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364 Evaluation of Percutaneous Tube Thoracostomy Performed by Trainee in Both Trauma and Non-Trauma Patients
Authors: Kulsum Maula, Md Kamrul Alam, Md Ibrahim Khalil, Md Nazmul Hasan, Mohammad Omar Faruq
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Background: Percutaneous Tube Thoracostomy (PTT) is an invasive procedure that can save a life now and then in different traumatic and non-traumatic conditions. But still, it is an enigma; how our trainee surgeons are at home in this procedure. Objectives: To evaluate the outcome of the percutaneous tube thoracostomy performed by trainees in both trauma and non-trauma patients. Study design: Prospective, Observational Study. The duration of the study was September 2018 to February 2019. Methods: All patients who need PTT in traumatic and non-traumatic conditions were selected by purposive sampling. Thereafter, they were scrutinized according to eligibility criteria and 96 patients were finalized. A pre-tested, observation-based, peer-reviewed data collection sheet was prepared before the study. Data regarding clinical and surgical outcome profiles were recorded. Data were compiled, edited, and analyzed. Results: Among 96 patients, the highest 32.29% belonged to age group 31-40 years and the lowest 9.37% belonged to the age group ≤20. The mean age of the respondents was 29.19±9.81. We found out of 96 patients, 70(72.91%) were indicated PTT for traumatic conditions and the rest 26(27.08%) were indicated PTT for non-traumatic chest conditions, where 36(37.5%) had simple penumothorax, 21(21.87%) haemothorax, 14(14.58%) massive pleural effusion, 13(13.54%) tension pneumothorax, 10(10.41%) haemopneumothorax, and 2(2.08%) had pyothorax respectively. In 53.12% of patients had right-sided intercostal chest tube (ICT) insertion, whereas 46.87% had left-sided ICT insertion. In our study, 89.55 % of the tube was placed at the normal anatomical position. Besides, 10.41% of tube thoracostomy were performed deviated from anatomical site. Among 96 patients 62.5% patients had length of incision 2-3cm, 35.41% had >3cm and 2.08% had <2cm respectively. Out of 96 patients, 75(78.13%) showed uneventful outcomes, whereas 21(21.87%) had complications, including 11.15%(11) each had wound infection, 4.46%(4) subcutaneous emphysema, 4.28%(3) drain auto expulsion, 2.85%(2) hemorrhage, 1.45%(1) had a non-functioning drain and empyema with ascending infection respectively (p=<0.05). Conclusion: PTT is a life-saving procedure that is most frequently implemented in chest trauma patients in our country. In the majority of cases, the outcome of PTT was uneventful (78.13). Besides this, more than one-third of patients had a length of incision more than 3 cm that needed extra stitches and 10.41% of cases of PTT were placed other than the normal anatomical site. Trainees of Dhaka Medical College Hospitals are doing well in their performance of PTT insertion, but still, some anatomical orientations are necessary to avoid operative and post-operative complications.Keywords: PTT, trainee, trauma, non-chest trauma patients
Procedia PDF Downloads 118363 Efficacy and Safety of Eucalyptus for Relief Cough Symptom: A Systematic Review and Meta-Analysis
Authors: Ladda Her, Juntip Kanjanasilp, Ratree Sawangjit, Nathorn Chaiyakunapruk
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Cough is the common symptom of the respiratory tract infections or non-infections; the duration of cough indicates a classification and severity of disease. Herbal medicines can be used as the alternative to drugs for relief of cough symptoms from acute and chronic disease. Eucalyptus was used for reducing cough with evidences suggesting it has an active role in reduction of airway inflammation. The present study aims to evaluate efficacy and safety of eucalyptus for relief of cough symptom in respiratory disease. Method: The Cochrane Library, MEDLINE (PubMed), Scopus, CINAHL, Springer, Science direct, ProQuest, and THAILIS databases. From its inception until 01/02/2019 for randomized control trials. We follow for the efficacy and safety of eucalyptus for reducing cough. Methodological quality was evaluated by using the Cochrane risk of bias tool; two reviewers in our team screened eligibility and extracted data. Result: Six studies were included for the review and five studies were included in the meta-analysis, there were 1.911 persons including children (n: 1) and adult (n: 5) studies; for study in children and adult were between 1 and 80 years old, respectively. Eucalyptus was used as mono herb (n: 2) and in combination with other herbs form (n: 4). All of the studies with eucalyptus were compared for efficacy and safety with placebo or standard treatment, Eucalyptus dosage form in studies included capsules, spray, and syrup. Heterogeneity was 32.44 used random effect model (I² = 1.2%, χ² = 1.01; P-value = 0.314). The efficacy of eucalyptus was showed a reduced cough symptom statistically significant (n = 402, RR: 1.40, 95%CI [1.19, 1.65], P-value < 0.0001) when compared with placebo. Adverse events (AEs) were reported mild to moderate intensity with mostly gastrointestinal symptom. The methodological quality of the included trials was overall poor. Conclusion: Eucalyptus appears to be beneficial and safe for relieving in respiratory diseases focus on cough frequency. The evidence was inconclusive due to limited quality trial. Well-designed trials for evaluating the effectiveness in humans, the effectiveness for reducing cough symptom in human is needed. Eucalyptus had safety as monotherapy or in combination with other herbs.Keywords: cough, eucalyptus, cineole, herbal medicine, systematic review, meta-analysis
