Search results for: agile methods
Commenced in January 2007
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Edition: International
Paper Count: 14836

Search results for: agile methods

4156 Waste Derived from Refinery and Petrochemical Plants Activities: Processing of Oil Sludge through Thermal Desorption

Authors: Anna Bohers, Emília Hroncová, Juraj Ladomerský

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Oil sludge with its main characteristic of high acidity is a waste product generated from the operation of refinery and petrochemical plants. Former refinery and petrochemical plant - Petrochema Dubová is present in Slovakia as well. Its activities was to process the crude oil through sulfonation and adsorption technology for production of lubricating and special oils, synthetic detergents and special white oils for cosmetic and medical purposes. Seventy years ago – period, when this historical acid sludge burden has been created – comparing to the environmental awareness the production was in preference. That is the reason why, as in many countries, also in Slovakia a historical environmental burden is present until now – 229 211 m3 of oil sludge in the middle of the National Park of Nízke Tatry mountain chain. Neither one of tried treatment methods – bio or non-biologic one - was proved as suitable for processing or for recovery in the reason of different factors admission: i.e. strong aggressivity, difficulty with handling because of its sludgy and liquid state et sim. As a potential solution, also incineration was tested, but it was not proven as a suitable method, as the concentration of SO2 in combustion gases was too high, and it was not possible to decrease it under the acceptable value of 2000 mg.mn-3. That is the reason why the operation of incineration plant has been terminated, and the acid sludge landfills are present until nowadays. The objective of this paper is to present a new possibility of processing and valorization of acid sludgy-waste. The processing of oil sludge was performed through the effective separation - thermal desorption technology, through which it is possible to split the sludgy material into the matrix (soil, sediments) and organic contaminants. In order to boost the efficiency in the processing of acid sludge through thermal desorption, the work will present the possibility of application of an original technology – Method of Blowing Decomposition for recovering of organic matter into technological lubricating oil.

Keywords: hazardous waste, oil sludge, remediation, thermal desorption

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4155 Investigating the Effectiveness of Multilingual NLP Models for Sentiment Analysis

Authors: Othmane Touri, Sanaa El Filali, El Habib Benlahmar

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Natural Language Processing (NLP) has gained significant attention lately. It has proved its ability to analyze and extract insights from unstructured text data in various languages. It is found that one of the most popular NLP applications is sentiment analysis which aims to identify the sentiment expressed in a piece of text, such as positive, negative, or neutral, in multiple languages. While there are several multilingual NLP models available for sentiment analysis, there is a need to investigate their effectiveness in different contexts and applications. In this study, we aim to investigate the effectiveness of different multilingual NLP models for sentiment analysis on a dataset of online product reviews in multiple languages. The performance of several NLP models, including Google Cloud Natural Language API, Microsoft Azure Cognitive Services, Amazon Comprehend, Stanford CoreNLP, spaCy, and Hugging Face Transformers are being compared. The models based on several metrics, including accuracy, precision, recall, and F1 score, are being evaluated and compared to their performance across different categories of product reviews. In order to run the study, preprocessing of the dataset has been performed by cleaning and tokenizing the text data in multiple languages. Then training and testing each model has been applied using a cross-validation approach where randomly dividing the dataset into training and testing sets and repeating the process multiple times has been used. A grid search approach to optimize the hyperparameters of each model and select the best-performing model for each category of product reviews and language has been applied. The findings of this study provide insights into the effectiveness of different multilingual NLP models for Multilingual Sentiment Analysis and their suitability for different languages and applications. The strengths and limitations of each model were identified, and recommendations for selecting the most performant model based on the specific requirements of a project were provided. This study contributes to the advancement of research methods in multilingual NLP and provides a practical guide for researchers and practitioners in the field.

Keywords: NLP, multilingual, sentiment analysis, texts

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4154 Integrated Approach to Reduce Intimate Partner Violence and Improve Mental Health among Pregnant Women: Mixed-Method Study from Nepal

Authors: Diksha Sapkota, Kathleen Baird, Amornrat Saito, Debra Anderson

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Background: Violence during pregnancy is global public health problem incurring huge amount of social, economic and human costs. It is of particular concern as it affects health of mother, neonates and also disrupt family functioning. Mental illness is one of its commonest consequences affecting both mother and baby and likely to be chronic if left unattended. Past decade has seen advances in knowledge about different forms of violence, its health impacts and intervention/s helping to confront the violence. However, limited range and lack of consistency in measurable outcomes undermine overall effect of interventions, and available evidence are largely slanted towards high-income countries. Despite recognition of integrating screening and counselling for abused pregnant women in health settings, there is a dearth of evidence on its effectiveness from developing countries limiting its applicability and feasibility. This study intends to summarise the high-quality evidence on intimate partner violence interventions in reducing violence and improving mental health and implement the promising intervention in our context. Methods: Quantitative systematic review will be done using PRISMA statement and based on its finding; randomised controlled intervention will be carried out. The study will be conducted among women attending ANC clinic of Dhulikhel Hospital, Nepal. Being the pilot study, samples just adequate to draw the inferences i.e. not less than 30 in each arm will be taken. Phenomological approach will be used to explore the strengths and weaknesses of tested intervention and recommendations for better planning in future. Conclusion: This study intends to provide concrete evidence on what works best in our context and will assist policymakers, programme planners, donors in informed decision making.

Keywords: intimate partner violence/prevention and control, mental health, Nepal, pregnant

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4153 Psychological Resilience Factors Associated with Climate Change Adaptations by Subsistence Farmers in a Rural Community, South Africa

Authors: Kgopa Bontle, Tholen Sodi

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Climate change poses a major threat to the well-being of both people and the environment, with subsistence farmers most affected as they rely on local supply systems that are sensitive to climate variation. This study documented psychological resilience factors associated with climate change adaptations by subsistence farmers in Maruleng Municipality, Limpopo Province. A qualitative study was conducted to examine the notions of climate change by subsistence farmers, the psychological resilience factors, the strategies to cope with climate change, adaptation methods, and the development of subsistence farmers’ psychological resilience factors model. Data were collected through direct interactions with participants using a grounded theory research design. An open-ended interview was used to collect data with a sample of 15 participants selected through theoretical sampling in Maruleng Municipality. The participants were both Sepedi and Xitsonga speaking from 2 villages, mostly unemployed, pensioners and dependent on social grants. The study included both males and females who were predominately the elderly. The research findings indicate that farmers have limited knowledge of what climate change is and what causes it. Furthermore, the research reflects that although their responses were non-scientific but sensible enough to know what they were dealing with. They mentioned extreme weather, which includes hot days and less rainfall and changes in seasons, as some of the impacts brought by climate change. The results also indicated that participants have learned to adapt through several adaptation strategies, including mulching, changes in irrigation time slots and being innovative. The resilience factors that emerged from the study were a passion for farming, hope, enthusiasm, courage, acceptance/tolerance, livelihood and belief systems. Looking at the socio-economic factors of the current study setting argumentation leads to the conclusion that it is important that government should assist the subsistence farmers as it was observed from the participants that they felt neglected by the government and policymakers as they are small scale farmers and are not included like commercial farmers.

