Search results for: water resource management

Authors: Brenda Thean I. Lim, Safurah Jaafar

Abstract:

Augmented reality (AR) in the healthcare industry has been gaining popularity in recent years, principally in areas of medical education, patient care and digital health solutions. One of the drivers in deciding to invest in AR technology is the potential economic benefits it could bring for patients and healthcare providers, including the pharmaceutical and medical technology sectors. Works of literature have shown that the benefits and impact of AR technologies have left trails of achievements in improving medical education and patient health outcomes. However, little has been published on the economic impact of AR in healthcare, a very resource-intensive industry. This systematic review was performed on studies focused on the benefits and impact of AR in healthcare to appraise if they meet the founded quality criteria so as to identify relevant publications for an in-depth analysis of the economic impact assessment. The literature search was conducted using multiple databases such as PubMed, Cochrane, Science Direct and Nature. Inclusion criteria include research papers on AR implementation in healthcare, from education to diagnosis and treatment. Only papers written in English language were selected. Studies on AR prototypes were excluded. Although there were many articles that have addressed the benefits of AR in the healthcare industry in the area of medical education, treatment and diagnosis and dental medicine, there were very few publications that identified the specific economic impact of technology within the healthcare industry. There were 13 publications included in the analysis based on the inclusion criteria. Out of the 13 studies, none comprised a systematically comprehensive cost impact evaluation. An outline of the cost-effectiveness and cost-benefit framework was made based on an AR article from another industry as a reference. This systematic review found that while the advancements of AR technology is growing rapidly and industries are starting to adopt them into respective sectors, the technology and its advancements in healthcare were still in their early stages. There are still plenty of room for further advancements and integration of AR into different sectors within the healthcare industry. Future studies will require more comprehensive economic analyses and costing evaluations to enable economic decisions for or against implementing AR technology in healthcare. This systematic review concluded that the current literature lacked detailed examination and conduct of economic impact and benefit analyses. Recommendations for future research would be to include details of the initial investment and operational costs for the AR infrastructure in healthcare settings while comparing the intervention to its conventional counterparts or alternatives so as to provide a comprehensive comparison on impact, benefit and cost differences.

Keywords: augmented reality, benefit, economic impact, healthcare, patient care

Procedia PDF Downloads 207

Authors: Harish Aryal, Roger Hague, Daniel Sotelo, Felipe Astete Salinas

Abstract:

This paper presents a comparative study of different coolants, materials, and temperatures that can affect the effectiveness of heat exchangers that are used in small modular reactors. The corrugated plate heat exchangers were chosen out of different plate options for testing purposes because of their ease of access and better performance than other existing heat exchangers in recent years. SolidWorks enables us to see various results between water coolants and helium coolants acting upon different types of conducting metals, which were selected from different fluids that ultimately satisfied accessibility requirements and were compatible with the software. Though not every element, material, fluid, or method was used in the testing phase, their purpose is to help further research that is to come since the innovation of nuclear power is the future. The tests that were performed are to help better understand the constant necessities that are seen in heat exchangers and through every adjustment see what the breaking points or improvements in the machine are. Depending on consumers and researchers, the results may give further feedback as to show why different types of materials and fluids would be preferred and why it is necessary to keep failures to improve future research.

Keywords: heat exchangers, Solidworks, coolants, small modular reactors, nuclear power, nanofluids, Nusselt number, friction factor, Reynolds number

Procedia PDF Downloads 73

Authors: Daniel Macedo Neto, Sandro Froehner, Juan Sanez

Abstract:

Suspended sediments (SS) are an environmental constituent able to represent the effects of land use changes on watersheds. One important consideration of land use change is its implication on trace element loading. Water bodies have the capacity to retain trace elements. Spatial variation in trace elements concentrations can be associated with land occupation and sources of pollution. In this work, the spatial variation of trace elements in suspended sediments from an urban river was assessed. Time-integrated fluvial suspended sediment samples were installed in three different sites of Barigui River. The suspend solids were collected every 30 days, from May 2015 to August 2015 (total samples 12). Site P1 covers 44 km2 drainage area and has low land occupation, whilst P2 cover an area of 87 km2 and it is totally urban as P3, which area is higher than 130 km2. Trace elements (As, Cd, Cr, P, Pb and Zn) were analysed by ICP-ES. All elements analyzed showed a similar pattern, i.e., the concentration raise with the urbanization, exception for As (P1=7.75; P2=5.75; P3=5.60mg/kg). There was increase in concentration for Cd (P1=0.75; P2=0.78; P3=1.45mg/kg), Cr (P1=59.50; P2=101.75; P3=102.00 mg/kg), Zn (P1=142.25; P2=152.50; P3=223.00mg/kg), P (P1=937.50; P2=1,545.00; P3=2,355.00 mg/kg) and for Pb (P1=31.25; P2=32.75; P3=39.17±2.56 mg/kg). The variation in concentrations were as follow -27.74% (As), +93.33% (Cd), +71.43% (Cr), +151.20% (P), +25.33% (Pb) e +56.77% (Zn). Cd, Cr, P, Pb and Zn presented a clear trend of increasing the concentration from upstream to downstream. Such variation is more notorious for P, Cd and Cr, possibly due the urbanization.

Keywords: trace elements, erosion, urbanization, suspended sediments

Procedia PDF Downloads 314

Authors: Belalia Douma Omar, Bakhta Boukhatem, Mohamed Ghrici

Abstract:

Self-compacting concrete (SCC) developed in Japan in the late 80s has enabled the construction industry to reduce demand on the resources, improve the work condition and also reduce the impact of environment by elimination of the need for compaction. Fuzzy logic (FL) approaches has recently been used to model some of the human activities in many areas of civil engineering applications. Especially from these systems in the model experimental studies, very good results have been obtained. In the present study, a model for predicting compressive strength of SCC containing various proportions of fly ash, as partial replacement of cement has been developed by using Adaptive Neuro-Fuzzy Inference System (ANFIS). For the purpose of building this model, a database of experimental data were gathered from the literature and used for training and testing the model. The used data as the inputs of fuzzy logic models are arranged in a format of five parameters that cover the total binder content, fly ash replacement percentage, water content, super plasticizer and age of specimens. The training and testing results in the fuzzy logic model have shown a strong potential for predicting the compressive strength of SCC containing fly ash in the considered range.

