Search results for: tertiary roads

Authors: Rahy Farooq, Maria Ahmad Khan, Ayesha Isani Majeed

Abstract:

Objective: The main aim of this research is to assess the knowledge, attitude and practices of female nursing staff and nursing students regarding breast cancer, to provide a baseline for monitoring trends of breast cancer awareness in them. Background: Healthcare professionals are a direct source of information for the patients and the general public as a whole. It is, therefore, essential that the information they convey be accurate and helps in building additional awareness. However, clinical experience does not influence the knowledge, attitude and practices regarding breast cancer. Nurses, being the prime part of the healthcare professionals, play a significant role and hence, their awareness regarding this pressing issue is pertinent. Lack of awareness regarding common presenting symptoms or breast cancer risk factors translates to poor breast cancer screening practices and late diagnosis. Methodology: A cross-sectional study of 280 female nurses was conducted at a tertiary care hospital in Islamabad, Pakistan. A pre-tested structured questionnaire with additional variables like cultural barriers to seeking medical help was used. The scores for outcome variables including knowledge, attitude and practices were pre-defined. Data was analyzed using SPSSv23. Results: Of the 280 participants with a mean age of 28.99±9.98 years, 142 (50.7%) were married, and 138 (49.3%) were unmarried. Mean scores were computed to be 6.14±2.93 (out of 12), 0.30±0.7 (out of 3) and 9.53±1.92 (out of 16) for knowledge, attitude and practice respectively. Using independent sample T-test, a statistically significant correlation was found when means for the score of Attitude was compared with age. With a p-value of 0.018, 117 nurses of age more than 30 years, faced more practical, financial, emotional and service barriers as compared to 163 women younger than 30 years of age. Knowledge of age-related lifetime risks was also significantly poor more in single women; with a p-value of 0.006 for identification of correct age as a risk factor and a p-value of 0.005 for correct identification of risk for development of breast cancer in the lifetime of women. By application of Chi-square test, there was a significant correlation between marital status and cultural barriers to seeking medical help, showing that single women (58.7%) shy away from talking about breast cancer considering it a taboo (p-value 0.028) whereas, more married nurses (59.2%) were apprehensive that they might be considered at fault by the society, as compared to 40.8% of single nurses. (p-value 0.038). Conclusion: Owing to the scarcity of awareness among nurses, this study recognizes the need for delivering effective information to the female nurses regarding breast cancer. Educating patients is likely to be effective if the female nurses play their part and have correct attitudes towards breast cancer practices. A better understanding of the knowledge and practices regarding breast cancer among the nursing population will enable high-risk patients to be recognized early. Therefore, we recommend arrangement of special courses and seminars for all healthcare professionals including the nursing staff.

Keywords: breast cancer, cultural barriers, kap, nurses

Procedia PDF Downloads 238

Authors: A. Venkatakrishnan, M. Juneja, S. Kapoor

Abstract:

Background: Gastrointestinal dysfunction is an emerging co morbidity seen in autism and may further strengthen the association between autism and celiac disease. This is supported by increased rates (22-70%) of gastrointestinal symptoms like diarrhea, constipation, abdominal discomfort/pain, and gastrointestinal inflammation in children with the etiology of autism is still elusive. In addition to genetic factors, environmental factors such as toxin exposure, intrauterine exposure to certain teratogenic drugs, are being proposed as possible contributing factors in the etiology of Autism Spectrum Disorders (ASD) in cognizance with reports of increased gut permeability and high rates of gastrointestinal symptoms noted in children with ASD, celiac disease has also been proposed as a possible etiological factor. Despite insufficient evidence regarding the benefit of restricted diets in Autism, GFD has been promoted as an alternative treatment for ASD. This study attempts to discern any correlation between ASD and celiac disease. Objective: This cross sectional study aims to determine the proportion of celiac disease in children with ASD. Methods: Study included 155 participants aged 2-12 yrs, diagnosed as ASD as per DSM-5 attending the child development center at a tertiary care hospital in Northern India. Those on gluten free diet or having other autoimmune conditions were excluded. A detailed Performa was filled which included sociodemographic details, history of gastrointestinal symptoms, anthropometry, systemic examination, and pertinent psychological testing was done using was assessed using Developmental Profile-3(DP-3) for Developmental Quotient, Childhood Autism Rating Scale-2 (CARS-2) for severity of ASD, Vineland Adaptive Behavior Scales (VABS) for adaptive behavior, Child Behavior Checklist (CBCL) for behavioral problems and BAMBI (Brief Autism Mealtime Behavior Scales) for feeding problems. Screening for celiac was done by TTG-IgA levels, and total serum IgA levels were measured to exclude IgA deficiency. Those with positive screen were further planned for HLA typing and endoscopic biopsy. Results: A total of 155 cases were included, out of which 5 had low IgA levels and were hence excluded from the study. The rest 150 children had TTG levels below the ULN and normal total serum IgA level. History of Gastrointestinal symptoms was present in 51 (34%) cases abdominal pain was the most frequent complaint (16.6%), followed by constipation (12.6%). Diarrhea was seen in 8 %. Gastrointestinal symptoms were significantly more common in children with ASD above 5 yrs (p-value 0.006) and those who were verbal (p = 0.000). There was no significant association between socio-demographic factors, anthropometric data, or severity of autism with gastrointestinal symptoms. Conclusion: None of the150 patients with ASD had raised TTG levels; hence no association was found between ASD and celiac disease. There is no justification for routine screening for celiac disease in children with ASD. Further studies are warranted to evaluate association of Non Celiac Gluten Sensitivity with ASD and any role of gluten-free diet in such patients.

Keywords: autism, celiac, gastrointestinal, gluten

Procedia PDF Downloads 120

Authors: Susanna Graziano, Lydia Krstic Ward

Abstract:

The purpose of this presentation is to demonstrate the steps of using multimedia and collaborative platforms in project-based learning. The presentation will demonstrate the stages of the learning project with various components of independent and collaborative learning, where students research the topic, share information, prepare a survey, use social media (Facebook, Instagram, WhasApp) and collaborative platforms (wikispaces.com and Google docs) to collect, analyze and process data, then produce reports and logos to be displayed as a final product. At the beginning of the presentation participants will answer a questionnaire about project based learning and share their experience on using social media, real–world project work and collaborative learning. Using a PPP, the presentation will walk participants through the steps of a completed project where tertiary education students are involved in putting together a multimedia campaign for safe driving in Kuwait. The research component of the project entails taking a holistic view on the problem of the high death rate in traffic accidents. The final goal of the project is to lead students to raise public awareness about the importance of safe driving. The project steps involve using the social media and collaborative platforms for collecting data and sharing the required materials to be used in the final product – a display of written reports, slogans and videos, as well as oral presentations. The same structure can be used to organize a multimedia campaign focusing on other issues, whilst scaffolding on students’ ability to brainstorm, retrieve information, organize it and engage in collaborative/ cooperative learning whilst being immersed in content-based learning as well as in authentic tasks. More specifically, the project we carried out at Box Hill College was a real-world one and involved a multimedia Campaign for Safe Driving since reckless driving is one of the major problems in the country. The idea for the whole project started by a presentation given by a board member of the Kuwaiti Society for Traffic Safety who was invited to college and spoke about: • Driving laws in the country, • What causes car accidents, • Driving safety tips. The principal goal of this project was to let students consider problems of traffic in Kuwait from different points of view. They also had to address the number and causes of accidents, evaluate the effectiveness of the local traffic law in order to send a warning about the importance of safe driving and, finally, suggest ways of its improvement. Benefits included: • Engagement, • Autonomy, • Motivation, • Content knowledge, • Language mastery, • Enhanced critical thinking, • Increased metacognitive awareness, • Improved social skills, • Authentic experience.

Keywords: social media, online learning platforms, collaborative platforms, project based learning

Procedia PDF Downloads 425

Authors: Rajkumar Ghosh

Abstract:

Rapid urbanization, rising population, changing lifestyles and in-migration, Lucknow is groundwater over-exploited area, with an abstract rate of 1968 m3/day/km2 in Gomti Nagar. The groundwater situation in Gomti Nagar is deteriorating day-by-day. According to the work, the calculated annual water deficiency in Gomti Nagar area will be 28061 Million Litre (ML) in 2022. Within 30 yrs., the water deficiency will be 735570 ML (till 2051). The calculated groundwater recharge in Gomti Nagar was 10813 ML/y (in 2022). The annual groundwater abstraction from Gomti Nagar area was 35332 ML/yr. (in 2022). Bye-laws (≥ 300 sq.m) existing RTRWHs can recharge 17.71 ML/yr. in Gomti Nagar area. The existing RTRWHs are contributing 0.07% for recharging groundwater table. In Gomti Nagar, the water level is dropping at a rate of 1.0 metre per year, and the depth of the water table is less than 30 metre below ground level (mbgl). Natural groundwater recharge is affected by the geomorphological conditions of the surrounding area. Gomti Nagar is located on the erosional terrace (Te) and depositional terrace (d) of the Gomti River. The flood plain in Lucknow city is less active due to the embankments on the both sides of the Gomti River. The alluvium is composed of clay sandy up to a depth of 30m, and the alignment of the Gomti River reveals the presence of sandy soil at shallow depths. Aquifer depth 120 metre. Recharge as in Gomti Nagar (it may vary) 0 – 150 metre. Infiltration rates in alluvial floodplains range from 0.8 to 74 cm/hr. Geologically and Geomorphologically support rapid percolation of rainwater through alluvium in Gomti Nagar, Lucknow city, Uttar Pradesh. Over-exploitation of groundwater causes natural hazards viz. land subsidence, development of cracks on roads and buildings, development of vacuum and compactness of soil/clay which leads towards land subsidence, devastating effects on natural stream flow. Gomti River already transitioning phase from ‘effluent’ to ‘influent’, and saline intrusion in Aquifer –II (among Five aquifers in Lucknow city). A 250 m long crack developed in 2007 due to groundwater depletion in Dullu Khera and Vader Khera village of Kakori, Uttar Pradesh. The groundwater table of Lucknow is declining and water table imbalance occurs due to 17 times less recharge than groundwater exploitation. Uttar Pradesh along with four states have extracted 49% of groundwater in the entire country. In Gomti Nagar area, 27305 no of houses are present and available build up area 3.8 sq. km (60% of plot area) based on Lucknow Development Authority (LDA) Master plan 2031. If RTRWHs would install in all the houses, then 12% harvested rainwater contribute to the water table in Gomti Nagar area. Till 2051, Gomti Nagar area will harvest 91110 ML of rainwater. There are minimalistic chances that any incidence of flood can occur due to RTRWH. Thus, it can conclud that RTRWH is not related to flood happening in urban areas viz. Gomti Nagar.

