to prevent resistance to the organisms. Polymerizable hydantoins are synthesized by tethering vinyl moieties to 5,5,-dialkyl hydantoin sacrificing the imide hydrogen in the molecule thereby restricting the halogen capture only to the amide nitrogen that results in compromised antibacterial activity. In order to increase the activity of the antimicrobial polymer, we have developed a scheme to maximize the attachment of chlorine to the amide and the imide moieties of hydantoin. Vinyl hydantoin monomer, (Z)-5-(4-((3-methylbuta-1,3-dien-2-yl)oxy)benzylidene)imidazolidine-2,4-dione (MBBID) was synthesized and copolymerized with a commercially available monomer, methyl methacrylate, by free radical polymerization. The antimicrobial activity of hydantoin is strongly dependent on their surface area and hence their microbial activity increases when incorporated in microspheres or nanoparticles as compared to their bulk counterpart. In this regard, smooth and rough surface microsphere of the vinyl monomer (MBBID) with commercial monomer was synthesized. The oxidative chlorine content of the copolymer ranged from 1.5 to 2.45 %. Further, to demonstrate the water purification potential, the thin column was packed with smooth or rough microspheres and challenged with simulated contaminated water that exhibited 6 log kill (total kill) of the bacteria in 20 minutes of exposure with smooth (25 mg/ml) and rough microsphere (15.0 mg/ml).Keywords: cyclic N-halamine, vinyl hydantoin monomer, rough surface microsphere, simulated contaminated water
Procedia PDF Downloads 1483351 Preparation of Activated Carbon From Waste Feedstock: Activation Variables Optimization and Influence
Authors: Oluwagbemi Victor Aladeokin
Abstract:
In the last decade, the global peanut cultivation has seen increased demand, which is attributed to their health benefits, rising to ~ 41.4 MMT in 2019/2020. Peanut and other nutshells are considered as waste in various parts of the world and are usually used for their fuel value. However, this agricultural by-product can be converted to a higher value product such as activated carbon. For many years, due to the highly porous structure of activated carbon, it has been widely and effectively used as an adsorbent in the purification and separation of gases and liquids. Those used for commercial purposes are primarily made from a range of precursors such as wood, coconut shell, coal, bones, etc. However, due to difficulty in regeneration and high cost, various agricultural residues such as rice husk, corn stalks, apricot stones, almond shells, coffee beans, etc, have been explored to produce activated carbons. In the present study, the potential of peanut shells as precursors in the production of activated carbon and their adsorption capacity is investigated. Usually, precursors used to produce activated carbon have carbon content above 45 %. A typical raw peanut shell has 42 wt.% carbon content. To increase the yield, this study has employed chemical activation method using zinc chloride. Zinc chloride is well known for its effectiveness in increasing porosity of porous carbonaceous materials. In chemical activation, activation temperature and impregnation ratio are parameters commonly reported to be the most significant, however, this study has also studied the influence of activation time on the development of activated carbon from peanut shells. Activated carbons are applied for different purposes, however, as the application of activated carbon becomes more specific, an understanding of the influence of activation variables to have a better control of the quality of the final product becomes paramount. A traditional approach to experimentally investigate the influence of the activation parameters, involves varying each parameter at a time. However, a more efficient way to reduce the number of experimental runs is to apply design of experiment. One of the objectives of this study is to optimize the activation variables. Thus, this work has employed response surface methodology of design of experiment to study the interactions between the activation parameters and consequently optimize the activation parameters (temperature, impregnation ratio, and activation time). The optimum activation conditions found were 485 °C, 15 min and 1.7, temperature, activation time, and impregnation ratio respectively. The optimum conditions resulted in an activated carbon with relatively high surface area ca. 1700 m2/g, 47 % yield, relatively high density, low ash, and high fixed carbon content. Impregnation ratio and temperature were found to mostly influence the final characteristics of the produced activated carbon from peanut shells. The results of this study, using response surface methodology technique, have revealed the potential and the most significant parameters that influence the chemical activation process, of peanut shells to produce activated carbon which can find its use in both liquid and gas phase adsorption applications.Keywords: chemical activation, fixed carbon, impregnation ratio, optimum, surface area
Procedia PDF Downloads 1503350 Validity of Clinical Disease Activity Index (CDAI) to Evaluate the Disease Activity of Rheumatoid Arthritis Patients in Sri Lanka: A Prospective Follow up Study Based on Newly Diagnosed Patients
Authors: Keerthie Dissanayake, Chandrika Jayasinghe, Priyani Wanigasekara, Jayampathy Dissanayake, Ajith Sominanda
Abstract:
The routine use of Disease Activity Score-28 (DAS28) to assess the disease activity in rheumatoid arthritis (RA) is limited due to its dependency on laboratory investigations and the complex calculations involved. In contrast, the clinical disease activity index (CDAI) is simple to calculate, which makes the "treat to target" strategy for the management of RA more practical. We aimed to assess the validity of CDAI compared to DAS28 in RA patients in Sri Lanka. A total of 103 newly diagnosed RA patients were recruited, and their disease activity was calculated using DAS 28 and CDAI during the first visit to the clinic (0 months) and re-assessed at 4 and 9 months of the follow-up visits. The validity of the CDAI, compared to DAS 28, was evaluated. Patients had a female preponderance (6:1) and a short symptom duration (mean = 6.33 months). The construct validity of CDAI, as assessed by Cronbach's α test, was 0.868. Convergent validity was assessed by correlation and Kappa statistics. Strong positive correlations were observed between CDAI and DAS 28 at the baseline (0 months), 4, and 9 months of evaluation (Spearman's r = 0.9357, 0.9354, 0.9106, respectively). Moderate-good inter-rater agreements between the DAS-28 and CDAI were observed (Weighted kappa of 0.660, 0.519, and 0.741 at 0, 4, and 9 months respectively). Discriminant validity, as assessed by ROC curves at 0, 4th, and 9th months of the evaluation, showed the area under the curve (AUC) of 0.958, 0.985, and 0.914, respectively. The suggested cut-off points for different CDAI disease activity categories according to ROC curves were ≤ 2 (Remission), >2 to ≤ 5 (low), >5 to ≤ 18 (moderate), > 18 (high). These findings indicate that the CDAI has good concordance with DAS 28 in assessing the disease activity in RA patients in this study sample.Keywords: rheumatoid arthritis, CDAI, disease activity, Sri Lanka, validation
