Search results for: hospital waste

Authors: P. H. Tee, S. M. Zamri, K. M. Kasim, S. K. Tiew

Abstract:

This study evaluates the management of osteoporosis in a tertiary care government hospital in Malaysia. As the number of admitted patients having osteoporotic fractures is on the rise, osteoporotic medications are an increasing financial burden to government hospitals because they account for half of the orthopedic budget and expenditure. Comprehensive knowledge among practitioners is important to detect early and avoid this preventable disease and its serious complications. The purpose of this study is to evaluate the awareness, knowledge, and practices in managing osteoporosis among practitioners in Hospital Tengku Ampuan Rahimah (HTAR), Klang. A questionnaire from an overseas study in managing osteoporosis among primary care physicians is adapted to Malaysia’s Clinical Practice Guideline of Osteoporosis 2012 (revised 2015) and international guidelines were distributed to all orthopedic practitioners in HTAR Klang (including surgeons, orthopedic medical officers), endocrinologists, rheumatologists and geriatricians. The participants were evaluated on their expertise in the diagnosis, prevention, treatment decision and medications for osteoporosis. Collected data were analyzed for all descriptive and statistical analyses as appropriate. All 45 participants responded to the questionnaire. Participants scored highest on expertise in prevention, followed by diagnosis, treatment decision and lastly, medication. Most practitioners stated that own-initiated continuing professional education from articles and books was the most effective way to update their knowledge, followed by attendance in conferences on osteoporosis. This study confirms the importance of comprehensive training and education regarding osteoporosis among tertiary care physicians and surgeons, predominantly in pharmacotherapy, to deliver wholesome care for osteoporotic patients.

Keywords: awareness, knowledge, osteoporosis, practices

Procedia PDF Downloads 130

Authors: Kira Merigan

Abstract:

BACKGROUND- Fertility preservation (FP) measures are increasingly recognised as an important consideration for children and adolescents planned to undergo potentially damaging gonadotoxic therapy. Worldwide, there are very few documented cases of FP in young females by way of ovarian stimulation and oocyte cryopreservation.AIM – To report a case series of mature oocyte cryopreservation in 5post-pubertal adolescents aged 14-17 years old, with varied medical conditions requiring gonadotoxic treatment. SETTING-These cases took place via a multidisciplinary team approach at The Royal Children’s Hospital, a large tertiary centre in Melbourne, Australia. INTERVENTION– Ovarian stimulation and oocyte collection was performed as detailed in each case. RESULTS –Across the 5 patients, 3-28 oocytes were retrieved. We report pre-treatment workup, complications, and delays to treatment. CONCLUSION- Oocyte cryopreservation may be a safe alternative to ovarian tissue cryopreservation (OTC) in the adolescent population

Keywords: fertility preservation, adolescent, ovarian stimulation, oocyte cryopreservation

Procedia PDF Downloads 167

Authors: Vidya Pratap, Seena Biju, Keshavdev A.

Abstract:

In the educational town of Manipal (located in southern India) households dispose their wastes without segregation. Mixed wastes (organic, inorganic and hazardous items) are collected either by private collectors or by the local municipal body in trucks and taken to dump yards. These collectors select certain recyclables from the collected trash and sell them to scrap merchants to earn some extra money. Rag pickers play a major role in picking up card board boxes, glass bottles and milk sachets from dump yards and public areas and scrap iron from construction sites for recycling. In keeping with the Indian Prime Minister’s mission of Swachh Bharat (A Clean India), the local municipal administration is taking efforts to ensure segregation of domestic waste at source. With this in mind, each household in a residential area in Manipal was given two buckets – for wet and dry wastes (wet waste referred to organic waste while dry waste included recyclable and hazardous items). A study was conducted in this locality covering a cluster of 145 households to assess the residents’ knowledge of recyclable, organic and hazardous items commonly disposed by households. Another objective of this research was to evaluate the extent to which the residents actually dispose their wastes appropriately. Questionnaires were self-administered to a member of each household with the assistance of individuals speaking the local language whenever needed. Respondents’ knowledge of whether an item was organic, inorganic or hazardous was captured through a questionnaire containing a list of 50 common items. Their behaviour was captured by asking how they disposed these items. Results show that more than 70% of respondents are aware that banana and orange peels, potato skin, egg shells and dried leaves are organic; similarly, more than 70% of them consider newspapers, notebook and printed paper are recyclable. Less than 65% of respondents are aware that plastic bags and covers and plastic bottles are recyclable. However, the results of the respondents’ recycling behaviour is less impressive. Fewer than 35% of respondents recycle card board boxes, milk sachets and glass bottles. Unfortunately, since plastic items like plastic bags and covers and plastic bottles are not accepted by scrap merchants, they are not recycled. This study shows that the local municipal authorities must find ways to recycle plastic into products, alternate fuel etc.

Keywords: behaviour, knowledge, plastic waste management, recyclables

Procedia PDF Downloads 172

Authors: Wadsana Sarakarn, Pimonpan Charoensri, Baliya Chaiyara

Abstract:

Objectives: To study the outcomes of the developed nursing model to prevent early postpartum hemorrhage (PPH). Materials and Methods: The analytical study was conducted in Sunpasitthiprasong Hospital during October 1st, 2015, until May 31st, 2017. After review the prevalence, risk factors, and outcomes of postpartum hemorrhage of the parturient who gave birth in Sunpasitthiprasong Hospital, the nursing model was developed under research regulation of Kemmis&McTaggart using 4 steps of operating procedures: 1) analyzing problem situation and gathering 2) creating the plan 3) noticing and performing 4) reflecting the result of the operation. The nursing model consisted of the screening tools for risk factors associated with PPH, the clinical nursing practice guideline (CNPG), and the collecting bag for measuring postpartum blood loss. Primary outcome was early postpartum hemorrhage. Secondary outcomes were postpartum hysterectomy, maternal mortality, personnel’s practice, knowledge, and satisfaction of the nursing model. The data were analyzed by using content analysis for qualitative data and descriptive statistics for quantitative data. Results: Before using the nursing model, the prevalence of early postpartum hemorrhage was under estimated (2.97%). There were 5 cases of postpartum hysterectomy and 2 cases of maternal death due to postpartum hemorrhage. During the study period, there was 22.7% prevalence of postpartum hemorrhage among 220 pregnant women who were vaginally delivered at Sunpasitthiprasong Hospital. No maternal death or postpartum hysterectomy was reported after using the nursing model. Among 16 registered nurses at the delivery room who evaluated using of the nursing model, they reported the high level of practice, knowledge, and satisfaction Conclusion: The nursing model for the prevention of early PPH is effective to decrease early PPH and other serious complications.