Keywords: RTRWH, aquifer, groundwater table, rainwater, infiltration

Procedia PDF Downloads 78

Authors: Anabel Moriña

Abstract:

In recent years, advances have been made in disability policy at Spanish universities, especially in terms of creating more inclusive learning environments. Nevertheless, while efforts to foster inclusion at the tertiary level -and the growing number of students with disabilities at university- are clear signs of progress, serious barriers to full participation in learning still exist. The research shows that university responses to diversity tend to be reactive, not proactive; as a result, higher education (HE) environments can be especially disabling. It has been demonstrated that the performance of students with disabilities is closely linked to the good will of university faculty and staff. Lectures are key players when it comes to helping or hindering students throughout the teaching/learning process. This paper presents an analysis of how lecturers respond to students with disabilities, the initial question being: do lecturers aid or hinder students? The general aim is to analyse-by listen to the students themselves-lecturers barriers and support identified as affecting academic performance and overall perception of the higher education (HE) experience. Biographical-narrative methodology was employed. This research analysed the results differentiating by fields of knowledge. The research was conducted in two phases: discussion groups along with individual oral/written interviews were set up with 44 students with disabilities and mini life histories were completed for 16 students who participated in the first stage. The study group consisted of students with disabilities enrolled during three academic years. The results of this paper noted that participating students identified many more barriers than bridges when speaking about the role lecturers play in their learning experience. Findings are grouped into several categories: Faculty attitudes when “dealing with” students with disabilities, teaching methodologies, curricular adaptations, and faculty training in working with students. Faculty does not always display appropriate attitudes towards students with disabilities. Study participants speak of them turning their backs on their problems-or behaving in an awkward manner. In many cases, it seems lecturers feel that curricular adaptations of any kind are a form of favouritism. Positive attitudes, however, often depend almost entirely on the good will of faculty and-although well received by students-are hard to come by. As the participants themselves suggest, this study confirms that good teaching practices not only benefit students with disabilities but the student body as a whole. In this sense, inclusive curricula provide new opportunities for all students. A general coincidence has been the lack of training on behalf of lecturers to adequately attend disabled students, and the need to cover this shortage. This can become a primary barrier and is more often due to deficient faculty training than to inappropriate attitudes on the part of lecturers. In conclusion, based on this research we can conclude that more barriers than bridges exist. That said, students do report receiving a good deal of support from their lecturers-although almost exclusively in a spirit of good will; when lecturers do help, however, it tends to have a very positive impact on students' academic performance.

Keywords: barriers, disability, higher education, lecturers

Procedia PDF Downloads 255

Authors: Akmez Nabeerasool, Michaelis Massaros, Nigel Brown, David Sanderson, David Parocki, Charlotte Thompson, Mike Lodge, Mikael Khan

Abstract:

The provision of clean and safe drinking water is of paramount importance and is a basic human need. Water scarcity coupled with tightening of regulations and the inability of current treatment technologies to deal with emerging contaminants and Pharmaceuticals and personal care products means that alternative treatment technologies that are viable and cost effective are required in order to meet demand and regulations for clean water supplies. Logistically, the application of water treatment in rural areas presents unique challenges due to the decentralisation of abstraction points arising from low population density and the resultant lack of infrastructure as well as the need to treat water at the site of use. This makes it costly to centralise treatment facilities and hence provide potable water direct to the consumer. Furthermore, across the UK there are segments of the population that rely on a private water supply which means that the owner or user(s) of these supplies, which can serve one household to hundreds, are responsible for the maintenance. The treatment of these private water supply falls on the private owners, and it is imperative that a chemical free technological solution that can operate unattended and does not produce any waste is employed. Arvia’s patented advanced oxidation technology combines the advantages of adsorption and electrochemical regeneration within a single unit; the Organics Destruction Cell (ODC). The ODC uniquely uses a combination of adsorption and electrochemical regeneration to destroy organics. Key to this innovative process is an alternative approach to adsorption. The conventional approach is to use high capacity adsorbents (e.g. activated carbons with high porosities and surface areas) that are excellent adsorbents, but require complex and costly regeneration. Arvia’s technology uses a patent protected adsorbent, Nyex™, which is a non-porous, highly conductive, graphite based adsorbent material that enables it to act as both the adsorbent and as a 3D electrode. Adsorbed organics are oxidised and the surface of the Nyex™ is regenerated in-situ for further adsorption without interruption or replacement. Treated water flows from the bottom of the cell where it can either be re-used or safely discharged. Arvia™ Technology Ltd. has trialled the application of its tertiary water treatment technology in treating reservoir water abstracted near Glasgow, Scotland, with promising results. Several other pilot plants have also been successfully deployed at various locations in the UK showing the suitability and effectiveness of the technology in removing recalcitrant organics (including pharmaceuticals, steroids and hormones), COD and colour.

Keywords: Arvia™ process, adsorption, water treatment, electrochemical oxidation

Procedia PDF Downloads 263

Authors: Cecilia Sosa, Fernanda Figueroa, Leonardo Calzada

Abstract:

Biosphere reserves (BR) are considered as the main strategy for biodiversity and ecosystems conservation. Mexican BR are mainly inhabited by rural communities who strongly depend on forests and their resources. Even though the dual objective of conservation and development has been sought in BR, land cover change is a common process in these areas, while most rural communities are highly marginalized, partly as a result of restrictions imposed by conservation to the access and use of resources. Achieving ecosystems conservation and social development face serious challenges. Factors such as financial support for development projects (public/private), environmental conditions, infrastructure and regional economic conditions might influence both land use change and wellbeing. Examining the temporal trends of conservation and development in BR is central for the evaluation of outcomes for these conservation strategies. In this study, we analyzed changes in primary vegetation cover (as a proxy for conservation) and the index of marginalization (as a proxy for development) in Mexican BR (2000-2015); we also explore the influence of various factors affecting these trends, such as conservation-development projects financial support (public or private), geographical distribution in ecoregions (as a proxy for shared environmental conditions) and in economic zones (as a proxy for regional economic conditions). We developed a spatial analysis at the municipal scale (2,458 municipalities nationwide) in ArcGIS, to obtain road densities, geographical distribution in ecoregions and economic zones, the financial support received, and the percent of municipality area under protection by protected areas and, particularly, by BR. Those municipalities with less than 25% of area under protection were regarded as part of the protected area. We obtained marginalization indexes for all municipalities and, using MODIS in Google Earth Engine, the number of pixels covered by primary vegetation. We used a linear mixed model in RStudio for the analysis. We found a positive correlation between the marginalization index and the percent of primary vegetation cover per year (r=0.49-0.5); i.e., municipalities with higher marginalization also show higher percent of primary vegetation cover. Also, those municipalities with higher area under protection have more development projects (r=0.46) and some environmental conditions were relevant for percent of vegetation cover. Time, economic zones and marginalization index were all important. Time was particularly, in 2005, when both marginalization and deforestation decreased. Road densities and financial support for conservation-development projects were irrelevant as factors in the general correlation. Marginalization is still being affected by the conservation strategies applied in BR, even though that this management category considers both conservation and development of local communities as its objectives. Our results suggest that roads densities and support for conservation-development projects have not been a factor of poverty alleviation. As better conservation is being attained in the most impoverished areas, we face the dilemma of how to improve wellbeing in rural communities under conservation, since current strategies have not been able to leave behind the conservation-development contraposition.