Keywords: climate change, psychological resilience factors, human adaptation, subsistence farmers

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4152 Effect of Media Osmolarity on Vi Biosynthesis on Salmonella enterica serovar Typhi Strain C6524 Cultured on Batch System

Authors: Dwi Arisandi Wijaya, Ernawati Arifin Giri-Rachman, Neni Nurainy

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Typhoid fever disease can be prevented by using a polysaccharide-based vaccine Vi which is a virulence factor of S.typhi. To produce high yield Vi polysaccharide from bacteria, it is important to know the biosynthesis of Vi polysaccharide and the regulators involved. In the In vivo condition, S. typhi faces different osmolarity, and the bacterial two-component system OmpR-EnvZ, regulate by up and down Capsular Vi polysaccharide biosynthesis. A high yielded Vi Polysaccharide strain, S. typhi strain C6524 used to study the effect of media osmolarity on Vi polysaccharide biosynthesis and the osmoregulation pattern of S. typhi strain C6524. The methods were performed by grown S. typhi strain C6524 grown on medium with 50 mM, 100 mM, and 150 mM osmolarity with the batch system. Vi polysaccharide concentration was measured by ELISA method. For further investigation of the osmoregulation pattern of strain C6524, the osmoregulator gene, OmpR, has been isolated and sequenced using the specific primer of the OmpR gene. Nucleotide sequence analysis is done with BLAST and Lallign. Amino Acid sequence analysis is done with Prosite and Multiple Sequence Alignment. The results of cultivation showed the average content of polysaccharide Vi for 50 mM, 100 mM, and 150 mM osmolarities 11.49 μg/mL, 12.06 μg/mL, and 14.53 μg/mL respectively. Analysis using Anova stated that the osmolarity treatment of 150 mM significantly affects Vi content. Analysis of nucleotide sequences shows 100% identity between S. typhi strain C6524 and Ty2. Analysis of amino acid sequences shows that the OmpR response regulator protein of the C6524 strain also has a α4-β5-α5 motif which is important for the regulatory activation system when phosphorylation occurs by domain kinase. This indicates that the regulator osmolarity response of S. typhi strain C6524 has no difference with the response regulator owned by S. typhi strain Ty2. A high Vi response rate in the 150 mM osmolarity treatment requires further research for RcsB-RcsC, another two-component system involved in Vi Biosynthesis.

Keywords: osmoregulator, OmpR, Salmonella, Vi polysaccharide

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4151 The Effect of Electromagnetic Stirring during Solidification of Nickel Based Alloys

Authors: Ricardo Paiva, Rui Soares, Felix Harnau, Bruno Fragoso

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Nickel-based alloys are materials well suited for service in extreme environments subjected to pressure and heat. Some industrial applications for Nickel-based alloys are aerospace and jet engines, oil and gas extraction, pollution control and waste processing, automotive and marine industry. It is generally recognized that grain refinement is an effective methodology to improve the quality of casted parts. Conventional grain refinement techniques involve the addition of inoculation substances, the control of solidification conditions, or thermomechanical treatment with recrystallization. However, such methods often lead to non-uniform grain size distribution and the formation of hard phases, which are detrimental to both wear performance and biocompatibility. Stirring of the melt by electromagnetic fields has been widely used in continuous castings with success for grain refinement, solute redistribution, and surface quality improvement. Despite the advantages, much attention has not been paid yet to the use of this approach on functional castings such as investment casting. Furthermore, the effect of electromagnetic stirring (EMS) fields on Nickel-based alloys is not known. In line with the gaps/needs of the state-of-art, the present research work targets to promote new advances in controlling grain size and morphology of investment cast Nickel based alloys. For such a purpose, a set of experimental tests was conducted. A high-frequency induction furnace with vacuum and controlled atmosphere was used to cast the Inconel 718 alloy in ceramic shells. A coil surrounded the casting chamber in order to induce electromagnetic stirring during solidification. Aiming to assess the effect of the electromagnetic stirring on Ni alloys, the samples were subjected to microstructural analysis and mechanical tests. The results show that electromagnetic stirring can be an effective methodology to modify the grain size and mechanical properties of investment-cast parts.

Keywords: investment casting, grain refinement, electromagnetic stirring, nickel alloys

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4150 The Impact of Legislation on Waste and Losses in the Food Processing Sector in the UK/EU

Authors: David Lloyd, David Owen, Martin Jardine

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Introduction: European weight regulations with respect to food products require a full understanding of regulation guidelines to assure regulatory compliance. It is suggested that the complexity of regulation leads to practices which result to over filling of food packages by food processors. Purpose: To establish current practices by food processors and the financial, sustainable and societal impacts on the food supply chain of ineffective food production practices. Methods: An analysis of food packing controls with 10 companies of varying food categories and quantitative based research of a further 15 food processes on the confidence in weight control analysis of finished food packs within their organisation. Results: A process floor analysis of manufacturing operations focussing on 10 products found over fill of packages ranging from 4.8% to 20.2%. Standard deviation figures for all products showed a potential for reducing average weight of the pack whilst still retain the legal status of the product. In 20% of cases, an automatic weight analysis machine was in situ however weight packs were still significantly overweight. Collateral impacts noted included the effect of overfill on raw material purchase and added food miles often on a global basis with one raw material alone creating 10,000 extra food miles due to the poor weight control of the processing unit. A case study of a meat and bakery product will be discussed with the impact of poor controls resulting from complex legislation. The case studies will highlight extra energy costs in production and the impact of the extra weight on fuel usage. If successful a risk assessment model used primarily on food safety but adapted to identify waste /sustainability risks will be discussed within the presentation.

Keywords: legislation, overfill, profile, waste

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4149 Improving Lane Detection for Autonomous Vehicles Using Deep Transfer Learning

Authors: Richard O’Riordan, Saritha Unnikrishnan

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Autonomous Vehicles (AVs) are incorporating an increasing number of ADAS features, including automated lane-keeping systems. In recent years, many research papers into lane detection algorithms have been published, varying from computer vision techniques to deep learning methods. The transition from lower levels of autonomy defined in the SAE framework and the progression to higher autonomy levels requires increasingly complex models and algorithms that must be highly reliable in their operation and functionality capacities. Furthermore, these algorithms have no room for error when operating at high levels of autonomy. Although the current research details existing computer vision and deep learning algorithms and their methodologies and individual results, the research also details challenges faced by the algorithms and the resources needed to operate, along with shortcomings experienced during their detection of lanes in certain weather and lighting conditions. This paper will explore these shortcomings and attempt to implement a lane detection algorithm that could be used to achieve improvements in AV lane detection systems. This paper uses a pre-trained LaneNet model to detect lane or non-lane pixels using binary segmentation as the base detection method using an existing dataset BDD100k followed by a custom dataset generated locally. The selected roads will be modern well-laid roads with up-to-date infrastructure and lane markings, while the second road network will be an older road with infrastructure and lane markings reflecting the road network's age. The performance of the proposed method will be evaluated on the custom dataset to compare its performance to the BDD100k dataset. In summary, this paper will use Transfer Learning to provide a fast and robust lane detection algorithm that can handle various road conditions and provide accurate lane detection.