Keywords: the development of a nursing model, prevention of postpartum hemorrhage, pregnant women, postpartum hemorrhage

Procedia PDF Downloads 99

Authors: Nnadi Ezekiel Ejiofor

Abstract:

In Enugu, Nigeria, this study investigates the connection between strategic leadership and project management sustainability, with an emphasis on building projects in the State. The study set out to accomplish two specific goals: first, it sought to establish a link between creative project management and resource efficiency in construction projects in Enugu State, Nigeria; and second, it sought to establish a link between innovative thinking and waste minimization in those same projects. A structured questionnaire was used to collect primary data from 45 registered construction enterprises in the study area as part of the study's descriptive research approach. Due to the nonparametric nature of the data, Spearman Rank Order Correlation was used to evaluate the acquired data. The findings demonstrate that creative project management had a significant positive impact on resource efficiency in construction projects carried out by architecture firms in Enugu State, Nigeria (r =.849; p.001), and that innovative thinking had a significant impact on waste reduction in those same projects (r =.849; p.001). It was determined that strategic leadership had a significant impact on the sustainability of project management, and it was thus advised that project managers should foresee, prepare for, and effectively communicate present and future developments to project staff in order to ensure that the objective of sustainable initiatives, such as recycling and reuse, is implemented in construction projects.

Keywords: construction, project management, strategic leadership, sustainability, waste reduction

Procedia PDF Downloads 50

Authors: Bipul Krishna Saha, Basab Chakraborty, Ashish Alex Sam, Parthasarathi Ghosh

Abstract:

The demand for energy is cumulatively increasing with time.  Since the availability of conventional energy resources is dying out gradually, significant interest is being laid on searching for alternate energy resources and minimizing the wastage of energy in various fields.  In such perspective, low-grade waste heat from several industrial sources can be reused to generate electricity. The present work is to further the adoption of the Organic Rankine Cycle (ORC) technology in Indian industrial sector.  The present paper focuses on extending the previously reported idea to the next level through a comparative review with three different working fluids using practical data from an Indian industrial plant. For comprehensive study in the simulation platform of Aspen Hysys^®, v8.6, the waste heat data has been collected from a current coke oven gas plant in India.  A parametric analysis of non-regenerative ORC and regenerative ORC is executed using the working fluids R-123, R-11 and R-21 for subcritical ORC system.  The primary goal is to determine the optimal working fluid considering various system parameters like turbine work output, obtained system efficiency, irreversibility rate and second law efficiency under applied multiple heat source temperature (160 °C- 180 °C).  Selection of the turbo-expanders is one of the most crucial tasks for low-temperature applications in ORC system. The present work is an attempt to make suitable recommendation for the appropriate configuration of the turbine. In a nutshell, this study justifies the proficiency of integrating the ORC technology in Indian perspective and also finds the appropriate parameter of all components integrated in ORC system for building up an ORC prototype.

Keywords: organic Rankine cycle, regenerative organic Rankine cycle, waste heat recovery, Indian industry

Procedia PDF Downloads 374

Authors: Ganesh Dattatraya Saratale, Min Kyu Oh

Abstract:

Rice straw is one of the most abundant lignocellulosic waste materials and its annual production is about 731 Mt in the world. This study treats the subject of effective utilization of this waste biomass for biofuels production. We have showed a comparative assessment of numerous pretreatment strategies for rice straw, comprising of major physical, chemical and physicochemical methods. Among the different methods employed for pretreatment alkaline pretreatment in combination with sodium chlorite/acetic acid delignification found efficient pretreatment with significant improvement in the enzymatic digestibility of rice straw. A cellulase dose of 20 filter paper units (FPU) released a maximum 63.21 g/L of reducing sugar with 94.45% hydrolysis yield and 64.64% glucose yield from rice straw, respectively. The effects of different pretreatment methods on biomass structure and complexity were investigated by FTIR, XRD and SEM analytical techniques. Finally the enzymatic hydrolysate of rice straw was used for ethanol production using developed Saccharomyces cerevisiae SR8. The developed yeast strain enabled efficient fermentation of xylose and glucose and produced higher ethanol production. Thus development of bioethanol production from lignocellulosic waste biomass is generic, applicable methodology and have great implication for using ‘green raw materials’ and producing ‘green products’ much needed today.

Keywords: rice straw, pretreatment, enzymatic hydrolysis, FPU, Saccharomyces cerevisiae SR8, ethanol fermentation

Procedia PDF Downloads 538

Authors: Essam A. Makky, Siti H. Mohd Rasdi, J. B. Al-Dabbagh, G. F. Najmuldeen

Abstract:

The synthesis of silver nano particles (SNPs) extensively studied by using chemical and physical methods. Here, the biological methods were used and give benefits in research field in the aspect of very low cost (from waste to wealth) and safe time as well. The study aims to isolate and exploit the microbial power in the production of industrially important by-products in nano-size with high economic value, to extract highly valuable materials from hazardous waste, to quantify nano particle size, and characterization of SNPs by X-Ray Diffraction (XRD) analysis. Disposal X-ray films were used as substrate because it consumes about 1000 tons of total silver chemically produced worldwide annually. This silver is being wasted when these films are used and disposed. Different bacterial isolates were obtained from various sources. Silver was extracted as nano particles by microbial power degradation from disposal X-ray film as the sole carbon source for ten days incubation period in darkness. The protein content was done and all the samples were analyzed using XRD, to characterize of silver (Ag) nano particles size in the form of silver nitrite. Bacterial isolates CL4C showed the average size of SNPs about 19.53 nm, GL7 showed average size about 52.35 nm and JF Outer 2A (PDA) showed 13.52 nm. All bacterial isolates partially identified using Gram’s reaction and the results obtained exhibited that belonging to Bacillus sp.