Procedia PDF Downloads 145362 The Indebtedness of Men and Women: A Study of Personal Bankruptcies in the Czech Republic
Authors: Zuzana Fišerová, Marie Paseková
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Debt relief (also labelled personal bankruptcy) is a bankruptcy settlement method which was implemented into Czech legislation by the Insolvency Act (Act No. 182/2006 Coll. on Insolvency and its Resolution) on 1 January 2008. The need to implement the institute of personal bankruptcy arose from the excessive over-indebtedness of many inhabitants of the Czech Republic after the crisis that arose around 2008 and 2009. The contribution analyses the development in the manner in which households approach personal bankruptcy and assesses and surveys the differences between indebtedness among men and women. The first section analyses the development in numbers of filed personal bankruptcy petitions and the successfulness thereof; it likewise analyses the impact of other economic influences (regional differences, unemployment etc.). The differences between debtors in dependency to gender are also surveyed. A survey of insolvency proceedings for 664 persons whose insolvency proceedings were commenced in 2008 was conducted, whilst the data were acquired from the publicly accessible insolvency register. The hypothesis on the equality of the average debt level of men and women was tested when comparing indebtedness in dependency to debtor gender. At a significance level of 0.05, the test confirmed that the mean value of debt level for women is lower than the mean value of debt level for men. Through analysis of further results, it was found that the average level of debt among women was CZK 537 thousand, while the average level of creditor satisfaction reached 46.2%. Men in the monitored sample had an average level of reported receivables of CZK 652 thousand, satisfaction of their creditors reached 58.8%. The main changes in the institute of personal bankruptcy are then evaluated in the closing discussion, and the impacts of these changes for households are assessed. The development of legislation in the Czech Republic and practice are shifting towards broader usage of personal bankruptcy, especially insofar as it can now also be used by entrepreneurs. Furthermore, the amendment of the Insolvency Act has enabled married couples to apply for joint debt relief, which has improved the position of the marriage partner with lower income and who would not get permission for debt relief on his/her own (mostly women are at issue). In current practice, the condition of adequate income is also solved by the fact that another person (usually a family member) undertakes to donate a certain monthly sum throughout the duration of the debt relief. Personal bankruptcy can thus be completed also by individuals to whom it would previously have been denied by the court.Keywords: debtor, households, insolvency act, over-indebtedness, personal bankruptcy
Procedia PDF Downloads 276361 Comparison of Physical and Chemical Effects on Senescent Cells
Authors: Svetlana Guryeva, Inna Kornienko, Andrey Usanov, Dmitry Usanov, Elena Petersen
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Every day cells in our organism are exposed to various factors: chemical agents, reactive oxygen species, ionizing radiation, and others. These factors can cause damage to DNA, cellular membrane, intracellular compartments, and proteins. The fate of cells depends on the exposure intensity and duration. The prolonged and intense exposure causes the irreversible damage accumulation, which triggers the permanent cell cycle arrest (cellular senescence) or cell death programs. In the case of low dose of impacts, it can lead to cell renovation and to cell functional state improvement. Therefore, it is a pivotal question to investigate the factors and doses that result in described positive effects. In order to estimate the influence of different agents, the proliferation index and levels of cell death markers (annexin V/propidium iodide), senescence-associated β-galactosidase, and lipofuscin were measured. The experiments were conducted on primary human fibroblasts of the 8th passage. According to the levels of mentioned markers, these cells were defined as senescent cells. The effect of low-frequency magnetic field was investigated. Different modes of magnetic field exposure were tested. The physical agents were compared with chemical agents: metformin (10 mM) and taurine (0.8 mM and 1.6 mM). Cells were incubating with chemicals for 5 days. The highest decrease in the level of senescence-associated β-galactosidase (21%) and lipofuscin (17%) was observed in the primary senescent fibroblasts after 5 days after double treatments with 48 h intervals with low-frequency magnetic field. There were no significant changes in the proliferation index after magnetic field application. The cytotoxic effect of magnetic field was not observed. The chemical agent taurine (1.6 mM) decreased the level of senescence-associated β-galactosidase (23%) and lipofuscin (22%). Metformin improved the activity of senescence-associated β-galactosidase on 15% and the level of lipofuscin on 19% in this experiment. According to these results, the effect of double treatment with 48 h interval with low-frequency magnetic field and the effect of taurine (1.6 mM) were comparable to the effect of metformin, for which anti-aging properties are proved. In conclusion, this study can become the first step towards creation of the standardized system for the investigation of different effects on senescent cells.Keywords: biomarkers, magnetic field, metformin, primary fibroblasts, senescence, taurine
