Search results for: medical factors
940 Asthma Nurse Specialist Improves the Management of Acute Asthma in a University Teaching Hospital: A Quality Improvement Project
Authors: T. Suleiman, C. Mchugh, H. Ranu
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Background; Asthma continues to be associated with poor patient outcomes, including mortality. An audit of the management of acute asthma admissions in our hospital in 2020 found poor compliance with National Asthma and COPD Audit Project (NACAP) standards which set out to improve inpatient asthma care. Clinical nurse specialists have been shown to improve patient care across a range of specialties. In September 2021, an asthma Nurse Specialist (ANS) was employed in our hospital. Aim; To re-audit management of acute asthma admissions using NACAP standards and assess for quality improvement post-employment of an ANS. Methodology; NACAP standards are wide-reaching; therefore, we focused on ‘specific elements of good practice’ in addition to the provision of inhaled corticosteroids (ICS) on discharge. Medical notes were retrospectively requested from the hospital coding department and selected as per NACAP inclusion criteria. Data collection and entry into the NACAP database were carried out. As this was a clinical audit, ethics approval was not required. Results; Cycle 1 (pre-ANS) and 2 (post-ANS) of the audit included 20 and 32 patients, respectively, with comparable baseline demographics. No patients had a discharge bundle completed on discharge in cycle 1 vs. 84% of cases in cycle 2. Regarding specific components of the bundle, 25% of patients in cycle 1 had their inhaler technique checked vs. 91% in cycle 2. Furthermore, 80% of patients had maintenance medications reviewed in cycle 1 vs. 97% in cycle 2. Medication adherence was addressed in 20% of cases in cycle 1 vs. 88% of cases in cycle 2. Personalized asthma action plans were not issued or reviewed in any cases in cycle 1 as compared with 84% of cases in cycle 2. Triggers were discussed in 30% of cases in cycle 1 vs. 88% of cases in cycle 2. Tobacco dependence was addressed in 44% of cases in cycle 1 vs. 100% of cases in cycle 2. No patients in cycle 1 had community follow-up requested within 2 days vs. 81% of the patients in cycle 2. Similarly, 20% of the patients in cycle 1 vs. 88% of the patients in cycle 2 had a 4-week asthma clinic follow-up requested. 75% of patients in cycle 1 were the recipient of ICS on discharge compared with 94% of patients in cycle 2. Conclusion; Our quality improvement project demonstrates the utility of an ANS in improving performance in the management of acute asthma admissions, evidenced here through concordance with NACAP standards. Asthma is a complex condition with biological, psychological, and sociological components; therefore, ANS is a suitable intervention to improve concordance with guidelines. ANS likely impacted performance directly, for example, by checking inhaler technique, and indirectly as a safety net ensuring doctors included ICS on discharge.Keywords: asthma, nurse specialist, clinical audit, quality improvement
Procedia PDF Downloads 379939 Cardiac Pacemaker in a Patient Undergoing Breast Radiotherapy-Multidisciplinary Approach
Authors: B. Petrović, M. Petrović, L. Rutonjski, I. Djan, V. Ivanović
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Objective: Cardiac pacemakers are very sensitive to radiotherapy treatment from two sources: electromagnetic influence from the medical linear accelerator producing ionizing radiation- influencing electronics within the pacemaker, and the absorption of dose to the device. On the other hand, patients with cardiac pacemakers at the place of a tumor are rather rare, and single clinic hardly has experience with the management of such patients. The widely accepted international guidelines for management of radiation oncology patients recommend that these patients should be closely monitored and examined before, during and after radiotherapy treatment by cardiologist, and their device and condition followed up. The number of patients having both cancer and pacemaker, is growing every year, as both cancer incidence, as well as cardiac diseases incidence, are inevitably growing figures. Materials and methods: Female patient, age 69, was diagnozed with valvular cardiomyopathy and got implanted a pacemaker in 2005 and prosthetic mitral valve in 1993 (cancer was diagnosed in 2012). She was stable cardiologically and came to radiation therapy department with the diagnosis of right breast cancer, with the tumor in upper lateral quadrant of the right breast. Since she had all lymph nodes positive (28 in total), she had to have irradiated the supraclavicular region, as well as the breast with the tumor bed. She previously received chemotherapy, approved by the cardiologist. The patient was estimated to be with the high risk as device was within the field of irradiation, and the patient had high dependence on her pacemaker. The radiation therapy plan was conducted as 3D conformal therapy. The delineated target was breast with supraclavicular region, where the pacemaker was actually placed, with the addition of a pacemaker as organ at risk, to estimate the dose to the device and its components as recommended, and the breast. The targets received both 50 Gy in 25 fractions (where 20% of a pacemaker received 50 Gy, and 60% of a device received 40 Gy). The electrode to the heart received between 1 Gy and 50 Gy. Verification of dose planned and delivered was performed. Results: Evaluation of the patient status according to the guidelines and especially evaluation of all associated risks to the patient during treatment was done. Patient was irradiated by prescribed dose and followed up for the whole year, with no symptoms of failure of the pacemaker device during, or after treatment in follow up period. The functionality of a device was estimated to be unchanged, according to the parameters (electrode impedance and battery energy). Conclusion: Patient was closely monitored according to published guidelines during irradiation and afterwards. Pacemaker irradiated with the full dose did not show any signs of failure despite recommendations data, but in correlation with other published data.Keywords: cardiac pacemaker, breast cancer, radiotherapy treatment planning, complications of treatment
Procedia PDF Downloads 438938 Influence of Infrared Radiation on the Growth Rate of Microalgae Chlorella sorokiniana
Authors: Natalia Politaeva, Iuliia Smiatskaia, Iuliia Bazarnova, Iryna Atamaniuk, Kerstin Kuchta
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Nowadays, the progressive decrease of primary natural resources and ongoing upward trend in terms of energy demand, have resulted in development of new generation technological processes which are focused on step-wise production and residues utilization. Thus, microalgae-based 3rd generation bioeconomy is considered one of the most promising approaches that allow production of value-added products and sophisticated utilization of residues biomass. In comparison to conventional biomass, microalgae can be cultivated in wide range of conditions without compromising food and feed production, and thus, addressing issues associated with negative social and environmental impacts. However, one of the most challenging tasks is to undergo seasonal variations and to achieve optimal growing conditions for indoor closed systems that can cover further demand for material and energetic utilization of microalgae. For instance, outdoor cultivation in St. Petersburg (Russia) is only suitable within rather narrow time frame (from mid-May to mid-September). At earlier and later periods, insufficient sunlight and heat for the growth of microalgae were detected. On the other hand, without additional physical effects, the biomass increment in summer is 3-5 times per week, depending on the solar radiation and the ambient temperature. In order to increase biomass production, scientists from all over the world have proposed various technical solutions for cultivators and have been studying the influence of various physical factors affecting biomass growth namely: magnetic field, radiation impact, and electric field, etc. In this paper, the influence of infrared radiation (IR) and fluorescent light on the growth rate of microalgae Chlorella sorokiniana has been studied. The cultivation of Chlorella sorokiniana was carried out in 500 ml cylindrical glass vessels, which were constantly aerated. To accelerate the cultivation process, the mixture was stirred for 15 minutes at 500 rpm following 120 minutes of rest time. At the same time, the metabolic needs in nutrients were provided by the addition of micro- and macro-nutrients in the microalgae growing medium. Lighting was provided by fluorescent lamps with the intensity of 2500 ± 300 lx. The influence of IR was determined using IR lamps with a voltage of 220 V, power of 250 W, in order to achieve the intensity of 13 600 ± 500 lx. The obtained results show that under the influence of fluorescent lamps along with the combined effect of active aeration and variable mixing, the biomass increment on the 2nd day was three times, and on the 7th day, it was eight-fold. The growth rate of microalgae under the influence of IR radiation was lower and has reached 22.6·106 cells·mL-1. However, application of IR lamps for the biomass growth allows maintaining the optimal temperature of microalgae suspension at approximately 25-28°C, which might especially be beneficial during the cold season in extreme climate zones.Keywords: biomass, fluorescent lamp, infrared radiation, microalgae
Procedia PDF Downloads 187937 A Dynamic Model for Circularity Assessment of Nutrient Recovery from Domestic Sewage
Authors: Anurag Bhambhani, Jan Peter Van Der Hoek, Zoran Kapelan
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The food system depends on the availability of Phosphorus (P) and Nitrogen (N). Growing population, depleting Phosphorus reserves and energy-intensive industrial nitrogen fixation are threats to their future availability. Recovering P and N from domestic sewage water offers a solution. Recovered P and N can be applied to agricultural land, replacing virgin P and N. Thus, recovery from sewage water offers a solution befitting a circular economy. To ensure minimum waste and maximum resource efficiency a circularity assessment method is crucial to optimize nutrient flows and minimize losses. Material Circularity Indicator (MCI) is a useful method to quantify the circularity of materials. It was developed for materials that remain within the market and recently extended to include biotic materials that may be composted or used for energy recovery after end-of-use. However, MCI has not been used in the context of nutrient recovery. Besides, MCI is time-static, i.e., it cannot account for dynamic systems such as the terrestrial nutrient cycles. Nutrient application to agricultural land is a highly dynamic process wherein flows and stocks change with time. The rate of recycling of nutrients in nature can depend on numerous factors such as prevailing soil conditions, local hydrology, the presence of animals, etc. Therefore, a dynamic model of nutrient flows with indicators is needed for the circularity assessment. A simple substance flow model of P and N will be developed with the help of flow equations and transfer coefficients that incorporate the nutrient recovery step along with the agricultural application, the volatilization and leaching processes, plant uptake and subsequent animal and human uptake. The model is then used for calculating the proportions of linear and restorative flows (coming from reused/recycled sources). The model will simulate the adsorption process based on the quantity of adsorbent and nutrient concentration in the water. Thereafter, the application of the adsorbed nutrients to agricultural land will be simulated based on adsorbate release kinetics, local soil conditions, hydrology, vegetation, etc. Based on the model, the restorative nutrient flow (returning to the sewage plant following human consumption) will be calculated. The developed methodology will be applied to a case study of resource recovery from wastewater. In the aforementioned case study located in Italy, biochar or zeolite is to be used for recovery of P and N from domestic sewage through adsorption and thereafter, used as a slow-release fertilizer in agriculture. Using this model, information regarding the efficiency of nutrient recovery and application can be generated. This can help to optimize the recovery process and application of the nutrients. Consequently, this will help to optimize nutrient recovery and application and reduce the dependence of the food system on the virgin extraction of P and N.Keywords: circular economy, dynamic substance flow, nutrient cycles, resource recovery from water