Keywords: nanotechnology, bioremediation, disposal X-ray film, nanoparticle, waste, XRD

Procedia PDF Downloads 483

Authors: Bouchra Wassate, Younes Karhat, Khadija El Falaki

Abstract:

Leachate is a source of surface water and groundwater contamination if it has not been pretreated. Indeed, due to its complex structure and its pollution load make its treatment extremely difficult to achieve the standard limits required. The objective of this work is to show the interest of advanced oxidation processes on leachate treatment of urban waste containing high concentrations of organic pollutants. The efficiency of Fenton (Fe2+ +H2O2 + H+) reagent for young leachate recovered from collection trucks household waste in the city of Casablanca, Morocco, was evaluated with the objectives of chemical oxygen demand (COD) and discoloration reductions. The optimization of certain physicochemical parameters (initial pH value, reaction time, and [Fe2+], [H2O2]/ [Fe2+] ratio) has yielded good results in terms of reduction of COD and discoloration of the leachate.

Keywords: COD removal, color removal, Fenton process, oxidation process, leachate

Procedia PDF Downloads 286

Authors: Prabhu Thangaraju, Manoj Deepak, A. Sivakumar

Abstract:

Removal of inter vertebral disc along with spinal fusion has many disadvantages such as causing stress fractures. If it is possible regenerate the spine it would be possible avoid the complications of the surgery and achieve better results. Our study involves the use of mesenchymal stem cells in regenerating the discs. Our study involved 10 patients who presented with degenerative disc disease between 2008-2011 in our hospital. After adequate pre-operative check prepared mesenchymal stem cells were injected into the disc spaces. These patients were subjected to conservative therapy for a minimum of six weeks before they were accepted into the study. They were followed up regularly for a minimum of 2years with serial radiographs and MRI. 8 out of the 10 patients had completed reduction in the pain. The T2 weighted MRI images in 9 out of the 10 patients showed a bright signal compared the previous Images which indicated that there was improvement in the hydration levels. From the case study of 10 patients who were subjected to mesenchymal cell therapy in our hospital, we can conclude that the use of mesenchymal cells in treatment of intervertebral disc degeneration in a safe and effective option.

Keywords: mesenchymal stem cells, intervertebral disc, the spine, disc degeneration

Procedia PDF Downloads 372

Authors: W. Kritsarikan, T. Patcharawit, T. Yingnakorn, S. Khumkoa

Abstract:

Neodymium-iron-boron (NdFeB) magnets classified as high-power magnets are widely used in various applications such as electrical and medical devices and account for 13.5 % of the permanent magnet’s market. Since its typical composition of 29 - 32 % Nd, 64.2 – 68.5 % Fe and 1 – 1.2 % B contains a significant amount of rare earth metals and will be subjected to shortages in the future. Domestic NdFeB magnet waste recycling should therefore be developed in order to reduce social, environmental impacts toward a circular economy. Most research works focus on recycling the magnet wastes, both from the manufacturing process and end of life. Each type of wastes has different characteristics and compositions. As a result, these directly affect recycling efficiency as well as the types and purity of the recyclable products. This research, therefore, focused on the recycling of manufacturing NdFeB magnet waste obtained from the sintering stage of magnet production and the waste contained 23.6% Nd, 60.3% Fe and 0.261% B in order to recover high purity neodymium oxide (Nd₂O₃) using hybrid metallurgical process via oxidative roasting and selective leaching techniques. The sintered NdFeB waste was first ground to under 70 mesh prior to oxidative roasting at 550 - 800 °C to enable selective leaching of neodymium in the subsequent leaching step using H₂SO₄ at 2.5 M over 24 h. The leachate was then subjected to drying and roasting at 700 – 800 °C prior to precipitation by oxalic acid and calcination to obtain neodymium oxide as the recycling product. According to XRD analyses, it was found that increasing oxidative roasting temperature led to an increasing amount of hematite (Fe₂O₃) as the main composition with a smaller amount of magnetite (Fe₃O₄) found. Peaks of neodymium oxide (Nd₂O₃) were also observed in a lesser amount. Furthermore, neodymium iron oxide (NdFeO₃) was present and its XRD peaks were pronounced at higher oxidative roasting temperatures. When proceeded to acid leaching and drying, iron sulfate and neodymium sulfate were mainly obtained. After the roasting step prior to water leaching, iron sulfate was converted to form hematite as the main compound, while neodymium sulfate remained in the ingredient. However, a small amount of magnetite was still detected by XRD. The higher roasting temperature at 800 °C resulted in a greater Fe₂O₃ to Nd₂(SO₄)₃ ratio, indicating a more effective roasting temperature. Iron oxides were subsequently water leached and filtered out while the solution contained mainly neodymium sulfate. Therefore, low oxidative roasting temperature not exceeding 600 °C followed by acid leaching and roasting at 800 °C gave the optimum condition for further steps of precipitation and calcination to finally achieve neodymium oxide.

Keywords: NdFeB magnet waste, oxidative roasting, recycling, selective leaching

Procedia PDF Downloads 182

Authors: Suresh Vanguri, Suresh Palla, Prasad G., Ramaswamy V., Kalyani K. V., Chaturvedi S. K., Mohapatra B. N., Sunder Rao TBVN

Abstract:

The utilization of industrial waste materials and by-products in the cement industry helps in the conservation of natural resources besides avoiding the problems arising due to waste dumping. The use of non-carbonated materials as raw mix components in clinker manufacturing is identified as one of the key areas to reduce Green House Gas (GHG) emissions. Chrome sludge is a waste material generated from the manufacturing process of sodium dichromate. This paper aims to present studies on the use of chrome sludge in clinker manufacturing, its impact on the development of clinker mineral phases and on the cement properties. Chrome sludge was found to contain substantial amounts of CaO, Fe2O3 and Al2O3 and therefore was used to replace some conventional sources of alumina and iron in the raw mix. Different mixes were prepared by varying the chrome sludge content from 0 to 5 % and the mixes were evaluated for burnability. Laboratory prepared clinker samples were evaluated for qualitative and quantitative mineralogy using X-ray Diffraction Studies (XRD). Optical microscopy was employed to study the distribution of clinker phases, their granulometry and mineralogy. Since chrome sludge also contains considerable amounts of chromium, studies were conducted on the leachability of heavy elements in the chrome sludge as well as in the resultant cement samples. Estimation of heavy elements, including chromium was carried out using ICP-OES. Further, the state of chromium valence, Cr (III) & Cr (VI), was studied using conventional chemical analysis methods coupled with UV-VIS spectroscopy. Assimilation of chromium in the clinker phases was investigated using SEM-EDXA studies. Bulk cement was prepared from the clinker to study the effect of chromium sludge on the cement properties such as setting time, soundness, strength development against the control cement. Studies indicated that chrome sludge can be successfully utilized and its content needs to be optimized based on raw material characteristics.