Keywords: ADAS, autonomous vehicles, deep learning, LaneNet, lane detection

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4148 Methodology of Automation and Supervisory Control and Data Acquisition for Restructuring Industrial Systems

Authors: Lakhoua Najeh

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Introduction: In most situations, an industrial system already existing, conditioned by its history, its culture and its context are in difficulty facing the necessity to restructure itself in an organizational and technological environment in perpetual evolution. This is why all operations of restructuring first of all require a diagnosis based on a functional analysis. After a presentation of the functionality of a supervisory system for complex processes, we present the concepts of industrial automation and supervisory control and data acquisition (SCADA). Methods: This global analysis exploits the various available documents on the one hand and takes on the other hand in consideration the various testimonies through investigations, the interviews or the collective workshops; otherwise, it also takes observations through visits as a basis and even of the specific operations. The exploitation of this diagnosis enables us to elaborate the project of restructuring thereafter. Leaving from the system analysis for the restructuring of industrial systems, and after a technical diagnosis based on visits, an analysis of the various technical documents and management as well as on targeted interviews, a focusing retailing the various levels of analysis has been done according a general methodology. Results: The methodology adopted in order to contribute to the restructuring of industrial systems by its participative and systemic character and leaning on a large consultation a lot of human resources that of the documentary resources, various innovating actions has been proposed. These actions appear in the setting of the TQM gait requiring applicable parameter quantification and a treatment valorising some information. The new management environment will enable us to institute an information and communication system possibility of migration toward an ERP system. Conclusion: Technological advancements in process monitoring, control and industrial automation over the past decades have contributed greatly to improve the productivity of virtually all industrial systems throughout the world. This paper tries to identify the principles characteristics of a process monitoring, control and industrial automation in order to provide tools to help in the decision-making process.

Keywords: automation, supervision, SCADA, TQM

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4147 Agricultural Investment in Ethiopia: The Case of Oromia Region

Authors: Misganaw Ayele Gelaw

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This abstract presents an overview of agricultural investment in Ethiopia, with a focus on the Oromia Region. Ethiopia is a developing country that heavily relies on agriculture as a major contributor to its economic growth and employment. The Oromia Region, located in the central part of the country, is the largest region in Ethiopia and plays a significant role in the agricultural sector. The study aims to explore the current state of agricultural investment in the Oromia Region, focusing on the opportunities, challenges, and potential benefits that arise from such investments. It also highlights the key agricultural investment strategies and policies implemented by the Ethiopian government to attract domestic and foreign investors. To achieve these objectives, a comprehensive literature review and analysis of relevant reports, publications, and government policies will be conducted. The study will also incorporate qualitative and quantitative data collection methods, such as interviews, surveys, and statistical analysis, to provide a well-rounded understanding of agricultural investment dynamics in the Oromia Region. The findings of this study are expected to shed light on the impact of agricultural investments on local farmers, rural development, food security, income generation, and overall economic growth in the Oromia Region. It will also identify the key risk factors and potential mitigations associated with agricultural investment, offering recommendations to policymakers, investors, and stakeholders to improve the effectiveness and sustainability of investment efforts in the region. This abstract highlights the importance of agricultural investment in the Oromia Region and Ethiopia as a whole, as it strives to enhance productivity, increase farmers' income, and contribute to the country's long-term development goals. By understanding the challenges and opportunities associated with agricultural investment, policymakers and investors can develop targeted strategies to ensure inclusive and sustainable growth in the agricultural sector, leading to improved livelihoods and economic prosperity in the Oromia Region.

Keywords: agriculture, investment, agriculture policy, economy

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4146 Attracting the North Holidaymaker to Ireland Using Social Media Channels: An Irish Marketing Strategy

Authors: Colm Barcoe, Garvan Whelan

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In tourism, engagement has been found to boost awareness of a destination and subsequently increase visits. Customer engagement in this industry is now facilitated by social media. This phenomenon is not very well researched in relation to Ireland and the North American tourism market. The objective of this paper is to present research findings on two related topics; the first is an investigation into the effectiveness of social media channels as components of a digital marketing campaign when promoting Ireland as a brand in North America. Secondly, this study reveals how Irish marketers have embraced social media platforms and channels with an innovative strategy that has successfully attracted growing numbers of US and Canadian holidaymakers to Ireland. A range of methodological approaches was applied in order to achieve the study’s objective. The methods used were both quantitative and qualitative, and the data was obtained from both Irish marketers and North American holidaymakers. Surveys of these holidaymakers in the pre, during and post-trip phases revealed their attitudes towards social media and Ireland as a destination. Semi-structured interviews with those responsible for implementing relationship marketing strategies for this segment provide insight into the effectiveness of social media when used to capitalise on the cultural link between Ireland and North America. Further analysis involved using Nvivo 11+ software to investigate the activities of the Irish destination marketer (DMO) and the engagement of the US and Canadian audiences through a detailed study of social media platform content. The findings from this investigation will extend an under-researched body of literature pertaining to Ireland as a destination and the successful digital marketing campaigns that have achieved exponential growth in this sector over the past five years. The empirical evidence presented also illustrates how the innovative use of social media has assisted the DMO to engage with the North American holidaymaker as part of an effective digital marketing strategy.

Keywords: channels, digital, engagement, marketing, strategies

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4145 The Alarming Caesarean-Section Delivery Rate in Addis Ababa, Ethiopia

Authors: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

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Background: According to the World Health Organization, caesarean section delivery rates of more than 10-15% caesarean section deliveries in any specific geographic region in the world are not justifiable. The aim of the study was to describe the level and analyse determinants of caesarean section delivery in Addis Ababa. Methods: Data was collected in Addis Ababa using a structured questionnaire administered to 901 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary logistic regression model was employed to identify predictors of caesarean section delivery. Results: Among the 835 women who delivered their last birth at healthcare facilities, 19.2% of them gave birth by caesarean section. About 9.0% of the caesarean section births were due to mother’s request or service provider’s influence without any medical indication. The caesarean section delivery rate was much higher than the recommended rate particularly among the non-slum residents (27.2%); clients of private healthcare facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women belonging to the highest wealth quintile household (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery by service providers. The logistic regression model shows that older age (30-49), secondary and above education, non-slum residence, high-risk pregnancy and receiving adequate antenatal care were significantly positively associated with caesarean section delivery. Conclusion: Despite the unreserved effort towards achieving MDG 5 through safe skilled delivery assistance among others, the high caesarean section rate beyond the recommend limit, and the finding that caesarean sections done without medical indications were also alarming. The government and city administration should take appropriate measures before the problems become setbacks in healthcare provision. Further investigations should focus on the effect of caesarean section delivery on maternal and child health outcomes in the study area.