Keywords: self-compacting concrete, fly ash, strength prediction, fuzzy logic

Procedia PDF Downloads 335

Authors: Masoud Swalehe, Semra Günay

Abstract:

Developed countries are losing many lives to non-communicable diseases as compared to their developing counterparts. The effects of these diseases are mostly sudden and manifest at a very short time prior to death or a dangerous attack and this has consolidated the significance of emergency medical system (EMS) as one of the vital areas of healthcare service delivery. The primary objective of this research is to reduce ambulance response times (RT) of Eskişehir province EMS since a number of studies have established a relationship between ambulance response times and survival chances of patients especially out of hospital cardiac arrest (OHCA) victims. It has been found out that patients who receive out of hospital medical attention in few (4) minutes after cardiac arrest because of low ambulance response times stand higher chances of survival than their counterparts who take longer times (more than 12 minutes) to receive out of hospital medical care because of higher ambulance response times. The study will make use of geographic information systems (GIS) technology to dynamically reallocate ambulance resources according to demand and time so as to reduce ambulance response times. Geospatial-time distribution of ambulance calls (demand) will be used as a basis for optimal ambulance deployment using system status management (SSM) strategy to achieve much demand coverage with the same number of ambulance resources to cause response time reduction. Drive-time polygons will be used to come up with time specific facility coverage areas and suggesting additional facility candidate sites where ambulance resources can be moved to serve higher demands making use of network analysis techniques. Emergency Ambulance calls’ data from 1st January 2014 to 31st December 2014 obtained from Eskişehir province health directorate will be used in this study. This study will focus on the reduction of ambulance response times which is a key Emergency Medical Services performance indicator.

Keywords: emergency medical services, system status management, ambulance response times, geographic information system, geospatial-time distribution, out of hospital cardiac arrest

Procedia PDF Downloads 300

Authors: Víctor Martínez del Rey, Kourosh Nasr Esfahani, Amir Masoud Samani Majd

Abstract:

In this experimental study, the behaviors of Mixed Oxidant solution components (MOS) and sodium hypochlorite (HYPO) as the most commonly applied surface disinfectant were compared through the effectiveness of chlorine disinfection as a function of the contact time and residual chlorine. In this regard, the variation of pH, free available chlorine (FAC) concentration, and electric conductivity (EC) of disinfection solutions in different concentrations were monitored over 48 h contact time. In parallel, the plant stress activated by chlorine-based disinfectants was assessed by comparing MOS and HYPO. The elements of pH and EC in the plant-soil and their environmental impacts, spread by disinfection solutions were analyzed through several concentrations of FAC including 500 mg/L, 1000 mg/L, and 5000 mg/L in irrigated water. All the experiments were carried out at the service station of Sant Cugat, Spain. The outcomes indicated lower pH and higher durability of MOS than HYPO at the same concentration of FAC which resulted in promising stability of FAC within MOS. Furthermore, the pH and EC value of plant-soil irrigated by NaOCl solution were higher than that of MOS solution at the same FAC concentration. On-site generation of MOS as a safe chlorination option might be considered an imaginary future of smart cities.

Keywords: disinfection, free available chlorine, on-site generation, sodium hypochlorite

Procedia PDF Downloads 118

Authors: Kianoosh Samimi, Farhad Estakhr, Mahdi Mahdikhani, Faramaz Moodi

Abstract:

The self-consolidating concrete (SCC) performance over ordinary concrete is generally related to the ingredients used. The metakaolin can modify various properties of concrete, due to high pozzolanic reactions and also makes a denser microstructure. The objective of this paper is to examine the influence of three types of Portland cement and metakaolin on compressive strength and transport properties of SCC at early ages and up to 90 days. Six concrete mixtures were prepared with three types of different cements and substitution of 15% metakaolin. The results show that the highest value of compressive strength was achieved for Portland Slag Cement (PSC) and without any metakaolin at age of 90 days. Conversely, the lowest level of compressive strength at all ages of conservation was obtained for Pozzolanic Portland Cement (PPC) and containing 15% metakaolin. As can be seen in the results, compressive strength in SCC containing Portland cement type II with metakaolin is higher compared to that relative to SCC without metakaolin from 28 days of age. On the other hand, the samples containing PSC and PPC with metakaolin had a lower compressive strength than the plain samples. Therefore, it can be concluded that metakaolin has a negative effect on the compressive strength of SCC containing PSC and PPC. In addition, results show that metakaolin has enhanced chloride durability of SCCs and reduced capillary water absorption at 28, 90 days.

Keywords: SCC, metakaolin, cement type, compressive strength, chloride diffusion

Procedia PDF Downloads 220

Authors: Aidan N. Smallwood, Celestine R. Weegenaar, Jack N. Evans

Abstract:

The intensive care unit (ICU) is a particularly resource heavy environment, in terms of staff, drugs and equipment required. Whilst many areas of the hospital are attempting to cut down on plastic use and minimise their impact on the environment, this has proven challenging within the confines of intensive care. Concurrently, as globalization has progressed over recent decades, there has been a tendency towards centralised manufacturing with international distribution networks for products, often covering large distances. In this study, we have modelled the standard consumption of plastic single-use items over the course of the first 24-hours of an average individual patient’s stay in a 12 bed ICU in the United Kingdom (UK). We have identified the country of manufacture and calculated the minimum possible distance travelled by each item from factory to patient. We have assumed direct transport via the shortest possible straight line from country of origin to the UK and have not accounted for transport within either country. Assuming an intubated patient with invasive haemodynamic monitoring and central venous access, there are a total of 52 distincts, largely plastic, disposable products which would reasonably be required in the first 24-hours after admission. Each product type has only been counted once to account for multiple items being shipped as one package. Travel distances from origin were summed to give the total distance combined for all 52 products. The minimum possible total distance travelled from country of origin to the UK for all types of product was 273,353 km, equivalent to 6.82 circumnavigations of the globe, or 71% of the way to the moon. The mean distance travelled was 5,256 km, approximately the distance from London to Mecca. With individual packaging for each item, the total weight of consumed products was 4.121 kg. The CO2 produced shipping these items by air freight would equate to 30.1 kg, however doing the same by sea would produce 0.2 kg CO2. Extrapolating these results to the 211,932 UK annual ICU admissions (2018-2019), even with the underestimates of distance and weight of our assumptions, air freight would account for 6586 tons CO2 emitted annually, approximately 130 times that of sea freight. Given the drive towards cost saving within the UK health service, and the decline of the local manufacturing industry, buying from intercontinental manufacturers is inevitable However, transporting all consumables by sea where feasible would be environmentally beneficial, as well as being less costly than air freight. At present, the NHS supply chain purchases from medical device companies, and there is no freely available information as to the transport mode used to deliver the product to the UK. This must be made available to purchasers in order to give a fuller picture of life cycle impact and allow for informed decision making in this regard.