Procedia PDF Downloads 197936 Electronic Waste Analysis And Characterization Study: Management Input For Highly Urbanized Cities
Authors: Jilbert Novelero, Oliver Mariano
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In a world where technological evolution and competition to create innovative products are at its peak, problems on Electronic Waste (E-Waste) are now becoming a global concern. E-waste is said to be any electrical or electronic devices that have reached the terminal of its useful life. The major issue are the volume and the raw materials used in crafting E-waste which is non-biodegradable and contains hazardous substances that are toxic to human health and the environment. The objective of this study is to gather baseline data in terms of the composition of E-waste in the solid waste stream and to determine the top 5 E-waste categories in a highly urbanized city. Recommendations in managing these wastes for its reduction were provided which may serve as a guide for acceptance and implementation in the locality. Pasig City was the chosen beneficiary of the research output and through the collaboration of the City Government of Pasig and its Solid Waste Management Office (SWMO); the researcher successfully conducted the Electronic Waste Analysis and Characterization Study (E-WACS) to achieve the objectives. E-WACS that was conducted on April 2019 showed that E-waste ranked 4th which comprises the 10.39% of the overall solid waste volume. Out of 345, 127.24kg which is the total daily domestic waste generation in the city, E-waste covers 35,858.72kg. Moreover, an average of 40 grams was determined to be the E-waste generation per person per day. The top 5 E-waste categories were then classified after the analysis. The category which ranked first is the office and telecommunications equipment that contained the 63.18% of the total generated E-waste. Second in ranking was the household appliances category with 21.13% composition. Third was the lighting devices category with 8.17%. Fourth on ranking was the consumer electronics and batteries category which was composed of 5.97% and fifth was the wires and cables category where it comprised the 1.41% of the average generated E-waste samples. One of the recommendations provided in this research is the implementation of the Pasig City Waste Advantage Card. The card can be used as a privilege card and earned points can be converted to avail of and enjoy services such as haircut, massage, dental services, medical check-up, and etc. Another recommendation raised is for the LGU to encourage a communication or dialogue with the technology and electronics manufacturers and distributors and international and local companies to plan the retrieval and disposal of the E-wastes in accordance with the Extended Producer Responsibility (EPR) policy where producers are given significant responsibilities for the treatment and disposal of post-consumer products.Keywords: E-waste, E-WACS, E-waste characterization, electronic waste, electronic waste analysis
Procedia PDF Downloads 118935 Design of a Small and Medium Enterprise Growth Prediction Model Based on Web Mining
Authors: Yiea Funk Te, Daniel Mueller, Irena Pletikosa Cvijikj
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Small and medium enterprises (SMEs) play an important role in the economy of many countries. When the overall world economy is considered, SMEs represent 95% of all businesses in the world, accounting for 66% of the total employment. Existing studies show that the current business environment is characterized as highly turbulent and strongly influenced by modern information and communication technologies, thus forcing SMEs to experience more severe challenges in maintaining their existence and expanding their business. To support SMEs at improving their competitiveness, researchers recently turned their focus on applying data mining techniques to build risk and growth prediction models. However, data used to assess risk and growth indicators is primarily obtained via questionnaires, which is very laborious and time-consuming, or is provided by financial institutes, thus highly sensitive to privacy issues. Recently, web mining (WM) has emerged as a new approach towards obtaining valuable insights in the business world. WM enables automatic and large scale collection and analysis of potentially valuable data from various online platforms, including companies’ websites. While WM methods have been frequently studied to anticipate growth of sales volume for e-commerce platforms, their application for assessment of SME risk and growth indicators is still scarce. Considering that a vast proportion of SMEs own a website, WM bears a great potential in revealing valuable information hidden in SME websites, which can further be used to understand SME risk and growth indicators, as well as to enhance current SME risk and growth prediction models. This study aims at developing an automated system to collect business-relevant data from the Web and predict future growth trends of SMEs by means of WM and data mining techniques. The envisioned system should serve as an 'early recognition system' for future growth opportunities. In an initial step, we examine how structured and semi-structured Web data in governmental or SME websites can be used to explain the success of SMEs. WM methods are applied to extract Web data in a form of additional input features for the growth prediction model. The data on SMEs provided by a large Swiss insurance company is used as ground truth data (i.e. growth-labeled data) to train the growth prediction model. Different machine learning classification algorithms such as the Support Vector Machine, Random Forest and Artificial Neural Network are applied and compared, with the goal to optimize the prediction performance. The results are compared to those from previous studies, in order to assess the contribution of growth indicators retrieved from the Web for increasing the predictive power of the model.Keywords: data mining, SME growth, success factors, web mining
Procedia PDF Downloads 267934 Identification of Text Domains and Register Variation through the Analysis of Lexical Distribution in a Bangla Mass Media Text Corpus
Authors: Mahul Bhattacharyya, Niladri Sekhar Dash
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The present research paper is an experimental attempt to investigate the nature of variation in the register in three major text domains, namely, social, cultural, and political texts collected from the corpus of Bangla printed mass media texts. This present study uses a corpus of a moderate amount of Bangla mass media text that contains nearly one million words collected from different media sources like newspapers, magazines, advertisements, periodicals, etc. The analysis of corpus data reveals that each text has certain lexical properties that not only control their identity but also mark their uniqueness across the domains. At first, the subject domains of the texts are classified into two parameters namely, ‘Genre' and 'Text Type'. Next, some empirical investigations are made to understand how the domains vary from each other in terms of lexical properties like both function and content words. Here the method of comparative-cum-contrastive matching of lexical load across domains is invoked through word frequency count to track how domain-specific words and terms may be marked as decisive indicators in the act of specifying the textual contexts and subject domains. The study shows that the common lexical stock that percolates across all text domains are quite dicey in nature as their lexicological identity does not have any bearing in the act of specifying subject domains. Therefore, it becomes necessary for language users to anchor upon certain domain-specific lexical items to recognize a text that belongs to a specific text domain. The eventual findings of this study confirm that texts belonging to different subject domains in Bangla news text corpus clearly differ on the parameters of lexical load, lexical choice, lexical clustering, lexical collocation. In fact, based on these parameters, along with some statistical calculations, it is possible to classify mass media texts into different types to mark their relation with regard to the domains they should actually belong. The advantage of this analysis lies in the proper identification of the linguistic factors which will give language users a better insight into the method they employ in text comprehension, as well as construct a systemic frame for designing text identification strategy for language learners. The availability of huge amount of Bangla media text data is useful for achieving accurate conclusions with a certain amount of reliability and authenticity. This kind of corpus-based analysis is quite relevant for a resource-poor language like Bangla, as no attempt has ever been made to understand how the structure and texture of Bangla mass media texts vary due to certain linguistic and extra-linguistic constraints that are actively operational to specific text domains. Since mass media language is assumed to be the most 'recent representation' of the actual use of the language, this study is expected to show how the Bangla news texts reflect the thoughts of the society and how they leave a strong impact on the thought process of the speech community.Keywords: Bangla, corpus, discourse, domains, lexical choice, mass media, register, variation
Procedia PDF Downloads 174933 Wood Energy, Trees outside Forests and Agroforestry Wood Harvesting and Conversion Residues Preparing and Storing
Authors: Adeiza Matthew, Oluwadamilola Abubakar
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Wood energy, also known as wood fuel, is a renewable energy source that is derived from woody biomass, which is organic matter that is harvested from forests, woodlands, and other lands. Woody biomass includes trees, branches, twigs, and other woody debris that can be used as fuel. Wood energy can be classified based on its sources, such as trees outside forests, residues from wood harvesting and conversion, and energy plantations. There are several policy frameworks that support the use of wood energy, including participatory forest management and agroforestry. These policies aim to promote the sustainable use of woody biomass as a source of energy while also protecting forests and wildlife habitats. There are several options for using wood as a fuel, including central heating systems, pellet-based systems, wood chip-based systems, log boilers, fireplaces, and stoves. Each of these options has its own benefits and drawbacks, and the most appropriate option will depend on factors such as the availability of woody biomass, the heating needs of the household or facility, and the local climate. In order to use wood as a fuel, it must be harvested and stored properly. Hardwood or softwood can be used as fuel, and the heating value of firewood depends on the species of tree and the degree of moisture content. Proper harvesting and storage of wood can help to minimize environmental impacts and improve wildlife habitats. The use of wood energy has several environmental impacts, including the release of greenhouse gases during combustion and the potential for air pollution from combustion by-products. However, wood energy can also have positive environmental impacts, such as the sequestration of carbon in trees and the reduction of reliance on fossil fuels. The regulation and legislation of wood energy vary by country and region, and there is an ongoing debate about the potential use of wood energy in renewable energy technologies. Wood energy is a renewable energy source that can be used to generate electricity, heat, and transportation fuels. Woody biomass is abundant and widely available, making it a potentially significant source of energy for many countries. The use of wood energy can create local economic and employment opportunities, particularly in rural areas. Wood energy can be used to reduce reliance on fossil fuels and reduce greenhouse gas emissions. Properly managed forests can provide a sustained supply of woody biomass for energy, helping to reduce the risk of deforestation and habitat loss. Wood energy can be produced using a variety of technologies, including direct combustion, co-firing with fossil fuels, and the production of biofuels. The environmental impacts of wood energy can be minimized through the use of best practices in harvesting, transportation, and processing. Wood energy is regulated and legislated at the national and international levels, and there are various standards and certification systems in place to promote sustainable practices. Wood energy has the potential to play a significant role in the transition to a low-carbon economy and the achievement of climate change mitigation goals.Keywords: biomass, timber, charcoal, firewood