Keywords: chrome sludge, leaching, mineralogy, non-carbonate materials

Procedia PDF Downloads 217

Authors: Batsukh Chultem, Oyunbileg Natsagdorj, Namsrai Steyrmunkh

Abstract:

Many industries, tourist camps and houses, discharge aqueous effluents containing relatively high levels of heavy metals, harmful organic compounds water. Untreated effluent from these manufacturing processes has an adverse impact on the environment. A specific problem associated with waste water in the environment is accumulation in the food chain and persistence in the environment. The screening of microorganisms resistant to pollution and able to detoxification them is essential for the development of clean-up technologies. The purpose of this study is to use advanced microbiological technology products for oxidizing organic and heavy metals pollutants as a biological treatment, to reduce water pollution, which arise as a result of waste water due to day-to-day operations of industries and houses of Ulaanbaatar city and tourist camps located around the lake Hovsgol, in Hovsgol province of Mongolia. By comparing the results from tests of effective microorganism’s bio-preparation treated sewage samples and not treated sewage samples shows that the treated sewage samples pollution decreased defending on treatment period and ratio. Treated water analyses show that: the suspended solids 352 mg/l, pH 5.85-7.95, ammonium nitrate 81.25-221.2 mg NH₄/l, nitrite 0.088-0.227 mg NO₂/l, nitrate 8.5-11.5 mg NO₃/l, and orthophosphate 1.06-15.46 mg PO₄/l. Also, heavy metals were decreased and microbiological test results defined parameters, respectively show the waste water pollution was reduced.

Keywords: effective microorganims, environment, pollution, treatment

Procedia PDF Downloads 131

Authors: Salman Imran, Chris Healey

Abstract:

Traditionally, medical care of children in England and Wales starts from primary care with a referral to secondary care paediatricians who may not investigate further. Many primary care doctors do not undergo a paediatric rotation/exposure in training. As a result, there are many who have not acquired the necessary skills to manage children hence increasing hospital referral. With the current demand on hospitals in the National Health Service managing more problems in the community is needed. One way of handling this is to set up clinics, meetings and huddles in GP surgeries where professionals involved (general practitioner, paediatrician, health visitor, community nurse, dietician, school nurse) come together and share information which can help improve communication and care. The increased awareness and education that paediatricians can impart in this way will help boost confidence for primary care professionals to be able to be more self-sufficient. This has been tried successfully in other regions e.g., St. Mary’s Hospital in London but is crucial for a more rural setting like ours. The primary aim of this project would be to educate specifically GP’s and generally all other health professionals involved. Additional benefits would be providing care nearer home, increasing patient’s confidence in their local surgery, improving communication and reducing unnecessary patient flow to already stretched hospital resources. Methods: This was done as a plan do study act cycle (PDSA). Three clinics were delivered in different practices over six months where feedback from staff and patients was collected. Designated time for teaching/discussion was used which involved some cases from the actual clinics. Both new and follow up patients were included. Two clinics were conducted by a paediatrician and nurse whilst the 3rd involved paediatrician and local doctor. The distance from hospital to clinics varied from two miles to 22 miles approximately. All equipment used was provided by primary care. Results: A total of 30 patients were seen. All patients found the location convenient as it was nearer than the hospital. 70-90% clearly understood the reason for a change in venue. 95% agreed to the importance of their local doctor being involved in their care. 20% needed to be seen in the hospital for further investigations. Patients felt this to be a more personalised, in-depth, friendly and polite experience. Local physicians felt this to be a more relaxed, familiar and local experience for their patients and they managed to get immediate feedback regarding their own clinical management. 90% felt they gained important learning from the discussion time and the paediatrician also learned about their understanding and gaps in knowledge/focus areas. 80% felt this time was valuable for targeted learning. Equipment, information technology, and office space could be improved for the smooth running of any future clinics. Conclusion: The acute paediatric outpatient clinic can be successfully established in primary care facilities. Careful patient selection and adequate facilities are important. We have demonstrated a further step in the reduction of patient flow to hospitals and upskilling primary care health professionals. This service is expected to become more efficient with experience.

Keywords: clinics, education, paediatricians, primary care

Procedia PDF Downloads 163

Authors: Birendra Kumar Bista, Rhitik Bista, Prafulla Koirala, Lokendra Mandal, Nikrsh Raj Shrestha, Vivek Kattel

Abstract:

Introduction: Poorly controlled diabetes is associated with cause and poor outcome of stroke. High blood sugar reduces cerebral blood flow, increases intracranial pressure, cerebral edema and neuronal death, especially among patients with poorly controlled diabetes.1 SGLT2 inhibitors are associated with 50% reduction in hemorrhagic stroke compared with placebo. SGLT2 inhibitors decrease cardiovascular events via reducing glucose, blood pressure, weight, arteriosclerosis, albuminuria and reduction of atrial fibrillation.2,3 No study has been documented in low income countries to see the role of post stroke SGLT2 inhibitors on diabetic patients at and after ICU admission. Aims: The aim of the study was to measure the 12 months outcome of diabetic patients with acute stroke admitted in ICU set up with naïve SGLT2 inhibitors add on therapy. Method: It was prospective cohort study carried out in a 250 bedded tertiary neurology care hospital at the province capital Biratnagar Nepal. Diabetic patient with acute stroke admitted in ICU from 1st January 2022 to 31st December 2022 who were not under SGLT2 inhibitors were included in the study. These patients were managed as per hospital protocol. Empagliflozin was added to the alternate enrolled patients. Empagliflozin was continued at the time of discharged and during follow up unless contraindicated. These patients were followed up for 12 months. Outcome measured were mortality, morbidity requiring readmission or hospital visit other than regular follow up, SGLT2 inhibitors related adverse events, neuropsychiatry comorbidity, functional status and biochemical parameters. Ethical permission was taken from hospital administration and ethical board. Results: Among 147 diabetic cases 68 were not treated with empagliflozin whereas 67 cases were started the SGLT2 inhibitors. HbA1c level and one year mortality was significantly low among patients on empaglifozin arm. Over a period of 12 months 427 acute stroke patients were admitted in the ICU. Out of them 44% were female, 61% hypertensive, 34% diabetic, 57% dyslipidemia, 26% smoker and with median age of 45 years. Among 427 cases 4% required neurosurgical interventions and 76% had hemorrhagic CVA. The most common reason for ICU admission was GCS<8 (51%). The median ICU stay was 5 days. ICU mortality was 21% whereas 1 year mortality was 41% with most common reason being pneumonia. Empaglifozin related adverse effect was seen in 11% most commonly lower urinary tract infection in 6%. Conclusion: Empagliflozin can safely be started among acute stroke with better Hba1C control and low mortality outcome compared to treatment without SGLT2 inhibitor.

Keywords: diabetes, ICU, mortality, SGLT2 inhibitors, stroke

Procedia PDF Downloads 60

Authors: Woranittha Kritsarikan

Abstract:

Neodymium-iron-boron (NdFeB) magnets classified as high-power magnets are widely used in various applications such as electrical and medical devices and account for 13.5 % of the permanent magnet’s market. Since its typical composition of 29 - 32 % Nd, 64.2 – 68.5 % Fe and 1 – 1.2 % B contains a significant amount of rare earth metals and will be subjected to shortages in the future. Domestic NdFeB magnet waste recycling should therefore be developed in order to reduce social, environmental impacts toward the circular economy. Most research works focus on recycling the magnet wastes, both from the manufacturing process and end of life. Each type of wastes has different characteristics and compositions. As a result, these directly affect recycling efficiency as well as the types and purity of the recyclable products. This research, therefore, focused on the recycling of manufacturing NdFeB magnet waste obtained from the sintering stage of magnet production and the waste contained 23.6% Nd, 60.3% Fe and 0.261% B in order to recover high purity neodymium oxide (Nd₂O₃) using hybrid metallurgical process via oxidative roasting and selective leaching techniques. The sintered NdFeB waste was first ground to under 70 mesh prior to oxidative roasting at 550 - 800 ᵒC to enable selective leaching of neodymium in the subsequent leaching step using H₂SO₄ at 2.5 M over 24 hours. The leachate was then subjected to drying and roasting at 700 – 800 ᵒC prior to precipitation by oxalic acid and calcination to obtain neodymium oxide as the recycling product. According to XRD analyses, it was found that increasing oxidative roasting temperature led to the increasing amount of hematite (Fe₂O₃) as the main composition with a smaller amount of magnetite (Fe3O4) found. Peaks of neodymium oxide (Nd₂O₃) were also observed in a lesser amount. Furthermore, neodymium iron oxide (NdFeO₃) was present and its XRD peaks were pronounced at higher oxidative roasting temperature. When proceeded to acid leaching and drying, iron sulfate and neodymium sulfate were mainly obtained. After the roasting step prior to water leaching, iron sulfate was converted to form hematite as the main compound, while neodymium sulfate remained in the ingredient. However, a small amount of magnetite was still detected by XRD. The higher roasting temperature at 800 ᵒC resulted in a greater Fe2O3 to Nd2(SO4)3 ratio, indicating a more effective roasting temperature. Iron oxides were subsequently water leached and filtered out while the solution contained mainly neodymium sulfate. Therefore, low oxidative roasting temperature not exceeding 600 ᵒC followed by acid leaching and roasting at 800 ᵒC gave the optimum condition for further steps of precipitation and calcination to finally achieve neodymium oxide.

Keywords: NdFeB magnet waste, oxidative roasting, recycling, selective leaching

Procedia PDF Downloads 177

Authors: Anna Bohers, Emília Hroncová, Juraj Ladomerský

Abstract:

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

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

Procedia PDF Downloads 200

Authors: Tulika Bhattacharyya, Suhita C. Chatterjee

Abstract:

West Bengal, one of the most rapidly ageing states in India, has inadequate structure for elder care. Therefore, there is an urgent need to improve elder care which involves focusing on different care settings where the elderly exists, like - Homes, Hospitals and Long-Term Care facilities (e.g. - Old Age Homes, Hospices). The study explores various elder care settings, with the intention to develop an understanding about them, and thereby generate comprehensive information about the entire spectrum of elder care in Kolkata. Empirical data are collected from the elderly and their caregivers in different settings. The tools for data collection are narratives, in-depth interviews and focus group discussions, along with field observations. Mixed method design is adopted to analyze the complexities of elder care in different set ups. The major challenges of elder care in private Homes are: architecturally inadequate housing conditions, paucity of financial support and scarcity of skilled caregivers. While the key factors preventing the Hospital and Long-Term Care Facilities from providing elder care services are inadequate policies and set governmental standards for elder care for the hospitalized elderly in various departments of the Hospital and the elderly residing in different kinds of Long Term Care Facilities. The limitations in each care setting results in considerable neglect and abuse of the elderly. The major challenges in elder care in West Bengal are lack of continuum between different care settings/ peripheral location of private Homes within public health framework and inadequate state Palliative policy- including narcotic regulations. The study suggests remedial measures to improve the capacity to deliver elder care in different settings.