Procedia PDF Downloads 268360 A Study on Adsorption Ability of MnO2 Nanoparticles to Remove Methyl Violet Dye from Aqueous Solution
Authors: Zh. Saffari, A. Naeimi, M. S. Ekrami-Kakhki, Kh. Khandan-Barani
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The textile industries are becoming a major source of environmental contamination because an alarming amount of dye pollutants are generated during the dyeing processes. Organic dyes are one of the largest pollutants released into wastewater from textile and other industrial processes, which have shown severe impacts on human physiology. Nano-structure compounds have gained importance in this category due their anticipated high surface area and improved reactive sites. In recent years several novel adsorbents have been reported to possess great adsorption potential due to their enhanced adsorptive capacity. Nano-MnO2 has great potential applications in environment protection field and has gained importance in this category because it has a wide variety of structure with large surface area. The diverse structures, chemical properties of manganese oxides are taken advantage of in potential applications such as adsorbents, sensor catalysis and it is also used for wide catalytic applications, such as degradation of dyes. In this study, adsorption of Methyl Violet (MV) dye from aqueous solutions onto MnO2 nanoparticles (MNP) has been investigated. The surface characterization of these nano particles was examined by Particle size analysis, Scanning Electron Microscopy (SEM), Fourier Transform Infrared (FTIR) spectroscopy and X-Ray Diffraction (XRD). The effects of process parameters such as initial concentration, pH, temperature and contact duration on the adsorption capacities have been evaluated, in which pH has been found to be most effective parameter among all. The data were analyzed using the Langmuir and Freundlich for explaining the equilibrium characteristics of adsorption. And kinetic models like pseudo first- order, second-order model and Elovich equation were utilized to describe the kinetic data. The experimental data were well fitted with Langmuir adsorption isotherm model and pseudo second order kinetic model. The thermodynamic parameters, such as Free energy of adsorption (ΔG°), enthalpy change (ΔH°) and entropy change (ΔS°) were also determined and evaluated.Keywords: MnO2 nanoparticles, adsorption, methyl violet, isotherm models, kinetic models, surface chemistry
Procedia PDF Downloads 250359 Development of Requirements Analysis Tool for Medical Autonomy in Long-Duration Space Exploration Missions
Authors: Lara Dutil-Fafard, Caroline Rhéaume, Patrick Archambault, Daniel Lafond, Neal W. Pollock
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Improving resources for medical autonomy of astronauts in prolonged space missions, such as a Mars mission, requires not only technology development, but also decision-making support systems. The Advanced Crew Medical System - Medical Condition Requirements study, funded by the Canadian Space Agency, aimed to create knowledge content and a scenario-based query capability to support medical autonomy of astronauts. The key objective of this study was to create a prototype tool for identifying medical infrastructure requirements in terms of medical knowledge, skills and materials. A multicriteria decision-making method was used to prioritize the highest risk medical events anticipated in a long-term space mission. Starting with those medical conditions, event sequence diagrams (ESDs) were created in the form of decision trees where the entry point is the diagnosis and the end points are the predicted outcomes (full recovery, partial recovery, or death/severe incapacitation). The ESD formalism was adapted to characterize and compare possible outcomes of medical conditions as a function of available medical knowledge, skills, and supplies in a given mission scenario. An extensive literature review was performed and summarized in a medical condition database. A PostgreSQL relational database was created to allow query-based evaluation of health outcome metrics with different medical infrastructure scenarios. Critical decision points, skill and medical supply requirements, and probable health outcomes were compared across chosen scenarios. The three medical conditions with the highest risk rank were acute coronary syndrome, sepsis, and stroke. Our efforts demonstrate the utility of this approach and provide insight into the effort required to develop appropriate content for the range of medical conditions that may arise.Keywords: decision support system, event-sequence diagram, exploration mission, medical autonomy, scenario-based queries, space medicine
Procedia PDF Downloads 118358 Extreme Heat and Workforce Health in Southern Nevada
Authors: Erick R. Bandala, Kebret Kebede, Nicole Johnson, Rebecca Murray, Destiny Green, John Mejia, Polioptro Martinez-Austria