Keywords: CO2, intensive care, plastic, transport

Procedia PDF Downloads 178

Authors: Antonello Troncone, Luigi Pugliese, Andrea Parise, Enrico Conte

Abstract:

The present study deals with the landslides periodically reactivated by groundwater level fluctuations owing to rainfall. The main type of movement which generally characterizes these landslides consists in sliding with quite small-displacement rates. Another peculiar characteristic of these landslides is that soil deformations are essentially concentrated within a thin shear band located below the body of the landslide, which, consequently, undergoes an approximately rigid sliding. In this context, a simple method is proposed in the present study to forecast the movements of this type of landslides owing to rainfall. To this purpose, the landslide body is schematized by means of a two-block model. Some analytical solutions are derived to relate rainfall measurements with groundwater level oscillations and these latter, in turn, to landslide mobility. The proposed method is attractive for engineering applications since it requires few parameters as input data, many of which can be obtained from conventional geotechnical tests. To demonstrate the predictive capability of the proposed method, the application to a well-documented landslide periodically reactivated by rainfall is shown.

Keywords: rainfall, water level fluctuations, landslide mobility, two-block model

Procedia PDF Downloads 121

Authors: Zhenyu Zhang, Hsi-Hsien Wei

Abstract:

Highway network systems play a vital role in disaster response for disaster-damaged areas. Damaged bridges in such network systems can impede disaster response by disrupting transportation of rescue teams or humanitarian supplies. Therefore, emergency inspection and repair of bridges to quickly collect damage information of bridges and recover the functionality of highway networks is of paramount importance to disaster response. A widely used measure of a network’s capability to recover from disasters is resilience. To enhance highway network resilience, plenty of studies have developed various repair scheduling methods for the prioritization of bridge-repair tasks. These methods assume that repair activities are performed after the damage to a highway network is fully understood via inspection, although inspecting all bridges in a regional highway network may take days, leading to the significant delay in repairing bridges. In reality, emergency repair activities can be commenced as soon as the damage data of some bridges that are crucial to emergency response are obtained. Given that emergency bridge inspection and repair (EBIR) activities are executed simultaneously in the response phase, the real-time interactions between these activities can occur – the blockage of highways due to repair activities can affect inspection routes which in turn have an impact on emergency repair scheduling by providing real-time information on bridge damages. However, the impact of such interactions on the optimal emergency inspection routes (EIR) and emergency repair schedules (ERS) has not been discussed in prior studies. To overcome the aforementioned deficiencies, this study develops a routing and scheduling model for EBIR while accounting for real-time inspection-repair interactions to maximize highway network resilience. A stochastic, time-dependent integer program is proposed for the complex and real-time interacting EBIR problem given multiple inspection and repair teams at locations as set post-disaster. A hybrid genetic algorithm that integrates a heuristic approach into a traditional genetic algorithm to accelerate the evolution process is developed. Computational tests are performed using data from the 2008 Wenchuan earthquake, based on a regional highway network in Sichuan, China, consisting of 168 highway bridges on 36 highways connecting 25 cities/towns. The results show that the simultaneous implementation of bridge inspection and repair activities can significantly improve the highway network resilience. Moreover, the deployment of inspection and repair teams should match each other, and the network resilience will not be improved once the unilateral increase in inspection teams or repair teams exceeds a certain level. This study contributes to both knowledge and practice. First, the developed mathematical model makes it possible for capturing the impact of real-time inspection-repair interactions on inspection routing and repair scheduling and efficiently deriving optimal EIR and ERS on a large and complex highway network. Moreover, this study contributes to the organizational dimension of highway network resilience by providing optimal strategies for highway bridge management. With the decision support tool, disaster managers are able to identify the most critical bridges for disaster management and make decisions on proper inspection and repair strategies to improve highway network resilience.

Keywords: disaster management, emergency bridge inspection and repair, highway network, resilience, uncertainty

Procedia PDF Downloads 109

Authors: Christin Koch, Andreas Winkel, Martin Kahlmeyer, Stefan Böhm

Abstract:

Due to environmental regulations on greenhouse gas emissions and the depletion of fossil fuels, there is an increasing interest in electric vehicles.To maximize their driving range, batteries with high storage capacities are needed. In most electric cars, rechargeable lithium-ion batteries are used because of their high energy density. However, it has to be taken into account that these batteries generate a large amount of heat during the charge and discharge processes. This leads to a decrease in a lifetime and damage to the battery cells when the temperature exceeds the defined operating range. To ensure an efficient performance of the battery cells, reliable thermal management is required. Currently, the cooling is achieved by heat sinks (e.g., cooling plates) bonded to the battery cells with a thermally conductive adhesive (TCA) that directs the heat away from the components. Especially when large amounts of heat have to be dissipated spontaneously due to peak loads, the principle of heat conduction is not sufficient, so attention must be paid to the mechanism of heat storage. An efficient method to store thermal energy is the use of phase change materials (PCM). Through an isothermal phase change, PCM can briefly absorb or release thermal energy at a constant temperature. If the phase change takes place in the transition from solid to liquid, heat is stored during melting and is released to the ambient during the freezing process upon cooling. The presented work displays the great potential of thermally conductive adhesives filled with microencapsulated PCM to limit peak temperatures in battery systems. The encapsulation of the PCM avoids the effects of aging (e.g., migration) and chemical reactions between the PCM and the adhesive matrix components. In this study, microencapsulation has been carried out by in situ polymerization. The microencapsulated PCM was characterized by FT-IR spectroscopy, and the thermal properties were measured by DSC and laser flash method. The mechanical properties, electrical and thermal conductivity, and adhesive toughness of the TCA/PCM composite were also investigated.

Keywords: phase change material, microencapsulation, adhesive bonding, thermal management

Procedia PDF Downloads 72

Authors: Kyere Vincent Nartey, Klaus Greve, Atiemo Sampson

Abstract:

E-waste is discarded electrical electronic equipment inclusive of all components, sub-assemblies and consumables which are part of the product at the time of discarding and known to contain both hazardous and valuable fractions. E-waste is recycled within the proposed ecological restoration of the Agbogbloshie enclave using crude and rudimental recycling procedures such as open burning and manual dismantling which result in pollution and contamination of soil, water and air. Using GIS, this study was conducted to examine the spatial distribution and extent of soil contamination by heavy metals from the e-waste recycling site in Agbogbloshie. From the month of August to November 2013, 146 soil samples were collected in addition to their coordinates using GPS. Elemental analysis performed on the collected soil samples using X-Ray fluorescence revealed over 30 elements including, Ni, Cr, Zn, Cu, Pb and Mn. Using geostatistical techniques in ArcGIS 10.1 spatial assessment and distribution maps were generated. Mathematical models or equations were used to estimate the degree of contamination and pollution index. Results from soil analysis from the Agbogbloshie enclave showed that levels of measured or observed elements were significantly higher than the Canadian EPA and Dutch environmental standards.