Keywords: elder care settings, family caregiver, home care, geriatric hospital care, long term care facility

Procedia PDF Downloads 287

Authors: Samiha Ramdani, Abdelhamid Geuttala

Abstract:

There is no doubt that the batteries increasingly used tires create environmental concerns. Algeria generates large amounts of by industrial and household waste, such as used tires and colored glass bottles and dishes, whose valuation in cementitious materials could be an interesting ecological and economical alternative for broadening eliminating cumbersome landfills. This work is a contribution to the promotion of local materials with the use of waste tires and glass bottle in the development of a new cementitious composite having the acceptable compressive strength and a capacity of improved strains. For this purpose, rubber crumb (GC) from shredding used tires were used as partial replacement of quarry sand with 10%, 20%, 40, 60%. In addition, some mixtures also contain glass powder at15% cement replacement by volume. The compressive strength, tensile strength, deformability, the water permeability and penetration Inions chlorides are studied. As results; an acceptable compressive strength was obtained with the substitution rate of 10% and 20% by volume, the deformability of the composite increases with increased replacement rate. The addition of finely ground glass as a partial replacement of cement concrete increases the resistance to penetration of Inions chloride and reduce the water permeability thereof; then increases their durability.

Keywords: crumb rubber, deformability, compressive strength, finely ground glass, durability, behavior law

Procedia PDF Downloads 321

Authors: Siti Rajaah Binti Sayed Sultan

Abstract:

Managing the code blue event is stressful for nurses, the patient, and the patient's families. The rapid response from the first and second responders in the code blue event will improve patient outcomes and prevent tissue hypoxia that leads to brain injury and other organ failures. Providing 1 minute for the cardiac massage and 2 minutes for defibrillation will significantly improve patient outcomes. As we know, the American Heart Association came out with guidelines for managing cardiac arrest patients. The hospital must provide competent staff to manage this situation. It can be achieved when the staff is well equipped with the skill, attitude, and knowledge to manage this situation with well-planned strategies, i.e., clear guidelines for managing the code blue event, competent staff, and functional equipment. The code blue simulation (CBS) was chosen in the training program for code blue management because it can mimic real scenarios. Having the code blue simulation module will allow the staff to appreciate what they will face during the code blue event, especially since it rarely happens in that area. This CBS module training will help the staff familiarize themselves with the activities that happened during actual events and be able to operate the equipment accordingly. Being challenged and independent in managing the code blue in the early phase gives the patient a better outcome. The CBS module will help the assessor and the hospital management team with the proper tools and guidelines for managing the code blue drill accordingly. As we know, prompt action will benefit the patient and their family. It also indirectly increases the confidence and job satisfaction among the nurses, increasing the standard of care, reducing the complication and hospital burden, and enhancing cost-effective care.

Keywords: code blue simulation module, development of code blue simulation module, code blue response time, code blue drill, cardiorespiratory arrest, managing code blue

Procedia PDF Downloads 67

Authors: Oscar Vega Camacho, Andrea Vargas Guevara, Ellery Rowina Ariza

Abstract:

This paper presents the application of finite dynamic programming, specifically the "Markov Chain" model, as part of the decision making process of a company in the cosmetics sector located in the vicinity of Bogota DC. The objective of this process was to decide whether the company should completely reconstruct its wastewater treatment plant or instead optimize the plant through the addition of equipment. The goal of both of these options was to make the required improvements in order to comply with parameters established by national legislation regarding the treatment of waste before it is released into the environment. This technique will allow the company to select the best option and implement a solution for the processing of waste to minimize environmental damage and the acquisition and implementation costs.

Keywords: decision making, Markov chain, optimization, wastewater

Procedia PDF Downloads 487

Authors: Walid K. M. Bani Salameh, Hesham Ahmad, Mohammad Al-Shannag

Abstract:

In Jordan having deficit atmospheric precipitation, an increase in water demand during summer months . Jordan can be regarded with a relatively high potential for waste water recycling and reuse. The main purpose of this paper was to investigate the removal of Total suspended solids (TSS) and chemical oxygen demand (COD) for olive mill waste water (OMW) by the electrocoagulation (EC) process. In the combination of electrocoagulation by using coupled iron–aluminum electrodes the optimum working pH was found to be in range 6. The efficiency of the electrocoagulation process allowed removal of TSS and COD about 82.5% and 47.5% respectively at 45 mA/cm2 after 70 minutes by using coupled iron–aluminum electrodes. These results showed that the optimum TSS and COD removal was obtained at the optimum experimental parameters such as current density, pH, and reaction time.

Keywords: olive mill wastewater, electrode, electrocoagulation (EC), TSS, COD

Procedia PDF Downloads 393

Authors: Lotfi Khiari, Antoine Karam, Claude-Alla Joseph, Marc Hébert

Abstract:

The main objective of incineration of sludge generated from municipal or agri-food waste treatment plant is to reduce the volume of sludge to be disposed of as a solid or liquid waste, whilst concentrating or destroying potentially harmful volatile substances. In some cities in Canada and United States of America (USA), a large amount of sludge is incinerated, which entails a loss of organic matter and water leading to phosphorus, potassium and some metallic trace element (MTE) accumulation in ashes. The purpose of this study was to evaluate the concentration of potentially hazardous MTE such as cadmium (Cd), lead (Pb) and mercury (Hg) in twelve sludge incineration ash samples obtained from municipal wastewater and other food processing waste treatments from Canada and USA. The average, maximum, and minimum values of MTE in ashes were calculated for each city individually and all together. The trace metal concentration values were compared to the literature reported values. The concentrations of MTE in ashes vary widely depending on the sludge origins and treatment options. The concentrations of MTE in ashes were found the range of 0.1-6.4 mg/kg for Cd; 13-286 mg/kg for Pb and 0.1-0.5 mg/kg for Hg. On average, the following order of metal concentration in ashes was observed: Pb > Cd > Hg. Results show that metal contents in most ashes were similar to MTE levels in synthetic inorganic fertilizers and many fertilizing residual materials. Consequently, the environmental effects of MTE content of these ashes would be low.