Procedia PDF Downloads 1573349 Low Enrollment in Antiretroviral Treatment among Pregnant Women Screened HIV Infected in Informal Health Centers in Cameroon
Authors: Lydie Audrey Amboua Schouame, Sylvie Kwedi Nolna, Antoine Socpa, Alexandre Benjamin Nkoum
Abstract:
Background: Despite the struggle of the Cameroonian Ministry of Public Health against informal health centers (IHCs) because of their illegality, IHCs are booming in Cameroon and a large part of the population uses them. In 2017, more than 3.000 IHCs were counted across the country. Most of these IHCs have antenatal clinics and they screen pregnant women for HIV. However, there is no data on the Prevention of Mother-To-Child Transmission of HIV (PMTCT) in this informal health sector in Cameroon. This study aimed to investigate the initiation of Antiretroviral treatment (ART) in pregnant women screened HIV positive in IHCs and associated factors. Methods: From January 01, 2018, to June 30, 2020, we carried out a cohort study of pregnant women attending their first antenatal visit and screened HIV positive in informal health centers in the cities of Douala and Ebolowa in Cameroon. Consenting participants were interviewed at two points: at least one week after delivery of the HIV result and three months later. The collected data were entered into Kobo collected and analyzed in SPSS V23.0 software. Results: A total of 182 HIV-infected pregnant women were enrolled in the study. The median age at enrollment was 30 years (IQR, 24-34) and the median gestational age at first ANC was 25 weeks (IQR, 19-31). Overall 61% (111/182) had a secondary level of education, 65% (118/182) were married/in a common-law relationship and 69% (126/182) had no income activity. At their first ANC, 91% (166/182) were naïve to ARV treatment. Among them, only 45% (74/166) initiated ART. The median delay in initiating ARV treatment was 5 days (IQR, 0-25). Of those who have started ART, only 64% (48/74) remained on treatment 3 months later. Conclusion: In order to eliminate mother-to-child transmission of HIV, attention should be paid to IHCs.Keywords: informal health centers, human immunodeficiency, antiretroviral treatment, pregnant women
Procedia PDF Downloads 1603348 Low Students' Access to University Education in Nigeria: Causes and Remedy
Authors: Robert Ogbanje Okwori
Abstract:
The paper explained the causes low students’ access to university education in Nigeria and how it can be remedied. It is discovered that low students’ access to university education in Nigeria is evident despite these number of universities in the country. In 2006/2007 academic session, 806,089 sat for Joint Unified Matriculation Board Examination (JAMB) into Nigerian universities and only 123,626 (15.3%) were admitted while 2011/2012 academic session, a total of 1,493,604 candidates sat for Joint Unified Matriculation Board Examination (JAMB) into Nigerian universities and only 65,073 (43.57%) were admitted. This necessitates for the research. Therefore, the study posed the following research questions. What are causes of low students’ access to university education in Nigeria? What are the challenges of students’ access to university education in Nigeria? How can students’ access to university education in Nigeria be improved? Sample survey research design was adopted for the study. A structured questionnaire was used to gather data for the study. Six hundred and eighty (680) respondents which comprised of 100 level university students; JAMB Officers and University administrators (Vice Chancellors, Registrars and Admission Officers) were used for the study. Stratified random sampling was applied for adequate representation of respondents from universities in the six geopolitical zones of Nigeria. Mean was used to answer research questions while Kuder-Richardson formula 20 was used to check the internal consistency of the instrument. The correlation coefficient of the instrument was 0.87. The major findings include the carrying capacity of each university contributes to low students’ access to university education and academic staff were inadequate. From the analysis of the study, it is concluded that the rate of access to university education is low, therefore, every university should establish distance learning programme to reduce university admission crisis. The training infrastructure in the universities should be improved upon by the owners to increase the carrying capacity of each university.Keywords: access, causes, low, university
Procedia PDF Downloads 4753347 Status of Vocational Education and Training in India: Policies and Practices
Authors: Vineeta Sirohi
Abstract:
The development of critical skills and competencies becomes imperative for young people to cope with the unpredicted challenges of the time and prepare for work and life. Recognizing that education has a critical role in reaching sustainability goals as emphasized by 2030 agenda for sustainability development, educating youth in global competence, meta-cognitive competencies, and skills from the initial stages of formal education are vital. Further, educating for global competence would help in developing work readiness and boost employability. Vocational education and training in India as envisaged in various policy documents remain marginalized in practice as compared to general education. The country is still far away from the national policy goal of tracking 25% of the secondary students at grade eleven and twelve under the vocational stream. In recent years, the importance of skill development has been recognized in the present context of globalization and change in the demographic structure of the Indian population. As a result, it has become a national policy priority and taken up with renewed focus by the government, which has set the target of skilling 500 million people by 2022. This paper provides an overview of the policies, practices, and current status of vocational education and training in India supported by statistics from the National Sample Survey, the official statistics of India. The national policy documents and annual reports of the organizations actively involved in vocational education and training have also been examined to capture relevant data and information. It has also highlighted major initiatives taken by the government to promote skill development. The data indicates that in the age group 15-59 years, only 2.2 percent reported having received formal vocational training, and 8.6 percent have received non-formal vocational training, whereas 88.3 percent did not receive any vocational training. At present, the coverage of vocational education is abysmal as less than 5 percent of the students are covered by the vocational education programme. Besides, launching various schemes to address the mismatch of skills supply and demand, the government through its National Policy on Skill Development and Entrepreneurship 2015 proposes to bring about inclusivity by bridging the gender, social and sectoral divide, ensuring that the skilling needs of socially disadvantaged and marginalized groups are appropriately addressed. It is fundamental that the curriculum is aligned with the demands of the labor market, incorporating more of the entrepreneur skills. Creating nonfarm employment opportunities for educated youth will be a challenge for the country in the near future. Hence, there is a need to formulate specific skill development programs for this sector and also programs for upgrading their skills to enhance their employability. There is a need to promote female participation in work and in non-traditional courses. Moreover, rigorous research and development of a robust information base for skills are required to inform policy decisions on vocational education and training.Keywords: policy, skill, training, vocational education