Keywords: e-waste, geostatistics, soil contamination, spatial distribution

Procedia PDF Downloads 515

Authors: Chieh-Nan Chen, Ji-Yu Lin, I-Ming Chu

Abstract:

Polypeptide thermosensitive hydrogel is an excellent candidate as a smart device to deliver drugs and cells due to its remarkable biocompatibility, low gelation concentration, and respond to temperature stimuli, it can be easily injected as a polymer solution into the patient’s body where it undergoes gelation due to an elevation in temperature. Poly (ethylene glycol) monomethyl ether-poly (ethyl-l-glutamate) (mPEG-PELG) contains a hydrophobic side chain –C2H5 which is useful in encapsulating and stabilizing hydrophobic drugs. In this study, we plan to focus on the hydrophobic anti-carcinogenic and anti-inflammatory drug curcumin, which due its insolubility in water, requires a proper carrier for delivery into the body. Our main concept is to use mPEG-PELG to stabilize curcumin, inject the curcumin-loaded hydrogel into the tumor site, and allow the enzymatically-sensitive hydrogel to be degraded by bodily fluids and release the drug. The polymers of interest have been successfully synthesized and characterized by 1H-NMR, FT-IR, SEM, and CMC. Curcumin loading content and drug release were assayed using HPLC. Preliminary results show that these materials have potential as a delivery vehicle for poorly soluble drugs.

Keywords: curcumin, drug release, hydrogel, polypeptide material

Procedia PDF Downloads 293

Authors: L. Nathaniel-Wurie

Abstract:

The Sellick manoeuvre a.k.a the application of cricoid force (CF), was first described by Brian Sellick in 1961. CF is the application of digital pressure against the cricoid cartilage with the intention of posterior force causing oesophageal compression against the vertebrae. This is designed to prevent passive regurgitation of gastric contents, which is a major cause of morbidity and mortality during emergency airway management inside and outside of the hospital. To the authors knowledge, there is no universally standardised training modality and, therefore, no reliable way to examine if there are appropriate outcomes. If force is not measured during training, how can one surmise that appropriate, accurate, or precise amounts of force are being used routinely. Poor homogeneity in teaching and untested outcomes will correlate with reduced efficacy and increased adverse effects. For this study, the accuracy of force delivery in trained professionals was tested, and outcomes contrasted against a novice control and a novice study group. In this study, 20 operating department practitioners were tested (with a mean experience of 5.3years of performing CF). Subsequent contrast with 40 novice students who were randomised into one of two arms. ‘Arm A’ were explained the procedure, then shown the procedure then asked to perform CF with the corresponding force measurement being taken three times. Arm B had the same process as arm A then before being tested, they had 10, and 30 Newtons applied to their hands to increase intuitive understanding of what the required force equated to, then were asked to apply the equivalent amount of force against a visible force metre and asked to hold that force for 20 seconds which allowed direct visualisation and correction of any over or under estimation. Following this, Arm B were then asked to perform the manoeuvre, and the force generated measured three times. This study shows that there is a wide distribution of force produced by trained professionals and novices performing the procedure for the first time. Our methodology for teaching the manoeuvre shows an improved accuracy, precision, and homogeneity within the group when compared to novices and even outperforms trained practitioners. In conclusion, if this methodology is adopted, it may correlate with higher clinical outcomes, less adverse events, and more successful airway management in critical medical scenarios.

Keywords: airway, cricoid, medical education, sellick

Procedia PDF Downloads 79

Authors: Norma Kok, Diemo Masuko, Thandokazi Dlongwana, Komala Pillay

Abstract:

CONTEXT: While many school principals have been outstanding teachers and have inherent leadership potential, many have not had access to the quality of leadership development or support that empowers them to produce high-quality education outcomes in extremely challenging circumstances. Further, school leaders in under-served communities face formidable challenges arising from insufficient infrastructure, overcrowded classrooms, socio-economic challenges within the community, and insufficient parental involvement, all of which put a strain on principals’ ability to lead their schools effectively. In addition few school leaders have access to other supportive networks, and many do not know how to build and leverage social capital to create opportunities for their schools and learners. Moreover, we know that fostering parental involvement in their children’s learning improves a child’s morale, attitude, and academic achievement across all subject areas, and promotes better behaviour and social adjustment. Citizen Leader Lab facilitates the Partners for Possibility (PfP) programme to provide leadership development and support to school leaders serving under-resourced communities in South Africa to create effective environments of learning. This is done by creating partnerships between school leaders and private-sector business leaders over a 12-month period. (185) OBJECTIVES: To explore school leaders’ perceptions of their leadership capacities and changes at their schools after being exposed to a year-long leadership development training programme. METHODS: School leaders gained new leadership capacities e.g. resilience, improved confidence, communication and conflict resolution skills - catalysing into improved cultures of collaborative decision-making and environments for enhanced teaching and learningprogramme based on the 70:20:10 model whereby: 10% of learning comes from workshops, 20% of learning takes place through peer learning and 70% of learning occurs through experiential learning as partnerships work together to identify and tackle challenges in targeted schools. Participants completed a post-programme questionnaire consisting of structured and unstructured questions and semi-structured interviews were conducted with them and their business leader. The interviews were audio-recorded, transcribed and thematic content analysis was undertaken. The analysis was inductive and emerging themes were identified. A code list was generated after coding was undertaken using computer software (Dedoose). Quantitative data gathered from surveys was aggregated and analysed. RESULTS: School leadership found the programme interesting and rewarding. They gained new leadership capacities such as resilience, improved confidence, communication and conflict resolution skills - catalyzing into improved cultures of collaborative decision-making and environments for enhanced teaching and learning. New networks resulted in tangible outcomes such as upgrades to school infrastructure, water and sanitation, vegetable gardens at schools resulting in nutrition for learners and/or intangible outcomes such as skills for members of school management teams (SMTs). Collaborative leadership led to SMTs being more aligned, efficient, and cohesive; and teachers being more engaged and motivated. Notable positive changes at the school inspired parents and community members to become more actively involved in the school and in their children’s education. CONCLUSION: The PfP programme leads to improved leadership capacities and improved school culture which leads to improved teaching and learning and new resources for schools.