Keywords: deforestation, local development, marginalization, protected areas

Procedia PDF Downloads 136

Authors: Soma Kanta Baral

Abstract:

Background: Since 1981, when the first AIDS case was reported, worldwide, more than 34 million people have been infected with HIV. Almost 95 percent of the people infected with HIV live in developing countries. As HBV & HIV share similar routes of transmission by sexual intercourse or drug use by parenteral injection, co-infection is common. Because of the limited access to healthcare & HIV treatment in developing countries, HIV-infected individuals are present late for care. Enumeration of CD4+ T cell count at the time of diagnosis has been useful to initiate the therapy in HIV infected individuals. The baseline CD4+ T cell count shows high immunological variability among patients. Methods: This prospective study was done in the serology section of the Department of Microbiology over a period of one year from august 2012 to July 2013. A total of 13037 individuals subjected for HIV test were included in the study comprising of 4982 males & 8055 females. Blood sample was collected by vein puncture aseptically with standard operational procedure in clean & dry test-tube. All blood samples were screened for HIV as described by WHO algorithm by Immuno-chromatography rapid kits. Further confirmation was done by biokit ELISA method as per the manufacturer’s guidelines. After informed consent, HIV positive individuals were screened for HBsAg by Immuno-chromatography rapid kits (Hepacard). Further confirmation was done by biokit ELISA method as per the manufacturer’s guidelines. EDTA blood samples were collected from the HIV sero-positive individuals for baseline CD4+ T count. Then, CD4+ T cells count was determined by using FACS Calibur Flow Cytometer (BD). Results: Among 13037 individuals screened for HIV, 104 (0.8%) were found to be infected comprising of 69(66.34%) males & 35 (33.65%) females. The study showed that the high infection was noted in housewives (28.7%), active age group (30.76%), rural area (56.7%) & in heterosexual route (80.9%) of transmission. Out of total HIV infected individuals, distribution of HBV co-infection was found to be 6(5.7%). All co- infected individuals were married, male, above the age of 25 years & heterosexual route of transmission. Baseline CD4+ T cell count of HIV infected patient was found higher (mean CD4+ T cell count; 283cells/cu.mm) than HBV co-infected patients (mean CD4+ T cell count; 91 cells/cu.mm). Majority (77.2%) of HIV infected & all co-infected individuals were presented in our center late (CD4+ T cell count;< 350/cu. mm) for diagnosis and care. Majority of co- infected 4 (80%) were late presented with advanced AIDS stage (CD4+ count; <200/cu.mm). Conclusions: The study showed a high percentage of HIV sero-positive & co- infected individuals. Baseline CD4+ T cell count of majority of HIV infected individuals was found to be low. Hence, more sustained and vigorous awareness campaigns & counseling still need to be done in order to promote early diagnosis and management.

Keywords: HIV/AIDS, HBsAg, co-infection, CD4+

Procedia PDF Downloads 215

Authors: Mark Christian Inductivo Siwa, Jesrelle Ormoc Bontuyan

Abstract:

This study was conducted in selected tertiary schools in selected universities in Asian countries such as Philippines, Thailand, and China, which are the top performing countries in Southeast Asian Games or SEA Games and Asian School Games (ASG), also known as the Youth SEA Games and Asian Games. The respondents of the study are sports administrators/directors and coaches in selected Southeast Asian countries such as Philippines, Thailand, and in Asia which is China. This study has generated a progressive sports operational model of Sports Leadership and Management in Selected Universities in Asia. This study utilized mixed-method research. It is a methodology for conducting research that involves collecting, analyzing and integrating quantitative (e.g., experiments, surveys) and qualitative (e.g., focus groups, interviews) research. This approach to research is used to provide integration for a better understanding of the research problem than either of each alone. This study particularly employed the explanatory sequential design of mixed methods, which involved two phases: the quantitative phase, which involves the collection and analysis of quantitative data, followed by the qualitative phase, which involves the collection and analysis of qualitative data. This study will prioritize the quantitative data and the findings will be followed up during the interpretation phase in the qualitative data of the study. The qualitative data help explain or build upon initial quantitative results. In phase I, the researcher began with the collection and analysis of the quantitative data. His investigation gave greater emphasis on the quantitative methods, particularly employed surveys with the coaches and sports directors of the three selected universities in Asia. In Phase II, the researcher subsequently collected and analyzed the qualitative data obtained through an interview with the sports directors to follow from or connect to the results of the quantitative phase. This study followed the data analysis spiral so that the researcher could follow – up or explain the quantitative results. The researcher engaged in the process of moving in analytic circles. Based on the school's mission and vision, the sports leadership and management consistently followed the key factors to take into account when leading the organization and managing the process in sports leadership and management when formulating objectives/goals, budget, equipment care and maintenance, facilities, training matrix, and consideration. Also, sports management demonstrates the need for development in terms of the upkeep and care of equipment as well as athlete funding. The development of goals or sports management goals, sports facilities and equipment, as well as improvements in demonstrating training and consideration, and incentives, should also include a maintenance plan. The study concluded with a progressive sports operational model that was created based on the result of the study.

Keywords: sports leadership and management, formulating objectives, budget, equipment care and maintenance, training, consideration, incentives, progressive sports operational model

Procedia PDF Downloads 92

Authors: Gelareh Ghaderi

Abstract:

the overall objective of this study is to develop two alternative plans of spatial and infrastructural development for the Netwerkstad Twente (Twente region) until 2040 and to assess the impacts of those two alternative plans. This region is located on the eastern border of the Netherlands, and it comprises of five municipalities. Based on the strengths and opportunities of the five municipalities of the Netwerkstad Twente, and in order develop the region internationally, strengthen the job market and retain skilled and knowledgeable young population, two alternative visions have been developed; environmental oriented vision, and economical oriented vision. Environmental oriented vision is based mostly on preserving beautiful landscapes. Twente would be recognized as an educational center, driven by green technologies and environment-friendly economy. Market-oriented vision is based on attracting and developing different economic activities in the region based on visions of the five cities of Netwerkstad Twente, in order to improve the competitiveness of the region in national and international scale. On the basis of the two developed visions and strategies for achieving the visions, land use and infrastructural development are modeled and assessed. Based on the SWOT analysis, criteria were formulated and employed in modeling the two contrasting land use visions by the year 2040. Land use modeling consists of determination of future land use demand, assessment of suitability land (Suitability analysis), and allocation of land uses on suitable land. Suitability analysis aims to determine the available supply of land for future development as well as assessing their suitability for specific type of land uses on the basis of the formulated set of criteria. Suitability analysis was operated using CommunityViz, a Planning Support System application for spatially explicit land suitability and allocation. Netwerkstad Twente has highly developed transportation infrastructure, consists of highways network, national road network, regional road network, street network, local road network, railway network and bike-path network. Based on the assumptions of speed limitations on different types of roads provided, infrastructure accessibility level of predicted land use parcels by four different transport modes is investigated. For evaluation of the two development scenarios, the Multi-criteria Evaluation (MCE) method is used. The first step was to determine criteria used for evaluation of each vision. All factors were categorized as economical, ecological and social. Results of Multi-criteria Evaluation show that Environmental oriented cities scenario has higher overall score. Environment-oriented scenario has impressive scores in relation to economical and ecological factors. This is due to the fact that a large percentage of housing tends towards compact housing. Twente region has immense potential, and the success of this project will define the Eastern part of The Netherlands and create a real competitive local economy with innovations and attractive environment as its backbone.

Keywords: economical oriented vision, environmental oriented vision, infrastructure, land use, multi criteria assesment, vision

Procedia PDF Downloads 227

Authors: S. R. H. Baqri, T. Shahina, M. T. Hasan

Abstract:

Pakistan is facing acute shortage of energy and looking for indigenous resources of the energy mix to meet the short fall. After the discovery of huge coal resources in Thar Desert of Sindh province, focus has shifted to coal power generation. The government of Pakistan has planned power generation of 20000 MW on coal by the year 2025. This target will be achieved by mining and power generation in Thar coal Field and on imported coal in different parts of Pakistan. Total indigenous coal production of around 3.0 million tons is being utilized in brick kilns, cement and sugar industry. Coal-based power generation is only limited to three units of 50 MW near Hyderabad from nearby Lakhra Coal field. The purpose of this presentation is to identify and redressal of issues of coal mining and utilization with reference to environmental hazards. Thar coal resource is estimated at 175 billion tons out of a total resource estimate of 184 billion tons in Pakistan. Coal of Pakistan is of Tertiary age (Palaeocene/Eocene) and classified from lignite to sub-bituminous category. Coal characterization has established three main pollutants such as Sulphur, Carbon dioxide and Methane besides some others associated with coal and rock types. The element Sulphur occurs in organic as well as inorganic forms associated with coals as free sulphur and as pyrite, gypsum, respectively. Carbon dioxide, methane and minerals are mostly associated with fractures, joints local faults, seatearth and roof rocks. The abandoned and working coal mines give kerosene odour due to escape of methane in the atmosphere. While the frozen methane/methane ices in organic matter rich sediments have also been reported from the Makran coastal and offshore areas. The Sulphur escapes into the atmosphere during mining and utilization of coal in industry. The natural erosional processes due to rivers, streams, lakes and coastal waves erode over lying sediments allowing pollutants to escape into air and water. Power plants emissions should be controlled through application of appropriate clean coal technology and need to be regularly monitored. Therefore, the systematic and scientific studies will be required to estimate the quantity of methane, carbon dioxide and sulphur at various sites such as abandoned and working coal mines, exploratory wells for coal, oil and gas. Pressure gauges on gas pipes connecting the coal-bearing horizons will be installed on surface to know the quantity of gas. The quality and quantity of gases will be examined according to the defined intervals of times. This will help to design and recommend the methods and procedures to stop the escape of gases into atmosphere. The element of Sulphur can be removed partially by gravity and chemical methods after grinding and before industrial utilization of coal.