Procedia PDF Downloads 1583346 Multidrug Resistance Mechanisms among Gram Negative Clinical Isolates from Egypt
Authors: Mona T. Kashef, Omneya M. Helmy
Abstract:
Multidrug resistant (MDR) bacteria have become a significant public health threat. The prevalence rates, of Gram negative MDR bacteria, are in continuous increase. However, few data are available about these resistant strains. Since, third generation cephalosporins are one of the most commonly used antimicrobials, we set out to investigate the prevalence, different mechanisms and clonal relatedness of multidrug resistance among third generation resistant Gram negative clinical isolates. A total of 114 Gram negative clinical isolates, previously characterized as being resistant to at least one of 3rd generation cephalosporins, were included in this study. Each isolate was tested, using Kirby Bauer disk diffusion method, against its assigned categories of antimicrobials. The role of efflux pump in resistance development was tested by the efflux pump inhibitor-based microplate assay using chloropromazine as an inhibitor. Detecting different aminoglycosides, β-lactams and quinolones resistance genes was done using polymerase chain reaction. The genetic diversity of MDR isolates was investigated using Random Amplification of Polymorphic DNA technique. MDR phenotype was detected in 101 isolates (89%). Efflux pump mediated resistance was detected in 49/101 isolates. Aminoglycosides resistance genes; armA and aac(6)-Ib were detected in one and 53 isolates, respectively. The aac(6)-Ib-cr allele, that also confers resistance to floroquinolones, was detected in 28/53 isolates. β-lactam resistance genes; blaTEM, blaSHV, blaCTX-M group 1 and group 9 were detected in 52, 29, 61 and 35 isolates, respectively. Quinolone resistance genes; qnrA, qnrB and qnrS were detectable in 2, 14, 8 isolates respectively, while qepA was not detectable at all. High diversity was observed among tested MDR isolates. MDR is common among 3rd generation cephalosporins resistant Gram negative bacteria, in Egypt. In most cases, resistance was caused by different mechanisms. Therefore, new treatment strategies should be implemented.Keywords: gram negative, multidrug resistance, RAPD typing, resistance genes
Procedia PDF Downloads 3223345 An Exploration of the Emergency Staff’s Perceptions and Experiences of Teamwork and the Skills Required in the Emergency Department in Saudi Arabia
Authors: Sami Alanazi
Abstract:
Teamwork practices have been recognized as a significant strategy to improve patient safety, quality of care, and staff and patient satisfaction in healthcare settings, particularly within the emergency department (ED). The EDs depend heavily on teams of interdisciplinary healthcare staff to carry out their operational goals and core business of providing care to the serious illness and injured. The ED is also recognized as a high-risk area in relation to service demand and the potential for human error. Few studies have considered the perceptions and experiences of the ED staff (physicians, nurses, allied health professionals, and administration staff) about the practice of teamwork, especially in Saudi Arabia (SA), and no studies have been conducted to explore the practices of teamwork in the EDs. Aim: To explore the practices of teamwork from the perspectives and experiences of staff (physicians, nurses, allied health professionals, and administration staff) when interacting with each other in the admission areas in the ED of a public hospital in the Northern Border region of SA. Method: A qualitative case study design was utilized, drawing on two methods for the data collection, comprising of semi-structured interviews (n=22) with physicians (6), nurses (10), allied health professionals (3), and administrative members (3) working in the ED of a hospital in the Northern Border region of SA. The second method is non-participant direct observation. All data were analyzed using thematic analysis. Findings: The main themes that emerged from the analysis were as follows: the meaningful of teamwork, reasons of teamwork, the ED environmental factors, the organizational factors, the value of communication, leadership, teamwork skills in the ED, team members' behaviors, multicultural teamwork, and patients and families behaviors theme. Discussion: Working in the ED environment played a major role in affecting work performance as well as team dynamics. However, Communication, time management, fast-paced performance, multitasking, motivation, leadership, and stress management were highlighted by the participants as fundamental skills that have a major impact on team members and patients in the ED. It was found that the behaviors of the team members impacted the team dynamics as well as ED health services. Behaviors such as disputes among team members, conflict, cooperation, uncooperative members, neglect, and emotions of the members. Besides that, the behaviors of the patients and their accompanies had a direct impact on the team and the quality of the services. In addition, the differences in the cultures have separated the team members and created undesirable gaps such the gender segregation, national origin discrimination, and similarity and different in interests. Conclusion: Effective teamwork, in the context of the emergency department, was recognized as an essential element to obtain the quality of care as well as improve staff satisfaction.Keywords: teamwork, barrier, facilitator, emergencydepartment
Procedia PDF Downloads 1453344 Ferrites of the MeFe2O4 System (Me – Zn, Cu, Cd) and Their Two Faces
Authors: B. S. Boyanov, A. B. Peltekov, K. I. Ivanov
Abstract:
The ferrites of Zn, Cd, Cu, and mixed ferrites with NiO, MnO, MgO, CoO, ZnO, BaO combine the properties of dielectrics, semiconductors, ferro-magnets, catalysts, etc. The ferrites are used in an impressive range of applications due to their remarkable properties. A specific disadvantage of ferrites is that they are undesirably obtained in a lot of processes connected with metal production. They are very stable and poorly soluble compounds. The obtained ZnFe2O4 in zinc production connecting about 15% of the total zinc remains practically insoluble in dilute solutions of sulfuric acid. This decreases the degree of recovery of zinc and necessitates to further process the zinc-containing cake. In this context, the ferrites; ZnFe2O4, CdFe2O4, and CuFe2O4 are synthesized in laboratory conditions using ceramic technology. Their homogeneity and structure are proven by X-Ray diffraction analysis and Mössbauer spectroscopy. The synthesized ferrites are subjected to strong acid and high temperature leaching with solutions of H2SO4, HCl, and HNO3 (7, 10 and 15 %). The results indicate that the highest degree of leaching of Zn, Cd, and Cu from the ferrites is achieved by use of HCl. The resulting values for the degree of leaching of metals using H2SO4 are lower, but still remain significantly higher for all of the experimental conditions compared to the values obtained using HNO3. Five zinc sulfide concentrates are characterized for iron content by chemical analysis, Web-based Information System, and iron phases by Mössbauer spectroscopy. The charging was optimized using the criterion of minimal amount of zinc ferrite produced when roasting the concentrates in a fluidized bed. The results obtained are interpreted in terms of the hydrometallurgical zinc production and maximum recovery of zinc, copper and cadmium from initial zinc sulfide concentrates after their roasting.Keywords: hydrometallurgy, inorganic acids, solubility, zinc ferrite