Procedia PDF Downloads 100932 Coordinative Remote Sensing Observation Technology for a High Altitude Barrier Lake
Authors: Zhang Xin
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Barrier lakes are lakes formed by storing water in valleys, river valleys or riverbeds after being blocked by landslide, earthquake, debris flow, and other factors. They have great potential safety hazards. When the water is stored to a certain extent, it may burst in case of strong earthquake or rainstorm, and the lake water overflows, resulting in large-scale flood disasters. In order to ensure the safety of people's lives and property in the downstream, it is very necessary to monitor the barrier lake. However, it is very difficult and time-consuming to manually monitor the barrier lake in high altitude areas due to the harsh climate and steep terrain. With the development of earth observation technology, remote sensing monitoring has become one of the main ways to obtain observation data. Compared with a single satellite, multi-satellite remote sensing cooperative observation has more advantages; its spatial coverage is extensive, observation time is continuous, imaging types and bands are abundant, it can monitor and respond quickly to emergencies, and complete complex monitoring tasks. Monitoring with multi-temporal and multi-platform remote sensing satellites can obtain a variety of observation data in time, acquire key information such as water level and water storage capacity of the barrier lake, scientifically judge the situation of the barrier lake and reasonably predict its future development trend. In this study, The Sarez Lake, which formed on February 18, 1911, in the central part of the Pamir as a result of blockage of the Murgab River valley by a landslide triggered by a strong earthquake with magnitude of 7.4 and intensity of 9, is selected as the research area. Since the formation of Lake Sarez, it has aroused widespread international concern about its safety. At present, the use of mechanical methods in the international analysis of the safety of Lake Sarez is more common, and remote sensing methods are seldom used. This study combines remote sensing data with field observation data, and uses the 'space-air-ground' joint observation technology to study the changes in water level and water storage capacity of Lake Sarez in recent decades, and evaluate its safety. The situation of the collapse is simulated, and the future development trend of Lake Sarez is predicted. The results show that: 1) in recent decades, the water level of Lake Sarez has not changed much and remained at a stable level; 2) unless there is a strong earthquake or heavy rain, it is less likely that the Lake Sarez will be broken under normal conditions, 3) lake Sarez will remain stable in the future, but it is necessary to establish an early warning system in the Lake Sarez area for remote sensing of the area, 4) the coordinative remote sensing observation technology is feasible for the high altitude barrier lake of Sarez.Keywords: coordinative observation, disaster, remote sensing, geographic information system, GIS
Procedia PDF Downloads 127931 Waste Burial to the Pressure Deficit Areas in the Eastern Siberia
Authors: L. Abukova, O. Abramova, A. Goreva, Y. Yakovlev
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Important executive decisions on oil and gas production stimulation in Eastern Siberia have been recently taken. There are unique and large fields of oil, gas, and gas-condensate in Eastern Siberia. The Talakan, Koyumbinskoye, Yurubcheno-Tahomskoye, Kovykta, Chayadinskoye fields are supposed to be developed first. It will result in an abrupt increase in environmental load on the nature of Eastern Siberia. In Eastern Siberia, the introduction of ecological imperatives in hydrocarbon production is still realistic. Underground water movement is the one of the most important factors of the ecosystems condition management. Oil and gas production is associated with the forced displacement of huge water masses, mixing waters of different composition, and origin that determines the extent of anthropogenic impact on water drive systems and their protective reaction. An extensive hydrogeological system of the depression type is identified in the pre-salt deposits here. Pressure relieve here is steady up to the basement. The decrease of the hydrodynamic potential towards the basement with such a gradient resulted in reformation of the fields in process of historical (geological) development of the Nepsko-Botuobinskaya anteclise. The depression hydrodynamic systems are characterized by extremely high isolation and can only exist under such closed conditions. A steady nature of water movement due to a strictly negative gradient of reservoir pressure makes it quite possible to use environmentally-harmful liquid substances instead of water. Disposal of the most hazardous wastes is the most expedient in the deposits of the crystalline basement in certain structures distant from oil and gas fields. The time period for storage of environmentally-harmful liquid substances may be calculated by means of the geological time scales ensuring their complete prevention from releasing into environment or air even during strong earthquakes. Disposal of wastes of chemical and nuclear industries is a matter of special consideration. The existing methods of storage and disposal of wastes are very expensive. The methods applied at the moment for storage of nuclear wastes at the depth of several meters, even in the most durable containers, constitute a potential danger. The enormous size of the depression system of the Nepsko-Botuobinskaya anteclise makes it possible to easily identify such objects at the depth below 1500 m where nuclear wastes will be stored indefinitely without any environmental impact. Thus, the water drive system of the Nepsko-Botuobinskaya anteclise is the ideal object for large-volume injection of environmentally harmful liquid substances even if there are large oil and gas accumulations in the subsurface. Specific geological and hydrodynamic conditions of the system allow the production of hydrocarbons from the subsurface simultaneously with the disposal of industrial wastes of oil and gas, mining, chemical, and nuclear industries without any environmental impact.Keywords: Eastern Siberia, formation pressure, underground water, waste burial
Procedia PDF Downloads 259930 An Exploratory Study of Changing Organisational Practices of Third-Sector Organisations in Mandated Corporate Social Responsibility in India
Authors: Avadh Bihari
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Corporate social responsibility (CSR) has become a global parameter to define corporates' ethical and responsible behaviour. It was a voluntary practice in India till 2013, driven by various guidelines, which has become a mandate since 2014 under the Companies Act, 2013. This has compelled the corporates to redesign their CSR strategies by bringing in structures, planning, accountability, and transparency in their processes with a mandate to 'comply or explain'. Based on the author's M.Phil. dissertation, this paper presents the changes in organisational practices and institutional mechanisms of third-sector organisations (TSOs) with the theoretical frameworks of institutionalism and co-optation. It became an interesting case as India is the only country to have a law on CSR, which is not only mandating the reporting but the spending too. The space of CSR in India is changing rapidly and affecting multiple institutions, in the context of the changing roles of the state, market, and TSOs. Several factors such as stringent regulation on foreign funding, mandatory CSR pushing corporates to look out for NGOs, and dependency of Indian NGOs on CSR funds have come to the fore almost simultaneously, which made it an important area of study. Further, the paper aims at addressing the gap in the literature on the effects of mandated CSR on the functioning of TSOs through the empirical and theoretical findings of this study. The author had adopted an interpretivist position in this study to explore changes in organisational practices from the participants' experiences. Data were collected through in-depth interviews with five corporate officials, eleven officials from six TSOs, and two academicians, located at Mumbai and Delhi, India. The findings of this study show the legislation has institutionalised CSR, and TSOs get co-opted in the process of implementing mandated CSR. Seventy percent of the corporates implement their CSR projects through TSOs in India; this has affected the organisational practices of TSOs to a large extent. They are compelled to recruit expert workforce, create new departments for monitoring & evaluation, communications, and adopt management practices of project implementation from corporates. These are attempts to institutionalise the TSOs so that they can produce calculated results as demanded by corporates. In this process, TSOs get co-opted in a struggle to secure funds and lose their autonomy. The normative, coercive, and mimetic isomorphisms of institutionalism come into play as corporates are mandated to take up CSR, thereby influencing the organisational practices of TSOs. These results suggest that corporates and TSOs require an understanding of each other's work culture to develop mutual respect and work towards the goal of sustainable development of the communities. Further, TSOs need to retain their autonomy and understanding of ground realities without which they become an extension of the corporate-funder. For a successful CSR project, engagement beyond funding is required from corporate, through their involvement and not interference. CSR-led community development can be structured by management practices to an extent, but cannot overshadow the knowledge and experience of TSOs.Keywords: corporate social responsibility, institutionalism, organisational practices, third-sector organisations
Procedia PDF Downloads 114929 Frequency of Surgical Complications in Diabetic Patients after Kidney Transplantation
Authors: Hakan Duger, Alparslan Ersoy, Canan Ersoy