Keywords: atmosphere, coal production, energy, pollutants

Procedia PDF Downloads 436

Authors: Muhammad Karim Ahmadzai

Abstract:

Floods are natural phenomena and are an integral part of the water cycle. The majority of them are the result of climatic conditions, but are also affected by the geology and geomorphology of the area, topography and hydrology, the water permeability of the soil and the vegetation cover, as well as by all kinds of human activities and structures. However, from the moment that human lives are at risk and significant economic impact is recorded, this natural phenomenon becomes a natural disaster. Flood management is now a key issue at regional and local levels around the world, affecting human lives and activities. The majority of floods are unlikely to be fully predicted, but it is feasible to reduce their risks through appropriate management plans and constructions. The aim of this Case Study is to identify, and map areas of flood risk in the Khinch District of Panjshir Province, Afghanistan specifically in the area of Peshghore, causing numerous damages. The main purpose of this study is to evaluate the contribution of remote sensing technology and Geographic Information Systems (GIS) in assessing the susceptibility of this region to flood events. Panjsher is facing Seasonal floods and human interventions on streams caused floods. The beds of which have been trampled to build houses and hotels or have been converted into roads, are causing flooding after every heavy rainfall. The streams crossing settlements and areas with high touristic development have been intensively modified by humans, as the pressure for real estate development land is growing. In particular, several areas in Khinch are facing a high risk of extensive flood occurrence. This study concentrates on the construction of a flood susceptibility map, of the study area, by combining vulnerability elements, using the Analytical Hierarchy Process/ AHP. The Analytic Hierarchy Process, normally called AHP, is a powerful yet simple method for making decisions. It is commonly used for project prioritization and selection. AHP lets you capture your strategic goals as a set of weighted criteria that you then use to score projects. This method is used to provide weights for each criterion which Contributes to the Flood Event. After processing of a digital elevation model (DEM), important secondary data were extracted, such as the slope map, the flow direction and the flow accumulation. Together with additional thematic information (Landuse and Landcover, topographic wetness index, precipitation, Normalized Difference Vegetation Index, Elevation, River Density, Distance from River, Distance to Road, Slope), these led to the final Flood Risk Map. Finally, according to this map, the Priority Protection Areas and Villages and the structural and nonstructural measures were demonstrated to Minimize the Impacts of Floods on residential and Agricultural areas.

Keywords: flood hazard, flood risk map, flood mitigation measures, AHP analysis

Procedia PDF Downloads 118

Authors: Vineet Agrawal, Deepanjali S., Medha R., Subitha L.

Abstract:

Background. Hospital malnutrition is a highly prevalent issue and is known to increase the morbidity, mortality, length of hospital stay, and cost of care. In India, studies on hospital malnutrition have been restricted to ICU, post-surgical, and cancer patients. We designed this study to assess the impact of hospital malnutrition on 30-day post-discharge and in-hospital mortality in patients admitted in the general medicine department, irrespective of diagnosis. Methodology. All patients aged above 18 years admitted in the medicine wards, excluding medico-legal cases, were enrolled in the study. Nutritional assessment was done within 72 h of admission, using Subjective Global Assessment (SGA), which classifies patients into three categories: Severely malnourished, Mildly/moderately malnourished, and Normal/well-nourished. Anthropometric measurements like Body Mass Index (BMI), Triceps skin-fold thickness (TSF), and Mid-upper arm circumference (MUAC) were also performed. Patients were followed-up during hospital stay and 30 days after discharge through telephonic interview, and their final diagnosis, comorbidities, and cause of death were noted. Multivariate logistic regression and cox regression model were used to determine if the nutritional status at admission independently impacted mortality at one month. Results. The prevalence of malnourishment by SGA in our study was 67.3% among 395 hospitalized patients, of which 155 patients (39.2%) were moderately malnourished, and 111 (28.1%) were severely malnourished. Of 395 patients, 61 patients (15.4%) expired, of which 30 died in the hospital, and 31 died within 1 month of discharge from hospital. On univariate analysis, malnourished patients had significantly higher morality (24.3% in 111 Cat C patients) than well-nourished patients (10.1% in 129 Cat A patients), with OR 9.17, p-value 0.007. On multivariate logistic regression, age and higher Charlson Comorbidity Index (CCI) were independently associated with mortality. Higher CCI indicates higher burden of comorbidities on admission, and the CCI in the expired patient group (mean=4.38) was significantly higher than that of the alive cohort (mean=2.85). Though malnutrition significantly contributed to higher mortality on univariate analysis, it was not an independent predictor of outcome on multivariate logistic regression. Length of hospitalisation was also longer in the malnourished group (mean= 9.4 d) compared to the well-nourished group (mean= 8.03 d) with a trend towards significance (p=0.061). None of the anthropometric measurements like BMI, MUAC, or TSF showed any association with mortality or length of hospitalisation. Inference. The results of our study highlight the issue of hospital malnutrition in medicine wards and reiterate that malnutrition contributes significantly to patient outcomes. We found that SGA performs better than anthropometric measurements in assessing under-nutrition. We are of the opinion that the heterogeneity of the study population by diagnosis was probably the primary reason why malnutrition by SGA was not found to be an independent risk factor for mortality. Strategies to identify high-risk patients at admission and treat malnutrition in the hospital and post-discharge are needed.

Keywords: hospitalization outcome, length of hospital stay, mortality, malnutrition, subjective global assessment (SGA)

Procedia PDF Downloads 150

Authors: Mohammed AL-Hasani

Abstract:

The Pandemic COVID-19 altered the daily habits and affected the functional performance of the cities after this crisis leaving remarkable impacts on many metropolises worldwide. It is so obvious that having more densification in the city leads to more threats altering this main approach that was called for achieving sustainable development. The main goal to achieve resiliency in the cities, especially in forcing risks, is to deal with a planning system that is able to resist, absorb, accommodate and recover from the impacts that had been affected. Many Cities in London, Wuhan, New York, and others worldwide carried different planning approaches and varied in reaction to safeguard the impacts of the pandemic. The cities globally varied from the radiant pattern predicted by Le Corbusier, or having multi urban centers more like the approach of Frank Lloyd Wright’s Broadacre City, or having linear growth or gridiron expansion that was common by Doxiadis, compact pattern, and many other hygiene patterns. These urban patterns shape the spatial distribution and Identify both open and natural spaces with gentrified and gentrifying areas. This crisis paid attention to reassess many planning approaches and examine the existing urban patterns focusing more on the aim of continuity and resiliency in managing the crises within the rapid transformation and the power of market forces. According to that, this paper hypothesized that those urban planning patterns determine the method of reaction in assuring quarantine for the inhabitance and the performance of public services and need to be updated through carrying out an innovative urban management system and adopt further resilience patterns in prospective urban planning approaches. This paper investigates the adaptivity and resiliency of variant urban planning patterns regarding selected cities worldwide that affected by COVID-19 and their role in applying certain management strategies in controlling the pandemic spread, finding out the main potentials that should be included in prospective planning approaches. The examination encompasses the spatial arrangement, blocks definition, plots arrangement, and urban space typologies. This paper aims to investigate the urban patterns to deliberate also the debate between densification as one of the more sustainable planning approaches and disaggregation tendency that was followed after the pandemic by restructuring and managing its application according to the assessment of the spatial distribution and urban patterns. The biggest long-term threat to dense cities proves the need to shift to online working and telecommuting, creating a mixture between using cyber and urban spaces to remobilize the city. Reassessing spatial design and growth, open spaces, urban population density, and public awareness are the main solutions that should be carried out to face the outbreak in our current cities that should be managed from global to tertiary levels and could develop criteria for designing the prospective cities

Keywords: COVID-19, densification, resiliency, urban patterns

Procedia PDF Downloads 130

Authors: Jodie Lee, Lorena Chan, Esther Tong

Abstract:

Hong Kong students face a unique learning environment. Starting from the 2010/2011 school year, The Education Bureau (EDB) of the Government of the Hong Kong Special Administrative Region implemented the fine-tuned Medium of Instruction (MOI) arrangements for secondary schools. Since then, secondary schools in Hong Kong have been given the flexibility to decide the most appropriate MOI arrangements for their schools and under the new academic structure for senior secondary education, particularly on the compulsory part of the mathematics curriculum. In 2019, Hong Kong Diploma of Secondary Education Examination (HKDSE), over 40% of school day candidates attempted the Mathematics Compulsory Part examination in the Chinese version while the rest took the English version. Moreover, only 14.38% of candidates sat for one of the extended Mathematics modules. This results in a serious of intricate issues to students’ learning in post-secondary education programmes. It is worth to note that when students further pursue to an higher education in Hong Kong or even oversea, they may facing substantial difficulties in transiting learning from learning mathematics in their mother tongue in Chinese-medium instruction (CMI) secondary schools to an English-medium learning environment. Some students understood the mathematics concepts were found to fail to fulfill the course requirements at college or university due to their learning experience in secondary study at CMI. They are particularly weak in comprehending the mathematics questions when they are doing their assessment or attempting the test/examination. A government funded project was conducted with the aims of providing integrated learning context and language support to students with a lower level of numeracy and/or with CMI learning experience. By introducing this “integrated concept + language mapping approach”, students can cope with the learning challenges in the compulsory English-medium mathematics and statistics subjects in their tertiary education. Ultimately, in the hope that students can enhance their mathematical ability, analytical skills, and numerical sense for their lifelong learning. The “Concept + Language Mapping “(CLM) approach was adopted and tried out in the bridging courses for students with a lower level of numeracy and/or with CMI learning experiences. At the beginning of each class, a pre-test was conducted, and class time was then devoted to introducing the concepts by CLM approach. For each concept, the key thematic items and their different semantic relations are presented using graphics and animations via the CLM approach. At the end of each class, a post-test was conducted. Quantitative data analysis was performed to study the effect on students’ learning via the CLM approach. Stakeholders' feedbacks were collected to estimate the effectiveness of the CLM approach in facilitating both content and language learning. The results based on both students’ and lecturers’ feedback indicated positive outcomes on adopting the CLM approach to enhance the mathematical ability and analytical skills of CMI students.