Procedia PDF Downloads 4383343 Bond Strength of Different Strengthening Systems: Concrete Elements under Freeze–Thaw Cycles and Salt Water Immersion Exposure
Authors: Firas Al-Mahmoud, Jean-Michel Mechling, Mohamed Shaban
Abstract:
The long-term durability of fibre reinforced polymer (FRP) composites is often stated as being the main reason for the use of these materials. Indeed, structures externally or Near Surface Mounted (NSM) reinforced with Carbon Fibre Reinforcement Polymer CFRP are often in contact with temperature cycles and salt water immersion and other environmental conditions that reduce the expected durability of the system. Bond degradation is a frequent cause of premature failure of structural elements and environmental conditions are known to relate to such failures. The purpose of this study is to investigate the effect of environmental exposure on the bond for different CFRP strengthening systems. Bending tests were conducted to evaluate the bond with and without environmental exposure. The specimens were strengthened with CFRP sheets, CFRP plates and NSM CFRP rods embedded in two filling materials: epoxy resin and mortar. Then, they were exposed to up to 300 freeze–thaw cycles. One freeze–thaw cycle consisted of four stages according to ASTM or immersed in 3.5% salted tap water. A total of thirty-six specimens were prepared for this purpose. Results showed a decrease in ultimate bond strength for specimens strengthened by CFRP sheets that were immersed in salt water for 120 days, while a reduction was shown for CFRP sheet and plate bonded specimens that were subjected to 300 freeze–thaw cycles. Exposing NSM CFRP rod strengthened specimens, embedded in resin or mortar, to freeze–thaw cycles or to immersion in salt water does not affect the bond strength.Keywords: durability, strengthening, FRP, bond, freeze–thaw
Procedia PDF Downloads 3543342 Influence of CA, SR and BA Substitution on lafeo3Performances During Chemical Looping Processes
Authors: Rong Sun, Laihong Shen
Abstract:
La-based perovskite oxygen carriers, especially the doped-La(M)FeO₃, showed excellent performances during chemical looping processes. However, the mechanisms of the undoped and doped La(M)FeO₃ are not clear at present, making the mechanisms clear may help the development of chemical looping technologies. In this paper, the method based on the density function theory (DFT) was used to analysis the influence of Ca, Sr, and Ba doping of La on the electronic structure, while the CO oxidation mechanisms on the surface of LaFeO₃ and Ca-doped LaFeO₃ oxygen carriers were also analyzed. The results showed that the band gap was decreased by the doping of low valence. While the doping of low valence element Ca, Sr, and Ba at La site simultaneously resulted to the moving of the valence band toward high energy and made the valence band cross the Fermi energy level. This was resulted from the holes generated by divalent ion substitution. The holes can change the total magnetization from antiferromagnet to weakly ferromagnetism. The calculation results about the formation of oxygen vacancy showed that substitutions of Ca, Sr, and Ba caused a large drop in oxygen vacancy formation energy, indicating that the bulk oxygen transport was improved. Based on the optimized bulk of the undoped and Ca-doped LaFeO₃(010) surface, the CO adsorption was analyzed. The results indicated that the adsorption energy increased by divalent ion substitution, meaning that the adsorption stability decreased. The results can provide a certain theoretical basis for the development of perovskite oxides in chemical looping technologies.Keywords: chemical looping technologies, lanthanum ferrate (LaFeO₃), divalent ion substitution, CO oxidation
Procedia PDF Downloads 1073341 Performance Investigation of Thermal Insulation Materials for Walls: A Case Study in Nicosia (Turkish Republic of North Cyprus)
Authors: L. Vafaei, McDominic Eze
Abstract:
The performance of thermal energy in homes and buildings is a significant factor in terms of energy efficiency of a building. In a large sense, the performance of thermal energy is dependent on many factors of which the amount of thermal insulation is at one end a considerable factor, as likewise the essence of mass and the wall thickness and also the thermal resistance of wall material. This study is aimed at illustrating the different wall system in Turkish Republic of North Cyprus (TRNC), acknowledge the problem and suggest a solution through comparing the effect of thermal radiation two model rooms- L1 (Ytong wall) and L2 (heat insulated wall using stone wool) set up for experimentation. The model room has four face walls. The study consists of two stage, the first test is to access the effect of solar radiation for south facing wall and the second stage is to test the thermal performance of Ytong and heat insulated wall, the effects of climatic condition during winter. The heat insulated wall contains material hollow brick, stone wool, and gypsum while the Ytong wall contains cement concrete, for the outer surface and the inner surface and Ytong stone. The total heat of the wall was determined, 7T-Type thermocouple was used with a data logger system to record the data, temperature change recorded at an interval of 10 minutes. The result obtained was that Ytong wall save more energy than the heat insulated wall at night while heat insulated wall saves energy during the day when intensity is at maximum.Keywords: heat insulation, hollow bricks, south facing, Ytong bricks wall
Procedia PDF Downloads 2683340 Improving Sample Analysis and Interpretation Using QIAGENs Latest Investigator STR Multiplex PCR Assays with a Novel Quality Sensor
Authors: Daniel Mueller, Melanie Breitbach, Stefan Cornelius, Sarah Pakulla-Dickel, Margaretha Koenig, Anke Prochnow, Mario Scherer
Abstract:
The European STR standard set (ESS) of loci as well as the new expanded CODIS core loci set as recommended by the CODIS Core Loci Working Group, has led to a higher standardization and harmonization in STR analysis across borders. Various multiplex PCRs assays have since been developed for the analysis of these 17 ESS or 23 CODIS expansion STR markers that all meet high technical demands. However, forensic analysts are often faced with difficult STR results and the questions thereupon. What is the reason that no peaks are visible in the electropherogram? Did the PCR fail? Was the DNA concentration too low? QIAGEN’s newest Investigator STR kits contain a novel Quality Sensor (QS) that acts as internal performance control and gives useful information for evaluating the amplification efficiency of the PCR. QS indicates if the reaction has worked in general and furthermore allows discriminating between the presence of inhibitors or DNA degradation as a cause for the typical ski slope effect observed in STR profiles of such challenging samples. This information can be used to choose the most appropriate rework strategy.Based on the latest PCR chemistry called FRM 2.0, QIAGEN now provides the next technological generation for STR analysis, the Investigator ESSplex SE QS and Investigator 24plex QS Kits. The new PCR chemistry ensures robust and fast PCR amplification with improved inhibitor resistance and easy handling for a manual or automated setup. The short cycling time of 60 min reduces the duration of the total PCR analysis to make a whole workflow analysis in one day more likely. To facilitate the interpretation of STR results a smart primer design was applied for best possible marker distribution, highest concordance rates and a robust gender typing.Keywords: PCR, QIAGEN, quality sensor, STR
Procedia PDF Downloads 4993339 Relationship Between Muscle Mass and Insulin Resistance in Cirrhotic Patients with Hepatitis B
Authors: Eyüp S. Akbas, Betul Ayaz, Beyza S. Haksever, Sema Basat
Abstract:
We aimed to evaluate the relationship between insulin resistance, muscle mass and muscle strength in patients with Hepatitis B virus-related cirrhosis. In our study, there were 65 patients with hepatitis B virus-related cirrhosis in Child A and B group and 65 healthy control individual. Control group was chosen between patients who admitted to the internal medicine clinic and had no pathological values in a routine examination. Muscle mass index was calculated with bioimpedance analysis for both groups to determine muscle strength and muscle mass. Handgrip strength, arm, and calf circumference were measured. In both groups, HOMA-IR was calculated to determine insulin resistance. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) value was detected 3,47±3,80 in the study group and 1,83±1,20 in control group. There were significant differences between the two groups in arm circumference, fasting insulin, fasting glucose, HOMA-IR, High-density lipoprotein (HDL) and total cholesterol parameters. The correlation coefficient between muscle mass and insulin resistance was statistically insignificant, especially in the study group. In healthy individuals group and all the groups, there wasn’t a correlation between muscle mass and insulin resistance. The upper limit for HOMA-IR was determined as 3,2. In control group, %78,9 of individuals were in HOMA-IR ( < 3.2) group and %21,1 of them were in ( ≥ 3,2) group. In study group, %68,3 of individuals were in HOMA-IR ( < 3,2) group and %31.7 were in HOMA-IR ( ≥ 3,2) group. In our study, we did not find a relationship between muscle mass and insulin resistance in patients with liver cirrhosis. In the study group, we detected a positive relationship between muscle mass, handgrip strength, and calf circumference. We did not find a relationship between insulin resistance and handgrip strength in our study.Keywords: cirrhosis, hepatitis B, Insulin resistance, muscle mass
Procedia PDF Downloads 1543338 Reducing the Risk of Alcohol Relapse after Liver-Transplantation
Authors: Rebeca V. Tholen, Elaine Bundy
Abstract:
Background: Liver transplantation (LT) is considered the only curative treatment for end-stage liver disease Background: Liver transplantation (LT) is considered the only curative treatment for end-stage liver disease (ESLD). The effects of alcoholism can cause irreversible liver damage, cirrhosis and subsequent liver failure. Alcohol relapse after transplant occurs in 20-50% of patients and increases the risk for recurrent cirrhosis, organ rejection, and graft failure. Alcohol relapse after transplant has been identified as a problem among liver transplant recipients at a large urban academic transplant center in the United States. Transplantation will reverse the complications of ESLD, but it does not treat underlying alcoholism or reduce the risk of relapse after transplant. The purpose of this quality improvement project is to implement and evaluate the effectiveness of a High-Risk Alcoholism Relapse (HRAR) Scale to screen and identify patients at high-risk for alcohol relapse after receiving an LT. Methods: The HRAR Scale is a predictive tool designed to determine the severity of alcoholism and risk of relapse after transplant. The scale consists of three variables identified as having the highest predictive power for early relapse including, daily number of drinks, history of previous inpatient treatment for alcoholism, and the number of years of heavy drinking. All adult liver transplant recipients at a large urban transplant center were screened with the HRAR Scale prior to hospital discharge. A zero to two ordinal score is ranked for each variable, and the total score ranges from zero to six. High-risk scores are between three to six. Results: Descriptive statistics revealed 25 patients were newly transplanted and discharged from the hospital during an 8-week period. 40% of patients (n=10) were identified as being high-risk for relapse and 60% low-risk (n=15). The daily number of drinks were determined by alcohol content (1 drink = 15g of ethanol) and number of drinks per day. 60% of patients reported drinking 9-17 drinks per day, and 40% reported ≤ 9 drinks. 50% of high-risk patients reported drinking ≥ 25 years, 40% for 11-25 years, and 10% ≤ 11 years. For number of inpatient treatments for alcoholism, 50% received inpatient treatment one time, 20% ≥ 1, and 30% reported never receiving inpatient treatment. Findings reveal the importance and value of a validated screening tool as a more efficient method than other screening methods alone. Integration of a structured clinical tool will help guide the drinking history portion of the psychosocial assessment. Targeted interventions can be implemented for all high-risk patients. Conclusions: Our findings validate the effectiveness of utilizing the HRAR scale to screen and identify patients who are a high-risk for alcohol relapse post-LT. Recommendations to help maintain post-transplant sobriety include starting a transplant support group within the organization for all high-risk patients. (ESLD). The effects of alcoholism can cause irreversible liver damage, cirrhosis and subsequent liver failure. Alcohol relapse after transplant occurs in 20-50% of patients, and increases the risk for recurrent cirrhosis, organ rejection, and graft failure. Alcohol relapse after transplant has been identified as a problem among liver transplant recipients at a large urban academic transplant center in the United States. Transplantation will reverse the complications of ESLD, but it does not treat underlying alcoholism or reduce the risk of relapse after transplant. The purpose of this quality improvement project is to implement and evaluate the effectiveness of a High-Risk Alcoholism Relapse (HRAR) Scale to screen and identify patients at high-risk for alcohol relapse after receiving a LT. Methods: The HRAR Scale is a predictive tool designed to determine severity of alcoholism and risk of relapse after transplant. The scale consists of three variables identified as having the highest predictive power for early relapse including, daily number of drinks, history of previous inpatient treatment for alcoholism, and the number of years of heavy drinking. All adult liver transplant recipients at a large urban transplant center were screened with the HRAR Scale prior to hospital discharge. A zero to two ordinal score is ranked for each variable, and the total score ranges from zero to six. High-risk scores are between three to six. Results: Descriptive statistics revealed 25 patients were newly transplanted and discharged from the hospital during an 8-week period. 