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The improvement of surgical techniques in recent years has reduced the frequency of postoperative complications in kidney transplant recipients. Novel immunosuppressive agents have reduced rates of graft loss due to acute rejection to less than 1%. However, surgical complications may still lead graft loss and morbidity in recipients. Because of potent immunosuppression, impaired wound healing and complications are frequent after transplantation. We compared the frequency of post-operative surgical complications in diabetic and non-diabetic patients after kidney transplantation. Materials and Methods: This retrospective study conducted in consecutive patients (213 females, 285 males, median age 39 years) who underwent kidney transplant surgery at our center between December 2005 and October 2015. The patients were divided into two groups: diabetics (46 ± 10 year, 26 males, 16 females) and non-diabetics (39 ± 12 year, 259 males, 197 females). Characteristics of both groups were obtained from medical records. Results: We performed 225 living and 273 deceased donor transplantations. Renal replacement type was hemodialysis in 60.8%, peritoneal dialysis in 17.3% and preemptive in 12%. The mean body mass indexes of the recipients were 24 ± 4.6 kg/m², donor age was 48.6 ± 14.3 years, cold ischemic time was 11.3 ± 6.1 hours, surgery time was 4.9 ± 1.2 hours, and recovery time was 54±31 min. The mean hospitalization duration was 19.1 ± 13.5 days. The frequency of postoperative surgical complications was 43.8%. There was no significant difference between the ratios of post-operative surgical complications in non-diabetic (43.5%) and diabetic (47.4%) groups (p=0.648). Post-operative surgical complications were lymphocele (24.6% vs. 23.7%), delayed wound healing (13.2% vs. 7.6%), hematoma (7.8% vs.15.8 %), urinary leak (4.6% vs. 5.3%), hemorrhage (5.1% vs. 0%), hydronephrosis (2.2% vs. 0%), renal artery thrombosis (1.5% vs. 0%), renal vein thrombosis (1% vs. 2.6%), urinoma (0.7% vs. 0%), urinary obstruction (0.5% vs. 0%), ureteral stenosis (0.5% vs. 0%) and ureteral reflux (0.2% vs. 0%) in non-diabetic and diabetic groups, respectively (p > 0.05). Mean serum creatinine levels in non-diabetics and diabetics were 1.43 ± 0.81 and 1.61 ± 0.96 mg/dL at 1st month (p=0.198). At the 6th month, the mean graft and patient survival times in patients with post-operative surgical complications were significantly lower than in those who did not (162.9 ± 3.4 vs. 175.6 ± 1.5 days, p=0.008, and 171 ± 2.9 vs. 176.1 ± 1.6 days, p=0.047, respectively). However, patient survival durations of non-diabetic (173 ± 27) and diabetic (177 ± 13 day) groups were comparable (p=0.396). Conclusion: As a result, we concluded that surgical complications such as lymphocele and delayed wound healing were common and that frequency of these complications in diabetic recipients did not differ from non-diabetic one. All persons involved in the postoperative care of kidney transplant recipients be aware of the potential surgical complications for rapid diagnosis and treatment.Keywords: kidney transplantation, diabetes mellitus, surgery, complication
Procedia PDF Downloads 178928 The Dynamics of a Droplet Spreading on a Steel Surface
Authors: Evgeniya Orlova, Dmitriy Feoktistov, Geniy Kuznetsov
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Spreading of a droplet over a solid substrate is a key phenomenon observed in the following engineering applications: thin film coating, oil extraction, inkjet printing, and spray cooling of heated surfaces. Droplet cooling systems are known to be more effective than film or rivulet cooling systems. It is caused by the greater evaporation surface area of droplets compared with the film of the same mass and wetting surface. And the greater surface area of droplets is connected with the curvature of the interface. Location of the droplets on the cooling surface influences on the heat transfer conditions. The close distance between the droplets provides intensive heat removal, but there is a possibility of their coalescence in the liquid film. The long distance leads to overheating of the local areas of the cooling surface and the occurrence of thermal stresses. To control the location of droplets is possible by changing the roughness, structure and chemical composition of the surface. Thus, control of spreading can be implemented. The most important characteristic of spreading of droplets on solid surfaces is a dynamic contact angle, which is a function of the contact line speed or capillary number. However, there is currently no universal equation, which would describe the relationship between these parameters. This paper presents the results of the experimental studies of water droplet spreading on metal substrates with different surface roughness. The effect of the droplet growth rate and the surface roughness on spreading characteristics was studied at low capillary numbers. The shadow method using high speed video cameras recording up to 10,000 frames per seconds was implemented. A droplet profile was analyzed by Axisymmetric Drop Shape Analyses techniques. According to change of the dynamic contact angle and the contact line speed three sequential spreading stages were observed: rapid increase in the dynamic contact angle; monotonous decrease in the contact angle and the contact line speed; and form of the equilibrium contact angle at constant contact line. At low droplet growth rate, the dynamic contact angle of the droplet spreading on the surfaces with the maximum roughness is found to increase throughout the spreading time. It is due to the fact that the friction force on such surfaces is significantly greater than the inertia force; and the contact line is pinned on microasperities of a relief. At high droplet growth rate the contact angle decreases during the second stage even on the surfaces with the maximum roughness, as in this case, the liquid does not fill the microcavities, and the droplet moves over the “air cushion”, i.e. the interface is a liquid/gas/solid system. Also at such growth rates pulsation of liquid flow was detected; and the droplet oscillates during the spreading. Thus, obtained results allow to conclude that it is possible to control spreading by using the surface roughness and the growth rate of droplets on surfaces as varied factors. Also, the research findings may be used for analyzing heat transfer in rivulet and drop cooling systems of high energy equipment.Keywords: contact line speed, droplet growth rate, dynamic contact angle, shadow system, spreading
Procedia PDF Downloads 330927 Decision-Making Process Based on Game Theory in the Process of Urban Transformation
Authors: Cemil Akcay, Goksun Yerlikaya
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Buildings are the living spaces of people with an active role in every aspect of life in today's world. While some structures have survived from the early ages, most of the buildings that completed their lifetime have not transported to the present day. Nowadays, buildings that do not meet the social, economic, and safety requirements of the age return to life with a transformation process. This transformation is called urban transformation. Urban transformation is the renewal of the areas with a risk of disaster and the technological infrastructure required by the structure. The transformation aims to prevent damage to earthquakes and other disasters by rebuilding buildings that have completed their non-earthquake-resistant economic life. It is essential to decide on other issues related to conversion and transformation in places where most of the building stock should transform into the first-degree earthquake belt, such as Istanbul. In urban transformation, property owners, local authority, and contractor must deal at a common point. Considering that hundreds of thousands of property owners are sometimes in the areas of transformation, it is evident how difficult it is to make the deal and decide. For the optimization of these decisions, the use of game theory is foreseeing. The main problem in this study is that the urban transformation is carried out in place, or the building or buildings are transport to a different location. There are many stakeholders in the Istanbul University Cerrahpaşa Medical Faculty Campus, which is planned to be carried out in the process of urban transformation, was tried to solve the game theory applications. An analysis of the decisions given on a real urban transformation project and the logical suitability of decisions taken without the use of game theory were also supervised using game theory. In each step of this study, many decision-makers are classifying according to a specific logical sequence, and in the game trees that emerged as a result of this classification, Nash balances were tried to observe, and optimum decisions were determined. All decisions taken for this project have been subjected to two significant differentiated comparisons using game theory, and as decisions are taken without the use of game theory, and according to the results, solutions for the decision phase of the urban transformation process introduced. The game theory model developed from beginning to the end of the urban transformation process, particularly as a solution to the difficulty of making rational decisions in large-scale projects with many participants in the decision-making process. The use of a decision-making mechanism can provide an optimum answer to the demands of the stakeholders. In today's world for the construction sector, it is also seeing that the game theory is a non-surprising consequence of the fact that it is the most critical issues of planning and making the right decision in future years.Keywords: urban transformation, the game theory, decision making, multi-actor project
Procedia PDF Downloads 140926 To Compare Norepinephrine and Norepinephrine with Methylene Blue for the Management of Septic Shock
Authors: K. Rajarajeswaran, Krishna Prasad
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Introduction: Refractory shock is a typical consequence of sepsis that does not improve with standard vasopressor therapy. A possible adjuvant therapeutic option for treating refractory shock in sepsis is methylene blue. This study looked at the effects of intravenous methylene blue plus norepinephrine given as a single bolus infusion on mortality and hemodynamic improvement in patients suffering from refractory shock. Methodology: This six-month observational prospective study was carried out at an intensive care unit, teaching hospital, and medical college. It involved 112 patients who had been diagnosed with refractory septic shock and needed vasopressor medication. Group B received injection norepinephrine 0.01 µg/kg/min infusion alone, while Group A received injection methylene blue 2 mg/kg iv single bolus (fixed dose) in addition to injection norepinephrine 0.01 µg/kg/min infusion. Both groups' noradrenaline doses were titrated to reach the desired MAP of 60–75 mm Hg. The amount of norepinephrine needed to sustain a MAP of more than 60 mm Hg was the data gathered. Serum lactate, procalcitonin level, C-reactive protein, length of stay in the intensive care unit (ICU), sequential organ failure assessment (SOFA) score, and duration of mechanical ventilation, incidence of acute kidney injury (AKI), and mortality were compared. Results: A total of 112 patients with refractory shock were included in the study. With the use of IV methylene blue, 36 (59.3%) patients showed significant improvement in MAP within 2 hours (77.12 ± 8.90 vs 74.28 ± 21.84, p = 0.005). Responders were 4.009 times more likely to have vasopressor-free time within 24 hours (19.5% vs 6.1%, p = 0.022, odds ratio 5.017, 95% confidence interval, 1.110–14.283). The serum lactate was lower, and urine output was higher in group I than in group II (p <0.05). Group I had a significantly greater reduction in SOFA score in 12 hours than group II. However, there was no significant difference in terms of mortality, length of ICU stay, ventilator free days, and incidence of AKI. In the responder group, there was a significant increase in the MAP and decrease in vasopressor requirement pre- and post-infusion of methylene blue (p < 0.05). Responder had shorter vasopressor-free days as compared with non-responder (5.44 vs 6.99, p = 0.007). Conclusion: When administered as adjuvant therapy, a single-dose bolus infusion of Methylene Blue plus Norepinephrine may aid in meeting early resuscitation goals for the management of patients with septic shock. But the patients' death rate, ICU stay duration, ventilator-free days, or incidence of AKI were unchanged.Keywords: norepinephrine, methylene blue, shock, vasopressor
Procedia PDF Downloads 18925 Recovering Trust in Institutions through Networked Governance: An Analytical Approach via the Study of the Provincial Government of Gipuzkoa
Authors: Xabier Barandiaran, Igone Guerra