Keywords: mathematics, Concept+Language Mapping, level of numeracy, medium of instruction

Procedia PDF Downloads 81

Authors: Tingneyuc Sekac, Sujoy Kumar Jana, Indrajit Pal, Dilip Kumar Pal

Abstract:

Tectonism induced Tsunami, landslide, ground shaking leading to liquefaction, infrastructure collapse, conflagration are the common earthquake hazards that are experienced worldwide. Apart from human casualty, the damage to built-up infrastructures like roads, bridges, buildings and other properties are the collateral episodes. The appropriate planning must precede with a view to safeguarding people’s welfare, infrastructures and other properties at a site based on proper evaluation and assessments of the potential level of earthquake hazard. The information or output results can be used as a tool that can assist in minimizing risk from earthquakes and also can foster appropriate construction design and formulation of building codes at a particular site. Different disciplines adopt different approaches in assessing and monitoring earthquake hazard throughout the world. For the present study, GIS and Remote Sensing potentials were utilized to evaluate and assess earthquake hazards of the study region. Subsurface geology and geomorphology were the common features or factors that were assessed and integrated within GIS environment coupling with seismicity data layers like; Peak Ground Acceleration (PGA), historical earthquake magnitude and earthquake depth to evaluate and prepare liquefaction potential zones (LPZ) culminating in earthquake hazard zonation of our study sites. The liquefaction can eventuate in the aftermath of severe ground shaking with amenable site soil condition, geology and geomorphology. The latter site conditions or the wave propagation media were assessed to identify the potential zones. The precept has been that during any earthquake event the seismic wave is generated and propagates from earthquake focus to the surface. As it propagates, it passes through certain geological or geomorphological and specific soil features, where these features according to their strength/stiffness/moisture content, aggravates or attenuates the strength of wave propagation to the surface. Accordingly, the resulting intensity of shaking may or may not culminate in the collapse of built-up infrastructures. For the case of earthquake hazard zonation, the overall assessment was carried out through integrating seismicity data layers with LPZ. Multi-criteria Evaluation (MCE) with Saaty’s Analytical Hierarchy Process (AHP) was adopted for this study. It is a GIS technology that involves integration of several factors (thematic layers) that can have a potential contribution to liquefaction triggered by earthquake hazard. The factors are to be weighted and ranked in the order of their contribution to earthquake induced liquefaction. The weightage and ranking assigned to each factor are to be normalized with AHP technique. The spatial analysis tools i.e., Raster calculator, reclassify, overlay analysis in ArcGIS 10 software were mainly employed in the study. The final output of LPZ and Earthquake hazard zones were reclassified to ‘Very high’, ‘High’, ‘Moderate’, ‘Low’ and ‘Very Low’ to indicate levels of hazard within a study region.

Keywords: hazard micro-zonation, liquefaction, multi criteria evaluation, tectonism

Procedia PDF Downloads 266

Authors: Tamar Trop

Abstract:

Bike sharing systems can be important elements of smart cities as they have the potential for impact on multiple levels. These systems can add a significant alternative to other modes of mass transit in cities that are continuously looking for measures to become more livable and maintain their attractiveness for citizens, businesses and tourism. Bike-sharing began in Europe in 1965, and a viable format emerged in the mid-2000s thanks to the introduction of information technology. The rate of growth in bike-sharing schemes and fleets has been very rapid since 2008 and has probably outstripped growth in every other form of urban transport. Today, public bike-sharing systems are available on five continents, including over 700 cities, operating more than 800,000 bicycles at approximately 40,000 docking stations. Since modern bike sharing systems have become prevalent only in the last decade, the existing literature analyzing these systems and their sustainability is relatively new. The purpose of the presented study is to assess the sustainability of these newly emerging transportation systems, by using the Envision™ rating system as a methodological framework and the Israeli 'Tel -O-Fun' – bike sharing project as a case study. The assessment was conducted by project team members. Envision™ is a new guidance and rating system used to assess and improve the sustainability of all types and sizes of infrastructure projects. This tool provides a holistic framework for evaluating and rating the community, environmental, and economic benefits of infrastructure projects over the course of their life cycle. This evaluation method has 60 sustainability criteria divided into five categories: Quality of life, leadership, resource allocation, natural world, and climate and risk. 'Tel -O-Fun' project was launched in Tel Aviv-Yafo on 2011 and today provides about 1,800 bikes for rent, at 180 rental stations across the city. The system is based on a complex computer terminal that is located in the docking stations. The highest-rated sustainable features that the project scored include: (a) Improving quality of life by: offering a low cost and efficient form of public transit, improving community mobility and access, enabling the flexibility of travel within a multimodal transportation system, saving commuters time and money, enhancing public health and reducing air and noise pollution; (b) improving resource allocation by: offering inexpensive and flexible last-mile connectivity, reducing space, materials and energy consumption, reducing wear and tear on public roads, and maximizing the utility of existing infrastructure, and (c) reducing of greenhouse gas emissions from transportation. Overall, 'Tel -O-Fun' project was highly scored as an environmentally sustainable and socially equitable infrastructure. The use of this practical framework for evaluation also yielded various interesting insights on the shortcoming of the system and the characteristics of good solutions. This can contribute to the improvement of the project and may assist planners and operators of bike sharing systems to develop a sustainable, efficient and reliable transportation infrastructure within smart cities.

Keywords: bike sharing, Envision™, sustainability rating system, sustainable infrastructure

Procedia PDF Downloads 340

Authors: Djeddi Mabrouk

Abstract:

The slow coming together between the Afro-Eurasia plates seems to be the main cause of the active deformation in the whole of North Africa which in consequence come true in Algeria with a large zone of deformation in an enough large limited band, southern through Saharan atlas and northern through tell atlas. Maghrebin and Atlassian Chain along North Africa are the consequence of this convergence. In junction zone, we have noticed a compressive regime NW-SE with a creases-faults structure and structured overthrust. From a geological point of view the north part of Algeria is younger then Saharan platform, it’s changing so unstable and constantly in movement, it’s characterized by creases openly reversed, overthrusts and reversed faults, and undergo perpetually complex movement vertically and horizontally. On structural level the north of Algeria it's a part of erogenous alpine peri-Mediterranean and essentially the tertiary age It’s spread from east to the west of Algeria over 1200 km.This oogenesis is extended from east to west on broadband of 100 km.The alpine chain is shaped by 3 domains: tell atlas in north, high plateaus in mid and Saharan atlas in the south In extreme south we find the Saharan platform which is made of Precambrian bedrock recovered by Paleozoic practically not deformed. The Algerian north and the Saharan platform are separated by an important accident along of 2000km from Agadir (Morocco) to Gabes (Tunisian). The seismic activity is localized essentially in a coastal band in the north of Algeria shaped by tell atlas, high plateaus, Saharan atlas. Earthquakes are limited in the first 20km of the earth's crust; they are caused by movements along faults of inverted orientation NE-SW or sliding tectonic plates. The center region characterizes Strong Earthquake Activity who locates mainly in the basin of Mitidja (age Neogene).The southern periphery (Atlas Blidéen) constitutes the June, more Important seism genic sources in the city of Algiers and east (Boumerdes region). The North East Region is also part of the tellian area, but it is characterized by a different strain in other parts of northern Algeria. The deformation is slow and low to moderate seismic activity. Seismic activity is related to the tectonic-slip earthquake. The most pronounced is that of 27 October 1985 (Constantine) of seismic moment magnitude Mw = 5.9. North-West region is quite active and also artificial seismic hypocenters which do not exceed 20km. The deep seismicity is concentrated mainly a narrow strip along the edge of Quaternary and Neogene basins Intra Mountains along the coast. The most violent earthquakes in this region are the earthquake of Oran in 1790 and earthquakes Orléansville (El Asnam in 1954 and 1980).