Keywords: biosolids, heavy metals, recycling, sewage sludge

Procedia PDF Downloads 380

Authors: Mbongeni Mabaso, Kandasamy Moodley, Gan Redhi

Abstract:

The recovery of industrially valuable organic solvents from liquid waste, generated in chemical processes, is economically crucial to countries which need to import organic solvents. In view of this, the main objective of this study was to determine the ability of selected ionic liquids, namely, 1-ethyl-3-methylimidazolium ethylsulphate, [EMIM] [ESO4] and 1-ethyl-3-methylpyridinium ethylsulphate, [EMpy][ESO4] to recover aromatic components from spent paint solvents. Preliminary studies done on the liquid waste, received from a paint manufacturing company, showed that the aromatic components were present in the range 6 - 21 % by volume. The separation of the aromatic components was performed with the ionic liquids listed above. The phases, resulting from the separation of the mixtures, were analysed with a Gas Chromatograph (GC) coupled to a FID detector. Chromatograms illustrate that the chosen ZB-Wax-Plus column gave excellent separation of all components of interest from the mixtures, including the isomers of xylene. The concentrations of aromatics recovered from the spent solvents were found to be the % ranges 13-33 and 23-49 respectively for imidazolium and pyridinium ionic liquids. These results also show that there is a significant correlation between π-character of ionic liquids and the level of extraction. It is therefore concluded that ionic liquids have the potential for macro-scale recovery of re-useable solvents present in liquid waste emanating from paint manufacture.

Keywords: synthesis, ionic liquid, imidazolium, pyridinium, extraction, aromatic solvents, spent paint organic solvents

Procedia PDF Downloads 337

Authors: Olga Shuvaeva, Tamara Romanova, Sergey Volynkin, Valentina Podolinnaya

Abstract:

Green chemistry concept is focused on the prevention of environmental pollution caused by human activity. However, there are a lot of contaminated areas in the world which pose a serious threat to ecosystems in terms of their conservation. Therefore in accordance with the principles of green chemistry, it should not be forgotten about the need to clean these areas. Furthermore, the waste material often contains the valuable components, the extraction of which by traditional wet chemical technologies is inefficient both from the economic and environmental protection standpoint. Wherein, the plants may be successfully used to ‘scavenge’ a range of metals from polluted land sites in an approach allowing to carry out both of these processes – phytoremediation and phytomining in conjunction. The goal of the present work was to study bioaccumulation ability of floating macrophytes such as water hyacinth and pondweed toward Hg, Ba, Cd, Mo and Pb as pollutants in aquatic medium and terrestrial plants (birch, reed, and cane) towards gold and silver as valuable components. The peculiarity of ongoing research was that the plants grew under extreme conditions (pH of drainage and pore waters was about 2.5). The study was conducted at the territory of Ursk tailings (Southwestern Siberia, Russia) formed as a result of primary polymetallic ores cyanidation. The waste material is mainly presented (~80%) by pyrite (FeS₂) and barite (BaSO₄), the raw minerals included FeAsS, HgS, PbS, Ag₂S as minor ones. It has been shown that water hyacinth demonstrates high ability to accumulate different metals, and what is especially important – to remove mercury from polluted waters with BCF value more than 1000. As for the gold, its concentrations in reed and cane growing near the waste material were estimated as 500 and 900 μg∙kg⁻¹ respectively. It was also found that the plants can survive under extreme conditions of acidic environment and hence we can assume that there is a principal opportunity to use them for the valuable substances extraction from an area of the mining waste dumps burial.

Keywords: bioaccumulation, gold, heavy metals, mine tailing

Procedia PDF Downloads 171

Authors: Pornthip Seangsanga

Abstract:

Sepsis or septic shock needs urgent care because it is a cause of the high mortality rate if patients do not receive timely treatment. Songkhla Hospital does not have a clear system or clinical practice guidelines for treatment of patients with severe sepsis or septic shock, which contributes to the said problem.To compare clinical outcomes based on the protocol after using the clinical guidelines between the Emergency Room, Intensive Care Unit, and the Ward. This quasi-experimental study was conducted on the population and 50 subjects who were diagnosed with severe sepsis or septic shock from December 2013 to May 2014. The data were collected using a nursing care and referring record form for patients with severe sepsis or septic shock at Songkhla Hospital. The record form had been tested for its validity by three experts, and the IOC was 1.The mortality rate in patients with severe sepsis or septic shock who were moved from the ER to the ICU was significantly lower than that of those patients moved from the Ward to the ICU within 48 hours. This was because patients with severe sepsis or septic shock who were moved from the ER to the ICU received more fluid within the first six hours according to the protocol which helped patients to have adequate tissue perfusion within the first six hours, and that helped improve blood flow to the kidneys, and the patients’ urine was found to be with a higher quantity of 0.5 cc/kg/hr, than those patients who were moved from the Ward to the ICU. This study shows that patients with severe sepsis or septic shock need to be treated immediately. Using the clinical practice guidelines along with timely diagnosis and treatment based on the sepsis bundle in giving sufficient and suitable amount of fluid to help improve blood circulation and blood pressure can clearly prevent or reduce severity of complications.

Keywords: clinical practice guidelines, caring, septic shock, sepsis bundle protocol

Procedia PDF Downloads 296

Authors: Dina Siniora, Jasia Baig

Abstract:

During the past few decades, the healthcare system has undergone profound changes in their healthcare decision-making competencies and moral aptitudes due to the vast advancement in technology, clinical skills, and scientific knowledge. Healthcare decision-making deals with morally contentious dilemmas ranging from illness, life and death judgments that require sensitivity and awareness towards the patient’s preferences while taking into consideration medicine’s abilities and boundaries. As the ever-evolving field of medicine continues to become more scientifically and morally multifarious; physicians and the hospital administrators increasingly rely on ethics committees to resolve problems that arise in everyday patient care. The role and latitude of responsibilities of ethics committees which includes being dispute intermediaries, moral analysts, policy educators, counselors, advocates, and reviewers; suggest the importance and effectiveness of a fully integrated committee. Despite achievements on Integrated Ethics and progress in standards and competencies, there is an imminent necessity for further improvement in quality within ethics consultation services in areas of credentialing, professionalism and standards of quality, as well as the quality of healthcare throughout the system. These concerns can be resolved first by collecting data about particular quality gaps and comprehend the level to which ethics committees are consistent with newly published ASBH quality standards. Policymakers should pursue improvement strategies that target both academic bioethics community and major stakeholders at hospitals, who directly influence ethics committees. This broader approach oriented towards education and intervention outcome in conjunction with preventive ethics to address disparities in quality on a systematic level. Adopting tools for improving competencies and processes within ethics consultation by implementing a credentialing process, upholding normative significance for the ASBH core competencies, advocating for professional Code of Ethics, and further clarifying the internal structures will improve productivity, patient satisfaction, and institutional integrity. This cannot be systemically achieved without a written certification exam for HCEC practitioners, credentialing and privileging HCEC practitioners at the hospital level, and accrediting HCEC services at the institutional level.