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The economic and financial crisis that hit European countries in 2008 revealed the inability of governments to respond unilaterally to the so-called “wicked” problems that affect our societies. Closely linked to this, the increasing disaffection of citizens towards politics has resulted in growing distrust of the citizenry not only in the institutions in general but also in the political system, in particular. Precisely, these two factors provoked the action of the local government of Gipuzkoa (Basque Country) to move from old ways of “doing politics” to a new way of “thinking politics” based on a collaborative approach, in which innovative modes of public decision making are prominent. In this context, in 2015, the initiative Etorkizuna Eraikiz (Building the Future), a contemporary form of networked governance, was launched by the Provincial Government. The paper focuses on the Etorkizuna Eraikiz initiative, a sound commitment from a local government to build jointly with the citizens the future of the territory. This paper will present preliminary results obtained from three different experiences of co-creation developed within Etorkizuna Eraikiz in which the formulation of networked governance is a mandatory pre-requisite. These experiences show how the network building approach among the different agents of the territory as well as the co-creation of public policies is the cornerstone of this challenging mission. Through the analysis of the information and documentation gathered during the four years of Etorkizuna-Eraikiz, and, specifically by delving into the strategy promoted by the initiative, some emerging analytical conclusions resulting from the promotion of this collaborative culture will be presented. For example, some preliminary results have shown a significant positive relationship between shared leadership and the formulation of the public good. In the period 2016-2018, a total of 73 projects were launched and funding by the Provincial Government of Gipuzkoa within the Etorkizuna Eraikiz initiative, that indicates greater engagement of the citizenry in the process of policy-making and therefore improving, somehow, the quality of the public policies. These statements have been supported by the last survey about the perspectives of the citizens toward politics and policies. Some of the more prominent results show us that there is still a high level of distrust in Politics (78,9% of respondents) but a greater trust in institutions such the Political Government of Gipuzkoa (40,8% of respondents declared as “good” the performance of this provincial institution). Regarding the Etorkizuna Eraikiz Initiative, it is being more readily recognized by citizens over this period of time (25,4% of the respondents in June 2018 agreed to know about the initiative giving it a mark of 5,89 ) and thus build trust and a sense of ownership. Although, there is a clear requirement for further research on the linkages between collaborative governance and level of trust, the paper, based on these findings, will provide some managerial and theoretical implications for collaborative governance in the territory.Keywords: network governance, collaborative governance, public sector innovation, citizen participation, trust
Procedia PDF Downloads 122924 Multicultural Education in the National Context: A Study of Peoples' Friendship University of Russia
Authors: Maria V. Mishatkina
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The modelling of dialogical environment is an essential feature of modern education. The dialogue of cultures is a foundation and an important prerequisite for a formation of a human’s main moral qualities such as an ability to understand another person, which is manifested in such values as tolerance, respect, mutual assistance and mercy. A formation of a modern expert occurs in an educational environment that is significantly different from what we had several years ago. Nowadays university education has qualitatively new characteristics. They may be observed in Peoples’ Friendship University of Russia (RUDN University), a top Russian higher education institution which unites representatives of more than 150 countries. The content of its educational strategies is not an adapted cultural experience but material between science and innovation. Besides, RUDN University’s profiles and specialization are not equal to the professional structures. People study not a profession in a strict sense but a basic scientific foundation of an activity in different socio-cultural areas (science, business and education). RUDN University also provides a considerable unit of professional education components. They are foreign languages skills, economic, political, ethnic, communication and computer culture, theory of information and basic management skills. Moreover, there is a rich social life (festive multicultural events, theme parties, journeys) and prospects concerning the inclusive approach to education (for example, a special course ‘Social Pedagogy: Issues of Tolerance’). In our research, we use such methods as analysis of modern and contemporary scientific literature, opinion poll (involving students, teachers and research workers) and comparative data analysis. We came to the conclusion that knowledge transfer of RUDN student in the activity happens through making goals, problems, issues, tasks and situations which simulate future innovative ambiguous environment that potentially prepares him/her to dialogical way of life. However, all these factors may not take effect if there is no ‘personal inspiration’ of students by communicative and dialogic values, their participation in a system of meanings and tools of learning activity that is represented by cooperation within the framework of scientific and pedagogical schools dialogue. We also found out that dominating strategies of ensuring the quality of education are those that put students in the position of the subject of their own education. Today these strategies and approaches should involve such approaches and methods as task, contextual, modelling, specialized, game-imitating and dialogical approaches, the method of practical situations, etc. Therefore, University in the modern sense is not only an educational institution, but also a generator of innovation, cooperation among nations and cultural progress. RUDN University has been performing exactly this mission for many decades.Keywords: dialogical developing situation, dialogue of cultures, readiness for dialogue, university graduate
Procedia PDF Downloads 220923 Comparison of Non-destructive Devices to Quantify the Moisture Content of Bio-Based Insulation Materials on Construction Sites
Authors: Léa Caban, Lucile Soudani, Julien Berger, Armelle Nouviaire, Emilio Bastidas-Arteaga
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Improvement of the thermal performance of buildings is a high concern for the construction industry. With the increase in environmental issues, new types of construction materials are being developed. These include bio-based insulation materials. They capture carbon dioxide, can be produced locally, and have good thermal performance. However, their behavior with respect to moisture transfer is still facing some issues. With a high porosity, the mass transfer is more important in those materials than in mineral insulation ones. Therefore, they can be more sensitive to moisture disorders such as mold growth, condensation risks or decrease of the wall energy efficiency. For this reason, the initial moisture content on the construction site is a piece of crucial knowledge. Measuring moisture content in a laboratory is a mastered task. Diverse methods exist but the easiest and the reference one is gravimetric. A material is weighed dry and wet, and its moisture content is mathematically deduced. Non-destructive methods (NDT) are promising tools to determine in an easy and fast way the moisture content in a laboratory or on construction sites. However, the quality and reliability of the measures are influenced by several factors. Classical NDT portable devices usable on-site measure the capacity or the resistivity of materials. Water’s electrical properties are very different from those of construction materials, which is why the water content can be deduced from these measurements. However, most moisture meters are made to measure wooden materials, and some of them can be adapted for construction materials with calibration curves. Anyway, these devices are almost never calibrated for insulation materials. The main objective of this study is to determine the reliability of moisture meters in the measurement of biobased insulation materials. The determination of which one of the capacitive or resistive methods is the most accurate and which device gives the best result is made. Several biobased insulation materials are tested. Recycled cotton, two types of wood fibers of different densities (53 and 158 kg/m3) and a mix of linen, cotton, and hemp. It seems important to assess the behavior of a mineral material, so glass wool is also measured. An experimental campaign is performed in a laboratory. A gravimetric measurement of the materials is carried out for every level of moisture content. These levels are set using a climatic chamber and by setting the relative humidity level for a constant temperature. The mass-based moisture contents measured are considered as references values, and the results given by moisture meters are compared to them. A complete analysis of the uncertainty measurement is also done. These results are used to analyze the reliability of moisture meters depending on the materials and their water content. This makes it possible to determine whether the moisture meters are reliable, and which one is the most accurate. It will then be used for future measurements on construction sites to assess the initial hygrothermal state of insulation materials, on both new-build and renovation projects.Keywords: capacitance method, electrical resistance method, insulation materials, moisture transfer, non-destructive testing
Procedia PDF Downloads 124922 Evaluation of Trabectedin Safety and Effectiveness at a Tertiary Cancer Center at Qatar: A Retrospective Analysis
Authors: Nabil Omar, Farah Jibril, Oraib Amjad
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Purpose: Trabecatine is a is a potent marine-derived antineoplastic drug which binds to the minor groove of the DNA, bending DNA towards the major groove resulting in a changed conformation that interferes with several DNA transcription factors, repair pathways and cell proliferation. Trabectedin was approved by the European Medicines Agency (EMA; London, UK) for the treatment of adult patients with advanced stage soft tissue sarcomas in whom treatment with anthracyclines and ifosfamide has failed, or for those who are not candidates for these therapies. The recommended dosing regimen is 1.5 mg/m2 IV over 24 hours every 3 weeks. The purpose of this study was to comprehensively review available data on the safety and efficacy of trabectedin used as indicated for patients at a Tertiary Cancer Center at Qatar. Methods: A medication administration report generated in the electronic health record identified all patients who received trabectedin between November 1, 2015 and November 1, 2017. This retrospective chart review evaluated the indication of trabectedin use, compliance to administration protocol and the recommended monitoring parameters, number of patients improved on the drug and continued treatment, number of patients discontinued treatment due to side-effects and the reported side effects. Progress and discharged notes were utilized to report experienced side effects during trabectedin therapy. A total of 3 patients were reviewed. Results: Total of 2 out of 3 patients who received trabectedin were receiving it for non-FDA and non-EMA, approved indications; metastatic rhabdomyosarcoma and ovarian cancer stage IV with poor prognosis. And only one patient received it as indicated for leiomyosarcoma of left ureter with metastases to liver, lungs and bone. None of the patients has continued the therapy due to development of serious side effects. One patient had stopped the medication after one cycle due to disease progression and transient hepatic toxicity, the other one had disease progression and developed 12 % reduction in LVEF after 12 cycles of trabectedin, and the third patient deceased, had disease progression on trabectedin after the 10th cycle that was received through peripheral line which resulted in developing extravasation and left arm cellulitis requiring debridement. Regarding monitoring parameters, at baseline the three patients had ECHO, and Creatine Phosphokinase (CPK) but it was not monitored during treatment as recommended. Conclusion: Utilizing this medication as indicated with performing the appropriate monitoring parameters as recommended can benefit patients who are receiving it. It is important to reinforce the intravenous administration via central intravenous line, the re-assessment of left ventricular ejection fraction (LVEF) by echocardiogram or multigated acquisition (MUGA) scan at 2- to 3-month intervals thereafter until therapy is discontinued, and CPK and LFTs levels prior to each administration of trabectedin.Keywords: trabectedin, drug-use evaluation, safety, effectiveness, adverse drug reaction, monitoring
