Search results for: sustainable management
558 A Mixed Method Investigation of the Impact of Practicum Experience on Mathematics Female Pre-Service Teachers’ Sense of Preparedness
Authors: Fatimah Alsaleh, Glenda Anthony
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The practicum experience is a critical component of any initial teacher education (ITE) course. As well as providing a near authentic setting for pre-service teachers (PSTs) to practice in, it also plays a key role in shaping their perceptions and sense of preparedness. Nevertheless, merely including a practicum period as a compulsory part of ITE may not in itself be enough to induce feelings of preparedness and efficacy; the quality of the classroom experience must also be considered. Drawing on findings of a larger study of secondary and intermediate level mathematics PSTs’ sense of preparedness to teach, this paper examines the influence of the practicum experience in particular. The study sample comprised female mathematics PSTs who had almost completed their teaching methods course in their fourth year of ITE across 16 teacher education programs in Saudi Arabia. The impact of the practicum experience on PSTs’ sense of preparedness was investigated via a mixed-methods approach combining a survey (N = 105) and in-depth interviews with survey volunteers (N = 16). Statistical analysis in SPSS was used to explore the quantitative data, and thematic analysis was applied to the qualitative interviews data. The results revealed that the PSTs perceived the practicum experience to have played a dominant role in shaping their feelings of preparedness and efficacy. However, despite the generally positive influence of practicum, the PSTs also reported numerous challenges that lessened their feelings of preparedness. These challenges were often related to the classroom environment and the school culture. For example, about half of the PSTs indicated that the practicum schools did not have the resources available or the support necessary to help them learn the work of teaching. In particular, the PSTs expressed concerns about translating the theoretical knowledge learned at the university into practice in authentic classrooms. These challenges engendered PSTs feeling less prepared and suggest that more support from both the university and the school is needed to help PSTs develop a stronger sense of preparedness. The area in which PSTs felt least prepared was that of classroom and behavior management, although the results also indicated that PSTs only felt a moderate level of general teaching efficacy and were less confident about how to support students as learners. Again, feelings of lower efficacy were related to the dissonance between the theory presented at university and real-world classroom practice. In order to close this gap between theory and practice, PSTs expressed the wish to have more time in the practicum, and more accountability for support from school-based mentors. In highlighting the challenges of the practicum in shaping PSTs’ sense of preparedness and efficacy, the study argues that better communication between the ITE providers and the practicum schools is necessary in order to maximize the benefit of the practicum experience.Keywords: impact, mathematics, practicum experience, pre-service teachers, sense of preparedness
Procedia PDF Downloads 114557 Intelligent Control of Agricultural Farms, Gardens, Greenhouses, Livestock
Authors: Vahid Bairami Rad
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The intelligentization of agricultural fields can control the temperature, humidity, and variables affecting the growth of agricultural products online and on a mobile phone or computer. Smarting agricultural fields and gardens is one of the best and best ways to optimize agricultural equipment and has a 100 percent direct effect on the growth of plants and agricultural products and farms. Smart farms are the topic that we are going to discuss today, the Internet of Things and artificial intelligence. Agriculture is becoming smarter every day. From large industrial operations to individuals growing organic produce locally, technology is at the forefront of reducing costs, improving results and ensuring optimal delivery to market. A key element to having a smart agriculture is the use of useful data. Modern farmers have more tools to collect intelligent data than in previous years. Data related to soil chemistry also allows people to make informed decisions about fertilizing farmland. Moisture meter sensors and accurate irrigation controllers have made the irrigation processes to be optimized and at the same time reduce the cost of water consumption. Drones can apply pesticides precisely on the desired point. Automated harvesting machines navigate crop fields based on position and capacity sensors. The list goes on. Almost any process related to agriculture can use sensors that collect data to optimize existing processes and make informed decisions. The Internet of Things (IoT) is at the center of this great transformation. Internet of Things hardware has grown and developed rapidly to provide low-cost sensors for people's needs. These sensors are embedded in IoT devices with a battery and can be evaluated over the years and have access to a low-power and cost-effective mobile network. IoT device management platforms have also evolved rapidly and can now be used securely and manage existing devices at scale. IoT cloud services also provide a set of application enablement services that can be easily used by developers and allow them to build application business logic. Focus on yourself. These development processes have created powerful and new applications in the field of Internet of Things, and these programs can be used in various industries such as agriculture and building smart farms. But the question is, what makes today's farms truly smart farms? Let us put this question in another way. When will the technologies associated with smart farms reach the point where the range of intelligence they provide can exceed the intelligence of experienced and professional farmers?Keywords: food security, IoT automation, wireless communication, hybrid lifestyle, arduino Uno
Procedia PDF Downloads 47556 Home-Based Care with Follow-Up at Outpatient Unit or Community-Follow-Up Center with/without Food Supplementation and/or Psychosocial Stimulation of Children with Moderate Acute Malnutrition in Bangladesh
Authors: Md Iqbal Hossain, Tahmeed Ahmed, Kenneth H. Brown
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Objective: To assess the effect of community-based follow up, with or without food-supplementation and/or psychosocial stimulation, as an alternative to current hospital-based follow-up of children with moderate-acute-malnutrition (WHZ < -2 to -3) (MAM). Design/methods: The study was conducted at the ICDDR,B Dhaka Hospital and in four urban primary health care centers of Dhaka, Bangladesh during 2005-2007. The efficacy of five different randomly assigned interventions was compared with respect to the rate of completion of follow-up, growth and morbidity in 227 MAM children aged 6-24 months who were initially treated at ICDDR,B for diarrhea and/or other morbidities. The interventions were: 1) Fortnightly follow-up care (FFC) at the ICDDR,B’s outpatient-unit, including growth monitoring, health education, and micro-nutrient supplementation (H-C, n=49). 2) FFC at community follow-up unit (CNFU) [established in the existing urban primary health-care centers close to the residence of the child] but received the same regimen as H-C (C-C, n=53). 3) As per C-C plus cereal-based supplementary food (SF) (C-SF, n=49). The SF packets were distributed on recruitment and at every visit in CNFU [@1 packet/day for 6–11 and 2 packets/day for 12-24 month old children. Each packet contained 20g toasted rice-powder, 10g toasted lentil-powder, 5g molasses, and 3g soy bean oil, to provide a total of ~ 150kcal with 11% energy from protein]. 4) As per C-C plus psychosocial stimulation (PS) (C-PS, n=43). PS consisted of child-stimulation and parental-counseling conducted by trained health workers. 5) As per C-C plus both SF+PS (C-SF+PS, n=33). Results: A total of 227children (48.5% female), with a mean ± SD age of 12.6 ±3.8 months, and WHZ of - 2.53±0.28 enrolled. Baseline characteristics did not differ by treatment group. The rate of spontaneous attendance at scheduled follow-up visits gradually decreased in all groups. Follow-up attendance and gain in weight and length were greater in groups C-SF, C-SF+PS, and C-PS than C-C, and these indicators were observed least in H-C. Children in the H-C group more often suffered from diarrhea (25 % vs. 4-9%) and fever (28% vs. 8-11%) than other groups (p < 0.05). Children who attended at least five of the total six scheduled follow-up visits gained more in weight (median: 0.86 vs. 0.62 kg, p=0.002), length (median: 2.4 vs. 2.0 cm, p=0.009) than those who attended fewer. Conclusions: Community-based service delivery, especially including supplementary food with or without psychosocial stimulation, permits better rehabilitation of children with MAM compared to current hospital outpatients-based care. By scaling the community-based follow-up including food supplementation with or without psychosocial stimulation, it will be possible to rehabilitate a greater number of MAM children in a better way.Keywords: community-based management, moderate acute malnutrition, psychosocial stimulation, supplementary food
Procedia PDF Downloads 432555 Preliminary Efficacy of a Pilot Paediatric Day Hospital Program Project to Address Severe Mental Illness, Obesity, and Binge Eating
Authors: Alene Toulany, Elizabeth Dettmer, Seena Grewal, Kaley Roosen, Andrea Regina, Cathleen Steinegger, Kate Stadelman, Melissa Chambers, Lindsay Lochhead, Kelsey Gallagher, Alissa Steinberg, Andrea Leyser, Allison Lougheed, Jill Hamilton
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Obesity and psychiatric disorders occur together so frequently that the combination has been coined an epidemic within an epidemic. Youth living with obesity are at increased risk for trauma, depression, anxiety and disordered eating. Although symptoms of binge eating disorder are common in paediatric obesity management programs, they are often not identified or addressed within treatment. At The Hospital for Sick Children (SickKids), a tertiary care paediatric hospital in Toronto, Canada, adolescents with obesity are treated in an interdisciplinary outpatient clinic (1-2 hours/week). This intensity of care is simply not enough to help these extremely complex patients. Existing day treatment programs for eating, and psychiatric disorders are not well suited for patients with obesity. In order to address this identified care gap, a unique collaboration was formed between the obesity, psychiatry, and eating disorder programs at SickKids in 2015. The aim of this collaboration was to provide an enhanced treatment arm to our general psychiatry day hospital program that addresses both the mental health issues and the lifestyle challenges common to youth with obesity and binge eating. The program is currently in year-one of a two-year pilot project and is designed for a length of stay of approximately 6 months. All youth participate in daily group therapy, academics, and structured mealtimes. The groups are primarily skills-based and are informed by cognitive/dialectical behavioural therapies. Weekly family therapy and individual therapy, as well as weekly medical appointments with a psychiatrist and a nurse, are provided. Youth in the enhanced treatment arm also receive regular sessions with a dietitian to establish normalized eating behaviours and monthly multifamily meal sessions to address challenges related to behaviour change and mealtimes in the home. Outcomes that will be evaluated include measures of mental health, anthropometrics, metabolic status, and healthcare satisfaction. At the end of the two years, it is expected that we will have had about 16 youth participants. This model of care delivery will be the first of its kind in Canada and is expected to inform future paediatric treatment practices.Keywords: adolescent, binge eating, mental illness, obesity