Keywords: Addis Ababa, caesarean section, mode of delivery, slum residence

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4144 Impact of Treatment of Fragility Fractures Due to Osteoporosis as an Economic Burden Worldwide: A Systematic Review

Authors: Fabiha Tanzeem

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BACKGROUND: Osteoporosis is a skeletal disease that is associated with a reduction in bone mass and microstructures of the bone and deterioration of bone tissue. Fragility fracture due to osteoporosis is the most significant complication of osteoporosis. The increasing prevalence of fragility fractures presents a growing burden on the global economy. There is a rapidly evolving need to improve awareness of the costs associated with these types of fractures and to review current policies and practices for the prevention and management of the disease. This systematic review will identify and describe the direct and indirect costs associated with osteoporotic fragility fractures from a global perspective from the included studies. The review will also find out whether the costs required for the treatment of fragility fractures due to osteoporosis impose an economic burden on the global healthcare system. METHODS: Four major databases were systematically searched for direct and indirect costs of osteoporotic fragility fracture studies in the English Language. PubMed, Cochrane Library, Embase and Google Scholar were searched for suitable articles published between 1990 and July 2020. RESULTS: The original search yielded 1166 papers; from these, 27 articles were selected for this review according to the inclusion and exclusion criteria. In the 27 studies, the highest direct costs were associated with the treatment of pelvic fractures, with the majority of the expenditure due to hospitalization and surgical treatments. It is also observed that most of the articles are from developed countries. CONCLUSION: This review indicates the significance of the economic burden of osteoporosis globally, although more research needs to be done in developing countries. In the treatment of fragility fractures, direct costs were the main reported expenditure in this review. The healthcare costs incurred globally can be significantly reduced by implementing measures to effectively prevent the disease. Raising awareness in children and adults by improving the quality of the information available and standardising policies and planning of services requires further research.

Keywords: systematic review, osteoporosis, cost of illness

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4143 Closed Incision Negative Pressure Therapy Dressing as an Approach to Manage Closed Sternal Incisions in High-Risk Cardiac Patients: A Multi-Centre Study in the UK

Authors: Rona Lee Suelo-Calanao, Mahmoud Loubani

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Objective: Sternal wound infection (SWI) following cardiac operation has a significant impact on patient morbidity and mortality. It also contributes to longer hospital stays and increased treatment costs. SWI management is mainly focused on treatment rather than prevention. This study looks at the effect of closed incision negative pressure therapy (ciNPT) dressing to help reduce the incidence of superficial SWI in high-risk patients after cardiac surgery. The ciNPT dressing was evaluated at 3 cardiac hospitals in the United Kingdom". Methods: All patients who had cardiac surgery from 2013 to 2021 were included in the study. The patients were classed as high risk if they have two or more of the recognised risk factors: obesity, age above 80 years old, diabetes, and chronic obstructive pulmonary disease. Patients receiving standard dressing (SD) and patients using ciNPT were propensity matched, and the Fisher’s exact test (two-tailed) and unpaired T-test were used to analyse categorical and continuous data, respectively. Results: There were 766 matched cases in each group. Total SWI incidences are lower in the ciNPT group compared to the SD group (43 (5.6%) vs 119 (15.5%), P=0.0001). There are fewer deep sternal wound infections (14(1.8%) vs. 31(4.04%), p=0.0149) and fewer superficial infections (29(3.7%) vs. 88 (11.4%), p=0.0001) in the ciNPT group compared to the SD group. However, the ciNPT group showed a longer average length of stay (11.23 ± 13 days versus 9.66 ± 10 days; p=0.0083) and higher mean logistic EuroSCORE (11.143 ± 13 versus 8.094 ± 11; p=0.0001). Conclusion: Utilization of ciNPT as an approach to help reduce the incidence of superficial and deep SWI may be effective in high-risk patients requiring cardiac surgery.

Keywords: closed incision negative pressure therapy, surgical wound infection, cardiac surgery complication, high risk cardiac patients

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4142 Improvement of Healthcare Quality and Psychological Stress Relieve for Transition Program in Intensive Care Units

Authors: Ru-Yu Lien, Shih-Hsin Hung, Shu-Fen Lu, Shu-I Chin, Wen-Ju Yang, Wan Ming-Shang, Chien-Ying Wang

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Background: Upon recovery from critical condition, patients are normally transferred from the intensive care units (ICUs) to the general wards. However, transferring patients to a new environment causes stressful experiences for both patients and their families. Therefore, there is a necessity to communicate with the patients and their families to reduce psychological stress and unplanned return. Methods: This study was performed in the general ICUs from January 1, 2021, to December 31, 2021, in Taipei Veteran General Hospital. The patients who were evaluated by doctors and liaison nurses transferred to the general wards were selected as the research objects and ranked by the Critical Care Transition Program (CCTP). The plan was applied to 40 patients in a study group and usual care support for a control group of 40 patients. The psychological condition of patients was evaluated by a migration stress scale and a hospital anxiety and depression scale. In addition, the rate of return to ICU was also measured. Results: A total of 63 patients out of 80 (78.8%) experienced moderate to severe degrees of anxiety, and 42 patients (52.6%) experienced moderate to severe degrees of depression before being transferred. The difference between anxiety and depression changed more after the transfer; moreover, when a transition program was applied, it was lower than without a transition program. The return to ICU rate in the study group was lower than in the usual transition group, with an adjusted odds ratio of 0.21 (95% confidence interval: 0.05-0.888, P=0.034). Conclusion: Our study found that the transfer program could reduce the anxiety and depression of patients and the associated stress on their families during the transition from ICU. Before being transferred out of ICU, the healthcare providers need to assess the needs of patients to set the goals of the care plan and perform patient-centered decision-making with multidisciplinary support.

Keywords: ICU, critical care transition program, healthcare, transition program

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4141 Extraction of Phycocyanin from Spirulina platensis by Isoelectric Point Precipitation and Salting Out for Scale Up Processes

Authors: Velasco-Rendón María Del Carmen, Cuéllar-Bermúdez Sara Paulina, Parra-Saldívar Roberto

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Phycocyanin is a blue pigment protein with fluorescent activity produced by cyanobacteria. It has been recently studied to determine its anticancer, antioxidant and antiinflamatory potential. Since 2014 it was approved as a Generally Recognized As Safe (GRAS) proteic pigment for the food industry. Therefore, phycocyanin shows potential for the food, nutraceutical, pharmaceutical and diagnostics industry. Conventional phycocyanin extraction includes buffer solutions and ammonium sulphate followed by chromatography or ATPS for protein separation. Therefore, further purification steps are time-requiring, energy intensive and not suitable for scale-up processing. This work presents an alternative to conventional methods that also allows large scale application with commercially available equipment. The extraction was performed by exposing the dry biomass to mechanical cavitation and salting out with NaCl to use an edible reagent. Also, isoelectric point precipitation was used by addition of HCl and neutralization with NaOH. The results were measured and compared in phycocyanin concentration, purity and extraction yield. Results showed that the best extraction condition was the extraction by salting out with 0.20 M NaCl after 30 minutes cavitation, with a concentration in the supernatant of 2.22 mg/ml, a purity of 3.28 and recovery from crude extract of 81.27%. Mechanical cavitation presumably increased the solvent-biomass contact, making the crude extract visibly dark blue after centrifugation. Compared to other systems, our process has less purification steps, similar concentrations in the phycocyanin-rich fraction and higher purity. The contaminants present in our process edible NaCl or low pHs that can be neutralized. It also can be adapted to a semi-continuous process with commercially available equipment. This characteristics make this process an appealing alternative for phycocyanin extraction as a pigment for the food industry.