Procedia PDF Downloads 143921 Customer Focus in Digital Economy: Case of Russian Companies
Authors: Maria Evnevich
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In modern conditions, in most markets, price competition is becoming less effective. On the one hand, there is a gradual decrease in the level of marginality in main traditional sectors of the economy, so further price reduction becomes too ‘expensive’ for the company. On the other hand, the effect of price reduction is leveled, and the reason for this phenomenon is likely to be informational. As a result, it turns out that even if the company reduces prices, making its products more accessible to the buyer, there is a high probability that this will not lead to increase in sales unless additional large-scale advertising and information campaigns are conducted. Similarly, a large-scale information and advertising campaign have a much greater effect itself than price reductions. At the same time, the cost of mass informing is growing every year, especially when using the main information channels. The article presents generalization, systematization and development of theoretical approaches and best practices in the field of customer focus approach to business management and in the field of relationship marketing in the modern digital economy. The research methodology is based on the synthesis and content-analysis of sociological and marketing research and on the study of the systems of working with consumer appeals and loyalty programs in the 50 largest client-oriented companies in Russia. Also, the analysis of internal documentation on customers’ purchases in one of the largest retail companies in Russia allowed to identify if buyers prefer to buy goods for complex purchases in one retail store with the best price image for them. The cost of attracting a new client is now quite high and continues to grow, so it becomes more important to keep him and increase the involvement through marketing tools. A huge role is played by modern digital technologies used both in advertising (e-mailing, SEO, contextual advertising, banner advertising, SMM, etc.) and in service. To implement the above-described client-oriented omnichannel service, it is necessary to identify the client and work with personal data provided when filling in the loyalty program application form. The analysis of loyalty programs of 50 companies identified the following types of cards: discount cards, bonus cards, mixed cards, coalition loyalty cards, bank loyalty programs, aviation loyalty programs, hybrid loyalty cards, situational loyalty cards. The use of loyalty cards allows not only to stimulate the customer to purchase ‘untargeted’, but also to provide individualized offers, as well as to produce more targeted information. The development of digital technologies and modern means of communication has significantly changed not only the sphere of marketing and promotion, but also the economic landscape as a whole. Factors of competitiveness are the digital opportunities of companies in the field of customer orientation: personalization of service, customization of advertising offers, optimization of marketing activity and improvement of logistics.Keywords: customer focus, digital economy, loyalty program, relationship marketing
Procedia PDF Downloads 163920 Pioneering Conservation of Aquatic Ecosystems under Australian Law
Authors: Gina M. Newton
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Australia’s Environment Protection and Biodiversity Conservation Act (EPBC Act) is the premiere, national law under which species and 'ecological communities' (i.e., like ecosystems) can be formally recognised and 'listed' as threatened across all jurisdictions. The listing process involves assessment against a range of criteria (similar to the IUCN process) to demonstrate conservation status (i.e., vulnerable, endangered, critically endangered, etc.) based on the best available science. Over the past decade in Australia, there’s been a transition from almost solely terrestrial to the first aquatic threatened ecological community (TEC or ecosystem) listings (e.g., River Murray, Macquarie Marshes, Coastal Saltmarsh, Salt-wedge Estuaries). All constitute large areas, with some including multiple state jurisdictions. Development of these conservation and listing advices has enabled, for the first time, a more forensic analysis of three key factors across a range of aquatic and coastal ecosystems: -the contribution of invasive species to conservation status, -how to demonstrate and attribute decline in 'ecological integrity' to conservation status, and, -identification of related priority conservation actions for management. There is increasing global recognition of the disproportionate degree of biodiversity loss within aquatic ecosystems. In Australia, legislative protection at Commonwealth or State levels remains one of the strongest conservation measures. Such laws have associated compliance mechanisms for breaches to the protected status. They also trigger the need for environment impact statements during applications for major developments (which may be denied). However, not all jurisdictions have such laws in place. There remains much opposition to the listing of freshwater systems – for example, the River Murray (Australia's largest river) and Macquarie Marshes (an internationally significant wetland) were both disallowed by parliament four months after formal listing. This was mainly due to a change of government, dissent from a major industry sector, and a 'loophole' in the law. In Australia, at least in the immediate to medium-term time frames, invasive species (aliens, native pests, pathogens, etc.) appear to be the number one biotic threat to the biodiversity and ecological function and integrity of our aquatic ecosystems. Consequently, this should be considered a current priority for research, conservation, and management actions. Another key outcome from this analysis was the recognition that drawing together multiple lines of evidence to form a 'conservation narrative' is a more useful approach to assigning conservation status. This also helps to addresses a glaring gap in long-term ecological data sets in Australia, which often precludes a more empirical data-driven approach. An important lesson also emerged – the recognition that while conservation must be underpinned by the best available scientific evidence, it remains a 'social and policy' goal rather than a 'scientific' goal. Communication, engagement, and 'politics' necessarily play a significant role in achieving conservation goals and need to be managed and resourced accordingly.Keywords: aquatic ecosystem conservation, conservation law, ecological integrity, invasive species
Procedia PDF Downloads 132919 Steel Concrete Composite Bridge: Modelling Approach and Analysis
Authors: Kaviyarasan D., Satish Kumar S. R.
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India being vast in area and population with great scope of international business, roadways and railways network connection within the country is expected to have a big growth. There are numerous rail-cum-road bridges constructed across many major rivers in India and few are getting very old. So there is more possibility of repairing or coming up with such new bridges in India. Analysis and design of such bridges are practiced through conventional procedure and end up with heavy and uneconomical sections. Such heavy class steel bridges when subjected to high seismic shaking has more chance to fail by stability because the members are too much rigid and stocky rather than being flexible to dissipate the energy. This work is the collective study of the researches done in the truss bridge and steel concrete composite truss bridges presenting the method of analysis, tools for numerical and analytical modeling which evaluates its seismic behaviour and collapse mechanisms. To ascertain the inelastic and nonlinear behaviour of the structure, generally at research level static pushover analysis is adopted. Though the static pushover analysis is now extensively used for the framed steel and concrete buildings to study its lateral action behaviour, those findings by pushover analysis done for the buildings cannot directly be used for the bridges as such, because the bridges have completely a different performance requirement, behaviour and typology as compared to that of the buildings. Long span steel bridges are mostly the truss bridges. Truss bridges being formed by many members and connections, the failure of the system does not happen suddenly with single event or failure of one member. Failure usually initiates from one member and progresses gradually to the next member and so on when subjected to further loading. This kind of progressive collapse of the truss bridge structure is dependent on many factors, in which the live load distribution and span to length ratio are most significant. The ultimate collapse is anyhow by the buckling of the compression members only. For regular bridges, single step pushover analysis gives results closer to that of the non-linear dynamic analysis. But for a complicated bridge like heavy class steel bridge or the skewed bridges or complicated dynamic behaviour bridges, nonlinear analysis capturing the progressive yielding and collapse pattern is mandatory. With the knowledge of the postelastic behaviour of the bridge and advancements in the computational facility, the current level of analysis and design of bridges has moved to state of ascertaining the performance levels of the bridges based on the damage caused by seismic shaking. This is because the buildings performance levels deals much with the life safety and collapse prevention levels, whereas the bridges mostly deal with the extent damages and how quick it can be repaired with or without disturbing the traffic after a strong earthquake event. The paper would compile the wide spectrum of modeling to analysis of the steel concrete composite truss bridges in general.Keywords: bridge engineering, performance based design of steel truss bridge, seismic design of composite bridge, steel-concrete composite bridge
Procedia PDF Downloads 185918 Clinicians' and Nurses' Documentation Practices in Palliative and Hospice Care: A Mixed Methods Study Providing Evidence for Quality Improvement at Mobile Hospice Mbarara, Uganda
Authors: G. Natuhwera, M. Rabwoni, P. Ellis, A. Merriman