Procedia PDF Downloads 350554 Unsupervised Detection of Burned Area from Remote Sensing Images Using Spatial Correlation and Fuzzy Clustering
Authors: Tauqir A. Moughal, Fusheng Yu, Abeer Mazher
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Land-cover and land-use change information are important because of their practical uses in various applications, including deforestation, damage assessment, disasters monitoring, urban expansion, planning, and land management. Therefore, developing change detection methods for remote sensing images is an important ongoing research agenda. However, detection of change through optical remote sensing images is not a trivial task due to many factors including the vagueness between the boundaries of changed and unchanged regions and spatial dependence of the pixels to its neighborhood. In this paper, we propose a binary change detection technique for bi-temporal optical remote sensing images. As in most of the optical remote sensing images, the transition between the two clusters (change and no change) is overlapping and the existing methods are incapable of providing the accurate cluster boundaries. In this regard, a methodology has been proposed which uses the fuzzy c-means clustering to tackle the problem of vagueness in the changed and unchanged class by formulating the soft boundaries between them. Furthermore, in order to exploit the neighborhood information of the pixels, the input patterns are generated corresponding to each pixel from bi-temporal images using 3×3, 5×5 and 7×7 window. The between images and within image spatial dependence of the pixels to its neighborhood is quantified by using Pearson product moment correlation and Moran’s I statistics, respectively. The proposed technique consists of two phases. At first, between images and within image spatial correlation is calculated to utilize the information that the pixels at different locations may not be independent. Second, fuzzy c-means technique is used to produce two clusters from input feature by not only taking care of vagueness between the changed and unchanged class but also by exploiting the spatial correlation of the pixels. To show the effectiveness of the proposed technique, experiments are conducted on multispectral and bi-temporal remote sensing images. A subset (2100×1212 pixels) of a pan-sharpened, bi-temporal Landsat 5 thematic mapper optical image of Los Angeles, California, is used in this study which shows a long period of the forest fire continued from July until October 2009. Early forest fire and later forest fire optical remote sensing images were acquired on July 5, 2009 and October 25, 2009, respectively. The proposed technique is used to detect the fire (which causes change on earth’s surface) and compared with the existing K-means clustering technique. Experimental results showed that proposed technique performs better than the already existing technique. The proposed technique can be easily extendable for optical hyperspectral images and is suitable for many practical applications.Keywords: burned area, change detection, correlation, fuzzy clustering, optical remote sensing
Procedia PDF Downloads 165553 High Throughput Virtual Screening against ns3 Helicase of Japanese Encephalitis Virus (JEV)
Authors: Soma Banerjee, Aamen Talukdar, Argha Mandal, Dipankar Chaudhuri
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Japanese Encephalitis is a major infectious disease with nearly half the world’s population living in areas where it is prevalent. Currently, treatment for it involves only supportive care and symptom management through vaccination. Due to the lack of antiviral drugs against Japanese Encephalitis Virus (JEV), the quest for such agents remains a priority. For these reasons, simulation studies of drug targets against JEV are important. Towards this purpose, docking experiments of the kinase inhibitors were done against the chosen target NS3 helicase as it is a nucleoside binding protein. Previous efforts regarding computational drug design against JEV revealed some lead molecules by virtual screening using public domain software. To be more specific and accurate regarding finding leads, in this study a proprietary software Schrödinger-GLIDE has been used. Druggability of the pockets in the NS3 helicase crystal structure was first calculated by SITEMAP. Then the sites were screened according to compatibility with ATP. The site which is most compatible with ATP was selected as target. Virtual screening was performed by acquiring ligands from databases: KinaseSARfari, KinaseKnowledgebase and Published inhibitor Set using GLIDE. The 25 ligands with best docking scores from each database were re-docked in XP mode. Protein structure alignment of NS3 was performed using VAST against MMDB, and similar human proteins were docked to all the best scoring ligands. The low scoring ligands were chosen for further studies and the high scoring ligands were screened. Seventy-three ligands were listed as the best scoring ones after performing HTVS. Protein structure alignment of NS3 revealed 3 human proteins with RMSD values lesser than 2Å. Docking results with these three proteins revealed the inhibitors that can interfere and inhibit human proteins. Those inhibitors were screened. Among the ones left, those with docking scores worse than a threshold value were also removed to get the final hits. Analysis of the docked complexes through 2D interaction diagrams revealed the amino acid residues that are essential for ligand binding within the active site. Interaction analysis will help to find a strongly interacting scaffold among the hits. This experiment yielded 21 hits with the best docking scores which could be investigated further for their drug like properties. Aside from getting suitable leads, specific NS3 helicase-inhibitor interactions were identified. Selection of Target modification strategies complementing docking methodologies which can result in choosing better lead compounds are in progress. Those enhanced leads can lead to better in vitro testing.Keywords: antivirals, docking, glide, high-throughput virtual screening, Japanese encephalitis, ns3 helicase
Procedia PDF Downloads 224552 Calibration of Residential Buildings Energy Simulations Using Real Data from an Extensive in situ Sensor Network – A Study of Energy Performance Gap
Authors: Mathieu Bourdeau, Philippe Basset, Julien Waeytens, Elyes Nefzaoui
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As residential buildings account for a third of the overall energy consumption and greenhouse gas emissions in Europe, building energy modeling is an essential tool to reach energy efficiency goals. In the energy modeling process, calibration is a mandatory step to obtain accurate and reliable energy simulations. Nevertheless, the comparison between simulation results and the actual building energy behavior often highlights a significant performance gap. The literature discusses different origins of energy performance gaps, from building design to building operation. Then, building operation description in energy models, especially energy usages and users’ behavior, plays an important role in the reliability of simulations but is also the most accessible target for post-occupancy energy management and optimization. Therefore, the present study aims to discuss results on the calibration ofresidential building energy models using real operation data. Data are collected through a sensor network of more than 180 sensors and advanced energy meters deployed in three collective residential buildings undergoing major retrofit actions. The sensor network is implemented at building scale and in an eight-apartment sample. Data are collected for over one year and half and coverbuilding energy behavior – thermal and electricity, indoor environment, inhabitants’ comfort, occupancy, occupants behavior and energy uses, and local weather. Building energy simulations are performed using a physics-based building energy modeling software (Pleaides software), where the buildings’features are implemented according to the buildingsthermal regulation code compliance study and the retrofit project technical files. Sensitivity analyses are performed to highlight the most energy-driving building features regarding each end-use. These features are then compared with the collected post-occupancy data. Energy-driving features are progressively replaced with field data for a step-by-step calibration of the energy model. Results of this study provide an analysis of energy performance gap on an existing residential case study under deep retrofit actions. It highlights the impact of the different building features on the energy behavior and the performance gap in this context, such as temperature setpoints, indoor occupancy, the building envelopeproperties but also domestic hot water usage or heat gains from electric appliances. The benefits of inputting field data from an extensive instrumentation campaign instead of standardized scenarios are also described. Finally, the exhaustive instrumentation solution provides useful insights on the needs, advantages, and shortcomings of the implemented sensor network for its replicability on a larger scale and for different use cases.Keywords: calibration, building energy modeling, performance gap, sensor network
Procedia PDF Downloads 151551 Performance Evaluation of Fingerprint, Auto-Pin and Password-Based Security Systems in Cloud Computing Environment
Authors: Emmanuel Ogala
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Cloud computing has been envisioned as the next-generation architecture of Information Technology (IT) enterprise. In contrast to traditional solutions where IT services are under physical, logical and personnel controls, cloud computing moves the application software and databases to the large data centres, where the management of the data and services may not be fully trustworthy. This is due to the fact that the systems are opened to the whole world and as people tries to have access into the system, many people also are there trying day-in day-out on having unauthorized access into the system. This research contributes to the improvement of cloud computing security for better operation. The work is motivated by two problems: first, the observed easy access to cloud computing resources and complexity of attacks to vital cloud computing data system NIC requires that dynamic security mechanism evolves to stay capable of preventing illegitimate access. Second; lack of good methodology for performance test and evaluation of biometric security algorithms for securing records in cloud computing environment. The aim of this research was to evaluate the performance of an integrated security system (ISS) for securing exams records in cloud computing environment. In this research, we designed and implemented an ISS consisting of three security mechanisms of biometric (fingerprint), auto-PIN and password into one stream of access control and used for securing examination records in Kogi State University, Anyigba. Conclusively, the system we built has been able to overcome guessing abilities of hackers who guesses people password or pin. We are certain about this because the added security system (fingerprint) needs the presence of the user of the software before a login access can be granted. This is based on the placement of his finger on the fingerprint biometrics scanner for capturing and verification purpose for user’s authenticity confirmation. The study adopted the conceptual of quantitative design. Object oriented and design methodology was adopted. In the analysis and design, PHP, HTML5, CSS, Visual Studio Java Script, and web 2.0 technologies were used to implement the model of ISS for cloud computing environment. Note; PHP, HTML5, CSS were used in conjunction with visual Studio front end engine design tools and MySQL + Access 7.0 were used for the backend engine and Java Script was used for object arrangement and also validation of user input for security check. Finally, the performance of the developed framework was evaluated by comparing with two other existing security systems (Auto-PIN and password) within the school and the results showed that the developed approach (fingerprint) allows overcoming the two main weaknesses of the existing systems and will work perfectly well if fully implemented.Keywords: performance evaluation, fingerprint, auto-pin, password-based, security systems, cloud computing environment