Keywords: alpine chain, seismicity north Algeria, earthquakes in Algeria, geophysics, Earth

Procedia PDF Downloads 407

Authors: Sascha Kraus, Wolfgang Hora, Philipp Stieg, Thomas Niemand, Ferdinand Thies, Matthias Filser

Abstract:

In most countries, small and medium-sized enterprises (SME) are the backbone of the economy due to their impact on job creation, innovation and wealth creation. Moreover, the ongoing globalization makes it inevitable – even for SME that traditionally focused on their domestic markets – to internationalize their business activities to realize further growth and survive in international markets. Thus, internationalization has become one of the most common growth strategies for SME and has received increasing scholarly attention over the last two decades. One the downside internationalization can be also regarded as the most complex strategy that a firm can undertake. Particularly for family firms, that are often characterized by limited financial capital, a risk-averse nature and limited growth aspirations, it could be argued that family firms are more likely to face greater challenges when taking the pathway to internationalization. Especially the triangulation of family, ownership, and management (so-called ‘familiness’) manifests in a unique behavior and decision-making process which is often characterized by the importance given to noneconomic goals and distinguishes a family firm from other businesses. Taking this into account, the concept of socio-emotional wealth (SEW) has been evolved to describe the behavior of family firms. In order to investigate how different internal and external firm characteristics shape internationalization success of family firms, we drew on a sample consisting of 297 small and medium-sized family firms from Germany, Austria, Switzerland, and Liechtenstein. Thus, we include SEW as essential family firm characteristic and added the two major intra-organizational characteristics, entrepreneurial orientation (EO), absorptive capacity (AC) as well as collaboration intensity (CI) and relational knowledge (RK) as two major external network characteristics. Based on previous research we assume that these characteristics are important to explain internationalization success of family firm SME. Regarding the data analysis, we applied a Fuzzy Set Qualitative Comparative Analysis (fsQCA), an approach that allows identifying configurations of firm characteristics, specifically used to study complex causal relationships where traditional regression techniques reach their limits. Results indicate that several combinations of these family firm characteristics can lead to international success, with no permanently required key characteristic. Instead, there are many roads to walk down for family firms to achieve internationalization success. Consequently, our data states that family owned SME are heterogeneous and internationalization is a complex and dynamic process. Results further show that network related characteristics occur in all sets, thus represent an essential element in the internationalization process of family owned SME. The contribution of our study is twofold, as we investigate different forms of international expansion for family firms and how to improve them. First, we are able to broaden the understanding of the intersection between family firm and SME internationalization with respect to major intra-organizational and network-related variables. Second, from a practical perspective, we offer family firm owners a basis for setting up internal capabilities to achieve international success.

Keywords: entrepreneurial orientation, family firm, fsQCA, internationalization, socio-emotional wealth

Procedia PDF Downloads 241

Authors: Vijaya Kumar, Vidayasagar Pagilla, Abraham Joshua, Rakshith Kedambadi, Prasanna Mithra

Abstract:

Background: Post stroke rehabilitation are aimed to accelerate for optimal sensorimotor recovery, functional gain and to reduce long-term dependency. Intensive physical therapy interventions can enhance this recovery as experience-dependent neural plastic changes either directly act at cortical neural networks or at distal peripheral level (muscular components). Neuromuscular Electrical Stimulation (NMES), a traditional bottom-up approach, mirror therapy (MT), a relatively new top down approach have found to be an effective adjuvant treatment methods for lower extremity motor and functional recovery in stroke rehabilitation. However there is a scarcity of evidence to compare their therapeutic gain in stroke recovery.Aim: To compare the efficacy of neuromuscular electrical stimulation (NMES) and mirror therapy (MT) in very early phase of post stroke rehabilitation addressed to lower extremity motor recovery and balance. Design: observer blinded Randomized Clinical Trial. Setting: Neurorehabilitation Unit, Department of Physical Therapy, Tertiary Care Hospitals. Subjects: 32 acute stroke subjects with first episode of unilateral stroke with hemiparesis, referred for rehabilitation (onset < 3 weeks), Brunnstorm lower extremity recovery stages ≥3 and MMSE score more than 24 were randomized into two group [Group A-NMES and Group B-MT]. Interventions: Both the groups received eclectic approach to remediate lower extremity recovery which includes treatment components of Roods, Bobath and Motor learning approaches for 30 minutes a day for 6 days. Following which Group A (N=16) received 30 minutes of surface NMES training for six major paretic muscle groups (gluteus maximus and medius,quadriceps, hamstrings, tibialis anterior and gastrocnemius). Group B (N=16) was administered with 30 minutes of mirror therapy sessions to facilitate lower extremity motor recovery. Outcome measures: Lower extremity motor recovery, balance and activities of daily life (ADLs) were measured by Fugyl Meyer Assessment (FMA-LE), Berg Balance Scale (BBS), Barthel Index (BI) before and after intervention. Results: Pre Post analysis of either group across the time revealed statistically significant improvement (p < 0.001) for all the outcome variables for the either group. All parameters of NMES had greater change scores compared to MT group as follows: FMA-LE (25.12±3.01 vs. 23.31±2.38), BBS (35.12±4.61 vs. 34.68±5.42) and BI (40.00±10.32 vs. 37.18±7.73). Between the groups comparison of pre post values showed no significance with FMA-LE (p=0.09), BBS (p=0.80) and BI (p=0.39) respectively. Conclusion: Though either groups had significant improvement (pre to post intervention), none of them were superior to other in lower extremity motor recovery and balance among acute stroke subjects. We conclude that eclectic approach is an effective treatment irrespective of NMES or MT as an adjunct.

Keywords: balance, motor recovery, mirror therapy, neuromuscular electrical stimulation, stroke

Procedia PDF Downloads 281

Authors: Mehrnaz Mostafavi

Abstract:

The assessment and categorization of incidental lung nodules present a considerable challenge in healthcare, often necessitating resource-intensive multiple computed tomography (CT) scans for growth confirmation. This research addresses this issue by introducing a distinct computational approach leveraging radiomics and deep-learning methods. However, understanding local services is essential before implementing these advancements. With diverse tracking methods in place, there is a need for efficient and accurate identification approaches, especially in the context of managing lung nodules alongside pre-existing cancer scenarios. This study explores the integration of text-based algorithms in medical data curation, indicating their efficacy in conjunction with machine learning and deep-learning models for identifying lung nodules. Combining medical images with text data has demonstrated superior data retrieval compared to using each modality independently. While deep learning and text analysis show potential in detecting previously missed nodules, challenges persist, such as increased false positives. The presented research introduces a Structured-Query-Language (SQL) algorithm designed for identifying pulmonary nodules in a tertiary cancer center, externally validated at another hospital. Leveraging natural language processing (NLP) and machine learning, the algorithm categorizes lung nodule reports based on sentence features, aiming to facilitate research and assess clinical pathways. The hypothesis posits that the algorithm can accurately identify lung nodule CT scans and predict concerning nodule features using machine-learning classifiers. Through a retrospective observational study spanning a decade, CT scan reports were collected, and an algorithm was developed to extract and classify data. Results underscore the complexity of lung nodule cohorts in cancer centers, emphasizing the importance of careful evaluation before assuming a metastatic origin. The SQL and NLP algorithms demonstrated high accuracy in identifying lung nodule sentences, indicating potential for local service evaluation and research dataset creation. Machine-learning models exhibited strong accuracy in predicting concerning changes in lung nodule scan reports. While limitations include variability in disease group attribution, the potential for correlation rather than causality in clinical findings, and the need for further external validation, the algorithm's accuracy and potential to support clinical decision-making and healthcare automation represent a significant stride in lung nodule management and research.

Keywords: lung cancer diagnosis, structured-query-language (SQL), natural language processing (NLP), machine learning, CT scans

Procedia PDF Downloads 101

Authors: P. M. Natarajan, Shambhu Kallolikar, S. Ganesh

Abstract:

By size and volume of water, Ganges River basin is the biggest among the fourteen major river basins in India. By Hindu’s faith, it is the main ‘holy river’ in this nation. But, of late, the pollution load, both domestic and industrial sources are deteriorating the surface and groundwater as well as land resources and hence the environment of the Ganges River basin is under threat. Seeing this scenario, the Indian government began to reclaim this river by two Ganges Action Plans I and II since 1986 by spending Rs. 2,747.52 crores ($457.92 million). But the result was no improvement in the water quality of the river and groundwater and environment even after almost three decades of reclamation, and hence now the New Indian Government is taking extra care to rejuvenate this river and allotted Rs. 2,037 cores ($339.50 million) in 2014 and Rs. 20,000 crores ($3,333.33 million) in 2015. The reasons for the poor water quality and stinking environment even after three decades of reclamation of the river are either no treatment/partial treatment of the sewage. Hence, now the authors are suggesting a tertiary level treatment standard of sewages of all sources and origins of the Ganges River basin and recycling the entire treated water for nondomestic uses. At 20million litres per day (MLD) capacity of each sewage treatment plant (STP), this basin needs about 2020 plants to treat the entire sewage load. Cost of the STPs is Rs. 3,43,400 million ($5,723.33 million) and the annual maintenance cost is Rs. 15,352 million ($255.87 million). The advantages of the proposed exercise are: we can produce a volume of 1,769.52 million m³ of biogas. Since biogas is energy, can be used as a fuel, for any heating purpose, such as cooking. It can also be used in a gas engine to convert the energy in the gas into electricity and heat. It is possible to generate about 3,539.04 million kilowatt electricity per annum from the biogas generated in the process of wastewater treatment in Ganges basin. The income generation from electricity works out to Rs 10,617.12million ($176.95million). This power can be used to bridge the supply and demand gap of energy in the power hungry villages where 300million people are without electricity in India even today, and to run these STPs as well. The 664.18 million tonnes of sludge generated by the treatment plants per annum can be used in agriculture as manure with suitable amendments. By arresting the pollution load the 187.42 cubic kilometer (km³) of groundwater potential of the Ganges River basin could be protected from deterioration. Since we can recycle the sewage for non-domestic purposes, about 14.75km³ of fresh water per annum can be conserved for future use. The total value of the water saving per annum is Rs.22,11,916million ($36,865.27million) and each citizen of Ganges River basin can save Rs. 4,423.83/ ($73.73) per annum and Rs. 12.12 ($0.202) per day by recycling the treated water for nondomestic uses. Further the environment of this basin could be kept clean by arresting the foul smell as well as the 3% of greenhouse gages emission from the stinking waterways and land. These are the ways to reclaim the waterways of Ganges River basin from deterioration.