Keywords: collaborative decision-making, collaborative leadership, community involvement, confidence

Procedia PDF Downloads 91

Authors: Noor-ul-Ain, Muhammad Tahir Khan, Kashif Khan, Adeela Ajmal, Hamid Mustafa

Abstract:

The objective of this study was to evaluate the preservative and upgrading potential of urea (70g/kg DM) added to high moisture oat silage at laboratory scale trial and urea was hydrolysed 95%. Microbial activity measured by pH and volatile fatty acids (VFA) and lactate production was reduced (p<0.001) by the urea addition. The pH of oat silage (without treated) was measured 5.7 and increased up to 8.00 on average while; volatile fatty acids (VFA) concentration was decreased. Relative proportions of fermentation acids changed after urea addition, increasing the acetate and butyrate and decreasing the propionate and lactate proportions. The addition of urea to oat silages increased (P<0.001) water soluble and ammonium nitrogen of the forage. These nitrogen fractions represented more than 40% of total nitrogen. After urea addition, total nitrogen content of oat silages increased from 21.0 g/kg DM to 28 g/kg DM. Application of urea at a rate of 70 g/kg DM significantly increased (P<0.001) the in situ degradation of neutral-detergent fibre after 48h of rumen incubation (NDF-situ). The NDF-situ was 200 g/kg NDF higher on oat forages ensiled with urea than on oat forages ensiled without urea. Oat silages can be effectively preserved and upgraded by ensiling with 70 g urea/kg dry matter. Further studies are required to evaluate voluntary intake of this forage.

Keywords: oat, silage, urea, pH, forage

Procedia PDF Downloads 470

Authors: Hamid Goharnejad, Milad Sadeghpoor Moalem, Mahmood Zakeri Niri, Leili Sadeghi Khalegh Abadi

Abstract:

While there are many benefits to using reservoir dams, their break leads to destructive effects. From the viewpoint of International Committee of Large Dams (ICOLD), dam break means the collapse of whole or some parts of a dam; thereby the dam will be unable to hold water. Therefore, studying dam break phenomenon and prediction of its behavior and effects reduces losses and damages of the mentioned phenomenon. One of the most common types of reservoir dams is embankment dam. Overtopping in embankment dams occurs because of flood discharge system inability in release inflows to reservoir. One of the most important issues among managers and engineers to evaluate the performance of the reservoir dam rim when sliding into the storage, creating waves is large and long. In this study, the effects of floods which caused the overtopping of the dam have been investigated. It was assumed that spillway is unable to release the inflow. To determine outflow hydrograph resulting from dam break, numerical model using Flow-3D software and empirical equations was used. Results of numerical models and their comparison with empirical equations show that numerical model and empirical equations can be used to study the flood resulting from dam break.

Keywords: embankment dam break, empirical equations, Taleghan dam, Flow-3D numerical model

Procedia PDF Downloads 321

Authors: Fatemeh Sadat Sharifi

Abstract:

In the present study, the capabilities of WAVEWATCH-III and MIKE21-SW for predicting the characteristics of wind waves in Hormuz Strait are evaluated. The GFS wind data (Global Forecast System) were derived. The bathymetry of gride with 2 arc-minute resolution, also were extracted from the ETOPO1. WAVEWATCH-III findings illustrate more valid prediction of wave features comparing to the MIKE-21 SW in deep water. Apparently, in shallow area, the MIKE-21 provides more uniformities with altimetry measurements. This may be due to the merits of the unstructured grid which are used in MIKE-21, leading to better representations of the coastal area. The findings on the direction of waves generated by wind in the modeling area indicate that in some regions, despite the increase in wind speed, significant wave height stays nearly unchanged. This is fundamental because of swift changes in wind track over the Strait of Hormuz. After discussing wind-induced waves in the region, the impact of instability of the surface layer on wave growth has been considered. For this purpose, the average monthly mean air temperature has been used. The results in cold months, when the surface layer is unstable, indicates an acceptable increase in the accuracy of prediction of the indicator wave height.

Keywords: numerical modeling, WAVEWATCH-III, Strait of Hormuz, MIKE21-SW

Procedia PDF Downloads 207

Authors: Totok Suhardijanto, Ninie Susanti Tedjowasono

Abstract:

This paper discusses the relationship between the distribution of Ancient Malay inscriptions and Spice Trade Route, especially in the relation with material cultures that accompany them, to understand how Malay could spread out around the archipelago beyond its original native-speakers’ region. The archipelago was known as the Spice Islands from the very beginning of the first century due to mace, cloves, and nutmeg that were originally exclusively found there. According to the Indian record, since the 2nd century, there has been a contact established between Indian and Indonesian people. A Chinese document from 3rd Century has mentioned Wangka (now widely known as Bangka) an island near Sumatra where some Chinese expeditions had visited. All of these records supported the existence of a maritime trade system and route between the archipelago and other countries during the first millennium. This paper will discuss first the Ancient Malay inscription spread around the archipelago from the perspectives of language variation and writing system style. Analyzing language variations of inscriptions certainly is not as easy as studying current spoken language variations in modern sociolinguistics. A huge amount of data is available for such kind of studies. On the contrary, in language variation research with inscription texts as an object, data is insufficient. Other resources will be needed to support the linguistic analysis. For this reason, this research made use of epigraphical evidence in the surrounding areas of the inscriptions to explain the variation of language and writing style. The research next expands the analysis to figure out the relationship between language variation and inscriptions distribution to the Spice Trade Route that spreads from the Molucca Sea to Mediterranian Sea. Data in this research consists of six different inscriptions: Kedukan Bukit, Koto Kapur, Dapunta Salendra, Sang Hyang Wintang, Ligor, and Laguna from the 7th-9th Century and found in Sumatra, Jawa, and the Philippines. In addition, as a comparative resource, this research also used Hikayat Tanjung Tanah, the first-founded Ancient Malay manuscript. In language analysis, we conduct a sociolinguistic method to explore the language variation and writing style of the inscriptions. For dealing with archaeological data, we conducted a hermeneutic method to analyze the possible meaning and social uses of the data. Language variations and writing system style in this research can be classified into two main groups. The language, epigraphical, and archaeological evidence explain that Ancient Malay had been widely used in the Eastern area of Spice Trade Route because it played an important role in the region as a lingua franca between people from different ethnic groups with different languages.