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Aims: Health workers are likely to document patients’ care inaccurately, especially when using new and revised case tools, and this could negatively impact patient care. This study set out to; (1) assess nurses’ and clinicians’ documentation practices when using a new patients’ continuation case sheet (PCCS) and (2) explore nurses’ and clinicians’ experiences regarding documentation of patients’ information in the new PCCS. The purpose of introducing the PCCS was to improve continuity of care for patients attending clinics at which they were unlikely to see the same clinician or nurse consistently. Methods: This was a mixed methods study. The cross-sectional inquiry retrospectively reviewed 100 case notes of active patients on hospice and palliative care program. Data was collected using a structured questionnaire with constructs formulated from the new PCCS under study. The qualitative element was face-to-face audio-recorded, open-ended interviews with a purposive sample of one palliative care clinician, and four palliative care nurse specialists. Thematic analysis was used. Results: Missing patients’ biogeographic information was prevalent at 5-10%. Spiritual and psychosocial issues were not documented in 42.6%, and vital signs in 49.2%. Poorest documentation practices were observed in past medical history part of the PCCS at 40-63%. Four themes emerged from interviews with clinicians and nurses-; (1) what remains unclear and challenges, (2) comparing the past with the present, (3) experiential thoughts, and (4) transition and adapting to change. Conclusions: The PCCS seems to be a comprehensive and simple tool to be used to document patients’ information at subsequent visits. The comprehensiveness and utility of the PCCS does paper to be limited by the failure to train staff in its use prior to introducing. The authors find the PCCS comprehensive and suitable to capture patients’ information and recommend it can be adopted and used in other palliative and hospice care settings, if suitable introductory training accompanies its introduction. Otherwise, the reliability and validity of patients’ information collected by this PCCS can be significantly reduced if some sections therein are unclear to the clinicians/nurses. The study identified clinicians- and nurses-related pitfalls in documentation of patients’ care. Clinicians and nurses need to prioritize accurate and complete documentation of patient care in the PCCS for quality care provision. This study should be extended to other sites using similar tools to ensure representative and generalizable findings.Keywords: documentation, information case sheet, palliative care, quality improvement
Procedia PDF Downloads 151917 Mental Well-Being and Quality of Life: A Comparative Study of Male Leather Tannery and Non-Tannery Workers of Kanpur City, India
Authors: Gyan Kashyap, Shri Kant Singh
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Improved mental health can be articulated as a good physical health and quality of life. Mental health plays an important role in survival of any one’s life. In today’s time people living with stress in life due to their personal matters, health problems, unemployment, work environment, living environment, substance use, life style and many more important reasons. Many studies confirmed that the significant proportion of mental health people increasing in India. This study is focused on mental well-being of male leather tannery workers in Kanpur city, India. Environment at work place as well as living environment plays an important health risk factors among leather tannery workers. Leather tannery workers are more susceptible to many chemicals and physical hazards, just because they are liable to be affected by their exposure to lots of hazardous materials and processes during tanning work in very hazardous work environment. The aim of this study to determine the level of mental health disorder and quality of life among male leather tannery and non-tannery workers in Kanpur city, India. This study utilized the primary data from the cross- sectional household study which was conducted from January to June, 2015 on tannery and non-tannery workers as a part of PhD program from the Jajmau area of Kanpur city, India. The sample of 286 tannery and 295 non-tannery workers has been collected from the study area. We have collected information from the workers of age group 15-70 those who were working at the time of survey for at least one year. This study utilized the general health questionnaire (GHQ-12) and work related stress scale to test the mental wellbeing of male tannery and non-tannery workers. By using GHQ-12 and work related stress scale, Polychoric factor analysis method has been used for best threshold and scoring. Some of important question like ‘How would you rate your overall quality of life’ on Likert scale to measure the quality of life, their earnings, education, family size, living condition, household assets, media exposure, health expenditure, treatment seeking behavior and food habits etc. Results from the study revealed that around one third of tannery workers had severe mental health problems then non-tannery workers. Mental health problem shown the statistically significant association with wealth quintile, 56 percent tannery workers had severe mental health problem those belong to medium wealth quintile. And 42 percent tannery workers had moderate mental health problem among those from the low wealth quintile. Work related stress scale found the statistically significant results for tannery workers. Large proportion of tannery and non-tannery workers reported they are unable to meet their basic needs from their earnings and living in worst condition. Important result from the study, tannery workers who were involved in beam house work in tannery (58%) had severe mental health problem. This study found the statistically significant association with tannery work and mental health problem among tannery workers.Keywords: GHQ-12, mental well-being, factor analysis, quality of life, tannery workers
Procedia PDF Downloads 387916 Effects of Macro and Micro Nutrients on Growth and Yield Performances of Tomato (Lycopersicon esculentum MILL.)
Authors: K. M. S. Weerasinghe, A. H. K. Balasooriya, S. L. Ransingha, G. D. Krishantha, R. S. Brhakamanagae, L. C. Wijethilke
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Tomato (Lycopersicon esculentum Mill.) is a major horticultural crop with an estimated global production of over 120 million metric tons and ranks first as a processing crop. The average tomato productivity in Sri Lanka (11 metric tons/ha) is much lower than the world average (24 metric tons/ha).To meet the tomato demand for the increasing population the productivity has to be intensified through the agronomic-techniques. Nutrition is one of the main factors which govern the growth and yield of tomato and the main nutrient source soil affect the plant growth and quality of the produce. Continuous cropping, improper fertilizer usage etc., cause widespread nutrient deficiencies. Therefore synthetic fertilizers and organic manures were introduced to enhance plant growth and maximize the crop yields. In this study, effects of macro and micronutrient supplementations on improvement of growth and yield of tomato were investigated. Selected tomato variety is Maheshi and plants were grown in Regional Agricultural and Research Centre Makadura under the Department of Agriculture recommended (DOA) macro nutrients and various combination of Ontario recommended dosages of secondary and micro fertilizer supplementations. There were six treatments in this experiment and each treatment was replicated in three times and each replicate consisted of six plants. Other than the DOA recommendation, five combinations of Ontario recommended dosage of secondary and micronutrients for tomato were also used as treatments. The treatments were arranged in a Randomized Complete Block Design. All cultural practices were carried out according to the DOA recommendations. The mean data was subjected to the statistical analysis using SAS package and mean separation (Duncan’s Multiple Range test at 5% probability level) procedures. Secondary and micronutrients containing treatments significantly increased most of the growth parameters. Plant height, plant girth, number of leaves, leaf area index etc. Fruits harvested from pots amended with macro, secondary and micronutrients performed best in terms of total yield; yield quality; to pots amended with DOA recommended dosage of fertilizer for tomato. It could be due to the application of all essential macro and micro nutrients that rise in photosynthetic activity, efficient translocation and utilization of photosynthates causing rapid cell elongation and cell division in actively growing region of the plant leading to stimulation of growth and yield were caused. The experiment revealed and highlighted the requirements of essential macro, secondary and micro nutrient fertilizer supplementations for tomato farming. The study indicated that, macro and micro nutrient supplementation practices can influence growth and yield performances of tomato fruits and it is a promising approach to get potential tomato yields.Keywords: macro and micronutrients, tomato, SAS package, photosynthates
Procedia PDF Downloads 474915 Study of Influencing Factors on the Flowability of Jute Nonwoven Reinforced Sheet Molding Compound
Authors: Miriam I. Lautenschläger, Max H. Scheiwe, Kay A. Weidenmann, Frank Henning, Peter Elsner
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Due to increasing environmental awareness jute fibers are more often used in fiber reinforced composites. In the Sheet Molding Compound (SMC) process, the mold cavity is filled via material flow allowing more complex component design. But, the difficulty of using jute fibers in this process is the decreased capacity of fiber movement in the mold. A comparative flow study with jute nonwoven reinforced SMC was conducted examining the influence of the fiber volume content, the grammage of the jute nonwoven textile and a mechanical modification of the nonwoven textile on the flowability. The nonwoven textile reinforcement was selected to support homogeneous fiber distribution. Trials were performed using two SMC paste formulations differing only in filler type. Platy-shaped kaolin with a mean particle size of 0.8 μm and ashlar calcium carbonate with a mean particle size of 2.7 μm were selected as fillers. Ensuring comparability of the two SMC paste formulations the filler content was determined to reach equal initial viscosity for both systems. The calcium carbonate filled paste was set as reference. The flow study was conducted using a jute nonwoven textile with 300 g/m² as reference. The manufactured SMC sheets were stacked and centrally placed in a square mold. The mold coverage was varied between 25 and 90% keeping the weight of the stack for comparison constant. Comparing the influence of the two fillers kaolin yielded better results regarding a homogeneous fiber distribution. A mold coverage of about 68% was already sufficient to homogeneously fill the mold cavity whereas for calcium carbonate filled system about 79% mold coverage was necessary. The flow study revealed a strong influence of the fiber volume content on the flowability. A fiber volume content of 12 vol.-% and 25 vol.-% were compared for both SMC formulations. The lower fiber volume content strongly supported fiber transport whereas 25 vol.-% showed insignificant influence. The results indicate a limiting fiber volume content for the flowability. The influence of the nonwoven textile grammage was determined using nonwoven jute material with 500 g/m² and a fiber volume content of 20 vol.-%. The 500 g/m² reinforcement material showed inferior results with regard to fiber movement. A mold coverage of about 90 % was required to prevent the destruction of the nonwoven structure. Below this mold coverage the 500 g/m² nonwoven material was ripped and torn apart. Low mold coverages led to damage of the textile reinforcement. Due to the ripped nonwoven structure the textile was modified with cuts in order to facilitate fiber movement in the mold. Parallel cuts of about 20 mm length and 20 mm distance to each other were applied to the textile and stacked with varying orientations prior to molding. Stacks with unidirectional orientated cuts over stacks with cuts in various directions e.g. (0°, 45°, 90°, -45°) were investigated. The mechanical modification supported tearing of the textile without achieving benefit for the flowability.Keywords: filler, flowability, jute fiber, nonwoven, sheet molding compound
Procedia PDF Downloads 333914 Application of the State of the Art of Hydraulic Models to Manage Coastal Problems, Case Study: The Egyptian Mediterranean Coast Model
Authors: Al. I. Diwedar, Moheb Iskander, Mohamed Yossef, Ahmed ElKut, Noha Fouad, Radwa Fathy, Mustafa M. Almaghraby, Amira Samir, Ahmed Romya, Nourhan Hassan, Asmaa Abo Zed, Bas Reijmerink, Julien Groenenboom