Keywords: extraction, phycocyanin, precipitation, scale-up

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4140 Evaluation of Golden Beam Data for the Commissioning of 6 and 18 MV Photons Beams in Varian Linear Accelerator

Authors: Shoukat Ali, Abdul Qadir Jandga, Amjad Hussain

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Objective: The main purpose of this study is to compare the Percent Depth dose (PDD) and In-plane and cross-plane profiles of Varian Golden beam data to the measured data of 6 and 18 MV photons for the commissioning of Eclipse treatment planning system. Introduction: Commissioning of treatment planning system requires an extensive acquisition of beam data for the clinical use of linear accelerators. Accurate dose delivery require to enter the PDDs, Profiles and dose rate tables for open and wedges fields into treatment planning system, enabling to calculate the MUs and dose distribution. Varian offers a generic set of beam data as a reference data, however not recommend for clinical use. In this study, we compared the generic beam data with the measured beam data to evaluate the reliability of generic beam data to be used for the clinical purpose. Methods and Material: PDDs and Profiles of Open and Wedge fields for different field sizes and at different depths measured as per Varian’s algorithm commissioning guideline. The measurement performed with PTW 3D-scanning water phantom with semi-flex ion chamber and MEPHYSTO software. The online available Varian Golden Beam Data compared with the measured data to evaluate the accuracy of the golden beam data to be used for the commissioning of Eclipse treatment planning system. Results: The deviation between measured vs. golden beam data was in the range of 2% max. In PDDs, the deviation increases more in the deeper depths than the shallower depths. Similarly, profiles have the same trend of increasing deviation at large field sizes and increasing depths. Conclusion: Study shows that the percentage deviation between measured and golden beam data is within the acceptable tolerance and therefore can be used for the commissioning process; however, verification of small subset of acquired data with the golden beam data should be mandatory before clinical use.

Keywords: percent depth dose, flatness, symmetry, golden beam data

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4139 A Multi-Agent System for Accelerating the Delivery Process of Clinical Diagnostic Laboratory Results Using GSM Technology

Authors: Ayman M. Mansour, Bilal Hawashin, Hesham Alsalem

Abstract:

Faster delivery of laboratory test results is one of the most noticeable signs of good laboratory service and is often used as a key performance indicator of laboratory performance. Despite the availability of technology, the delivery time of clinical laboratory test results continues to be a cause of customer dissatisfaction which makes patients feel frustrated and they became careless to get their laboratory test results. The Medical Clinical Laboratory test results are highly sensitive and could harm patients especially with the severe case if they deliver in wrong time. Such results affect the treatment done by physicians if arrived at correct time efforts should, therefore, be made to ensure faster delivery of lab test results by utilizing new trusted, Robust and fast system. In this paper, we proposed a distributed Multi-Agent System to enhance and faster the process of laboratory test results delivery using SMS. The developed system relies on SMS messages because of the wide availability of GSM network comparing to the other network. The software provides the capability of knowledge sharing between different units and different laboratory medical centers. The system was built using java programming. To implement the proposed system we had many possible techniques. One of these is to use the peer-to-peer (P2P) model, where all the peers are treated equally and the service is distributed among all the peers of the network. However, for the pure P2P model, it is difficult to maintain the coherence of the network, discover new peers and ensure security. Also, security is a quite important issue since each node is allowed to join the network without any control mechanism. We thus take the hybrid P2P model, a model between the Client/Server model and the pure P2P model using GSM technology through SMS messages. This model satisfies our need. A GUI has been developed to provide the laboratory staff with the simple and easy way to interact with the system. This system provides quick response rate and the decision is faster than the manual methods. This will save patients life.

Keywords: multi-agent system, delivery process, GSM technology, clinical laboratory results

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4138 Occupational Health Programs for Artisanal and Small-Scale Gold Mining: A Systematic Review for the WHO Global Plan of Action for Workers' Health

Authors: Vivian W. L. Tsang, Karen Lockhart, Samuel Spiegel, Annalee Yassi

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Background: Workers in the informal economy often incur exposure to well-documented occupational health hazards. Insufficient attention has been afforded to rigorously evaluating intervention programs to reduce the risks, especially in artisanal and small-scale gold mining (ASGM). Objectives: This systematic review, conducted as part of the World Health Organization’s Global Plan of Action for Workers’ Health, sought to assess the state of knowledge on occupational health programs and interventions for the informal artisanal and small-scale gold mining (ASGM) sector, an occupation which directly employs at least 50 million people. Methods: We used a comprehensive search strategy for four well-known databases relevant to health outcomes: PubMed, Engineering Village, OVID Medline, and Web of Science, and employed the PRISMA framework for our analysis. Findings: Ten studies met the inclusion criteria of a primary study focused on assessing the impact of interventions addressing occupational health concerns in ASGM. There were no studies evaluating or even identifying comprehensive occupational health and safety programs for this sector, although target interventions addressing specific hazards exist. Major areas of intervention –education and introduction of mercury-reducing/eliminating technology were identified, and the challenges and limitations of each intervention taken into the assessment. Even for these, however, there was a lack of standardization for measuring outcome or impact, let alone long-term health outcomes for miners and mining communities. Conclusion: There is an urgent need for research on comprehensive occupational health programs addressing the array of hazards faced by artisanal and small-scale miners.

Keywords: informal economy, artisanal and small-scale gold mining, occupational health, health and safety, workplace safety

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4137 Improving Fingerprinting-Based Localization System Using Generative Artificial Intelligence

Authors: Getaneh Berie Tarekegn

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A precise localization system is crucial for many artificial intelligence Internet of Things (AI-IoT) applications in the era of smart cities. Their applications include traffic monitoring, emergency alarming, environmental monitoring, location-based advertising, intelligent transportation, and smart health care. The most common method for providing continuous positioning services in outdoor environments is by using a global navigation satellite system (GNSS). Due to nonline-of-sight, multipath, and weather conditions, GNSS systems do not perform well in dense urban, urban, and suburban areas.This paper proposes a generative AI-based positioning scheme for large-scale wireless settings using fingerprinting techniques. In this article, we presented a novel semi-supervised deep convolutional generative adversarial network (S-DCGAN)-based radio map construction method for real-time device localization. We also employed a reliable signal fingerprint feature extraction method with t-distributed stochastic neighbor embedding (t-SNE), which extracts dominant features while eliminating noise from hybrid WLAN and long-term evolution (LTE) fingerprints. The proposed scheme reduced the workload of site surveying required to build the fingerprint database by up to 78.5% and significantly improved positioning accuracy. The results show that the average positioning error of GAILoc is less than 39 cm, and more than 90% of the errors are less than 82 cm. That is, numerical results proved that, in comparison to traditional methods, the proposed SRCLoc method can significantly improve positioning performance and reduce radio map construction costs.