Keywords: Holy Ganges River, lifeline of India, wastewater treatment and management, making Ganges permanently holy

Procedia PDF Downloads 285

Authors: Reshma Raskar-Phule, Makarand Landge, Saurabh Singh, Vijay Singh, Jash Saparia, Shivam Tripathi

Abstract:

For any construction project, slope calculations are necessary in order to evaluate constructability on the site, such as the slope of parking lots, sidewalks, and ramps, the slope of sanitary sewer lines, slope of roads and highways. When slopes and grades are to be determined, designers are concerned with establishing proper slopes and grades for their projects to assess cut and fill volume calculations and determine inverts of pipes. There are several established instruments commonly used to determine slopes, such as Dumpy level, Abney level or Hand Level, Inclinometer, Tacheometer, Henry method, etc., and surveyors are very familiar with the use of these instruments to calculate slopes. However, they have some other drawbacks which cannot be neglected while major surveying works. Firstly, it requires expert surveyors and skilled staff. The accessibility, visibility, and accommodation to remote hilly terrain with these instruments and surveying teams are difficult. Also, determination of gentle slopes in case of road and sewer drainage constructions in congested urban places with these instruments is not easy. This paper aims to develop a method that requires minimum field work, minimum instruments, no high-end technology or instruments or software, and low cost. It requires basic and handy surveying accessories like a plane table with a fixed weighing machine, standard weights, alidade, tripod, and ranging rods should be able to determine the terrain slope in congested areas as well as in remote hilly terrain. Also, being simple and easy to understand and perform the people of that local rural area can be easily trained for the proposed method. The idea for the proposed method is based on the principle of resolution of weight components. When any object of standard weight ‘W’ is placed on an inclined surface with a weighing machine below it, then its cosine component of weight is presently measured by that weighing machine. The slope can be determined from the relation between the true or actual weight and the apparent weight. A proper procedure is to be followed, which includes site location, centering and sighting work, fixing the whole set at the identified station, and finally taking the readings. A set of experiments for slope determination, mild and moderate slopes, are carried out by the proposed method and by the theodolite instrument in a controlled environment, on the college campus, and uncontrolled environment actual site. The slopes determined by the proposed method were compared with those determined by the established instruments. For example, it was observed that for the same distances for mild slope, the difference in the slope obtained by the proposed method and by the established method ranges from 4’ for a distance of 8m to 2o15’20” for a distance of 16m for an uncontrolled environment. Thus, for mild slopes, the proposed method is suitable for a distance of 8m to 10m. The correlation between the proposed method and the established method shows a good correlation of 0.91 to 0.99 for various combinations, mild and moderate slope, with the controlled and uncontrolled environment.

Keywords: surveying, plane table, weight component, slope determination, hilly terrain, construction

Procedia PDF Downloads 96

Authors: F. Slaven, M. Uys, Y. Erasmus

Abstract:

The South African National Mental Health Education Programme (SANMHEP) was a National Department of Health (NDoH) initiative to strengthen mental health services in South Africa in collaboration with the Foundation for Professional Development (FPD), SANOFI and the various provincial departments of health. The programme was implemented against the backdrop of a number of challenges in the management of mental health in the country related to staff shortages and infrastructure, the intersection of mental health with the growing burden of non-communicable diseases and various forms of violence, and challenges around substance abuse and its relationship with mental health. The Mental Health Care Act (No. 17 of 2002) prescribes that mental health should be integrated into general health services including primary, secondary and tertiary levels to improve access to services and reduce stigma associated with mental illness. In order for the provisions of the Act to become a reality, and for the journey of mental health patients through the system to improve, sufficient and skilled health care providers are critical. SANMHEP specifically targeted Medical Doctors and Professional Nurses working within the facilities that are listed to conduct 72-hour assessments, as well as District Hospitals. The aim of the programme was to improve the clinical diagnosis and management of mental disorders/conditions and the understanding of and compliance with the Mental Health Care Act and related Regulations and Guidelines in the care, treatment and rehabilitation of mental health care users. The course used a blended-learning approach and trained 1 120 health care providers through 36 workshops between February and November 2019. Of those trained, 689 (61.52%) were Professional Nurses, 337 (30.09%) were Medical Doctors, and 91 (8.13%) indicated their occupation as ‘other’ (of these more than half were psychologists). The pre- and post-evaluation of the face-to-face training sessions indicated a marked improvement in knowledge and confidence level scores (both clinical and legislative) in the care, treatment and rehabilitation of mental health care users by participants in all the training sessions. There was a marked improvement in the knowledge and confidence of participants in performing certain mental health activities (on average the ratings increased by 2.72; or 27%) and in managing certain mental health conditions (on average the ratings increased by 2.55; or 25%). The course also required that participants obtain 70% or higher in their formal assessments as part of the online component. The 337 participants who completed and passed the course scored 90% on average. This illustrates that when participants attempted and completed the course, they did very well. To further assess the effect of the course on the knowledge and behaviour of the trained mental health care practitioners a mixed-method outcome evaluation is currently underway consisting of a survey with participants three months after completion, follow-up interviews with participants, and key informant interviews with department of health officials and course facilitators. This will enable a more detailed assessment of the impact of the training on participants' perceived ability to manage and treat mental health patients.

Keywords: mental health, public health facilities, South Africa, training

Procedia PDF Downloads 119

Authors: Zuhal Eltayeb Awad

Abstract:

Alryad neighborhood is located in Khartoum town– the administrative center of the Capital of Sudan. The neighborhood is one of the high-income residential areas with villa type development of low-density. It was planned and developed in 1972 with large plots (600-875m²), wide crossing roads and balanced environment. Recently the area transformed into more compact urban form of high density, mixed-use integrated development with more intensive use of land; multi-storied apartments. The most important socio-economic process in the neighborhood has been the commercialization and deinitialization of the area in connect with the displacement of the residential function. This transformation affected the quality of the neighborhood and the inter-related features of the built environment. A case study approach was chosen to gather the necessary qualitative and quantitative data. A detailed survey on existing development pattern was carried out over the whole area of Alryad. Data on the built and social environment of the neighborhoods were collected through observations, interviews and secondary data sources. The paper reflected a theoretical and empirical interest in the particular characteristics of compact neighborhood with high density, and mixed land uses and their effect on social wellbeing of the residents all in the context of the sustainable development. The research problem is focused on the challenges of transformation that associated with compact neighborhood that created multiple urban problems, e.g., stress of essential services (water supply, electricity, and drainage), congestion of streets and demand for parking. The main objective of the study is to analyze the transformation of this area from residential use to commercial and administrative use. The study analyzed the current situation of the neighborhood compared to the five principles of sustainable neighborhood prepared by UN Habitat. The study found that the neighborhood is experienced changes that occur to inner-city residential areas and the process of change of the neighborhood was originated by external forces due to the declining economic situation of the whole country. It is evident that non-residential uses have taken place uncontrolled, unregulated and haphazardly that led to damage the residential environment and deficiency in infrastructure. The quality of urban life and in particular on levels of privacy was reduced, the neighborhood changed gradually to be a central business district that provides services to the whole Khartoum town. The change of house type may be attributed to a demand-led housing market and absence of policy. The results showed that Alryad is not fully sustainable and self-contained, street network characteristics and mixed land-uses development are compatible with the principles of sustainability. The area of streets represents 27.4% of the total area of the neighborhood. Residential density is 4,620 people/ km², that is lower than the recommendations, and the limited block land-use specialization is higher than 10% of the blocks. Most inhabitants have a high income so that there is no social mix in the neighborhood. The study recommended revision of the current zoning regulations in order to control and regulate undesirable development in the neighborhood and provide new solutions which allow promoting the neighborhood sustainable development.

Keywords: compact neighborhood, land uses, mixed use, residential area, transformation

Procedia PDF Downloads 129

Authors: Muhammad Shuaibu Birniwa

Abstract:

Automobile Independent Workshop Service Technicians (popularly called roadside mechanics) are technical personals that repairs most of the automobile vehicles in Nigeria. Majority of these mechanics acquired their skills through apprenticeship training. Modern vehicle imported into the country posed greater challenges to the present automobile technicians particularly in the area of carrying out maintenance repairs of these latest automobile vehicles (autotronics vehicle) due to their inability to possessed autotronic skills competency. To source for solution to the above mentioned problems, therefore a research is carried out in North – Western region of Nigeria to produce a suitable maintenance training modules that can be used to train the technicians for them to upgrade/acquire the needed competencies for successful maintenance repair of the autotronic vehicles that were running everyday on the nation’s roads. A cluster sampling technique is used to obtain a sample from the population. The population of the study is all autotronic inclined lecturers, instructors and independent workshop service technicians that are within North – Western region of Nigeria. There are seven states (Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto and Zamfara) in the study area, these serves as clusters in the population. Five (5) states were randomly selected to serve as the sample size. The five states are Jigawa, Kano, Katsina, Kebbi and Zamfara, the entire population of the five states which serves as clusters is (183), lecturers (44), instructors (49) and autotronic independent workshop service technicians (90), all of them were used in the study because of their manageable size. 183 copies of autotronic maintenance training module questionnaires (AMTMQ) with 174 and 149 question items respectively were administered and collected by the researcher with the help of an assistants, they are administered to 44 Polytechnic lecturers in the department of mechanical engineering, 49 instructors in skills acquisition centres/polytechnics and 90 master craftsmen of an independent workshops that are autotronic inclined. Data collected for answering research questions 1, 3, 4 and 5 were analysed using SPSS software version 22, Grand Mean and standard deviation were used to answer the research questions. Analysis of Variance (ANOVA) was used to test null hypotheses one (1) to three (3) and t-test statistical tool is used to analyzed hypotheses four (4) and five (5) all at 0.05 level of significance. The research conducted revealed that; all the objectives, contents/tasks, facilities, delivery systems and evaluation techniques contained in the questionnaire were required for the development of the autotronic maintenance training modules for independent workshop service technicians in the north – western zone of Nigeria. The skills upgrade training conducted by federal government in collaboration with SURE-P, NAC and SMEDEN was not successful because the educational status of the target population was not considered in drafting the needed training modules. The mode of training used does not also take cognizance of the theoretical aspect of the trainees, especially basic science which rendered the programme ineffective and insufficient for the tasks on ground.