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Summertemperature data from Clark County was collected and used to estimate two different heat-related indexes: the heat index (HI) and excess heat factor (EHF). These two indexes were used jointly with data of health-related deaths in Clark County to assess the effect of extreme heat on the exposed population. The trends of the heat indexes were then analyzed for the 2007-2016 decadeandthe correlation between heat wave episodes and the number of heat-related deaths in the area was estimated. The HI showed that this value has increased significantly in June, July, and August over the last ten years. The same trend was found for the EHF, which showed a clear increase in the severity and number of these events per year. The number of heat wave episodes increased from 1.4 per year during the 1980-2016 period to 1.66 per yearduring the 2007-2016 period. However, a different trend was found for heat-wave-event duration, which decreasedfrom an average of 20.4 days during the trans-decadal period (1980-2016) to 18.1 days during the most recent decade(2007-2016). The number of heat-related deaths was also found to increase from 2007 to 2016, with 2016 with the highest number of heat-related deaths. Both HI and the number of deaths showeda normal-like distribution for June, July, and August, with the peak values reached in late July and early August. The average maximum HI values better correlated with the number of deaths registered in Clark County than the EHF, probably because HI uses the maximum temperature and humidity in its estimation,whereas EHF uses the average medium temperature. However, it is worth testing the EHF of the study zone because it was reported to fit properly in the case of heat-related morbidity. For the overall period, 437 heat-related deaths were registered in Clark County, with 20% of the deaths occurring in June, 52% occurring in July, 18% occurring in August,and the remaining 10% occurring in the other months of the year. The most vulnerable subpopulation was people over 50 years old, for which 76% of the heat-related deaths were registered.Most of the cases were associated with heart disease preconditions. The second most vulnerable subpopulation was young adults (20-50), which accounted for 23% of the heat-related deaths. These deathswere associated with alcoholic/illegal drug intoxication.Keywords: heat, health, hazards, workforce
Procedia PDF Downloads 101357 Characteristics of Acute Bacterial Prostatitis in Elderly Patients Attended in the Emergency Department
Authors: Carles Ferré, Ferran Llopis, Javier Jacob, Jordi Giol, Xavier Palom, Ignasi Bardés
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Objective: To analyze the characteristics of acute bacterial prostatitis (ABP) in elderly patients attended in the emergency department (ED). Methods: Observational and cohort study with prospective follow-up including patients with ABP presenting to the ED from January-December 2012. Data were collected for demographic variables, comorbidities, clinical and microbiological findings, treatment, outcome, and reconsultation at 30 days follow up. Findings were compared between patients ≥ 75 years (study group) and < 75 years (control group). Results: During the study period 241 episodes of ABP were included for analysis. Mean age was 62,9 ± 16 years, and 64 (26.5%) were ≥ 75 years old. A history of prostate adenoma was reported in 54 cases (22,4%), diabetes mellitus in 47 patients (19,5%) and prior manipulation of the lower urinary tract in 40 (17%). Mean symptoms duration was 3.38 ± 4.04 days, voiding symptoms were present in 176 cases (73%) and fever in 154 (64%). From 216 urine cultures, 128 were positive (59%) and 24 (17,6%) out of 136 blood cultures. Escherichia coli was the main pathogen in 58.6% of urine cultures and 64% of blood cultures (with resistant strains to fluoroquinolones in 27,7%, cotrimoxazole in 22,9% and amoxicillin/clavulanic in 27.7% of cases). Seventy patients (29%) were admitted to the hospital, and 3 died. At 30-day follow-up, 29 patients (12%) returned to the ED. In the bivariate analysis previous manipulation of the urinary tract, history of cancer, previous antibiotic treatment, resistant E. coli strains to amoxicillin-clavulanate and ciprofloxacin and extended spectrum beta-lactamase (ESBL) producers, renal impairment, and admission to the hospital were significantly more frequent (p < 0.05) among patients ≥ 75 years compared to those younger than 75 years. Conclusions: Ciprofloxacin and amoxicillin-clavulanate appear not to be good options for the empiric treatment of ABP for patients ≥ 75 years given the drug-resistance pattern in our series, and the proportion of ESBL-producing strains of E. coli should be taken into account. Awaiting bacteria identification and antibiogram from urine and/or blood cultures, treatment on an inpatient basis should be considered in older patients with ABP.Keywords: acute bacterial prostatitits, antibiotic resistance, elderly patients, emergency
Procedia PDF Downloads 367356 Sublethal Effects of Entomopathogenic Nematodes and Fungus against the Red Palm Weevil, Rhynchophorus Ferrugineus (Olivier) (Curculionidae: Coleoptera)
Authors: M. Manzoor, J. N. Ahmad, R. M. Giblin Davis, N. Javed, M. S. Haider