Keywords: location-aware services, feature extraction technique, generative adversarial network, long short-term memory, support vector machine

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4136 The Singapore Innovation Web and Facilitation of Knowledge Processes

Authors: Ola Jon Mork, Irina Emily Hansen

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The European Growth Strategy Program calls for more efficient methods for knowledge creation and innovation. This study contributes with new insights into the Singapore Innovation System; more precisely how knowledge processes are facilitated. The research material is collected by visiting the different innovation locations in Singapore and depth interview with key persons. The different innovation actors web sites and brochures have been studied. Governmental reports and figures have also been studied. The findings show that facilitation of Knowledge Processes in the Singapore Innovation System has a basic structure with three processes, which is 1) Idea capturing – 2)Technology and Business Execution – 3)Idea Realization. Dedicated innovation parks work with the most promising entrepreneurs; more precisely: finding the persons with the motivation to 'change the world'. The innovation park will facilitate these entrepreneurs for 100 days, where they also will be connected to a global network of venture capital. And, the entrepreneurs will have access to mentors from these venture companies. Research institutes parks work with the development of world leading technology. To facilitate knowledge development they connect with industrial companies which are the most promising applicators of their technology. Knowledge facilitation is the main purpose, but this cooperation/testing is also serving as a platform for funding. Probably this is cooperation is also attractive for world leading companies. Dedicated innovation parks work with facilitation of innovators of new applications and perfection of products for the end- user. These parks can be specialized in special areas, like health products and life science products. Another example of this is automotive companies giving research call for these parks to develop and innovate new products and services upon their technology. Common characteristics for the knowledge facilitation in the Singapore Innovation System are a short trial period for promising actors, normally 100 days. It is also a strong focus on training of the entrepreneurs. Presentations and diffusion of knowledge is an important part of the facilitation. Funding will be available for the most successful entrepreneurs and innovators.

Keywords: knowledge processes, facilitation, innovation, Singapore innovation web

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4135 Correlation of Serum Apelin Level with Coronary Calcium Score in Patients with Suspected Coronary Artery Disease

Authors: M. Zeitoun, K. Abdallah, M. Rashwan

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Introduction: A growing body of evidence indicates that apelin, a relatively recent member of the adipokines family, has a potential anti-atherogenic effect. An association between low serum apelin state and coronary artery disease (CAD) was previously reported; however, the relationship between apelin and the atherosclerotic burden was unclear. Objectives: Our aim was to explore the correlation of serum apelin level with coronary calcium score (CCS) as a quantitative marker of coronary atherosclerosis. Methods: This observational cross-sectional study enrolled 100 consecutive subjects referred for cardiac multi-detector computed tomography (MDCT) for assessment of CAD (mean age 54 ± 9.7 years, 51 male and 49 females). Clinical parameters, glycemic and lipid profile, high sensitivity CRP (hsCRP), homeostasis model assessment of insulin resistance (HOMA-IR), serum creatinine and complete blood count were assessed. Serum apelin levels were determined using a commercially available Enzyme Immunoassay (EIA) Kit. High-resolution non-contrast CT images were acquired by a 64-raw MDCT and CCS was calculated using the Agatston scoring method. Results: Forty-three percent of the studied subjects had positive coronary artery calcification (CAC). The mean CCS was 79 ± 196.5 Agatston units. Subjects with detectable CAC had significantly higher fasting plasma glucose, HbA1c, and WBCs count than subjects without detectable CAC (p < 0.05). Most importantly, subjects with detectable CAC had significantly lower serum apelin level than subjects without CAC (1.3 ± 0.4 ng/ml vs. 2.8 ± 0.6 ng/ml, p < 0.001). In addition, there was a statistically significant inverse correlation between serum apelin levels and CCS (r = 0.591, p < 0.001); on multivariate analysis this correlation was found to be independent of traditional cardiovascular risk factors and hs-CRP. Conclusion:To the best of our knowledge, this is the first report of an independent association between apelin and CCS in patients with suspected CAD. Apelin emerges as a possible novel biomarker for CAD, but this result remains to be proved prospectively.

Keywords: HbA1c, apelin, adipokines, coronary calcium score (CCS), coronary artery disease (CAD)

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4134 Control of Oil Content of Fried Zucchini Slices by Partial Predrying and Process Optimization

Authors: E. Karacabey, Ş. G. Özçelik, M. S. Turan, C. Baltacıoğlu, E. Küçüköner

Abstract:

Main concern about deep-fat-fried food materials is their high final oil contents absorbed during frying process and/or after cooling period, since diet including high content of oil is accepted unhealthy by consumers. Different methods have been evaluated to decrease oil content of fried food stuffs. One promising method is partially drying of food material before frying. In the present study it was aimed to control and decrease the final oil content of zucchini slices by means of partial drying and to optimize process conditions. Conventional oven drying was used to decrease moisture content of zucchini slices at a certain extent. Process performance in terms of oil uptake was evaluated by comparing oil content of predried and then fried zucchini slices with those determined for directly fried ones. For predrying and frying processes, oven temperature and weight loss and frying oil temperature and time pairs were controlled variables, respectively. Zucchini slices were also directly fried for sensory evaluations revealing preferred properties of final product in terms of surface color, moisture content, texture and taste. These properties of directly fried zucchini slices taking the highest score at the end of sensory evaluation were determined and used as targets in optimization procedure. Response surface methodology was used for process optimization. The properties, determined after sensory evaluation, were selected as targets; meanwhile oil content was aimed to be minimized. Results indicated that final oil content of zucchini slices could be reduced from 58% to 46% by controlling conditions of predrying and frying processes. As a result, it was suggested that predrying could be one choose to reduce oil content of fried zucchini slices for health diet. This project (113R015) has been supported by TUBITAK.