Keywords: autotronics, roadside, mechanics, technicians, independent

Procedia PDF Downloads 73

Authors: Suang K. Lau, Ismail Goolam, Rafid Al-Asady

Abstract:

Background: The majority of patients with hepatocellular carcinoma (HCC) are not suitable for curative treatment, in the form of surgical resection or transplantation, due to tumour extent and underlying liver dysfunction. In these non-resectable cases, a variety of non-surgical therapies are available, including microwave ablation (MWA), which has shown increasing popularity due to its low morbidity, low reported complication rate, and the ability to perform multiple ablations simultaneously. Objective: The aim of this study was to evaluate the validity of MWA as a viable treatment option in the management of HCC and hepatic metastatic disease, by assessing its efficacy and complication rate at a tertiary hospital situated in Westmead (Australia). Methods: A retrospective observational study was performed evaluating patients that underwent MWA between 1/1/2017–31/12/2018 at Westmead Hospital, NSW, Australia. Outcome measures, including residual disease, recurrence rates, as well as major and minor complication rates, were retrospectively analysed over a 12-months period following MWA treatment. Excluded patients included those whose lesions were treated on the basis of residual or recurrent disease from previous treatment, which occurred prior to the study window (11 patients) and those who were lost to follow up (2 patients). Results: Following treatment of 106 new hepatic lesions, the complete response rate (CR) was 86% (91/106) at 12 months follow up. 10 patients had the residual disease at post-treatment follow up imaging, corresponding to an incomplete response (ICR) rate of 9.4% (10/106). The local recurrence rate (LRR) was 4.6% (5/106) with follow-up period up to 12 months. The minor complication rate was 9.4% (10/106) including asymptomatic pneumothorax (n=2), asymptomatic pleural effusions (n=2), right lower lobe pneumonia (n=3), pain requiring admission (n=1), hypotension (n=1), cellulitis (n=1) and intraparenchymal hematoma (n=1). There was 1 major complication reported, with pleuro-peritoneal fistula causing recurrent large pleural effusion necessitating repeated thoracocentesis (n=1). There was no statistically significant association between tumour size, location or ablation factors, and risk of recurrence or residual disease. A subset analysis identified 6 segment VIII lesions, which were treated via a trans-pleural approach. This cohort demonstrated an overall complication rate of 33% (2/6), including 1 minor complication of asymptomatic pneumothorax and 1 major complication of pleuro-peritoneal fistula. Conclusions: Microwave ablation therapy is an effective and safe treatment option in cases of non-resectable hepatocellular carcinoma and liver metastases, with good local tumour control and low complication rates. A trans-pleural approach for high segment VIII lesions is associated with a higher complication rate and warrants greater caution.

Keywords: hepatocellular carcinoma, liver metastases, microwave ablation, trans-pleural approach

Procedia PDF Downloads 136

Authors: Ravisinh Solanki, Ravi Patel, Chhaganbhai Patel

Abstract:

Purpose: The purpose of this study is to develop a methodology for the risk assessment and evaluation of nitrosamine impurities in Glipizide antidiabetic formulations. Nitroso compounds, including nitrosamines, have emerged as significant concerns in drug products, as highlighted by the ICH M7 guidelines. This study aims to identify known and potential sources of nitrosamine impurities that may contaminate Glipizide formulations and assess their presence. By determining observed or predicted levels of these impurities and comparing them with regulatory guidance, this research will contribute to ensuring the safety and quality of combination antidiabetic drug products on the market. Factors contributing to the presence of genotoxic nitrosamine contaminants in glipizide medications, such as secondary and tertiary amines, and nitroso group-complex forming molecules, will be investigated. Additionally, conditions necessary for nitrosamine formation, including the presence of nitrosating agents, and acidic environments, will be examined to enhance understanding and mitigation strategies. Method: The methodology for the study involves the implementation of the N-Nitroso Acid Precursor (NAP) test, as recommended by the WHO in 1978 and detailed in the 1980 International Agency for Research on Cancer monograph. Individual glass vials containing equivalent to 10mM quantities of Glipizide is prepared. These compounds are dissolved in an acidic environment and supplemented with 40 mM NaNO2. The resulting solutions are maintained at a temperature of 37°C for a duration of 4 hours. For the analysis of the samples, an HPLC method is employed for fit-for-purpose separation. LC resolution is achieved using a step gradient on an Agilent Eclipse Plus C18 column (4.6 X 100 mm, 3.5µ). Mobile phases A and B consist of 0.1% v/v formic acid in water and acetonitrile, respectively, following a gradient mode program. The flow rate is set at 0.6 mL/min, and the column compartment temperature is maintained at 35°C. Detection is performed using a PDA detector within the wavelength range of 190-400 nm. To determine the exact mass of formed nitrosamine drug substance related impurities (NDSRIs), the HPLC method is transferred to LC-TQ-MS/MS with the same mobile phase composition and gradient program. The injection volume is set at 5 µL, and MS analysis is conducted in Electrospray Ionization (ESI) mode within the mass range of 100−1000 Daltons. Results: The samples of NAP test were prepared according to the protocol. The samples were analyzed using HPLC and LC-TQ-MS/MS identify possible NDSRIs generated in different formulations of glipizide. It was found that the NAP test generated a various NDSRIs. The new finding, which has not been reported yet, discovered contamination of Glipizide. These NDSRIs are categorised based on the predicted carcinogenic potency and recommended its acceptable intact in medicines. The analytical method was found specific and reproducible.

Keywords: NDSRI, nitrosamine impurities, antidiabetic, glipizide, LC-MS/MS

Procedia PDF Downloads 33

Authors: Rebecca Dewfall, Mark Coleman, Vladimir Basabe

Abstract:

Oxide scale growth is an inevitable byproduct of the high temperature processing of steel. Blister is a phenomenon that occurs due to oxide growth, where high temperatures result in the swelling of surface scale, producing a bubble-like feature. Blisters can subsequently become embedded in the steel substrate during hot rolling in the finishing mill. This rolled in scale defect causes havoc within industry, not only with wear on machinery but loss of customer satisfaction, poor surface finish, loss of material, and profit. Even though blister is a highly prevalent issue, there is still much that is not known or understood. The classic iron oxidation system is a complex multiphase system formed of wustite, magnetite, and hematite, producing multi-layered scales. Each phase will have independent properties such as thermal coefficients, growth rate, and mechanical properties, etc. Furthermore, each additional alloying element will have different affinities for oxygen and different mobilities in the oxide phases so that oxide morphologies are specific to alloy chemistry. Therefore, blister regimes can be unique to each steel grade resulting in a diverse range of formation mechanisms. Laboratory conditions were selected to simulate industrial hot rolling with temperature ranges approximate to the formation of secondary and tertiary scales in the finishing mills. Samples with composition: 0.15Wt% C, 0.1Wt% Si, 0.86Wt% Mn, 0.036Wt% Al, and 0.028Wt% Cr, were oxidised in a thermo-gravimetric analyser (TGA), with an air velocity of 10litresmin-1, at temperaturesof 800°C, 850°C, 900°C, 1000°C, 1100°C, and 1200°C respectively. Samples were held at temperature in an argon atmosphere for 10minutes, then oxidised in air for 600s, 60s, 30s, 15s, and 4s, respectively. Oxide morphology and Blisters were characterised using EBSD, WDX, nanoindentation, FIB, and FEG-SEM imaging. Blister was found to have both a nucleation and growth process. During nucleation, the scale detaches from the substrate and blisters after a very short period, roughly 10s. The steel substrate is then exposed inside of the blister and further oxidised in the reducing atmosphere of the blister, however, the atmosphere within the blister is highly dependent upon the porosity of the blister crown. The blister crown was found to be consistently between 35-40um for all heating regimes, which supports the theory that the blister inflates, and the oxide then subsequently grows underneath. Upon heating, two modes of blistering were identified. In Mode 1 it was ascertained that the stresses produced by oxide growth will increase with increasing oxide thickness. Therefore, in Mode 1 the incubation time for blister formation is shortened by increasing temperature. In Mode 2 increase in temperature will result in oxide with a high ductility and high oxide porosity. The high oxide ductility and/or porosity accommodates for the intrinsic stresses from oxide growth. Thus Mode 2 is the inverse of Mode 1, and incubation time is increased with temperature. A new phenomenon was reported whereby blister formed exclusively through cooling at elevated temperatures above mode 2.

Keywords: FEG-SEM, nucleation, oxide morphology, surface defect

Procedia PDF Downloads 144

Authors: Shreya Saxena

Abstract:

Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

Procedia PDF Downloads 98