Procedia PDF Downloads 131550 Civic E-Participation in Central and Eastern Europe: A Comparative Analysis
Authors: Izabela Kapsa
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Civic participation is an important aspect of democracy. The contemporary model of democracy is based on citizens' participation in political decision-making (deliberative democracy, participatory democracy). This participation takes many forms of activities like display of slogans and symbols, voting, social consultations, political demonstrations, membership in political parties or organizing civil disobedience. The countries of Central and Eastern Europe after 1989 are characterized by great social, economic and political diversity. Civil society is also part of the process of democratization. Civil society, funded by the rule of law, civil rights, such as freedom of speech and association and private ownership, was to play a central role in the development of liberal democracy. Among the many interpretations of concepts, defining the concept of contemporary democracy, one can assume that the terms civil society and democracy, although different in meaning, nowadays overlap. In the post-communist countries, the process of shaping and maturing societies took place in the context of a struggle with a state governed by undemocratic power. State fraud or repudiation of the institution is a representative state, which in the past was the only way to manifest and defend its identity, but after the breakthrough became one of the main obstacles to the development of civil society. In Central and Eastern Europe, there are many obstacles to the development of civil society, for example, the elimination of economic poverty, the implementation of educational campaigns, consciousness-related obstacles, the formation of social capital and the deficit of social activity. Obviously, civil society does not only entail an electoral turnout but a broader participation in the decision-making process, which is impossible without direct and participative democratic institutions. This article considers such broad forms of civic participation and their characteristics in Central and Eastern Europe. The paper is attempts to analyze the functioning of electronic forms of civic participation in Central and Eastern European states. This is not accompanied by a referendum or a referendum initiative, and other forms of political participation, such as public consultations, participative budgets, or e-Government. However, this paper will broadly present electronic administration tools, the application of which results from both legal regulations and increasingly common practice in state and city management. In the comparative analysis, the experiences of post-communist bloc countries will be summed up to indicate the challenges and possible goals for further development of this form of citizen participation in the political process. The author argues that for to function efficiently and effectively, states need to involve their citizens in the political decision-making process, especially with the use of electronic tools.Keywords: Central and Eastern Europe, e-participation, e-government, post-communism
Procedia PDF Downloads 187549 Nephroprotective Effect of Asparagus falcatus Leaf Extract on Adriamycin Induced Nephrotoxicity in Wistar Rats: A Dose Response Study
Authors: A. M. S. S. Amarasiri, A. P. Attanayake, K. A. P. W. Jayatilaka, L. K. B. Mudduwa
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Adriamycin (ADR) is an effective anthracyclin antitumor drug, but its clinical use is limited due to renal toxicity. The leaves of Asparagus falcatus (Family: Liliaceae) have been used in the management of renal diseases since antiquity. In the present investigation, the aqueous leaf extract of A. falcatus was evaluated for acute nephroprotective activity in ADR induced nephrotoxic rats. Nephrotoxicity was induced in healthy male Wistar rats by intraperitoneal administration of ADR 20 mg/kg. The lyophilized powder of the aqueous refluxed (4h) leaf extract of A. falcatus was administered orally at three selected doses; 200, 400 and 600 mg/kg for three consecutive days. Fosinopril sodium (0.09 mg/kg) was used as the standard drug. Administration of the plant extract and the standard drug was commenced 24 hours after the induction of nephrotoxicity to rats. The nephroprotective effect was determined by selected biochemical parameters and by the assessment of histopathology on H and E stained kidney sections. The results were compared to a group of control rats with ADR induced nephrotoxicity. A group of rats administered with the equivalent volume of normal saline served as the healthy control. Administration of ADR 20 mg/kg produced a significant increase in the concentrations of serum creatinine (61%) and urine protein (73%) followed by a significant decrease in serum total protein (21%) and albumin (44%) of the plant extract treated animals compared to the healthy control group (p < 0.05). The aqueous extract of Asparagus falcatus at the three doses; 200, 400 and 600 mg/kg and the standard drug were found to decrease the elevation of concentrations of serum creatinine (33%, 51%, 54% and 42%) and urine protein (8%, 63%, 80% and 86%) respectively. The serum concentrations of total protein (12%, 17%, 29% and 12%) and albumin (3%, 17%, 17% and 16%) were significantly increased compared to the nephrotoxic control group respectively. Assessment of histopathology on H and E stained kidney sections demonstrated that ADR induced renal injury, as evidenced by loss of brush border, cytoplasmic vacuolization, pyknosis in renal tubular epithelial cells, haemorrhages, glomerular congestion and presence of hyaline casts. Treatment with the plant extract and the standard drug resulted in attenuation of the morphological destruction in rats. The results of the present study revealed that the aqueous leaf extract of A. falcatus possesses significant nephroprotective activity against adriamycin induced acute nephrotoxicity. The improved kidney functions were supported with the results of selected biochemical parameters and histological changes observed on H and E stained sections of the kidney tissues in Wistar rats.Keywords: adriamycin induced nephrotoxicity, asparagus falcatus, biochemical assessment, histopathological assessment, nephroprotective activity
Procedia PDF Downloads 157548 Management Problems in a Patient With Long-term Undiagnosed Permanent Hypoparathyroidism
Authors: Babarina Maria, Andropova Margarita
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Introduction: Hypoparathyroidism (HypoPT) is a rare endocrine disorder with an estimated prevalence of 0.25 per 1000 individuals. The most common cause of HypoPT is the loss of active parathyroid tissue following thyroid or parathyroid surgery. Sometimes permanent postoperative HypoPT occures, manifested by hypocalcemia in combination with low levels of PTH during 6 months or more after surgery. Cognitive impairments in patients with hypocalcemia due to chronic HypoPT are observed, and this can lead to problems and challenges in everyday living: memory loss and impaired concentration, that may be the cause of poor compliance. Clinical case: Patient K., 66 years old, underwent thyroidectomy in 2013 (at the age of 55) because of papillary thyroid cancer T1NxMx, histopathology findings confirmed the diagnosis. 5 years after the surgery, she was followed up on an outpatient basis, TSH levelsonly were monitored, and the dose of levothyroxine was adjusted. In 2018 due to, increasing complaints include tingling and cramps in the arms and legs, memory loss, sleep disorder, fatigue, anxiety, hair loss, muscle pain, tachycardia, positive Chvostek, and Trousseau signs were diagnosed during examination, also in blood analyses: total Ca 1.86 mmol/l (2.15-2.55), Ca++ 0.96 mmol/l (1.12-1.3), P 1.55 mmol/l (0.74-1.52), Mg 0.79 mmol/l (0.66-1.07) - chronic postoperative HypoPT was diagnosed. Therapy was initiated: alfacalcidol 0.5 mcg per day, calcium carbonate 2000 mg per day, cholecalciferol 1000 IU per day, magnesium orotate 3000 mg per day. During the case follow-up, hypocalcemia, hyperphosphatemia persisted, hypercalciuria15.7 mmol/day (2.5-6.5) was diagnosed. Dietary recommendations were given because of the high content of phosphorus rich foods, and therapy was adjusted: the dose of alfacalcidol was increased to 2.5 mcg per day, and the dose of calcium carbonate was reduced to 1500 mg per day. As part of the screening for complications of hypoPT, data for cataracts, Fahr syndrome, nephrocalcinosis, and kidney stone disease were not obtained. However, HypoPT compensation was not achieved, and therefore hydrochlorothiazide 25 mg was initiated, the dose of alfacalcidol was increased to 3 mcg per day, calcium carbonate to 3000 mg per day, magnesium orotate and cholecalciferol were continued at the same doses. Therapeutic goals were achieved: calcium phosphate product <4.4 mmol2/l2, there were no episodes of hypercalcemia, twenty-four-hour urinary calcium excretion was significantly reduced. Conclusion: Timely prescription, careful explanation of drugs usage rules, and monitoring and maintaining blood and urine parameters within the target contribute to the prevention of HypoPT complications development and life-threatening events.Keywords: hypoparathyroidism, hypocalcemia, hyperphosphatemia, hypercalciuria
Procedia PDF Downloads 99547 Kitchen Bureaucracy: The Preparation of Banquets for Medieval Japanese Royalty
Authors: Emily Warren
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Despite the growing body of research on Japanese food history, little has been written about the attitudes and perspectives premodern Japanese people held about their food, even on special celebratory days. In fact, the overall image that arises from the literature is one of ambivalence: that the medieval nobility of the Heian and Kamakura periods (795-1333) did not much care about what they ate and for that reason, food seems relatively scarce in certain historical records. This study challenges this perspective by analyzing the manuals written to guide palace management and feast preparation for royals, introducing two of the sources into English for the first time. This research is primarily based on three manuals that address different aspects of royal food culture and preparation. The Chujiruiki, or Record of the Palace Kitchens (1295), is a fragmentary manual written by a bureaucrat in charge of the main palace kitchen office. This document collection details the utensils, furnishing, and courses that officials organized for the royals’ two daily meals in the morning (asagarei gozen) and in the afternoon (hiru gozen) when they enjoyed seven courses, each one carefully cooked and plated. The orchestration of daily meals and frequent banquets would have been complicated affairs for those preparing the tableware and food, thus requiring texts like the Chûjiruiki, as well as another manual, the Nicchûgyôji (11th c.), or The Daily Functions. Because of the complex coordination between various kitchen-related bureaucratic offices, kitchen officials endeavored to standardize the menus and place settings depending on the time of year, religious abstinence days, and available ingredients flowing into the capital as taxes. For the most important annual banquets and rites celebrating deities and the royal family, kitchen officials would likely refer to the Engi Shiki (927), or Protocols of the Engi Era, for details on offerings, servant payments, and menus. This study proposes that many of the great feast events, and indeed even daily meals at the palace, were so standardized and carefully planned for repetition that there would have been little need for the contents of such feasts to be detailed in diaries or novels—places where historians have noted a lack of the mention of food descriptions. These descriptions were not included for lack of interest on the part of the nobility, but rather because knowledge of what would be served at banquets and feasts would be considered a matter-of-course in the same way that a modern American would likely not need to state the menu of a traditional Thanksgiving meal to an American audience. Where food was concerned, novelty more so than tradition prompted a response in personal records, like diaries.Keywords: banquets, bureaucracy, Engi shiki, Japanese food