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The invasive Red Palm Weevil (RPW) (Rhynchophorus ferrugineus [Olivier] (Coleoptera: Curculionidae) is one of the most destructive palm pests in the world. Synthetic pesticides are environmentally hazardous pest control strategies being used in the past with emerging need of eco-friendly biological approaches including microbial entomopathogens for RPW management. The sublethal effects of a single entomopathogenic fungus (EPF) Beauveria bassiana (WG-11) (Ascomycota: Hypocreales) and two entomopathogenic nematode (EPN) species Heterorhabditis bacteriophora (Poinar) and Steinernema carpocapsae (Weiser) (Nematoda: Rhabditida) were evaluated in various combinations against laboratory-reared 3rd, 5th and 8th instar larvae of RPW in laboratory assays. Individual and combined effects of both entomopathogens (EP) were observed after the pre-application of B. bassiana fungus at 1-2-week intervals. A number of parameters were measured after the application of sub-lethal doses of EPF such as diet consumption, development, frass production, mortality, and weight gain. Combined treatments were tested for additive and synergistic effects. Synergism was more frequently observed in B. bassiana and S. carpocapsae combined treatments than in B. bassiana and H. bacteriophora combinations. Early instar larvae of RPW were more susceptible than older instars. Synergistic effects were observed in the 3rd and 5th instars exposed to B. bassiana and S. carpocapsae at 0, 7 and 14-day intervals. Whereas, in 8th instar larvae, the synergistic effect was observed only in B. bassiana and S. carpocapsae treatments after 0 and 7 days intervals. EPN treatments decreased pupation, egg hatching and emergence of adults. Lethal effects of nematodes were also observed in all growth stages of R. ferrugineus. Reduced larval weight, increased larval, pre-pupal and pupal duration, reduced adult weight and life span were observed. Sub-lethal concentrations of both entomopathogens induced variations in the different developmental stages and reduced food consumption, frass production, growth, and weight gain. So, on the basis of results, it is concluded that synthetic pesticides should be replaced with environmentally friendly sustainable biopesticides.Keywords: H. bacteriophora, S. carpocapsae, B. bassiana, mortality
Procedia PDF Downloads 155355 Maternal and Neonatal Outcome Analysis in Preterm Abdominal Delivery Underwent Umbilical Cord Milking Compared to Early Cord Clamping
Authors: Herlangga Pramaditya, Agus Sulistyono, Risa Etika, Budiono Budiono, Alvin Saputra
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Preterm birth and anemia of prematurity are the most common cause of morbidity and mortality in neonates, and anemia of the preterm neonates has become a major issue. The timing of umbilical cord clamping after a baby is born determines the amount of blood transferred from the placenta to fetus, Delayed Cord Clamping (DCC) has proven to prevent anemia in the neonates but it is constrained concern regarding the delayed in neonatal resuscitation. Umbilical Cord Milking (UCM) could be an alternative method for clamping the umbilical cord due to the active blood transfer from the placenta to the fetus. The aim of this study was to analyze the difference between maternal and neonatal outcome in preterm abdominal delivery who underwent UCM compared to ECC. This was an experimental study with randomized post-test only control design. Analyzed maternal and neonatal outcomes, significant P values (P <0.05). Statistical comparison was carried out using Paired Samples t-test (α two tailed 0,05). The result was the mean of preoperative mother’s hemoglobin in UCM group compared to ECC (10,9 + 0,9 g/dL vs 10,4 + 0,9 g/dL) and postoperative (11,1 + 1,1 g/dL vs 10,5 + 0,7 g/dL), the delta was (0,2 + 0,7 vs 0,1 + 0,6.). It showed no significant difference (P=0,395 vs 0,627). The mean of 3rd phase labor duration in UCM group vs ECC was (20,5 + 3,5 second vs 21,1 + 3,3 second), showed insignificant difference (P=0,634). The amount of bleeding after delivery in UCM group compared to ECC has the median of 190 cc (100-280cc) vs 210 cc (150-330 cc) showed insignificant difference (P=0,083) so the incidence of post-partum bleeding was not found. The mean of the neonates hemoglobin, hematocrit and erythrocytes of UCM group compared to ECC was (19,3 + 0,7 vs 15,9 + 0,8 g/dl), (57,1 + 3,6 % vs 47,2 + 2,8 %), and (5,4 + 0,4 g/dl vs 4,5 + 0,3 g/dl) showed significant difference (P<0,0001). There was no baby in UCM group received blood transfusion and one baby in the control ECC group received blood transfusion was found. Umbilical Cord Milking has shown to increase the baby’s blood component such as hemoglobin, hematocrit, and erythrocytes 6 hours after birth as well as lowering the incidence of blood transfusions. Maternal and neonatal morbidity were not found. Umbilical Cord Milking was the act of clamping the umbilical cord that was more beneficial to the baby and no adverse or negative effects on the mother.Keywords: umbilical cord milking, early cord clamping, maternal and neonatal outcome, preterm, abdominal delivery
Procedia PDF Downloads 233354 Adaptive Training Methods Designed to Improve a Shorter Resident Curriculum in Obstetrics and Gynecology
Authors: Philippe Judlin, Olivier Morel
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Background: In France, the resident curriculum (RC) in Obstetrics and Gynecology (OBGYN) takes five years. In the course of the last 15 years, this RC has undergone major changes, characterized mainly by successive reductions of work hours. The program used to comprise long and frequent shifts, huge workload, poor supervision and erratic theoretical teaching. A decade ago, the French Ministry of Heath recommended a limitation of shift duration up to 24 hours and a minimum of 11 hours off duty between shifts. Last year, in order to comply with European Union directives, new recommendations have further limited residents’ work hours to 48 hours per week. Methods: Assessment of the residency program adjustments recently made to accommodate the recommendations while improving the training quality in resorting to new methods. Results: The challenge facing