Keywords: health process, optimization, response surface methodology, oil uptake, conventional oven

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4133 Combinational Therapeutic Targeting of BRD4 and CDK7 Synergistically Induces Anticancer Effects in Hepatocellular Carcinoma

Authors: Xinxiu Li, Chuqian Zheng, Yanyan Qian, Hong Fan

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Objectives: In hepatocellular carcinoma (HCC), oncogenes are continuously and robustly transcribed due to aberrant expression of essential components of the trans-acting super-enhancers (SE) complex. Preclinical and clinical trials are now being conducted on small-molecule inhibitors that target core-transcriptional components, including as transcriptional bromodomain protein 4 (BRD4) and cyclin-dependent kinase 7 (CDK7), in a number of malignant tumors. This study aims to explore whether co-overexpression of BRD4 and CDK7 is a potential marker of worse prognosis and a combined therapeutic target in HCC. Methods: The expression pattern of BRD4 and CDK7 and their correlation with prognosis in HCC were analyzed by RNA sequencing data and survival data of HCC patients from TCGA and GEO datasets. The protein levels of BRD4 and CDK7 were determined by immunohistochemistry (IHC), and survival data of patients were analyzed using the Kaplan-Meier method. The mRNA expression levels of genes in HCC cell lines were evaluated by quantitative PCR (q-PCR). CCK-8 and colony formation assays were conducted to assess cell proliferation of HCC upon treatment with BRD4 inhibitor JQ1 or/and CDK7 inhibitor THZ1. Results: It was shown that BRD4 and CDK7 were often overexpressed in HCCs and were associated with poor prognosis of HCC by analyzing the TCGA and GEO datasets. BRD4 or CDK7 overexpression was related to a lower survival rate. It's interesting to note that co-overexpression of CDK7 and BRD4 was a worse prognostic factor in HCC. Treatment with JQ1 or THZ1 alone had an inhibitory effect on cell proliferation; however, when JQ1 and THZ1 were combined, there was a more notable suppression of cell growth. At the same time, the combined use of JQ1 and THZ1 synergistically suppresses the expression of HCC driver genes. Conclusion: Our research revealed that BRD4 and CDK7 coupled can be a useful biomarker in HCC prognosis and the combination of JQ1 and THZ1 can be a promising therapeutic therapy against HCC.

Keywords: BRD4, CDK7, cell proliferation, combined inhibition

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4132 Correlation of Urinary Waxy Casts with Renal Pathology

Authors: Muner M. B. Mohamed, Vipin Varghese, Dustin Chalmers, Khalid M. G. Mohammed, Juan Carlos Q. Velez

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Background: Urinary waxy casts (uWxC) are traditionally described in textbooks as indicative of chronic renal parenchymal disease. However, data supporting this contention is lacking. uWxC can be seen in the context of various renal syndromes, including acute kidney injury, chronic kidney disease, rapidly progressive glomerulonephritis (GN), and nephrotic syndrome. Thus, we investigated the correlation between the identification of uWxC and renal pathological findings. Methods: We prospectively collected data of patients seen in nephrology consultation with a urine specimen subjected to the microscopic examination of the urinary sediment (MicrExUrSed) over a 3-year period. Within this cohort, we identified cases in which a kidney biopsy was concomitantly performed. We assessed the association of uWxC with glomerular or tubular pathology and with chronicity [interstitial fibrosis and tubular atrophy (IFTA) and glomerular obsolescence (GO)]. Results: Among 683 patients with MicrExUrSed,103 (15%) underwent kidney biopsy and were included. The mean age was 55 years, 51% women, 50% white, and 38% self-identified black. Median serum creatinine was 3.2 (0-7-15.6) mg/dL and not significantly different between those with and without uWxC (4.7 vs 3.8 mg/dL, p=0.13). uWxC was identified in 35 (34%) cases. A glomerulopathy was diagnosed in 79 (77%). Among those with uWxC (n=35), a glomerulopathy was more likely to be found with concomitant acute tubular injury (ATI) than without ATI (57% vs. 23%, p=0.0006), whereas among those without uWxC, glomerulopathies were found with or without concomitant ATI with similar frequency (41% vs. 34%, p=0.48). Overall (n=103), more patients with uWxC had ≥ 20% IFTA compared to those without uWxC (74% vs 51%, p=0.03). Among those with glomerulopathy (n=79), more patients with uWxC had ≥ 20% IFTA compared to those without uWxC (89% vs. 56%, p=0.004). uWxC did not correlate with GO. Conclusion: Identification of uWxC denotes a greater likelihood of finding evidence of ATI superimposed with a glomerulopathy rather than finding an isolated glomerular lesion. uWxC is associated with a greater probability of finding ≥ 20% IFTA in a kidney biopsy specimen, particularly in those with a glomerular pathology. This observation may help clinicians weigh on the suitability of a kidney biopsy when chronicity or coexistence of ATI is in question.

Keywords: waxy cast, kidney biopsy, acute tubular injury, glomerulopathy

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4131 Detection of Flood Prone Areas Using Multi Criteria Evaluation, Geographical Information Systems and Fuzzy Logic. The Ardas Basin Case

Authors: Vasileiou Apostolos, Theodosiou Chrysa, Tsitroulis Ioannis, Maris Fotios

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The severity of extreme phenomena is due to their ability to cause severe damage in a small amount of time. It has been observed that floods affect the greatest number of people and induce the biggest damage when compared to the total of annual natural disasters. The detection of potential flood-prone areas constitutes one of the fundamental components of the European Natural Disaster Management Policy, directly connected to the European Directive 2007/60. The aim of the present paper is to develop a new methodology that combines geographical information, fuzzy logic and multi-criteria evaluation methods so that the most vulnerable areas are defined. Therefore, ten factors related to geophysical, morphological, climatological/meteorological and hydrological characteristics of the basin were selected. Afterwards, two models were created to detect the areas pronest to flooding. The first model defined the gravitas of each factor using Analytical Hierarchy Process (AHP) and the final map of possible flood spots were created using GIS and Boolean Algebra. The second model made use of the fuzzy logic and GIS combination and a respective map was created. The application area of the aforementioned methodologies was in Ardas basin due to the frequent and important floods that have taken place these last years. Then, the results were compared to the already observed floods. The result analysis shows that both models can detect with great precision possible flood spots. As the fuzzy logic model is less time-consuming, it is considered the ideal model to apply to other areas. The said results are capable of contributing to the delineation of high risk areas and to the creation of successful management plans dealing with floods.

Keywords: analytical hierarchy process, flood prone areas, fuzzy logic, geographic information system

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4130 Grid and Market Integration of Large Scale Wind Farms using Advanced Predictive Data Mining Techniques

Authors: Umit Cali

Abstract:

The integration of intermittent energy sources like wind farms into the electricity grid has become an important challenge for the utilization and control of electric power systems, because of the fluctuating behaviour of wind power generation. Wind power predictions improve the economic and technical integration of large amounts of wind energy into the existing electricity grid. Trading, balancing, grid operation, controllability and safety issues increase the importance of predicting power output from wind power operators. Therefore, wind power forecasting systems have to be integrated into the monitoring and control systems of the transmission system operator (TSO) and wind farm operators/traders. The wind forecasts are relatively precise for the time period of only a few hours, and, therefore, relevant with regard to Spot and Intraday markets. In this work predictive data mining techniques are applied to identify a statistical and neural network model or set of models that can be used to predict wind power output of large onshore and offshore wind farms. These advanced data analytic methods helps us to amalgamate the information in very large meteorological, oceanographic and SCADA data sets into useful information and manageable systems. Accurate wind power forecasts are beneficial for wind plant operators, utility operators, and utility customers. An accurate forecast allows grid operators to schedule economically efficient generation to meet the demand of electrical customers. This study is also dedicated to an in-depth consideration of issues such as the comparison of day ahead and the short-term wind power forecasting results, determination of the accuracy of the wind power prediction and the evaluation of the energy economic and technical benefits of wind power forecasting.