Procedia PDF Downloads 106546 Influencing Factors and Mechanism of Patient Engagement in Healthcare: A Survey in China
Authors: Qing Wu, Xuchun Ye, Kirsten Corazzini
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Objective: It is increasingly recognized that patients’ rational and meaningful engagement in healthcare could make important contributions to their health care and safety management. However, recent evidence indicated that patients' actual roles in healthcare didn’t match their desired roles, and many patients reported a less active role than desired, which suggested that patient engagement in healthcare may be influenced by various factors. This study aimed to analyze influencing factors on patient engagement and explore the influence mechanism, which will be expected to contribute to the strategy development of patient engagement in healthcare. Methods: On the basis of analyzing the literature and theory study, the research framework was developed. According to the research framework, a cross-sectional survey was employed using the behavior and willingness of patient engagement in healthcare questionnaire, Chinese version All Aspects of Health Literacy Scale, Facilitation of Patient Involvement Scale and Wake Forest Physician Trust Scale, and other influencing factor related scales. A convenience sample of 580 patients was recruited from 8 general hospitals in Shanghai, Jiangsu Province, and Zhejiang Province. Results: The results of the cross-sectional survey indicated that the mean score for the patient engagement behavior was (4.146 ± 0.496), and the mean score for the willingness was (4.387 ± 0.459). The level of patient engagement behavior was inferior to their willingness to be involved in healthcare (t = 14.928, P < 0.01). The influencing mechanism model of patient engagement in healthcare was constructed by the path analysis. The path analysis revealed that patient attitude toward engagement, patients’ perception of facilitation of patient engagement and health literacy played direct prediction on the patients’ willingness of engagement, and standard estimated values of path coefficient were 0.341, 0.199, 0.291, respectively. Patients’ trust in physician and the willingness of engagement played direct prediction on the patient engagement, and standard estimated values of path coefficient were 0.211, 0.641, respectively. Patient attitude toward engagement, patients’ perception of facilitation and health literacy played indirect prediction on patient engagement, and standard estimated values of path coefficient were 0.219, 0.128, 0.187, respectively. Conclusions: Patients engagement behavior did not match their willingness to be involved in healthcare. The influencing mechanism model of patient engagement in healthcare was constructed. Patient attitude toward engagement, patients’ perception of facilitation of engagement and health literacy posed indirect positive influence on patient engagement through the patients’ willingness of engagement. Patients’ trust in physician and the willingness of engagement had direct positive influence on the patient engagement. Patient attitude toward engagement, patients’ perception of physician facilitation of engagement and health literacy were the factors influencing the patients’ willingness of engagement. The results of this study provided valuable evidence on guiding the development of strategies for promoting patient rational and meaningful engagement in healthcare.Keywords: healthcare, patient engagement, influencing factor, the mechanism
Procedia PDF Downloads 150545 Regional Review of Outcome of Cervical Smears Reported with Cytological Features of Non Cervical Glandular Neoplasia
Authors: Uma Krishnamoorthy, Vivienne Beavers, Janet Marshall
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Introduction: Cervical cytology showing features raising the suspicion of non cervical glandular neoplasia are reported as code 0 under the United Kingdom National Health Service Cervical screening programme ( NHSCSP). As the suspicion is regarding non cervical neoplasia, smear is reported as normal and patient informed that cervical screening result is normal. GP receives copy of results where it states further referral is indicated in small font within text of report. Background: There were several incidents of delayed diagnosis of endometrial cancer in Lancashire which prompted this Northwest Regional review to enable an understanding of underlying pathology outcome of code zero smears to raise awareness and also to review whether further action on wording of smear results was indicated to prevent such delay. Methodology: All Smears reported at the Manchester cytology centre who process cytology for Lancashire population from March 2013 to March 2014 were reviewed and histological diagnosis outcome of women in whom smear was reported as code zero was reviewed retrospectively . Results: Total smears reported by the cytology centre during this period was approximately 109400. Reports issued with result code 0 among this during this time period was 49.Results revealed that among three fourth (37) of women with code zero smear (N=49), evidence of underlying pathology of non cervical origin was confirmed. Of this, 73 % (36) were due to endometrial pathology with 49 % (24) endometrial carcinoma, 12 % (6)polyp, 4 % atypical endometrial hyperplasia (2), 6 % endometrial hyperplasia without atypia (3), and 2 % adenomyosis (1 case) and 2 % ( 1 case) due to ovarian adenocarcinoma. Conclusion: This review demonstrated that more than half (51 %) of women with a code 0 smear report were diagnosed with underlying carcinoma and 75 % had a confirmed underlying pathology contributory to code 0 smear findings. Recommendations and Action Plan: A local rapid access referral and management pathway for this group of women was implemented as a result of this in our unit. The findings and Pathway were shared with other regional units served by the cytology centre through the Pan Lancashire cervical screening board and through the Cytology centre. Locally, the smear report wording was updated to include a rubber stamp/ print in "Red Bold letters" stating that " URGENT REFERRAL TO GYNAECOLOGY IS INDICATED". Findings were also shared through the Pan Lancashire board with National cervical screening programme board, and revisions to wording of code zero smear reports to highlight the need for Urgent referral has now been agreed at National level to be implemented.Keywords: code zero smears, endometrial cancer, non cervical glandular neoplasia, ovarian cancer
Procedia PDF Downloads 287544 Using Fractal Architectures for Enhancing the Thermal-Fluid Transport
Authors: Surupa Shaw, Debjyoti Banerjee
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Enhancing heat transfer in compact volumes is a challenge when constrained by cost issues, especially those associated with requirements for minimizing pumping power consumption. This is particularly acute for electronic chip cooling applications. Technological advancements in microelectronics have led to development of chip architectures that involve increased power consumption. As a consequence packaging, technologies are saddled with needs for higher rates of power dissipation in smaller form factors. The increasing circuit density, higher heat flux values for dissipation and the significant decrease in the size of the electronic devices are posing thermal management challenges that need to be addressed with a better design of the cooling system. Maximizing surface area for heat exchanging surfaces (e.g., extended surfaces or “fins”) can enable dissipation of higher levels of heat flux. Fractal structures have been shown to maximize surface area in compact volumes. Self-replicating structures at multiple length scales are called “Fractals” (i.e., objects with fractional dimensions; unlike regular geometric objects, such as spheres or cubes whose volumes and surface area values scale as integer values of the length scale dimensions). Fractal structures are expected to provide an appropriate technology solution to meet these challenges for enhanced heat transfer in the microelectronic devices by maximizing surface area available for heat exchanging fluids within compact volumes. In this study, the effect of different fractal micro-channel architectures and flow structures on the enhancement of transport phenomena in heat exchangers is explored by parametric variation of fractal dimension. This study proposes a model that would enable cost-effective solutions for thermal-fluid transport for energy applications. The objective of this study is to ascertain the sensitivity of various parameters (such as heat flux and pressure gradient as well as pumping power) to variation in fractal dimension. The role of the fractal parameters will be instrumental in establishing the most effective design for the optimum cooling of microelectronic devices. This can help establish the requirement of minimal pumping power for enhancement of heat transfer during cooling. Results obtained in this study show that the proposed models for fractal architectures of microchannels significantly enhanced heat transfer due to augmentation of surface area in the branching networks of varying length-scales.Keywords: fractals, microelectronics, constructal theory, heat transfer enhancement, pumping power enhancement
Procedia PDF Downloads 315543 Humic Acid and Azadirachtin Derivatives for the Management of Crop Pests
Authors: R. S. Giraddi, C. M. Poleshi
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Organic cultivation of crops is gaining importance consumer awareness towards pesticide residue free foodstuffs is increasing globally. This is also because of high costs of synthetic fertilizers and pesticides, making the conventional farming non-remunerative. In India, organic manures (such as vermicompost) are an important input in organic agriculture. Though vermicompost obtained through earthworm and microbe-mediated processes is known to comprise most of the crop nutrients, but they are in small amounts thus necessitating enrichment of nutrients so that crop nourishment is complete. Another characteristic of organic manures is that the pest infestations are kept under check due to induced resistance put up by the crop plants. In the present investigation, deoiled neem cake containing azadirachtin, copper ore tailings (COT), a source of micro-nutrients and microbial consortia were added for enrichment of vermicompost. Neem cake is a by-product obtained during the process of oil extraction from neem plant seeds. Three enriched vermicompost blends were prepared using vermicompost (at 70, 65 and 60%), deoiled neem cake (25, 30 and 35%), microbial consortia and COTwastes (5%). Enriched vermicompost was thoroughly mixed, moistened (25+5%), packed and incubated for 15 days at room temperature. In the crop response studies, the field trials on chili (Capsicum annum var. longum) and soybean, (Glycine max cv JS 335) were conducted during Kharif 2015 at the Main Agricultural Research Station, UAS, Dharwad-Karnataka, India. The vermicompost blend enriched with neem cake (known to possess higher amounts of nutrients) and vermicompost were applied to the crops and at two dosages and at two intervals of crop cycle (at sowing and 30 days after sowing) as per the treatment plan along with 50% recommended dose of fertilizer (RDF). 10 plants selected randomly in each plot were studied for pest density and plant damage. At maturity, crops were harvested, and the yields were recorded as per the treatments, and the data were analyzed using appropriate statistical tools and procedures. In the crops, chili and soybean, crop nourishment with neem enriched vermicompost reduced insect density and plant damage significantly compared to other treatments. These treatments registered as much yield (16.7 to 19.9 q/ha) as that realized in conventional chemical control (18.2 q/ha) in soybean, while 72 to 77 q/ha of green chili was harvested in the same treatments, being comparable to the chemical control (74 q/ha). The yield superiority of the treatments was of the order neem enriched vermicompost>conventional chemical control>neem cake>vermicompost>untreated control. The significant features of the result are that it reduces use of inorganic manures by 50% and synthetic chemical insecticides by 100%.Keywords: humic acid, azadirachtin, vermicompost, insect-pest