program directors was to provide an all-encompassing curriculum to OBGYN residents despite fewer work hours. Program has been dramatically redesigned, and several measures have been put in place: -The resident rotation system has been redesigned. Residents used to make 6-month rotations between 10-12 Departments of OBGYN or Surgery. Fewer Departments, those providing the best teaching, have been kept in the new RC. -Extensive inhouse supervision has been implemented for all kinds of clinical activities. Effectual supervision of residents has proved to be an effective tool to improve the quality of training. -The tutorship system, with academic members individually overseeing residents during their curriculum, has been perfected. It allows a better follow-up of residents’ progresses during the 5-year program. -The set up of an extensive program of lectures encompassing all maters in Obstetrics & Gynecology. These mandatory lectures are available online in a dedicated website. Therefore, face-to-face lectures have been limited in order to fit in the 48-hour limit. -The use of simulation has been significantly increased in obstetrics, materno-fetal medicine and surgery (stressing especially laparoscopic training). -Residents’ feedback has been taken into account in the setup of the new RC. Conclusion: This extensive overhaul of the Obstetrics and Gynecology RC has been in place since last year only. Nevertheless, the new program seems to adequately take into account the new recommendations while providing a better and more consistent teaching to the OBGYN residents.Keywords: education, laparoscopy, residency, simulation
Procedia PDF Downloads 181353 Anti-lipidemic and Hematinic Potentials of Moringa Oleifera Leaves: A Clinical Trial on Type 2 Diabetic Subjects in a Rural Nigerian Community
Authors: Ifeoma C. Afiaenyi, Elizabeth K. Ngwu, Rufina N. B. Ayogu
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Diabetes has crept into the rural areas of Nigeria, causing devastating effects on its sufferers; most of them could not afford diabetic medications. Moringa oleifera has been used extensively in animal models to demonstrate its antilipidaemic and haematinic qualities; however, there is a scarcity of data on the effect of graded levels of Moringa oleifera leaves on the lipid profile and hematological parameters in human diabetic subjects. The study determined the effect of Moringa oleifera leaves on the lipid profile and hematological parameters of type 2 diabetic subjects in Ukehe, a rural Nigerian community. Twenty-four adult male and female diabetic subjects were purposively selected for the study. These subjects were shared into four groups of six subjects each. The diets used in the study were isocaloric. A control group (diabetics, group 1) was fed diets without Moringa oleifera leaves. Experimental groups 2, 3 and 4 received 20g, 40g and 60g of Moringa oleifera leaves daily, respectively, in addition to the diets. The subjects' lipid profile and hematological parameters were measured prior to the feeding trial and at the end of the feeding trial. The feeding trial lasted for fourteen days. The data obtained were analyzed using the computer program Statistical Product for Service Solution (SPSS) for windows version 21. A Paired-samples t-test was used to compare the means of values collected before and after the feeding trial within the groups and significance was accepted at p < 0.05. There was a non-significant (p > 0.05) decrease in the mean total cholesterol of the subjects in groups 1, 2 and 3 after the feeding trial. There was a non-significant (p > 0.05) decrease in the mean triglyceride levels of the subjects in group 1 after the feeding trial. Groups 1 and 3 subjects had a non-significant (p > 0.05) decrease in their mean low-density lipoprotein (LDL) cholesterol after the feeding trial. Groups 1, 2 and 4 had a significant (p < 0.05) increase in their mean high-density lipoprotein (HDL) cholesterol after the feeding trial. A significant (p < 0.05) decrease in the mean hemoglobin level was observed only in group 4 subjects. Similarly, there was a significant (p < 0.05) decrease in the mean packed cell volume of group 4 subjects. It was only in group 4 that a significant (p < 0.05) decrease in the mean white blood cells of the subjects was also observed. The changes observed in the parameters assessed were not dose-dependent. Therefore, a similar study of longer duration and more samples is imperative to authenticate these results.Keywords: anemia, diabetic subjects, lipid profile, moringa oleifera
Procedia PDF Downloads 187352 Re-Examining the Distinction between Odour Nuisance and Health Impact: A Community’s Campaign against Landfill Gas Exposure in Shongweni, South Africa
Authors: Colin David La Grange, Lisa Frost Ramsay