Keywords: Ancient Malay, Spice trade route, language variation, writing system variation

Procedia PDF Downloads 193

Authors: Ekta Yadav, Sukanta Bhattacharya, Brijesh Yadav, Ariel Hus, Jagjit Yadav

Abstract:

Background and Significance: Respiratory exposure to toxicants (chemicals or particulates) causes disruption of lung homeostasis leading to lung toxicity/injury manifested as pulmonary inflammation, edema, and/or other effects depending on the type and extent of exposure. This emphasizes the need for investigating toxicant type-specific mechanisms to understand therapeutic targets. Aquaporins, aka water channels, are known to play a role in lung homeostasis. Particularly, the two major lung aquaporins AQP5 and AQP1 expressed in alveolar epithelial and vasculature endothelia respectively allow for movement of the fluid between the alveolar air space and the associated vasculature. In view of this, the current study is focused on understanding the regulation of lung aquaporins and other targets during inhalation exposure to toxic chemicals (Cigarette smoke chemicals) versus toxic particles (Carbon nanoparticles) or co-exposures to understand their relevance as markers of injury and intervention. Methodologies: C57BL/6 mice (5-7 weeks old) were used in this study following an approved protocol by the University of Cincinnati Institutional Animal Care and Use Committee (IACUC). The mice were exposed via oropharyngeal aspiration to multiwall carbon nanotube (MWCNT) particles suspension once (33 ugs/mouse) followed by housing for four weeks or to Cigarette smoke Extract (CSE) using a daily dose of 30µl/mouse for four weeks, or to co-exposure using the combined regime. Control groups received vehicles following the same dosing schedule. Lung toxicity/injury was assessed in terms of homeostasis changes in the lung tissue and lumen. Exposed lungs were analyzed for transcriptional expression of specific targets (AQPs, surfactant protein A, Mucin 5b) in relation to tissue homeostasis. Total RNA from lungs extracted using TRIreagent kit was analyzed using qRT-PCR based on gene-specific primers. Total protein in bronchoalveolar lavage (BAL) fluid was determined by the DC protein estimation kit (BioRad). GraphPad Prism 5.0 (La Jolla, CA, USA) was used for all analyses. Major findings: CNT exposure alone or as co-exposure with CSE increased the total protein content in the BAL fluid (lung lumen rinse), implying compromised membrane integrity and cellular infiltration in the lung alveoli. In contrast, CSE showed no significant effect. AQP1, required for water transport across membranes of endothelial cells in lungs, was significantly upregulated in CNT exposure but downregulated in CSE exposure and showed an intermediate level of expression for the co-exposure group. Both CNT and CSE exposures had significant downregulating effects on Muc5b, and SP-A expression and the co-exposure showed either no significant effect (Muc5b) or significant downregulating effect (SP-A), suggesting an increased propensity for infection in the exposed lungs. Conclusions: The current study based on the lung toxicity mouse model showed that both toxicant types, particles (CNT) versus chemicals (CSE), cause similar downregulation of lung innate defense targets (SP-A, Muc5b) and mostly a summative effect when presented as co-exposure. However, the two toxicant types show differential induction of aquaporin-1 coinciding with the corresponding differential damage to alveolar integrity (vascular permeability). Interestingly, this implies the potential of AQP1 as a differential marker of toxicant type-specific lung injury.

Keywords: aquaporin, gene expression, lung injury, toxicant exposure

Procedia PDF Downloads 184

Authors: Anne Eugenia Wright

Abstract:

This study examines issues in accessibility to maritime cultural heritage. Using the Pillar Dollar Wreck in Biscayne National Park, Florida, this study presents an approach to public outreach based on the concept of Design for All. Design for All advocates creating products that are accessible and functional for all users, including those with visual, hearing, learning, mobility, or economic impairments. As a part of this study, a small exhibit was created that uses 3D products as a way to bring maritime cultural heritage to the public. It was presented to the public at East Carolina University’s Joyner Library. Additionally, this study presents a methodology for 3D printing scaled photogrammetry models of archaeological sites in full color. This methodology can be used to present a realistic depiction of underwater archaeological sites to those who are incapable of accessing them in the water. Additionally, this methodology can be used to present underwater archaeological sites that are inaccessible to the public due to conditions such as visibility, depth, or protected status. This study presents a practical use for 3D photogrammetry models, as well as an accessibility strategy to expand the outreach potential for maritime archaeology.

Keywords: Underwater Archaeology, 3D Printing, Photogrammetry, Design for All

Procedia PDF Downloads 138

Authors: Hamdi Belfeki, Belgacem Chandoul, Mnasser Hassouna, Mondher Mejri

Abstract:

Aqueous and ethanolic extracts of eight Tunisian aromatic and medicinal plants (TAMP) were characterized by studying their composition in polyphenols and also their antiradical and antioxidant capacities. In absence and in the presence of the various extracts, α-amylase from Bacillus subtlis activity, was measured in order to detect a potential inhibition. The total contents of polyphenols and flavonoid vary in function of TAMP and the mobile phase used for the extraction (distilled water or ethanol). The ethanolic extracts showed the most significant antiradical and antioxidant activities. Only the extracts from Coriandrum sativum showed a significant inhibiting effect on the α-amylase activity. This inhibiting capacity could be correlated with the chemical profile of the two extracts, due to the fact that they have the greatest amount of total flavonoid. The ethanolic extract has the most important antioxidant and anti-radicalizing activities among the sixteen extracts studied. The inhibition kinetics of the two coriander extracts were evaluated by pre-incubation method, using Lineweaver-Burk’s equation, obtained by linearization of Michaeilis-Menten’s expression. The results showed that both extracts exercised a competitive inhibition mechanism.

Keywords: α-amylase, antioxidant activity, aromatic and medicinal plants, inhibition

Procedia PDF Downloads 450

Authors: Radouane Elbahjaoui, Hamid El Qarnia

Abstract:

The present work aims to investigate numerically the thermal and flow characteristics of a rectangular latent heat storage unit (LHSU) during the melting process of a phase change material (PCM). The LHSU consists of a number of vertical and identical plates of PCM separated by rectangular channels. The melting process is initiated when the LHSU is heated by a heat transfer fluid (HTF: water) flowing in channels in a downward or upward direction. The proposed study is motivated by the need to optimize the thermal performance of the LHSU by accelerating the charging process. A mathematical model is developed and a fixed-grid enthalpy formulation is adopted for modeling the melting process coupling with convection-conduction heat transfer. The finite volume method was used for discretization. The obtained numerical results are compared with experimental, analytical and numerical ones found in the literature and reasonable agreement is obtained. Thereafter, the numerical investigations were carried out to highlight the effects of the HTF flow direction and the aspect ratio of the PCM slabs on the heat transfer characteristics and thermal performance enhancement of the LHSU.