Procedia PDF Downloads 274542 Case Study of Human Factors and Ergonomics in the Design and Use of Harness-Embedded Costumes in the Entertainment Industry
Authors: Marielle Hanley, Brandon Takahashi, Gerry Hanley, Gabriella Hancock
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Safety harnesses and their protocols are very common within the construction industry, and the Occupational Safety and Health Administration has provided extensive guidelines with protocols being constantly updated to ensure the highest level of safety within construction sites. There is also extensive research on harnesses that are meant to keep people in place in moving vehicles, such as seatbelts. Though this research is comprehensive in these areas, the findings and recommendations are not generally applicable to other industry sectors where harnesses are used, such as the entertainment industry. The focus of this case study is on the design and use of harnesses used by theme park employees wearing elaborate costumes in parades and performances. The key factors of posture, kinesthetic factors, and harness engineering interact in significantly different ways when the user is performing repetitive choreography with 20 to 40 lbs. of apparatus connected to harnesses that need to be hidden from the audience’s view. Human factors and ergonomic analysis take into account the required performers’ behaviors, the physical and mental preparation and posture of the performer, the design of the harness-embedded costume, and the environmental conditions during the performance (e.g., wind) that can determine the physical stresses placed on the harness and performer. The uniqueness and expense of elaborate costumes frequently result in one or two costumes created for production, and a variety of different performers need to fit into the same costume. Consequently, the harnesses should be adjustable if they are to minimize the physical and cognitive loads on the performer, but they are frequently more a “one-size fits all”. The complexity of human and technology interactions produces a range of detrimental outcomes, from muscle strains to nerve damage, mental and physical fatigue, and reduced motivation to perform at peak levels. Based on observations conducted over four years for this case study, a number of recommendations to institutionalize the human factors and ergonomic analyses can significantly improve the safety, reliability, and quality of performances with harness-embedded costumes in the entertainment industry. Human factors and ergonomic analyses can be integrated into the engineering design of the performance costumes with embedded harnesses, the conditioning and training of the performers using the costumes, the choreography of the performances within the staged setting and the maintenance of the harness-embedded costumes. By applying human factors and ergonomic methodologies in the entertainment industry, the industry management and support staff can significantly reduce the risks of injury, improve the longevity of unique performers, increase the longevity of the harness-embedded costumes, and produce the desired entertainment value for audiences.Keywords: ergonomics in entertainment industry, harness-embedded costumes, performer safety, injury prevention
Procedia PDF Downloads 82541 The Church of San Paolo in Ferrara, Restoration and Accessibility
Authors: Benedetta Caglioti
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The ecclesiastical complex of San Paolo in Ferrara represents a monument of great historical, religious and architectural importance. Its long and articulated story, over time, is already manifested by the mere reading of its planimetric and altimetric configuration, apparently unitary but, in reality, marked by modifications and repeated additions, even of high quality. It follows, in terms of protection, restoration and enhancement, a commitment of due respect for how the ancient building was built and enriched over its centuries of life. Hence a rigorous methodological approach, while being aware of the fact that every monument, in order to live and make use of the indispensable maintenance, must always be enjoyed and visited, therefore it must enjoy, in the right measure and compatibly with its nature, the possibility of improvements and functional, distributive, technological adjustments and related to the safety of people and things. The methodological approach substantiates the different elements of the project (such as distribution functionality, safety, structural solidity, environmental comfort, the character of the site, building and urban planning regulations, financial resources and materials, the same organization methods of the construction site) through the guiding principles of restoration, defined for a long time: the 'minimum intervention,' the 'recognisability' or 'distinguishability' of old and new, the Physico-chemical and figurative 'compatibility,' the 'durability' and the, at least potential, 'reversibility' of what is done, leading to the definition of appropriate "critical choices." The project tackles, together with the strictly functional ones, also the directly conservative and restoration issues, of a static, structural and material technology nature, with special attention to precious architectural surfaces, In order to ensure the best architectural quality through conscious enhancement, the project involves a redistribution of the interior and service spaces, an accurate lighting system inside and outside the church and a reorganization of the adjacent urban space. The reorganization of the interior is designed with particular attention to the issue of accessibility for people with disabilities. To accompany the community to regain possession of the use of the church's own space, already in its construction phase, the project proposal has hypothesized a permeability and flexibility in the management of the works such as to allow the perception of the found Monument to gradually become more and more familiar at the citizenship. Once the interventions have been completed, it is expected that the Church of San Paolo, second in importance only to the Cathedral, from which it is a few steps away, will be inserted in an already existing circuit of use of the city which over the years has systematized the different aspects of culture, the environment and tourism for the creation of greater awareness in the perception of what Ferrara can offer in cultural terms.Keywords: conservation, accessibility, regeneration, urban space
Procedia PDF Downloads 102540 A Literature Review on the Use of Information and Communication Technology within and between Emergency Medical Teams during a Disaster
Authors: Badryah Alshehri, Kevin Gormley, Gillian Prue, Karen McCutcheon
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In a disaster event, sharing patient information between the pre-hospitals Emergency Medical Services (EMS) and Emergency Department (ED) hospitals is a complex process during which important information may be altered or lost due to poor communication. The aim of this study was to critically discuss the current evidence base in relation to communication between pre-EMS hospital and ED hospital professionals by the use of Information and Communication Systems (ICT). This study followed the systematic approach; six electronic databases were searched: CINAHL, Medline, Embase, PubMed, Web of Science, and IEEE Xplore Digital Library were comprehensively searched in January 2018 and a second search was completed in April 2020 to capture more recent publications. The study selection process was undertaken independently by the study authors. Both qualitative and quantitative studies were chosen that focused on factors which are positively or negatively associated with coordinated communication between pre-hospital EMS and ED teams in a disaster event. These studies were assessed for quality and the data were analysed according to the key screening themes which emerged from the literature search. Twenty-two studies were included. Eleven studies employed quantitative methods, seven studies used qualitative methods, and four studies used mixed methods. Four themes emerged on communication between EMTs (pre-hospital EMS and ED staff) in a disaster event using the ICT. (1) Disaster preparedness plans and coordination. This theme reported that disaster plans are in place in hospitals, and in some cases, there are interagency agreements with pre-hospital and relevant stakeholders. However, the findings showed that the disaster plans highlighted in these studies lacked information regarding coordinated communications within and between the pre-hospital and hospital. (2) Communication systems used in the disaster. This theme highlighted that although various communication systems are used between and within hospitals and pre-hospitals, technical issues have influenced communication between teams during disasters. (3) Integrated information management systems. This theme suggested the need for an integrated health information system which can help pre-hospital and hospital staff to record patient data and ensure the data is shared. (4) Disaster training and drills. While some studies analysed disaster drills and training, the majority of these studies were focused on hospital departments other than EMTs. These studies suggest the need for simulation disaster training and drills, including EMTs. This review demonstrates that considerable gaps remain in the understanding of the communication between the EMS and ED hospitals staff in relation to response in disasters. The review shows that although different types of ICTs are used, various issues remain which affect coordinated communication among the relevant professionals.Keywords: communication, emergency communication services, emergency medical teams, emergency physicians, emergency nursing, paramedics, information and communication technology, communication systems
Procedia PDF Downloads 81539 Uterine Torsion: A Rare Differential Diagnosis for Acute Abdominal Pain in Pregnancy
Authors: Tin Yee Ling, Kavita Maravar, Ruzica Ardalic