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Hydrogen sulphide (H2S) is a minor component of landfill gas, but significant in its distinct odorous quality and its association with landfill-related community complaints. The World Health Organisation (WHO) provides two guidelines for H2S: a health guideline at 150 µg/m3 on a 24-hour average, and a nuisance guideline at 7 µg/m3 on a 30-minute average. Albeit a practical distinction for impact assessment, this paper highlights the danger of the apparent dualism between nuisance and health impact, particularly when it is used to dismiss community concerns of perceived health impacts at low concentrations of H2S, as in the case of a community battle against the impacts of a landfill in Shongweni, KwaZulu-Natal, South Africa. Here community members reported, using a community developed mobile phone application, a range of health symptoms that coincided with, or occurred subsequent to, odour events and localised H2S peaks. Local doctors also documented increased visits for symptoms of respiratory distress, eye and skin irritation, and stress after such odour events. Objectively measured H2S and other pollutant concentrations during these events, however, remained below WHO health guidelines. This case study highlights the importance of the physiological link between the experience of environmental nuisance and overall health and wellbeing, showing these to be less distinct than the WHO guidelines would suggest. The potential mechanisms of impact of an odorous plume, with key constituents at concentrations below traditional health thresholds, on psychologically and/or physiologically sensitised individuals are described. In the case of psychological sensitisation, previously documented mechanisms such as aversive conditioning and odour-triggered panic are relevant. Physiological sensitisation to environmental pollutants, evident as a seemingly disproportionate physical (allergy-type) response to either low concentrations or a short duration exposure of a toxin or toxins, remains extensively examined but still not well understood. The links between a heightened sensitivity to toxic compounds, accumulation of some compounds in the body, and a pre-existing or associated immunological stress disorder are presented as a possible explanation.Keywords: immunological stress disorder, landfill odour, odour nuisance, odour sensitisation, toxin accumulation
Procedia PDF Downloads 115351 On the Weightlessness of Vowel Lengthening: Insights from Arabic Dialect of Yemen and Contribution to Psychoneurolinguistics
Authors: Sadeq Al Yaari, Muhammad Alkhunayn, Montaha Al Yaari, Ayman Al Yaari, Aayah Al Yaari, Adham Al Yaari, Sajedah Al Yaari, Fatehi Eissa
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Introduction: It is well established that lengthening (longer duration) is considered one of the correlates of lexical and phrasal prominence. However, it is unexplored whether the scope of vowel lengthening in the Arabic dialect of Yemen (ADY) is differently affected by educated and/or uneducated speakers from different dialectal backgrounds. Specifically, the research aims to examine whether or not linguistic background acquired through different educational channels makes a difference in the speech of the speaker and how that is reflected in related psychoneurolinguistic impairments. Methods: For the above mentioned purpose, we conducted an articulatory experiment wherein a set of words from ADY were examined in the dialectal speech of thousand and seven hundred Yemeni educated and uneducated speakers aged 19-61 years growing up in five regions of the country: Northern, southern, eastern, western and central and were, accordingly, assigned into five dialectal groups. A seven-minute video clip was shown to the participants, who have been asked to spontaneously describe the scene they had just watched before the researchers linguistically and statistically analyzed recordings to weigh vowel lengthening in the speech of the participants. Results: The results show that vowels (monophthongs and diphthongs) are lengthened by all participants. Unexpectedly, educated and uneducated speakers from northern and central dialects lengthen vowels. Compared with uneducated speakers from the same dialect, educated speakers lengthen fewer vowels in their dialectal speech. Conclusions: These findings support the notion that extensive exposure to dialects on account of standard language can cause changes to the patterns of dialects themselves, and this can be seen in the speech of educated and uneducated speakers of these dialects. Further research is needed to clarify the phonemic distinctive features and frequency of lengthening in other open class systems (i.e., nouns, adjectives, and adverbs). Phonetic and phonological report measures are needed as well as validation of existing measures for assessing phonemic vowel length in the Arabic population in general and Arabic individuals with voice, speech, and language impairments in particular.Keywords: vowel lengthening, Arabic dialect of Yemen, phonetics, phonology, impairment, distinctive features
Procedia PDF Downloads 31350 Investigation of Poly P-Dioxanone as Promising Biodegradable Polymer for Short-Term Medical Application
Authors: Stefanie Ficht, Lukas Schübel, Magdalena Kleybolte, Markus Eblenkamp, Jana Steger, Dirk Wilhelm, Petra Mela
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Although 3D printing as transformative technology has become of increasing interest in the medical field and the demand for biodegradable polymers has developed to a considerable extent, there are only a few additively manufactured, biodegradable implants on the market. Additionally, the sterilization of such implants and its side effects on degradation have still not been sufficiently studied. Within this work, thermosensitive poly p-dioxanone (PPDO) samples were printed with fused filament fabrication (FFF) and investigated. Subsequently, H₂O₂ plasma and gamma radiation were used as low-temperature sterilization techniques and compared among each other and the control group (no sterilization). In order to assess the effect of different sterilization on the degradation behavior of PPDO, the samples were immersed in phosphate-buffered solution (PBS) over 28 days, and surface morphology, thermal properties, molecular