Keywords: PCM, TES, LHSU, melting

Procedia PDF Downloads 261

Authors: Mauricio Gracia, Luis Leal, Bharat Verma

Abstract:

Computational fluid dynamics (CFD) has become nowadays an important tool in the process of hydrodynamic design of modern ships. CFD is used to model any phenomena related to fluid flow in a control volume like a ship or any offshore structure in the sea. In the present study, the current force drag coefficients for a Colombian Navy Frigate in deep and shallow water are estimated through the application of CFD. The study shows the process of simulating the ship current drag coefficients using the CFD simulations method, which is conducted using STAR-CCM+ software package. The Almirante Padilla class Frigate ship scale model is investigated. The results show the ship current drag coefficient calculated considering a current speed of 1 knot with a 90° drift angle for the full-scale ship. Predicted results were compared against the current drag coefficients published in the Lloyds register OCIMF report. It is shown that the simulation results agree fairly well with the published results and that STAR-CCM+ code can predict current drag coefficients.

Keywords: CFD, current draft coefficient, STAR-CCM+, OCIMF, Bollard pull

Procedia PDF Downloads 176

Authors: Se-Hwa Park, En-Kyung Han, Jae-Young Lim, Hye-Jung Ahn

Abstract:

Purpose: The objective of this study is to provide basic data for understanding the substance of inpatient life with CRPS (Complex Regional Pain Syndrome) and developing efficient and effective nursing intervention. Methods: From September 2018 to November, we have interviewed 10 CRPS patients about inpatient experiences. To understand the implication of inpatient life experiences with CRPS and intrinsic structure, we have used the question: 'How about the inpatient experiences with CRPS'. For data analysis, the method suggested by Colaizzi was applied as a phenomenological method. Results: According to the analysis, the study participants' inpatient life process was structured in six categories: (a) breakthrough pain experience (b) the limitation of pain treatment, (c) worsen factors of pain during inpatient period, (d) treat method for pain, (e) positive experience for inpatient period, (f) requirements for medical team, family and people in hospital room. Conclusion: Inpatient with CRPS have experienced the breakthrough pain. They had expected immediate treatment for breakthrough pain, but they experienced severe pain because immediate treatment was not implemented. Pain-worsening factors which patients with CRPS are as follows: personal factors from negative emotions such as insomnia, stress, sensitive character, pain part touch or vibration stimulus on the bed, physical factors from high threshold or rapid speed during fast transfer, conflict with other people, climate factors such as humidity or low temperature, noise, smell, lack of space because of many visitors. Patients actively manage the pain committing into another tasks or diversion. And also, patients passively manage the pain, just suppress, give-up. They think positively about rehabilitation treatment. And they require the understanding and sympathy for other people, and emotional support, immediate intervention for medical team. Based on the results of this study, we suppose the guideline of systematic breakthrough pain management for the relaxation of sudden pain, using notice of informing caution for touch or vibration. And we need to develop non-medicine pain management nursing intervention.

Keywords: breakthrough pain, CRPS, complex regional pain syndrome, inpatient life experiences, phenomenological method

Procedia PDF Downloads 129

Authors: Maira Farooq Maneka

Abstract:

Death has increasingly caused humans to investigate its reality and what lies after it, if something at all, with personal conviction and concern. Till date it remains a matter of speculation. We do not encounter arguments other than ‘faith’ from major world religions when justifying claims about life after death (LAD) as it is an unseen phenomenon. This paper attempts to analyse the Islamic idea of resurrection (after death) and its justification that is distinct from faith but instead contemplative in nature. To do this a legal lens was adopted which allowed the categorisation of selected Quranic arguments under the heading of direct evidence, indirect evidence and intuitive reasoning. Results: Four kinds of direct evidences are discussed under the themes of sleep, droughts, predictions and Quranic challenge. The section of indirect evidences narrows its scope only to two, out of many, broad possible signs that pointed towards the reality of resurrection. These include the signs found in nature such as sun and water as well as signs one finds within the human body such as the creation and function of human fingertips. Finally the last section tries to amalgamate Quran’s appeal to human rationality that facilitates the reader in accepting the possibility of resurrection and hence a final Day of Judgement. These include the notion of accountability, pleasure, pain and human agency.

Keywords: Islam, life after death, Quran, resurrection

Procedia PDF Downloads 95

Authors: Aubrey Langeland, Richard Neitzel, Kowit Nambunmee

Abstract:

Electronic waste, ‘e-waste’, refers generally to discarded electronics and electrical equipment, including products from cell phones and laptops to wires, batteries and appliances. While e-waste represents a transformative source of income in low- and middle-income countries, informal e-waste workers use rudimentary methods to recover materials, simultaneously releasing harmful chemicals into the environment and creating a health hazard for themselves and surrounding communities. Valuable materials such as precious metals, copper, aluminum, ferrous metals, plastic and components are recycled from e-waste. However, persistent organic pollutants such as polychlorinated biphenyls (PCBs) and some polybrominated diphenyl ethers (PBDEs), and heavy metals are toxicants contained within e-waste and are of great concern to human and environmental health. The current study seeks to evaluate the environmental contamination resulting from informal e-waste recycling in a predominantly agricultural community in northeastern Thailand. To accomplish this objective, five types of environmental samples were collected and analyzed for concentrations of eight metals commonly associated with e-waste recycling during the period of July 2016 through July 2017. Rice samples from the community were collected after harvest and analyzed using inductively coupled plasma mass spectrometry (ICP-MS) and gas furnace atomic spectroscopy (GF-AS). Soil samples were collected and analyzed using methods similar to those used in analyzing the rice samples. Surface water samples were collected and analyzed using absorption colorimetry for three heavy metals. Environmental air samples were collected using a sampling pump and matched-weight PVC filters, then analyzed using Inductively Coupled Argon Plasma-Atomic Emission Spectroscopy (ICAP-AES). Finally, surface wipe samples were collected from surfaces in homes where e-waste recycling activities occur and were analyzed using ICAP-AES. Preliminary1 results indicate that some rice samples have concentrations of lead and cadmium significantly higher than limits set by the United States Department of Agriculture (USDA) and the World Health Organization (WHO). Similarly, some soil samples show levels of copper, lead and cadmium more than twice the maximum permissible level set by the USDA and WHO, and significantly higher than other areas of Thailand. Surface water samples indicate that areas near e-waste recycling activities, particularly the burning of e-waste products, result in increased levels of cadmium, lead and copper in surface waters. This is of particular concern given that many of the surface waters tested are used in irrigation of crops. Surface wipe samples measured concentrations of metals commonly associated with e-waste, suggesting a danger of ingestion of metals during cooking and other activities. Of particular concern is the relevance of surface contamination of metals to child health. Finally, air sampling showed that the burning of e-waste presents a serious health hazard to workers and the environment through inhalation and deposition2. Our research suggests a need for improved methods of e-waste recycling that allows workers to continue this valuable revenue stream in a sustainable fashion that protects both human and environmental health. 1Statistical analysis to be finished in October 2017 due to follow-up field studies occurring in July and August 2017. 2Still awaiting complete analytic results.