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Background: Uterine torsion (UT) in pregnancy of more than 45-degree along the longitudinal axis is a rare occurrence, and the aetiology remains unclear. Case: A 34-year-old G2P1 woman with a history of one previous caesarean section presented at 36+2 weeks with sudden onset lower abdominal pain, syncopal episode, and tender abdomen on examination. She was otherwise haemodynamically stable. Cardiotocography showed a pathological trace with initial prolonged bradycardia followed by a subsequent tachycardia with reduced variability. An initial diagnosis of uterine dehiscence was made, given the history and clinical presentation. She underwent an emergency caesarean section which revealed a 180-degree UT along the longitudinal axis, with oedematous left round ligament lying transverse anterior to the uterus and a segment of large bowel inferior to the round ligament. Detorsion of uterus was performed prior to delivery of the foetus, and anterior uterine wall was intact with no signs of rupture. There were no anatomical uterine abnormalities found other than stretched left ovarian and round ligaments, which were repaired. Delivery was otherwise uneventful, and she was discharged on day 2 postpartum. Discussion: UT is rare as the number of reported cases is within the few hundreds worldwide. Generally, the uterus is supported in place by uterine ligaments, which limit the mobility of the structure. The causes of UT are unknown, but risk factors such as uterine abnormalities, increased uterine ligaments’ flexibility in pregnancy, and foetal malposition has been identified. UT causes occlusion of uterine vessels, which can lead to ischaemic injury of the placenta causing premature separation of the placenta, preterm labour, and foetal morbidity and mortality if delivery is delayed. Diagnosing UT clinically is difficult as most women present with symptoms similar to placenta abruption or uterine rupture (abdominal pain, vaginal bleeding, shock), and one-third are asymptomatic. The management of UT involves surgical detorsion of the uterus and delivery of foetus via caesarean section. Extra vigilance should be taken to identify the anatomy of the uterus experiencing torsion prior to hysterotomy. There have been a few cases reported with hysterotomy on posterior uterine wall for delivery of foetus as it may be difficult to identify and reverse a gravid UT when foetal well-being is at stake. Conclusion: UT should be considered a differential diagnosis of acute abdominal pain in pregnancy. It is crucial that the torsion is addressed immediately as it is associated with maternal and foetal morbidity and mortality.Keywords: uterine torsion, pregnancy complication, abdominal pain, torted uterus
Procedia PDF Downloads 150538 Outcomes of Pregnancy in Women with TPO Positive Status after Appropriate Dose Adjustments of Thyroxin: A Prospective Cohort Study
Authors: Revathi S. Rajan, Pratibha Malik, Nupur Garg, Smitha Avula, Kamini A. Rao
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This study aimed to analyse the pregnancy outcomes in patients with TPO positivity after appropriate L-Thyroxin supplementation with close surveillance. All pregnant women attending the antenatal clinic at Milann-The Fertility Center, Bangalore, India- from Aug 2013 to Oct 2014 whose booking TSH was more than 2.5 mIU/L were included along with those pregnant women with prior hypothyroidism who were TPO positive. Those with TPO positive status were vigorously managed with appropriate thyroxin supplementation and the doses were readjusted every 3 to 4 weeks until delivery. Women with recurrent pregnancy loss were also tested for TPO positivity and if tested positive, were monitored serially with TSH and fT4 levels every 3 to 4 weeks and appropriately supplemented with thyroxin when the levels fluctuated. The testing was done after an informed consent in all these women. The statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data. 460 pregnant women were screened for thyroid dysfunction at booking of which 52% were hypothyroid. Majority of them (31.08%) were subclinically hypothyroid and the remaining were overt. 25% of the total no. of patients screened were TPO positive. The various pregnancy complications that were observed in the TPO positive women were gestational glucose intolerance [60%], threatened abortion [21%], midtrimester abortion [4.3%], premature rupture of membranes [4.3%], cervical funneling [4.3%] and fetal growth restriction [3.5%]. 95.6% of the patients who followed up till the end delivered beyond 30 weeks. 42.6% of these patients had previous history of recurrent abortions or adverse obstetric outcome and 21.7% of the delivered babies required NICU admission. Obstetric outcomes in our study in terms of midtrimester abortions, placental abruption, and preterm delivery improved for the better after close monitoring of the thyroid hormone [TSH and fT4] levels every 3 to 4 weeks with appropriate dose adjustment throughout pregnancy. Euthyroid women with TPO positive status enrolled in the study incidentally were those with recurrent abortions/infertility and required thyroxin supplements due to elevated Thyroid hormone (TSH, fT4) levels during the course of their pregnancy. Significant associations were found with age>30 years and Hyperhomocysteinemia [p=0.017], recurrent pregnancy loss or previous adverse obstetric outcomes [p=0.067] and APLA [p=0.029]. TPO antibody levels >600 I U/ml were significantly associated with development of gestational hypertension [p=0.041] and fetal growth restriction [p=0.082]. Euthyroid women with TPO positivity were also screened periodically to counter fluctuations of the thyroid hormone levels with appropriate thyroxin supplementation. Thus, early identification along with aggressive management of thyroid dysfunction and stratification of these patients based on their TPO status with appropriate thyroxin supplementation beginning in the first trimester will aid risk modulation and also help avert complications.Keywords: TPO antibody, subclinical hypothyroidism, anti nuclear antibody, thyroxin
Procedia PDF Downloads 319537 Freight Forwarders’ Liability: A Need for Revival of Unidroit Draft Convention after Six Decades
Authors: Mojtaba Eshraghi Arani
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The freight forwarders, who are known as the Architect of Transportation, play a vital role in the supply chain management. The package of various services which they provide has made the legal nature of freight forwarders very controversial, so that they might be qualified once as principal or carrier and, on other occasions, as agent of the shipper as the case may be. They could even be involved in the transportation process as the agent of shipping line, which makes the situation much more complicated. The courts in all countries have long had trouble in distinguishing the “forwarder as agent” from “forwarder as principal” (as it is outstanding in the prominent case of “Vastfame Camera Ltd v Birkart Globistics Ltd And Others” 2005, Hong Kong). It is not fully known that in the case of a claim against the forwarder, what particular parameter would be used by the judge among multiple, and sometimes contradictory, tests for determining the scope of the forwarder liability. In particular, every country has its own legal parameters for qualifying the freight forwarders that is completely different from others, as it is the case in France in comparison with Germany and England. The unpredictability of the courts’ decisions in this regard has provided the freight forwarders with the opportunity to impose any limitation or exception of liability while pretending to play the role of a principal, consequently making the cargo interests incur ever-increasing damage. The transportation industry needs to remove such uncertainty by unifying national laws governing freight forwarders liability. A long time ago, in 1967, The International Institute for Unification of Private Law (UNIDROIT) prepared a draft convention called “Draft Convention on Contract of Agency for Forwarding Agents Relating to International Carriage of Goods” (hereinafter called “UNIDROIT draft convention”). The UNIDROIT draft convention provided a clear and certain framework for the liability of freight forwarder in each capacity as agent or carrier, but it failed to transform to a convention, and eventually, it was consigned to oblivion. Today, after nearly 6 decades from that era, the necessity of such convention can be felt apparently. However, one might reason that the same grounds, in particular, the resistance by forwarders’ association, FIATA, exist yet, and thus it is not logical to revive a forgotten draft convention after such long period of time. It is argued in this article that the main reason for resisting the UNIDROIT draft convention in the past was pending efforts for developing the “1980 United Nation Convention on International Multimodal Transport of Goods”. However, the latter convention failed to become in force on due time in a way that there was no new accession since 1996, as a result of which the UNIDROIT draft convention must be revived strongly and immediately submitted to the relevant diplomatic conference. A qualitative method with the concept of interpretation of data collection has been used in this manuscript. The source of the data is the analysis of international conventions and cases.Keywords: freight forwarder, revival, agent, principal, uidroit, draft convention
Procedia PDF Downloads 70536 Advances in Design Decision Support Tools for Early-stage Energy-Efficient Architectural Design: A Review
Authors: Maryam Mohammadi, Mohammadjavad Mahdavinejad, Mojtaba Ansari
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The main driving force for increasing movement towards the design of High-Performance Buildings (HPB) are building codes and rating systems that address the various components of the building and their impact on the environment and energy conservation through various methods like prescriptive methods or simulation-based approaches. The methods and tools developed to meet these needs, which are often based on building performance simulation tools (BPST), have limitations in terms of compatibility with the integrated design process (IDP) and HPB design, as well as use by architects in the early stages of design (when the most important decisions are made). To overcome these limitations in recent years, efforts have been made to develop Design Decision Support Systems, which are often based on artificial intelligence. Numerous needs and steps for designing and developing a Decision Support System (DSS), which complies with the early stages of energy-efficient architecture design -consisting of combinations of different methods in an integrated package- have been listed in the literature. While various review studies have been conducted in connection with each of these techniques (such as optimizations, sensitivity and uncertainty analysis, etc.) and their integration of them with specific targets; this article is a critical and holistic review of the researches which leads to the development of applicable systems or introduction of a comprehensive framework for developing models complies with the IDP. Information resources such as Science Direct and Google Scholar are searched using specific keywords and the results are divided into two main categories: Simulation-based DSSs and Meta-simulation-based DSSs. The strengths and limitations of different models are highlighted, two general conceptual models are introduced for each category and the degree of compliance of these models with the IDP Framework is discussed. The research shows movement towards Multi-Level of Development (MOD) models, well combined with early stages of integrated design (schematic design stage and design development stage), which are heuristic, hybrid and Meta-simulation-based, relies on Big-real Data (like Building Energy Management Systems Data or Web data). Obtaining, using and combining of these data with simulation data to create models with higher uncertainty, more dynamic and more sensitive to context and culture models, as well as models that can generate economy-energy-efficient design scenarios using local data (to be more harmonized with circular economy principles), are important research areas in this field. The results of this study are a roadmap for researchers and developers of these tools.Keywords: integrated design process, design decision support system, meta-simulation based, early stage, big data, energy efficiency
Procedia PDF Downloads 157535 Modeling and Simulating Productivity Loss Due to Project Changes
Authors: Robert Pellerin, Michel Gamache, Remi Trudeau, Nathalie Perrier