40% of patients (n=10) were identified as being high-risk for relapse and 60% low-risk (n=15). The daily number of drinks were determined by alcohol content (1 drink = 15g of ethanol) and number of drinks per day. 60% of patients reported drinking 9-17 drinks per day, and 40% reported ≤ 9 drinks. 50% of high-risk patients reported drinking ≥ 25 years, 40% for 11-25 years, and 10% ≤ 11 years. For number of inpatient treatments for alcoholism, 50% received inpatient treatment one time, 20% ≥ 1, and 30% reported never receiving inpatient treatment. Findings reveal the importance and value of a validated screening tool as a more efficient method than other screening methods alone. Integration of a structured clinical tool will help guide the drinking history portion of the psychosocial assessment. Targeted interventions can be implemented for all high-risk patients. Conclusions: Our findings validate the effectiveness of utilizing the HRAR scale to screen and identify patients who are a high-risk for alcohol relapse post-LT. Recommendations to help maintain post-transplant sobriety include starting a transplant support group within the organization for all high-risk patients.Keywords: alcoholism, liver transplant, quality improvement, substance abuse
Procedia PDF Downloads 1193337 Serological Screening of Barrier Maintained Rodent Colony
Authors: R. Posia, J. Mistry, K. Kamani
Abstract:
The health screening of laboratory rodents is essential for ensuring animal health and the validity of biomedical research data. Routine health monitoring is necessary to verify the effectiveness of biosecurity and the specific pathogen free (SPF) status of the colony. The present screening was performed in barrier maintained rat (Rattus norvegicus) colony. Rats were maintained under a controlled environment and strict biosecurity in the facility. The screening was performed on quarterly bases from randomly selected animals from breeding and or maintenance colonies. Selected animals were subject to blood collection under isoflurane anaesthesia. Serum was separated from the collected blood and stored samples at -60 ± 10 °C until further use. A total of 88 samples were collected quarterly bases from animals in a year. In the serological test, enzyme-linked immunosorbent assay (ELISA) was used for screening of serum samples against sialodacryoadenitis virus (SDAV), Sendai virus (SV), and Kilham’s rat virus (KRV). ELISA kits were procured from XpressBio, USA. Test serum samples were run along with positive control, negative control serum in 96 well ELISA plates as per the procedure recommended by the vendor. Test ELISA plate reading was taken in the microplate reader. This screening observed that none of the samples was observed positive for the sialodacryoadenitis virus (SDAV), Sendai virus (SV), and Kilham’s rat virus (KRV), indicating that effectiveness of biosecurity practices followed in the rodent colony. The result of serological screening helps us to declare that our rodent colony is specifically pathogen free for these pathogens.Keywords: biosecurity, ELISA, specific pathogen free, serological screening, serum
Procedia PDF Downloads 833336 Analysis of the Relationship between Micro-Regional Human Development and Brazil's Greenhouse Gases Emission
Authors: Geanderson Eduardo Ambrósio, Dênis Antônio Da Cunha, Marcel Viana Pires
Abstract:
Historically, human development has been based on economic gains associated with intensive energy activities, which often are exhaustive in the emission of Greenhouse Gases (GHGs). It requires the establishment of targets for mitigation of GHGs in order to disassociate the human development from emissions and prevent further climate change. Brazil presents itself as one of the most GHGs emitters and it is of critical importance to discuss such reductions in intra-national framework with the objective of distributional equity to explore its full mitigation potential without compromising the development of less developed societies. This research displays some incipient considerations about which Brazil’s micro-regions should reduce, when the reductions should be initiated and what its magnitude should be. We started with the methodological assumption that human development and GHGs emissions arise in the future as their behavior was observed in the past. Furthermore, we assume that once a micro-region became developed, it is able to maintain gains in human development without the need of keep growing GHGs emissions rates. The human development index and the carbon dioxide equivalent emissions (CO2e) were extrapolated to the year 2050, which allowed us to calculate when the micro-regions will become developed and the mass of GHG’s emitted. The results indicate that Brazil must throw 300 GT CO2e in the atmosphere between 2011 and 2050, of which only 50 GT will be issued by micro-regions before it’s develop and 250 GT will be released after development. We also determined national mitigation targets and structured reduction schemes where only the developed micro-regions would be required to reduce. The micro-region of São Paulo, the most developed of the country, should be also the one that reduces emissions at most, emitting, in 2050, 90% less than the value observed in 2010. On the other hand, less developed micro-regions will be responsible for less impactful reductions, i.e. Vale do Ipanema will issue in 2050 only 10% below the value observed in 2010. Such methodological assumption would lead the country to issue, in 2050, 56.5% lower than that observed in 2010, so that the cumulative emissions between 2011 and 2050 would reduce by 130 GT CO2e over the initial projection. The fact of associating the magnitude of the reductions to the level of human development of the micro-regions encourages the adoption of policies that favor both variables as the governmental planner will have to deal with both the increasing demand for higher standards of living and with the increasing magnitude of reducing emissions. However, if economic agents do not act proactively in local and national level, the country is closer to the scenario in which emits more than the one in which mitigates emissions. The research highlighted the importance of considering the heterogeneity in determining individual mitigation targets and also ratified the theoretical and methodological feasibility to allocate larger share of contribution for those who historically emitted more. It is understood that the proposals and discussions presented should be considered in mitigation policy formulation in Brazil regardless of the adopted reduction target.Keywords: greenhouse gases, human development, mitigation, intensive energy activities
Procedia PDF Downloads 3233335 Comparison Between Conventional Ultrafiltration Combined with Modified Ultrafiltration and Conventional Ultrafiltration Only for Adult Open-heart Surgery: Perspective from Systemic Inflammation, Vascular Resistance, and Cardiac Index