Keywords: ethics consultation, hospital, medical ethics, quality

Procedia PDF Downloads 189

Authors: Saidur R. Chowdhury, Mamme K. Addai, Ernest K. Yanful

Abstract:

The research was performed to assess the potential of nickel smelter slag, an industrial waste, as an adsorbent in the removal of metals from aqueous solution. An investigation was carried out for Arsenic (As), Copper (Cu), lead (Pb) and Cadmium (Cd) adsorption from aqueous solution. Smelter slag was obtain from Ni ore at the Vale Inco Ni smelter in Sudbury, Ontario, Canada. The batch experimental studies were conducted to evaluate the removal efficiencies of smelter slag. The slag was characterized by surface analytical techniques. The slag contained different iron oxides and iron silicate bearing compounds. In this study, the effect of pH, contact time, particle size, competition by other ions, slag dose and distribution coefficient were evaluated to measure the optimum adsorption conditions of the slag as an adsorbent for As, Cu, Pb and Cd. The results showed 95-99% removal of As, Cu, Pb, and almost 50-60% removal of Cd, while batch experimental studies were conducted at 5-10 mg/L of initial concentration of metals, 10 g/L of slag doses, 10 hours of contact time and 170 rpm of shaking speed and 25oC condition. The maximum removal of Arsenic (As), Copper (Cu), lead (Pb) was achieved at pH 5 while the maximum removal of Cd was found after pH 7. The column experiment was also conducted to evaluate adsorption depth and service time for metal removal. This study also determined adsorption capacity, adsorption rate and mass transfer rate. The maximum adsorption capacity was found to be 3.84 mg/g for As, 4 mg/g for Pb, and 3.86 mg/g for Cu. The adsorption capacity of nickel slag for the four test metals were in decreasing order of Pb > Cu > As > Cd. Modelling of experimental data with Visual MINTEQ revealed that saturation indices of < 0 were recorded in all cases suggesting that the metals at this pH were under- saturated and thus in their aqueous forms. This confirms the absence of precipitation in the removal of these metals at the pHs. The experimental results also showed that Fe and Ni leaching from the slag during the adsorption process was found to be very minimal, ranging from 0.01 to 0.022 mg/L indicating the potential adsorbent in the treatment industry. The study also revealed that waste product (Ni smelter slag) can be used about five times more before disposal in a landfill or as a stabilization material. It also highlighted the recycled slags as a potential reactive adsorbent in the field of remediation engineering. It also explored the benefits of using renewable waste products for the water treatment industry.

Keywords: adsorption, industrial waste, recycling, slag, treatment

Procedia PDF Downloads 146

Authors: Bukra Kalayci, Geraldine Brennan

Abstract:

Introduction: Over the last decade, a proliferation of literature related to textile and fashion business in the context of sustainable production and consumption has emerged. However, the economic and environmental benefits of solid waste recovery have not been comprehensively searched. Therefore at the end-of-life or end-of-use textile waste management remains a gap. Solid textile waste reuse and recycling principles of the circular economy need to be developed to close the disposal stage of the textile supply chain. The environmental problems associated with the over-production and –consumption of textile products arise. Together with growing population and fast fashion culture the share of solid textile waste in municipal waste is increasing. Focusing on post-consumer textile waste literature, this research explores the opportunities, obstacles and enablers or success factors associated with closed-loop textile business systems. Methodology: A systematic literature review was conducted in order to identify best practices and gaps from the existing body of knowledge related to closed-loop post-consumer textile waste initiatives over the last decade. Selected keywords namely: ‘cradle-to-cradle ‘, ‘circular* economy* ‘, ‘closed-loop* ‘, ‘end-of-life* ‘, ‘reverse* logistic* ‘, ‘take-back* ‘, ‘remanufacture* ‘, ‘upcycle* ‘ with the combination of (and) ‘fashion* ‘, ‘garment* ‘, ‘textile* ‘, ‘apparel* ‘, clothing* ‘ were used and the time frame of the review was set between 2005 to 2017. In order to obtain a broad coverage, Web of Knowledge and Science Direct databases were used, and peer-reviewed journal articles were chosen. The keyword search identified 299 number of papers which was further refined into 54 relevant papers that form the basis of the in-depth thematic analysis. Preliminary findings: A key finding was that the existing literature is predominantly conceptual rather than applied or empirical work. Moreover, the enablers or success factors, obstacles and opportunities to implement closed-loop systems in the textile industry were not clearly articulated and the following considerations were also largely overlooked in the literature. While the circular economy suggests multiple cycles of discarded products, components or materials, most research has to date tended to focus on a single cycle. Thus the calculations of environmental and economic benefits of closed-loop systems are limited to one cycle which does not adequately explore the feasibility or potential benefits of multiple cycles. Additionally, the time period textile products spend between point of sale, and end-of-use/end-of-life return is a crucial factor. Despite past efforts to study closed-loop textile systems a clear gap in the literature is the lack of a clear evaluation framework which enables manufacturers to clarify the reusability potential of textile products through consideration of indicators related too: quality, design, lifetime, length of time between manufacture and product return, volume of collected disposed products, material properties, and brand segment considerations (e.g. fast fashion versus luxury brands).

Keywords: circular fashion, closed loop business, product service systems, solid textile waste elimination

Procedia PDF Downloads 204

Authors: Lutpi Ginanjar

Abstract:

Environmental hygiene is indispensable for people to live healthy, safe and peaceful. In a small environment, the cleanliness of the environment is very easy to overcome, but on the larger environment requires a more complicated management and considerable investments. In general environmental hygiene are managed by the Department of Hygiene and Landscaper. Found a good management, but much less good management. The difficulties that are often encountered on waste management also caused public awareness itself. In addition, communities have difficulty in making a report about the rubbish because not dibangunnyasistem good information. Essai aims to build information systems environment clean especially the handling of waste in the city of Bandung, West Java province. The system was built with PHP software. Expected results obtained after the construction of the information system of environmental hygiene can be demonstrated to the community will be the health of the environment.

Keywords: information systems, SMS gateway, management, software, PHP

Procedia PDF Downloads 487