Keywords: renewable energy sources, wind power, forecasting, data mining, big data, artificial intelligence, energy economics, power trading, power grids

Procedia PDF Downloads 487
4129 Ambulatory Care Utilization of Individuals with Cerebral Palsy in Taiwan- A Country with Universal Coverage and No Gatekeeper Regulation

Authors: Ming-Juei Chang, Hui-Ing Ma, Tsung-Hsueh Lu

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Introduction: Because of the advance of medical care (e.g., ventilation techniques and gastrostomy feeding), more and more children with CP can live to adulthood. However, little is known about the use of health care services from children to adults who have CP. The patterns of utilization of ambulatory care are heavily influenced by insurance coverage and primary care gatekeeper regulation. The purpose of this study was to examine patterns of ambulatory care utilization among individuals with CP in Taiwan, a country with universal coverage and no gatekeeper regulation. Methods: A representative sample of one million patients (about 1/23 of total population) covered by Taiwan’s National Health Insurance was used to analyze the ambulatory care utilization in individuals with CP. Data were analyzed by 3 different age groups (children, youth and adults) during 2000 to 2003. Participants were identified by the presence of CP diagnosis made by pediatricians or physicians of physical and rehabilitation medicine and stated at least three times in claims data. Results: Annual rates of outpatient physician visits were 31680 for children, 16492 for youth, and 28617 for adults with CP (per 1000 persons). Individuals with CP received over 50% of their outpatient care from hospital outpatient department. Higher use of specialist physician services was found in children (54.7%) than in the other two age groups (28.4% in youth and 18.8% in adults). Diseases of respiratory system were the most frequent diagnoses for visits in both children and youth with CP. Diseases of the circulatory system were the main reasons (24.3%) that adults with CP visited hospital outpatient care department or clinics. Conclusion: This study showed different patterns of ambulatory care utilization among different age groups. It appears that youth and adults with CP continue to have complex health issues and rely heavily on the health care system. Additional studies are needed to determine the factors which influence ambulatory care utilization among individuals with CP.

Keywords: cerebral palsy, health services, lifespan, universal coverage

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4128 Acute Hepatitis A Outbreak in Men Who Has Sex with Men in a Medical Center in Northern Taiwan

Authors: Yu-Tzu Hsu, Alice Wu, Hsiang-Kuang Tseng

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Introduction: Hepatitis A virus causes acute hepatitis and is usually transmitted by a fecal-oral route of food contamination, which is more prevalent in areas with poor hygienic practices. However, we described a hepatitis A outbreak associated with a fecal-oral route of sexual behavior in men who has sex with men (MSM) in Northern Taiwan. Methods: We retrospectively collected patients with acute HAV infection in MacKay Memorial Hospital, Taipei, Taiwan between July 2015 and November 2016. Demographic data (age, gender, onset time and infection risk), laboratory data (GOT, GPT, bilirubin, HIV status, HBsAg, HCV antibody and syphilis), clinical symptoms and travel history with a foreign tour were analyzed. We compared variables between HIV and non-HIV group. Unless otherwise stated, continuous variables were expressed as mean ± SD, and categorical variables were expressed as number (percentage) for each item. The t test for continuous variables was applied for the comparison between two groups and chi-square for categorical variables were applied for measures of association. Results: We collected 80 cases during the study period. Among them, 54 (67.5%) cases were MSM and 43 (53.8%) cases were HIV positive. The average age was 32.6±7.59 years-old. The average value of initial liver function was 1324 IU/L for AST (GOT), 2100 IU/L for ALT (GPT), and 5.82 mg/dL for bilirubin. We found seven (8.6%) cases were in the status of HBV carrier, five (6.3%) cases were positive for HCV antibody, and 15 (18.6%) cases were co-infected with syphilis. With regards to associated symptoms, 32 (40%) had fever, 46 (57.5%) had nausea, 34 (42.5%) had abdominal discomfort and 46 (57.5%) had general malaise. To compare the non-HIV patients with HIV patients, HIV patients were more likely to be male (p=0.008), MSM (p=0.000), co-infected syphilis (p=0.000) and slowly improving liver function of transaminases (p=0.033, 0.027). Conclusion: The HAV outbreak in Northern Taiwan was mainly occurred in MSM population. Hereafter, our cohort data support a policy in Taiwan to provide one dose of free HAV vaccine shot in this population. Hopefully, the outbreak could be stop by the free vaccine policy and public education.

Keywords: acute hepatitis A, men who has sex with men, human immunodeficiency virus, vaccine

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4127 Evaluation of Hepatic Metabolite Changes for Differentiation Between Non-Alcoholic Steatohepatitis and Simple Hepatic Steatosis Using Long Echo-Time Proton Magnetic Resonance Spectroscopy

Authors: Tae-Hoon Kim, Kwon-Ha Yoon, Hong Young Jun, Ki-Jong Kim, Young Hwan Lee, Myeung Su Lee, Keum Ha Choi, Ki Jung Yun, Eun Young Cho, Yong-Yeon Jeong, Chung-Hwan Jun

Abstract:

Purpose: To assess the changes of hepatic metabolite for differentiation between non-alcoholic steatohepatitis (NASH) and simple steatosis on proton magnetic resonance spectroscopy (1H-MRS) in both humans and animal model. Methods: The local institutional review board approved this study and subjects gave written informed consent. 1H-MRS measurements were performed on a localized voxel of the liver using a point-resolved spectroscopy (PRESS) sequence and hepatic metabolites of alanine (Ala), lactate/triglyceride (Lac/TG), and TG were analyzed in NASH, simple steatosis and control groups. The group difference was tested with the ANOVA and Tukey’s post-hoc tests, and diagnostic accuracy was tested by calculating the area under the receiver operating characteristics (ROC) curve. The associations between metabolic concentration and pathologic grades or non-alcoholic fatty liver disease(NAFLD) activity scores were assessed by the Pearson’s correlation. Results: Patient with NASH showed the elevated Ala(p<0.001), Lac/TG(p < 0.001), TG(p < 0.05) concentration when compared with patients who had simple steatosis and healthy controls. The NASH patients were higher levels in Ala(mean±SEM, 52.5±8.3 vs 2.0±0.9; p < 0.001), Lac/TG(824.0±168.2 vs 394.1±89.8; p < 0.05) than simple steatosis. The area under the ROC curve to distinguish NASH from simple steatosis was 1.00 (95% confidence interval; 1.00, 1.00) with Ala and 0.782 (95% confidence interval; 0.61, 0.96) with Lac/TG. The Ala and Lac/TG levels were well correlated with steatosis grade, lobular inflammation, and NAFLD activity scores. The metabolic changes in human were reproducible to a mice model induced by streptozotocin injection and a high-fat diet. Conclusion: 1H-MRS would be useful for differentiation of patients with NASH and simple hepatic steatosis.

Keywords: non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, 1H MR spectroscopy, hepatic metabolites

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