Authors: Ratna Farida Soenarto, Anas Alatas, Made Ryan Kharmayani
Abstract:
Background: Conventional ultrafiltration (CUF) system was shown to be helpful in reducing anti-inflammatory mediators for patients who underwent open heart surgery. Additionally, modified ultrafiltration (MUF) has been shown to reduce anti-inflammatory mediators further while reducing interstitial fluid volume at the same time. However, there has been minimal data concerning the efficacy of combining both ultrafiltration methods. This study aims to compare inflammation marker, vascular resistance, and cardiac index on CUF+MUF patients with CUF only patients undergoing open heart surgery. Method: This is a single blind randomized controlled trial on patients undergoing open heart surgery between June 2021 - October 2021 in CiptoMangunkusumo National Referral Hospital and Jakarta Heart Hospital. Patients wererandomized using block randomization into modified ultrafiltration following conventional ultrafiltration (CUF+MUF) and conventional ultrafiltration (CUF) only. Outcome assessed in this study were 24-hoursinterleukin-6 levels, systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), and cardiac index. Results: A total of 38patients were included (19 CUF+MUF and 19 CUF subjects). There was no difference in postoperative IL-6 level between groups (p > 0.05).No difference in PVR was observed between groups.Higher difference in SVR was observed in CUF+MUF group (-646 vs. -261dyn/s/cm-5, p < 0.05). Higher cardiac index was observed on CUF+MUF group (0.93 vs. 0.48, p < 0.05). Conclusion: Patients undergoing open heart surgery with modified ultrafiltration following conventional ultrafiltration had similar systemic inflammatory response and better cardiac response than those having conventional ultrafiltration.Keywords: open-heart, CUF, MUF, SVR, PVR, IL-6
Procedia PDF Downloads 1583334 Evaluation of Surgical Site Infection in Bile Spillage Cases Compared to Non Bile Spillage Cases Following Laparoscopic Cholecystectomy
Authors: Ishwor Paudel, Pratima Gautam, Sandeep Bhattarai
Abstract:
Bile spillage occurs frequently during laparoscopic cholecystectomy yet its impact on postoperative outcomes remains unknown. It might not be as innocuous as some surgeons tend to believe and in fact, might be associated with post-operative surgical site infections (SSI). It often leads to patient dissatisfaction, emergency department visits, with subsequent readmission and additional procedures. While some authors found no increase in SSI following bile spillage (BS) compared to non-bile spillage cases, others found bile spillage to be associated with SSI. Therefore we sought to examine whether bile spillage is indeed associated with an increased risk of postoperative wound infections after laparoscopic cholecystectomy. I hypothesize that patients who experience BS during operation, have an increased risk of SSI compared to those who do not. This is a prospective observational study conducted in the Department of Surgery, Patan Hospital over a period of one year. Patients undergoing Laparoscopic cholecystectomy were included and bile spillage, if happened was noted. All cases were followed up for 30 days and SSI was diagnosed as per CDC-defined criteria. Fisher’s test was applied to compare SSI in bile spillage versus non-bile spillage cases. A total of 112 patients were included in the final analysis. Bile spillage occurred in 20 cases and was absent in the rest i.e.92 cases. Among bile spillage cases, SSI was found in 4 cases (20%), whereas in nonbile spillage cases, SSI was found in 8 cases (8.7%). However, it was statistically not significant (p-value>0.05). Eleven (92%) cases were superficial SSI and one was an organ-space infection. No mortality or 30-day readmission. Spillage of Gallbladder content does not lead to an increase in SSIs. However as the rate of SSI is still higher, Surgeons should be careful to avoid iatrogenic gallbladder perforation and in case of bile spillage thorough peritoneal irrigation with normal saline should be done.Keywords: organ space infection, Laparoscopic cholecystectomy, biliary spillage, surgical site infection
Procedia PDF Downloads 813333 The Population Death Model and Influencing Factors from the Data of The "Sixth Census": Zhangwan District Case Study
Authors: Zhou Shangcheng, Yi Sicen
Abstract:
Objective: To understand the mortality patterns of Zhangwan District in 2010 and provide the basis for the development of scientific and rational health policy. Methods: Data are collected from the Sixth Census of Zhangwan District and disease surveillance system. The statistical analysis include death difference between age, gender, region and time and the related factors. Methods developed for the Global Burden of Disease (GBD) Study by the World Bank and World Health Organization (WHO) were adapted and applied to Zhangwan District population health data. DALY rate per 1,000 was calculated for varied causes of death. SPSS 16 is used by statistic analysis. Results: From the data of death population of Zhangwan District we know the crude mortality rate was 6.03 ‰. There are significant differences of mortality rate in male and female population which was respectively 7.37 ‰ and 4.68 ‰. 0 age group population life expectancy in Zhangwan District in 2010 was 78.40 years old(Male 75.93, Female 81.03). The five leading causes of YLL in descending order were: cardiovascular diseases(42.63DALY/1000), malignant neoplasm (23.73DALY/1000), unintentional injuries (5.84DALY/1000), Respiratory diseases(5.43 DALY/1000), Respiratory infections (2.44DALY/1000). In addition, there are strong relation between the marital status , educational level and mortality in some to a certain extend. Conclusion Zhangwan District, as city level, is at lower mortality levels. The mortality of the total population of Zhangwan District has a downward trend and life expectancy is rising.Keywords: sixth census, Zhangwan district, death level differences, influencing factors, cause of death
Procedia PDF Downloads 2743332 Analysis of Peoples' Adherence to Safety Measures that Curb Ebola Virus Diseases in Nigeria (A Case Study of State of Osun)
Authors: Shittu Bisi Agnes
Abstract:
Ebola virus Diseases outbreak in Nigeria caused a lot of concerns considering the mode of transmission and no known cure discovered. Therefore a lot of safety measures were taken which eventually led to the eradication of the virus in Nigeria. This therefore attempted to determine the various safety measures, how socio-economic characteristic of the people affected adherence to safety measures. And provide reasonable recommendations for total eradication of the virus, future outbreak and general environmental safety Data were collected with the aid of well structured questionnaires and administered 180 randomly selected of the state and oral interview was also utilize. Data collected were analysed using both descriptive tools and inferential statistics vis-a-vis regression analysis. Finding showed that 70.5% was strongly adhere to almost all the measures, 15.2% was fairly advent, 3% was poorly observing the selected measures while 1.3% was in different. 65% of the respondents was strongly aware of the advent of ebola virus diseases, 20% was fairly in awareness, 8.5% was poorly in awareness while 6.55% was in aware of any disease outbreak. Safety measures put forwards were; hand washing, use of hand sanitize-rs, no shaking of hands non-consumption of wildlife games(Bush Meat) and general health and environmental safety measures. It was recommended that policy instrument to increase peoples income will accelerate eradication of diseases as this will enable households to pay for monetary safety measures, health and environmental education, in form of talk shop, workshop, lectures could be organised at the political ward levels, schools, market women, religious bodies functional unions and mass media.Keywords: ebola diseases, pay, safety, outbreak