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The context of large engineering projects is particularly favorable to the appearance of engineering changes and contractual modifications. These elements are potential causes for claims. In this paper, we investigate one of the critical components of the claim management process: the calculation of the impacts of changes in terms of losses of productivity due to the need to accelerate some project activities. When project changes are initiated, delays can arise. Indeed, project activities are often executed in fast-tracking in an attempt to respect the completion date. But the acceleration of project execution and the resulting rework can entail important costs as well as induce productivity losses. In the past, numerous methods have been proposed to quantify the duration of delays, the gains achieved by project acceleration, and the loss of productivity. The calculation related to those changes can be divided into two categories: direct cost and indirect cost. The direct cost is easily quantifiable as opposed to indirect costs which are rarely taken into account during the calculation of the cost of an engineering change or contract modification despite several research projects have been made on this subject. However, proposed models have not been accepted by companies yet, nor they have been accepted in court. Those models require extensive data and are often seen as too specific to be used for all projects. These techniques are also ignoring the resource constraints and the interdependencies between the causes of delays and the delays themselves. To resolve this issue, this research proposes a simulation model that mimics how major engineering changes or contract modifications are handled in large construction projects. The model replicates the use of overtime in a reactive scheduling mode in order to simulate the loss of productivity present when a project change occurs. Multiple tests were conducted to compare the results of the proposed simulation model with statistical analysis conducted by other researchers. Different scenarios were also conducted in order to determine the impact the number of activities, the time of occurrence of the change, the availability of resources, and the type of project changes on productivity loss. Our results demonstrate that the number of activities in the project is a critical variable influencing the productivity of a project. When changes occur, the presence of a large number of activities leads to a much lower productivity loss than a small number of activities. The speed of reducing productivity for 30-job projects is about 25 percent faster than the reduction speed for 120-job projects. The moment of occurrence of a change also shows a significant impact on productivity. Indeed, the sooner the change occurs, the lower the productivity of the labor force. The availability of resources also impacts the productivity of a project when a change is implemented. There is a higher loss of productivity when the amount of resources is restricted.Keywords: engineering changes, indirect costs overtime, productivity, scheduling, simulation
Procedia PDF Downloads 234534 Challenges Faced by the Parents of Mentally Challenged Children in India
Authors: Chamaraja Parulli
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Family is an important social institution devoted to the growth of a child, and parents are the important agents of socialization. Mentally challenged children are those who are affected by intellectual disability, which is manifested by limitation in intellectual functioning and adoptive behavior. Intellectual disability affects about 3-4 percentage of the general population. Intellectual disability is caused by genetic condition, problems during pregnancy, problems during childbirth, or illness. Mental retardation is the world’s most complex and challenging issue. The stigmatization of disability results in social and economic marginalization. Parents of the mentally challenged children will have a very high level of parenting stress, which is significantly more than the stress perceived by the parents of the children without disability. The prevalence of severe mental disorder called Schizophrenia is among 1.1 percent of the total population in India. On the other hand, 11 to 12 percent is the overall lifetime occurrence rate of mental disorders. While the government has a separate program for mental health, the segment is marred by lack of adequate doctors and infrastructure. Mentally retarded children have certain limitations in mental functioning and skills, which makes them slow learners in speaking, walking, and taking care of their personal needs such as dressing and eating. Accepting a child with mental handicap becomes difficult for parents and to the whole family, as they have to face many problems, including those of management, finance, deprivation of rest, and leisure. Also, the problems faced by the parents can be seen in different areas like – educational, psychological, social, emotional, financial and family related issues. The study brought out various difficulties and problems faced by the parents as well as family members. The findings revealed that the mental retardation is not only a medico-psychological problem but also a socio-cultural problem. The study results, however, indicate that the quality of life of the family having children with mental retardation can be improved to a greater extent by building up a child-friendly ambience at home. The main aim of the present study is to assess the problems faced by the parents of mentally challenged children, with the help of personal interview data collected from the parents of mentally challenged children, residing in Shimoga District of Karnataka State, India. These individuals were selected using stratified random sampling method. Organizing effective intervention programs for parents, family, society, and educational institutions towards reduction of family stress, augmenting the family’s strengths, increasing child’s competence and enhancing the positive attitudes and values of the society will go a long way for the peaceful existence of the mentally challenged children.Keywords: mentally challenged children, intellectual disability, special children, social infrastructure, differently abled, psychological stress, marginalization
Procedia PDF Downloads 104533 The Awareness of Cardiovascular Diseases among General Population in Western Regions of Saudi Arabia
Authors: Ali Saeed Alghamdi, Basel Mazen Alsolami, Basel Saeed Alghamdi, Muhanad Saleh Alzahrani Alamri, Salman Anwar Thabet, Abdulhalim J. Kinsara
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Objectives: This study measures the knowledge of the cardiovascular disease among the general population in western regions of Saudi Arabia, and it aimed to increase the level of awareness about cardiovascular diseases among the general population by providing an awareness lecture that included information about the risk factors, major symptoms, and prevention of cardiovascular diseases. The lecture has been attached at the end of the questionnaire. Setting: This study was conducted through an online questionnaire that included our aim and main objectives that targeted the general population in the Western regions of Saudi Arabia (Makkah and Madinah regions). Participants: This study participants were 460 collected through an online questionnaire. Methods: All Saudi citizens and residents who live in the western region of Saudi Arabia aged 18 years and above will be invited to participate voluntarily. A pre-structured questionnaire was designed to collect data on age, gender, marital status, education level, occupation, lifestyle habits, and history of heart diseases, with cardiac symptoms and risk factors sections. Results: The majority of respondents were females (74.8%) and Saudis. The knowledge about cardiovascular disease risk factors was weak. Only (18.5%) scores an excellent response regarding risk factors awareness. Lack of exercise, stress, and obesity were the most known risk factors. Regarding cardiovascular disease symptoms, chest pain scores the highest symptom (87.6%) among other symptoms like dyspnea, syncope, and excessive sweating. Participants revealed a poor awareness regarding cardiovascular disease symptoms also (0.9%). However, preventable factors for cardiovascular diseases were more knowledgeable than others categories in this study (60% fall into excellent knowledge). Smoking cessation, normal cholesterol level, and normal blood pressure score the highest preventable methods (92.2%), (88.6%), and (78.7%) respectively. 83.7% of the participant have attended the awareness lecture, and 99 of the attendees reported that the lecture increased their knowledge about cardiovascular disease. Conclusion: This study discussed the level of community awareness of cardiovascular disease in terms of symptoms, risk factors, and protective factors. We found a huge lack of the participant's level of knowledge about the disease and how to prevent it. Moreover, we measure the prevalence of the comorbidities among our participants (diabetes, hypertension, hypercholesterolemia/ hypertriglyceridemia) and their extent of adherence to their medication. In conclusion, this study not only demonstrates awareness of cardiovascular disease risk factors, symptoms, management, and the association between each domain but also provides educational material. Further educational material and campaigns are required to increase awareness and knowledge about cardiovascular diseases.Keywords: awareness, cardiovascular diseases, education, prevention, risk factors
Procedia PDF Downloads 123532 The Effect of Psychosocial, Behavioral and Disease Specific Characteristics on Health-Related Quality of Life after Primary Surgery for Colorectal Cancer: A Cross Sectional Study of a Regional Australian Population
Authors: Lakmali Anthony, Madeline Gillies
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Background: Colorectal cancer (CRC) is usually managed with surgical resection. Many of the outcomes traditionally used to define successful operative management, such as resection margin, do not adequately reflect patients’ experience. Patient-reported outcomes (PRO), such as Health-Related Quality of life (HRQoL), provide a means by which the impact of surgery for cancer can be reported in a patient-centered way. HRQoL has previously been shown to be impacted by psychosocial, behavioral and disease-specific characteristics. This exploratory cross-sectional study aims to; (1) describe postoperative HRQoL in patients who underwent primary resection in a regional Australian hospital; (2) describe the prevalence of anxiety, depression and clinically significant fear of cancer recurrence (FCR) in this population; and (3) identify demographic, psychosocial, disease and treatment factors associated with poorer self-reported HRQoL. Methods: Consecutive patients who had resection of colorectal cancer in a single regional Australian hospital between 2015 and 2022 were eligible. Participants were asked to complete a survey instrument designed to assess HRQoL, as well as validated instruments that assess several other psychosocial PROs hypothesized to be associated with HRQoL; emotional distress, fear of cancer recurrence, social support, dispositional optimism, body image and spirituality. Demographic and disease-specific data were also collected via medical record review. Results: Forty-six patients completed the survey. Clinically significant levels of fear of recurrence as well as emotional distress, were present in this group. Many domains of HRQoL were significantly worse than an Australian reference population for CRC. Demographic and disease factors associated with poor HRQoL included smoking and ongoing adjuvant systemic therapy. The primary operation was not associated with HRQoL; however, the operative approach (laparoscopic vs. open) was associated with HRQoL for these patients. All psychosocial factors measured were associated with HRQoL, including cancer worry, emotional distress, body image and dispositional optimism. Conclusion: HRQoL is an important outcome in surgery for both research and clinical practice. This study provides an overview of the quality of life in a regional Australian population of postoperative colorectal cancer patients and the factors that affect it. Understanding HRQoL and awareness of patients particularly vulnerable to poor outcomes should be used to aid the informed consent and shared decision-making process between surgeon and patient.Keywords: surgery, colorectal, cancer, PRO, HRQoL
Procedia PDF Downloads 66531 Potential Cross-Protection Roles of Chitooligosaccharide in Alleviating Cd Toxicity in Edible Rape (Brassica rapa L.)