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Coastal problems are stressing the coastal environment due to its complexity. The dynamic interaction between the sea and the land results in serious problems that threaten coastal areas worldwide, in addition to human interventions and activities. This makes the coastal environment highly vulnerable to natural processes like flooding, erosion, and the impact of human activities as pollution. Protecting and preserving this vulnerable coastal zone with its valuable ecosystems calls for addressing the coastal problems. This, in the end, will support the sustainability of the coastal communities and maintain the current and future generations. Consequently applying suitable management strategies and sustainable development that consider the unique characteristics of the coastal system is a must. The coastal management philosophy aims to solve the conflicts of interest between human development activities and this dynamic nature. Modeling emerges as a successful tool that provides support to decision-makers, engineers, and researchers for better management practices. Modeling tools proved that it is accurate and reliable in prediction. With its capability to integrate data from various sources such as bathymetric surveys, satellite images, and meteorological data, it offers the possibility for engineers and scientists to understand this complex dynamic system and get in-depth into the interaction between both the natural and human-induced factors. This enables decision-makers to make informed choices and develop effective strategies for sustainable development and risk mitigation of the coastal zone. The application of modeling tools supports the evaluation of various scenarios by affording the possibility to simulate and forecast different coastal processes from the hydrodynamic and wave actions and the resulting flooding and erosion. The state-of-the-art application of modeling tools in coastal management allows for better understanding and predicting coastal processes, optimizing infrastructure planning and design, supporting ecosystem-based approaches, assessing climate change impacts, managing hazards, and finally facilitating stakeholder engagement. This paper emphasizes the role of hydraulic models in enhancing the management of coastal problems by discussing the diverse applications of modeling in coastal management. It highlights the modelling role in understanding complex coastal processes, and predicting outcomes. The importance of informing decision-makers with modeling results which gives technical and scientific support to achieve sustainable coastal development and protection.Keywords: coastal problems, coastal management, hydraulic model, numerical model, physical model
Procedia PDF Downloads 28913 Effects of Culture Conditions on the Adhesion of Yeast Candida spp. and Pichia spp. to Stainless Steel with Different Polishing and Their Control
Authors: Ružica Tomičić, Zorica Tomičić, Peter Raspor
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An abundant growth of unwanted yeasts in food processing plants can lead to problems in quality and safety with significant financial losses. Candida and Pichia are the genera mainly involved in spoilage of products in the food and beverage industry. These contaminating microorganisms can form biofilms on food contact surfaces, being difficult to eradicate, increasing the probability of microbial survival and further dissemination during food processing. It is well known that biofilms are more resistant to antimicrobial agents compared to planktonic cells and this makes them difficult to eliminate. Among the strategies used to overcome resistance to antifungal drugs and preservatives, the use of natural substances such as plant extracts has shown particular promise, and many natural substances have been found to exhibit antifungal properties. This study aimed to investigated the impact of growth medium (Malt Extract broth (MEB) or Yeast Peptone Dextrose (YPD) broth) and temperatures (7°C, 37°C, 43°C for Candida strains and 7°C, 27°C, 32°C for Pichia strains) on the adhesion of Candida spp. and Pichia spp. to stainless steel (AISI 304) discs with different degrees of surface roughness (Ra = 25.20 – 961.9 nm), a material commonly used in the food industry. We also evaluated the antifungal and antiadhesion activity of plant extracts such as Humulus lupulus, Alpinia katsumadai and Evodia rutaecarpa against C. albicans, C glabrata and P. membranifaciens and investigated whether these plant extracts can interfere with biofilm formation. The adhesion was assessed by the crystal violet staining method, while the broth microdilution method CLSI M27-A3 was used to determine the minimum inhibitory concentration (MIC) of plant extracts. Our results indicated that the nutrient content of the medium significantly influenced the amount of adhered cells of the tested yeasts. The growth medium which resulted in a higher adhesion of C. albicans and C. glabrata was MEB, while for C. parapsilosis and C. krusei was YPD. In the case of P. pijperi and P. membranifaciens, YPD broth was more effective in promoting adhesion than MEB. Regarding the effect of temperature, C. albicans strain adhered to stainless steel surfaces in significantly higher level at a temperature of 43°C, while on the other hand C. glabrata, C. parapsilosis and C. krusei showed a different behavior with significantly higher adhesion at 37°C than at 7°C and 43°C. Further, the adherence ability of Pichia strains was highest at 27°C. Based on the MIC values, all plant extracts exerted significant antifungal effects with MIC values ranged from 100 to 400 μg/mL. It was observed that biofilm of C. glabrata were more resistance to plant extracts as compared to C. albicans. However, extracts of A. katsumadai and E. rutaecarpa promoted the growth and development of the preformed biofilm of P. membranifaciens. Thus, the knowledge of how these microorganisms adhere and which factors affect this phenomenon is of great importance in order to avoid their colonization on food contact surfaces.Keywords: adhesion, Candida spp., Pichia spp., plant extracts
Procedia PDF Downloads 194912 Interfacial Reactions between Aromatic Polyamide Fibers and Epoxy Matrix
Authors: Khodzhaberdi Allaberdiev
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In order to understand the interactions on the interface polyamide fibers and epoxy matrix in fiber- reinforced composites were investigated industrial aramid fibers: armos, svm, terlon using individual epoxy matrix components, epoxies: diglycidyl ether of bisphenol A (DGEBA), three- and diglycidyl derivatives of m, p-amino-, m, p-oxy-, o, m,p-carboxybenzoic acids, the models: curing agent, aniline and the compound, that depict of the structure the primary addition reaction the amine to the epoxy resin, N-di (oxyethylphenoxy) aniline. The chemical structure of the surface of untreated and treated polyamide fibers analyzed using Fourier transform infrared spectroscopy (FTIR). The impregnation of fibers with epoxy matrix components and N-di (oxyethylphenoxy) aniline has been carried out by heating 150˚C (6h). The optimum fiber loading is at 65%.The result a thermal treatment is the covalent bonds formation , derived from a combined of homopolymerization and crosslinking mechanisms in the interfacial region between the epoxy resin and the surface of fibers. The reactivity of epoxy resins on interface in microcomposites (MC) also depends from processing aids treated on surface of fiber and the absorbance moisture. The influences these factors as evidenced by the conversion of epoxy groups values in impregnated with DGEBA of the terlons: industrial, dried (in vacuum) and purified samples: 5.20 %, 4.65% and 14.10%, respectively. The same tendency for svm and armos fibers is observed. The changes in surface composition of these MC were monitored by X-ray photoelectron spectroscopy (XPS). In the case of the purified fibers, functional groups of fibers act as well as a catalyst and curing agent of epoxy resin. It is found that the value of the epoxy groups conversion for reinforced formulations depends on aromatic polyamides nature and decreases in the order: armos >svm> terlon. This difference is due of the structural characteristics of fibers. The interfacial interactions also examined between polyglycidyl esters substituted benzoic acids and polyamide fibers in the MC. It is found that on interfacial interactions these systems influences as well as the structure and the isomerism of epoxides. The IR-spectrum impregnated fibers with aniline showed that the polyamide fibers appreciably with aniline do not react. FTIR results of treated fibers with N-di (oxyethylphenoxy) aniline fibers revealed dramatically changes IR-characteristic of the OH groups of the amino alcohol. These observations indicated hydrogen bondings and covalent interactions between amino alcohol and functional groups of fibers. This result also confirms appearance of the exo peak on Differential Scanning Calorimetry (DSC) curve of the MC. Finally, the theoretical evaluation non-covalent interactions between individual epoxy matrix components and fibers has been performed using the benzanilide and its derivative contaning the benzimidazole moiety as a models of terlon and svm,armos, respectively. Quantum-topological analysis also demonstrated the existence hydrogen bond between amide group of models and epoxy matrix components.All the results indicated that on the interface polyamide fibers and epoxy matrix exist not only covalent, but and non-covalent the interactions during the preparation of MC.Keywords: epoxies, interface, modeling, polyamide fibers
Procedia PDF Downloads 266911 Evaluation of Cardiac Rhythm Patterns after Open Surgical Maze-Procedures from Three Years' Experiences in a Single Heart Center
Authors: J. Yan, B. Pieper, B. Bucsky, H. H. Sievers, B. Nasseri, S. A. Mohamed
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In order to optimize the efficacy of medications, the regular follow-up with long-term continuous monitoring of heart rhythmic patterns has been facilitated since clinical introduction of cardiac implantable electronic monitoring devices (CIMD). Extensive analysis of rhythmic circadian properties is capable to disclose the distributions of arrhythmic events, which may support appropriate medication according rate-/rhythm-control strategy and minimize consequent afflictions. 348 patients (69 ± 0.5ys, male 61.8%) with predisposed atrial fibrillation (AF), undergoing primary ablating therapies combined to coronary or valve operations and secondary implantation of CIMDs, were involved and divided into 3 groups such as PAAF (paroxysmal AF) (n=99, male 68.7%), PEAF (persistent AF) (n=94, male 62.8%), and LSPEAF (long-standing persistent AF) (n=155, male 56.8%). All patients participated in three-year ambulant follow-up (3, 6, 9, 12, 18, 24, 30 and 36 months). Burdens of atrial fibrillation recurrence were assessed using cardiac monitor devices, whereby attacks frequencies and their circadian patterns were systemically analyzed. Anticoagulants and regular anti-arrhythmic medications were evaluated and the last were listed in terms of anti-rate and anti-rhythm regimens. Patients in the PEAF-group showed the least AF-burden after surgical ablating procedures compared to both of the other subtypes (p < 0.05). The AF-recurrences predominantly performed such attacks’ property as shorter than one hour, namely within 10 minutes (p < 0.05), regardless of AF-subtypes. Concerning circadian distribution of the recurrence attacks, frequent AF-attacks were mostly recorded in the morning in the PAAF-group (p < 0.05), while the patients with predisposed PEAF complained less attack-induced discomforts in the latter half of the night and the ones with LSPEAF only if they were not physically active after primary surgical ablations. Different AF-subtypes presented distinct therapeutic efficacies after appropriate surgical ablating procedures and recurrence properties in sense of circadian distribution. An optimization of medical regimen and drug dosages to maintain the therapeutic success needs more attention to detailed assessment of the long-term follow-up. Rate-control strategy plays a much more important role than rhythm-control in the ongoing follow-up examinations.Keywords: atrial fibrillation, CIMD, MAZE, rate-control, rhythm-control, rhythm patterns
Procedia PDF Downloads 156