Procedia PDF Downloads 6003331 Association between Severe Acidemia before Endotracheal Intubation and the Lower First Attempt Intubation Success Rate
Authors: Keiko Naito, Y. Nakashima, S. Yamauchi, Y. Kunitani, Y. Ishigami, K. Numata, M. Mizobe, Y. Homma, J. Takahashi, T. Inoue, T. Shiga, H. Funakoshi
Abstract:
Background: A presence of severe acidemia, defined as pH < 7.2, is common during endotracheal intubation for critically ill patients in the emergency department (ED). Severe acidemia is widely recognized as a predisposing factor for intubation failure. However, it is unclear that acidemic condition itself actually makes endotracheal intubation more difficult. We aimed to evaluate if a presence of severe acidemia before intubation is associated with the lower first attempt intubation success rate in the ED. Methods: This is a retrospective observational cohort study in the ED of an urban hospital in Japan. The collected data included patient demographics, such as age, sex, and body mass index, presence of one or more factors of modified LEMON criteria for predicting difficult intubation, reasons for intubation, blood gas levels, airway equipment, intubation by emergency physician or not, and the use of the rapid sequence intubation technique. Those with any of the following were excluded from the analysis: (1) no blood gas drawn before intubation, (2) cardiopulmonary arrest, and (3) under 18 years of age. The primary outcome was the first attempt intubation success rates between a severe acidemic patients (SA) group and a non-severe acidemic patients (NA) group. Logistic regression analysis was used to test the first attempt success rates for intubations between those two groups. Results: Over 5 years, a total of 486 intubations were performed; 105 in the SA group and 381 in the NA group. The univariate analysis showed that the first attempt intubation success rate was lower in the SA group than in the NA group (71.4% vs 83.5%, p < 0.01). The multivariate logistic regression analysis identified that severe acidemia was significantly associated with the first attempt intubation failure (OR 1.9, 95% CI 1.03-3.68, p = 0.04). Conclusions: A presence of severe acidemia before endotracheal intubation lowers the first attempt intubation success rate in the ED.Keywords: acidemia, airway management, endotracheal intubation, first-attempt intubation success rate
Procedia PDF Downloads 2513330 Assessing the Seed Yield of Some Varieties of Sesame (Sesami indicum) Under Disease Condition (Cercospora Leaf Spot) Caused by (Cercospora sesami, Zimm) and Identifying Disease Resistant Varieties
Authors: P. S. Akami, H. Nahunnaro, A. Zubainatu
Abstract:
Cercospora leaf spot (Cercospora sesami. Zimm) has been identified as one of the most prevalent diseases, posing serious constraints to sesame production in producing areas. Two sets of experiments were carried out. The first and second experiments were conducted in the Modibbo Adama University of Technology Yola at the Crop Production and Horticulture and Plant Science Departments, respectively. The field experiment was carried out using a Randomized Complete Block Design and was replicated three times on a plot size of 4m x 5m with four sesame varieties and three Mancob-M fungicide levels (0g, 2g and 4g) to give a total of Twelve treatments. The laboratory experiment involved the isolation of the pathogens from diseased leaves with symptoms of Cercospora leaf spot, which was identified as Cercospora sesami. Data collected were subjected to analysis of variance for a randomized complete block design using SAS (1999) statistical package. The treatment means that are significantly different were separated using the Least Significant Difference at P=0.05. The result revealed that 4g Mancob M recorded the lowest mean value for disease incidence and severity at 8WAS, which was 90.30% and 35.60%, respectively, while the control (0g) recorded the highest mean value for disease incidence and severity at 90.30% and 59.80% respectively. Ex-Sudan recorded the lowest value of 720 kg/ha, while NCRIBEN 03 recorded the highest yield of 834 kg/ha-¹. For the concentrations, 2g recorded a higher yield of 843 kg/ha-¹ followed by 0g, which recorded 765 kg/ha-¹. Conclusively, Cercospora leaf spot of sesame was found to be prevalent. E8 has a higher resistance to the disease, while NCRIBEN 03 tends to be more susceptible. It is therefore recommended that further trials should be carried out using different varieties in different locations.Keywords: disease, evaluation, prevalence, treatment, resistance
Procedia PDF Downloads 1013329 Foot-and-Mouth Virus Detection in Asymptomatic Dairy Cows without Foot-and-Mouth Disease Outbreak
Authors: Duanghathai Saipinta, Tanittian Panyamongkol, Witaya Suriyasathaporn
Abstract:
Animal management aims to provide a suitable environment for animals allowing maximal productivity in those animals. Prevention of disease is an important part of animal management. Foot-and-mouth disease (FMD) is a highly contagious viral disease in cattle and is an economically important animal disease worldwide. Monitoring the FMD virus in farms is useful management for the prevention of the FMD outbreak. A recent publication indicated collection samples from nasal swabs can be used for monitoring FMD in symptomatic cows. Therefore, the objectives of this study were to determine the FMD virus in asymptomatic dairy cattle using nasal swab samples during the absence of an FMD outbreak. The study was conducted from December 2020 to June 2021 using 185 asymptomatic signs of FMD dairy cattle in Chiang Mai Province, Thailand. By random cow selection, nasal mucosal swabs were used to collect samples from the selected cows and then were to evaluate the presence of FMD viruses using the real-time rt-PCR assay. In total, 4.9% of dairy cattle detected FMD virus, including 2 dairy farms in Mae-on (8 samples; 9.6%) and 1 farm in the Chai-Prakan district (1 sample; 1.2%). Interestingly, both farms in Mae-on were the outbreak of the FMD after this detection for 6 months. This indicated that the FMD virus presented in asymptomatic cattle might relate to the subsequent outbreak of FMD. The outbreak demonstrates the presence of the virus in the environment. In conclusion, monitoring of FMD can be performed by nasal swab collection. Further investigation is needed to show whether the FMD virus presented in asymptomatic FMD cattle could be the cause of the subsequent FMD outbreak or not.Keywords: cattle, foot-and-mouth disease, nasal swab, real-time rt-PCR assay
Procedia PDF Downloads 236