Authors: Haiying Zong, Yi Yuan, Pengcheng Li
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Cadmium (Cd), one of the toxic heavy metals, has high solubility and mobility in agricultural soils and is readily taken up by roots and transported to the vegetative and reproductive organs which can cause deleterious effects on crop yield and quality. Excess Cd in plants can interfere with many metabolic processes, such as photosynthesis, transpiration, respiration or nutrients homeostasis. Generally, the main methods to reduce Cd accumulation in plants are to decrease the concentration of Cd in the soil solution through reduction of Cd influx into the soil system, site selection, and management practices. However, these approaches can be very costly and consume a lot of energy Therefore, it is critical to develop effective approaches to reduce the Cd concentration in plants. It is proved that chitooligosaccharide (COS) can enhance the plant's tolerance to abiotic stress including drought stress, salinity stress, and toxic metal stress. However, so far little information is known about whether foliar application with COS modulates Cd-induced toxicity in plants. The metal detoxification processes of plants treated with COS also remain unclear. In this study, edible rape (Brassica rapa L.), one of the most widely consumed leafy vegetables, was selected as an experimental mode plant. The effect of foliar application with COS on reducing Cd accumulation in edible rape was investigated. Moreover, Cd subcellular distribution pattern in response to Cd stress in the rape plant sprayed with COS was further tested in order to explore the potential detoxification mechanisms in plants. The results demonstrated that spraying COS at different concentrations (25, 50,100 and 200 mg L-1) possess diverse functions including growth-promoting,chlorophyll contents-enhancing, malondialdehyde (MDA) level-decreasing in leaves, Cd2+ concentration-decreasingin shoots and roots of edible rape under Cd stress. In addition, it was found that COS can also dramatically improve superoxide dismutase (SOD) activity, catalase (CAT) activity and peroxidase (POX) activity of edible rape leaves. The relievingeffect of COS was related to theconcentration and COS with 50-100 mg L-1 displayed the best activity. Furtherly, theexperiments results exhibitedthat COS could decrease the proportion of Cd in the organelle fraction of leaves by 40.1% while enhance the proportion of Cd in the soluble fraction by 13.2% at the concentration of 50 mg L-1. The above results showed that COS may have thepotential to improve plant resistance to Cd via promoting antioxidant enzyme activities and altering Cd subcellular distribution. All the results described here open up a new way to study the protection role of COS in alleviating Cd tolerance and lay the foundation for future research about the detoxification mechanism at subcellular level.Keywords: chitooligosaccharide, cadmium, edible rape (Brassica rapa L.), subcellular distribution
Procedia PDF Downloads 291530 Incidence and Risk Factors of Traumatic Lumbar Puncture in Newborns in a Tertiary Care Hospital
Authors: Heena Dabas, Anju Paul, Suman Chaurasia, Ramesh Agarwal, M. Jeeva Sankar, Anurag Bajpai, Manju Saksena
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Background: Traumatic lumbar puncture (LP) is a common occurrence and causes substantial diagnostic ambiguity. There is paucity of data regarding its epidemiology. Objective: To assess the incidence and risk factors of traumatic LP in newborns. Design/Methods: In a prospective cohort study, all inborn neonates admitted in NICU and planned to undergo LP for a clinical indication of sepsis were included. Neonates with diagnosed intraventricular hemorrhage (IVH) of grade III and IV were excluded. The LP was done by operator - often a fellow or resident assisted by bedside nurse. The unit has policy of not routinely using any sedation/analgesia during the procedure. LP is done by 26 G and 0.5-inch-long hypodermic needle inserted in third or fourth lumbar space while the infant is in lateral position. The infants were monitored clinically and by continuous measurement of vital parameters using multipara monitor during the procedure. The occurrence of traumatic tap along with CSF parameters and other operator and assistant characteristics were recorded at the time of procedure. Traumatic tap was defined as presence of visible blood or more than 500 red blood cells on microscopic examination. Microscopic trauma was defined when CSF is not having visible blood but numerous RBCs. The institutional ethics committee approved the study protocol. A written informed consent from the parents and the health care providers involved was obtained. Neonates were followed up till discharge/death and final diagnosis was assigned along with treating team. Results: A total of 362 (21%) neonates out of 1726 born at the hospital were admitted during the study period (July 2016 to January, 2017). Among these neonates, 97 (26.7%) were suspected of sepsis. A total of 54 neonates were enrolled who met the eligibility criteria and parents consented to participate in the study. The mean (SD) birthweight was 1536 (732) grams and gestational age 32.0 (4.0) weeks. All LPs were indicated for late onset sepsis at the median (IQR) age of 12 (5-39) days. The traumatic LP occurred in 19 neonates (35.1%; 95% C.I 22.6% to 49.3%). Frank blood was observed in 7 (36.8%) and in the remaining, 12(63.1%) CSF was detected to have microscopic trauma. The preliminary risk factor analysis including birth weight, gestational age and operator/assistant and other characteristics did not demonstrate clinically relevant predictors. Conclusion: A significant number of neonates requiring lumbar puncture in our study had high incidence of traumatic tap. We were not able to identify modifiable risk factors. There is a need to understand the reasons and further reduce this issue for improving management in NICUs.Keywords: incidence, newborn, traumatic, lumbar puncture
Procedia PDF Downloads 290529 Alternate Approaches to Quality Measurement: An Exploratory Study in Differentiation of “Quality” Characteristics in Services and Supports
Authors: Caitlin Bailey, Marian Frattarola Saulino, Beth Steinberg
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Today, virtually all programs offered to people with intellectual and developmental disabilities tout themselves as person-centered, community-based and inclusive, yet there is a vast range in type and quality of services that use these similar descriptors. The issue is exacerbated by the fields’ measurement practices around quality, inclusion, independent living, choice and person-centered outcomes. For instance, community inclusion for people with disabilities is often measured by the number of times person steps into his or her community. These measurement approaches set standards for quality too low so that agencies supporting group home residents to go bowling every week can report the same outcomes as an agency that supports one person to join a book club that includes people based on their literary interests rather than disability labels. Ultimately, lack of delineation in measurement contributes to the confusion between face value “quality” and true quality services and supports for many people with disabilities and their families. This exploratory study adopts alternative approaches to quality measurement including co-production methods and systems theoretical framework in order to identify the factors that 1) lead to high-quality supports and, 2) differentiate high-quality services. Project researchers have partnered with community practitioners who are all committed to providing quality services and supports but vary in the degree to which they are actually able to provide them. The study includes two parts; first, an online survey distributed to more than 500 agencies that have demonstrated commitment to providing high-quality services; and second, four in-depth case studies with agencies in three United States and Israel providing a variety of supports to children and adults with disabilities. Results from both the survey and in-depth case studies were thematically analyzed and coded. Results show that there are specific factors that differentiate service quality; however meaningful quality measurement practices also require that researchers explore the contextual factors that contribute to quality. These not only include direct services and interactions, but also characteristics of service users, their environments as well as organizations providing services, such as management and funding structures, culture and leadership. Findings from this study challenge researchers, policy makers and practitioners to examine existing quality service standards and measurements and to adopt alternate methodologies and solutions to differentiate and scale up evidence-based quality practices so that all people with disabilities have access to services that support them to live, work, and enjoy where and with whom they choose.Keywords: co-production, inclusion, independent living, quality measurement, quality supports
Procedia PDF Downloads 393