Keywords: e-waste, environmental contamination, informal recycling, metals

Procedia PDF Downloads 362

Authors: Erna Judith Roach, Nalini Bhaskaranand

Abstract:

Background & Significance: Asthma is the most common chronic disease among children. Education is the cornerstone of management of asthma to help the affected children. In India there are about 1.5- 3.0 million asthmatic children in the age group of 5-11 years. Many parents face management dilemmas in administration of medications to their children. Mothers being primary caregivers of children are often responsible for administering medications to them. The purpose of the study was to develop an educational package on techniques of drug administration for mothers of asthmatic children and determine its effectiveness in terms of improvement in skill in drug administration. Methodology: A quasi- experimental time series pre-test post -test control group design was used. Mothers of asthmatic children attending paediatric outpatient departments of selected hospitals along with their children between 5 and 12 years were included. Sample size consisted of 40 mothers in the experimental and 40 mothers in the control groups. Block randomization was used to assign samples to both the groups. The data collection instruments used were Baseline Proforma, Clinical Proforma, Daily asthma drug intake and symptoms diary and Observation Rating Scales on technique of using a metered dose inhaler with spacer; metered dose inhaler with facemask; metered dose inhaler alone and dry powder inhaler. The educational package consisted of a video and booklet on techniques of drug administration. Data were collected at baseline, 1, 3 and 6 months. Findings: The mean post-test scores in techniques of drug administration were higher than the mean pre-test scores in the experimental group in all techniques. The Friedman test (p < 0.01), Wilcoxon Signed Rank test (p < 0.008) and Mann Whitney U (p < 0.01) showed statistically significant difference in the experimental group than the control group. There was significant decrease in the average number of symptom days (11 Vs. 4 days/ month) and hospital visits (5 to 1 per month) in the experimental group when compared to the control group. Conclusion: The educational package was found to be effective in improving the skill of mothers in drug administration in all the techniques, especially with using the metered dose inhaler with spacer.

Keywords: childhood asthma, drug administration, mothers of children, inhaler

Procedia PDF Downloads 423

Authors: Macie Matta, Ahmad Jabri, Stephanie Jackson

Abstract:

Introduction: In the absence of hypotension, pulmonary embolism (PE) causing right ventricular dysfunction or strain, whether confirmed by imaging or cardiac biomarkers, is deemed to be an intermediate-risk category. Urgent treatment of intermediate-risk PE can prevent progression to hemodynamic instability and death. Management options include thrombolysis, thrombectomy, or systemic anticoagulation. We aim to evaluate the short-term outcomes of a half-dose tissue plasminogen activator (tPA) for the management of intermediate-risk PE. Methods: We retrospectively identified adult patients diagnosed with intermediate-risk PE between the years 2000 and 2021. Demographic data, lab values, imaging, treatment choice, and outcomes were all obtained through chart review. Primary outcomes measured include major bleeding events and in-hospital mortality. Patients on standard systemic anticoagulation without receiving thrombolysis or thrombectomy served as controls. Patient data were analyzed using SAS®️ Software (version 9.4; Cary, NC) to compare individuals that received half-dose tPA with controls, and statistical significance was set at a p-value of 0.05. Results: We included 57 patients in our final analysis, with 19 receiving tPA. Patient characteristics and comorbidities were comparable between both groups. There was a significant difference between PE location, presence of acute deep vein thrombosis, and peak troponin level between both groups. The thrombolytic cohort was more likely to demonstrate a 60/60 sign and thrombus in transit finding on echocardiography than controls. The thrombolytic group was more likely to have major bleeding (17% vs 7.9%, p= 0.4) and in-hospital mortality (5.3% vs 0%, p=0.3); however, this was not statistically significant. Patients who received half-dose tPA had non-significantly higher rates of major bleeding and in-hospital mortality. Larger scale, randomized control trials are needed to establish the benefit and safety of thrombolytics in patients with intermediate-risk PE.

Keywords: pulmonary embolism, half dose thrombolysis, tissue plasminogen activator, cardiac biomarkers, echocardiographic findings, major bleeding event

Procedia PDF Downloads 75

Authors: Goldie Lynn Diaz, Ma. Teresa Tricia G. Bautista, Elisabeth Engeljakob, Mary Glaze Rosal

Abstract:

Introduction: Residents are expected to convey unfavorable news, discuss prognoses, and relieve suffering, and address do-not-resuscitate orders, yet some report a lack of competence in providing this type of care. Recognizing this need, Family Medicine residency programs are incorporating end-of-life care from symptom and pain control, counseling, and humanistic qualities as core proficiencies in training. Objective: This study determined the competency of Family Medicine Residents from various institutions in Metro Manila on rendering care for the dying. Materials and Methods: Trainees completed a Palliative Care Evaluation tool to assess their degree of confidence in patient and family interactions, patient management, and attitudes towards hospice care. Results: Remarkably, only a small fraction of participants were confident in performing independent management of terminal delirium and dyspnea. Fewer than 30% of residents can do the following without supervision: discuss medication effects and patient wishes after death, coping with pain, vomiting and constipation, and reacting to limited patient decision-making capacity. Half of the respondents had confidence in supporting the patient or family member when they become upset. Majority expressed confidence in many end-of-life care skills if supervision, coaching and consultation will be provided. Most trainees believed that pain medication should be given as needed to terminally ill patients. There was also uncertainty as to the most appropriate person to make end-of-life decisions. These attitudes may be influenced by personal beliefs rooted in cultural upbringing as well as by personal experiences with death in the family, which may also affect their participation and confidence in caring for the dying. Conclusion: Enhancing the quality and quantity of end-of-life care experiences during residency with sufficient supervision and role modeling may lead to knowledge and skill improvement to ensure quality of care. Fostering bedside learning opportunities during residency is an appropriate venue for teaching interventions in end-of-life care education.

Keywords: end of life care, geriatrics, palliative care, residency training skill

Procedia PDF Downloads 257