weight, inherent viscosity, and mechanical properties were examined at regular time intervals. The study demonstrates that PPDO was printed with great success and that thermal properties, molecular weight (Mw), and inherent viscosity (IV) were not significantly affected by the printing process itself. H₂O₂ plasma sterilization did not significantly harm the thermosensitive polymer, while gamma radiation lowered IV and Mw statistically significantly compared to the control group (p < 0.001). During immersion in PBS, a decrease in Mw and mechanical strength occurred for all samples. However, gamma sterilized samples were affected to a much higher extent compared to the two other sample groups both in final values and timeline. This was confirmed by scanning electron microscopy showing no changes of surface morphology of (non-sterilized) control samples, first microcracks appearing on plasma sterilized samples after two weeks while being present on gamma sterilized samples already immediately after radiation to then further deteriorate over immersion duration. To conclude, we demonstrated that FFF and H₂O₂ plasma sterilization are well suited for processing thermosensitive, biodegradable polymers used for the development of innovative short-term medical applications.Keywords: additive manufacturing, sterilization, biodegradable, thermosensitive, medical application
Procedia PDF Downloads 116349 Improving the Constructability of Highway Design Plans
Authors: R. Edward Minchin Jr.
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The U.S. Federal Highway Administration (FHWA) Every Day Counts Program (EDC) has resulted in state DOTs putting evermore emphasis on speeding up the delivery of highway and bridge construction projects for use by the driving public. This has resulted in an increase in the use of alternative construction delivery systems such as design-build (D-B), construction manager at-risk (CMR) or construction manager/general contractor (CM/GC), and adding alternative technical concepts (ATCs) to traditional design-bid-build (DBB) contracts. ATCs have exhibited great potential for delivering substantial benefits like cost savings, increased constructability, and quicker project delivery. Previous research has found that knowledge of project constructability was lacking in state Department of Transportation (DOT) planning, programming, and environmental staffs. Many agencies have therefore relied on a set of ‘acceptable’ design solutions over the years of working with their local resource agencies. The result is that the permitting process for several government agencies has become increasingly restrictive with the result that the DOTs and their industry partners lose the ability to innovate after a permit is approved. The intent of this paper is to report on the research team’s progress in this ongoing effort furnish the United States government with a uniform set of guidelines for the application of constructability reviews during all phases of project development and delivery. The research uses surveys and interviews to determine which states have implemented formal programs to ensure that the constructor is furnished with a set of contract documents that affords said constructor with the best possible opportunity to successfully construct the project with the highest quality standards, within the contract duration and without exceeding the construction budget. Once these states are identified, workshops are held all over the nation, resulting in the team learning the best current practices and giving the team the ability to recommend new practices that will improve the process. The plan is for the FHWA to encourage or require state DOTs to use these practices on all federally funded highway and bridge construction projects. The project deliverable is a Guidebook for FHWA to use in disseminating the recommended practices to the states.Keywords: alternative construction delivery, alternative technical concepts, constructability, construction design plans
Procedia PDF Downloads 200348 Analysis of Structural Modeling on Digital English Learning Strategy Use
Authors: Gyoomi Kim, Jiyoung Bae
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The purpose of this study was to propose a framework that verifies the structural relationships among students’ use of digital English learning strategy (DELS), affective domains, and their individual variables. The study developed a hypothetical model based on previous studies on language learning strategy use as well as digital language learning. The participants were 720 Korean high school students and 430 university students. The instrument was a self-response questionnaire that contained 70 question items based on Oxford’s SILL (Strategy Inventory for Language Learning) as well as the previous studies on language learning strategies in digital learning environment in order to measure DELS and affective domains. The collected data were analyzed through structural equation modeling (SEM). This study used quantitative data analysis procedures: Explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). Firstly, the EFA was conducted in order to verify the hypothetical model; the factor analysis was conducted preferentially to identify the underlying relationships between measured variables of DELS and the affective domain in the EFA process. The hypothetical model was established with six indicators of learning strategies (memory, cognitive, compensation, metacognitive, affective, and social strategies) under the latent variable of the use of DELS. In addition, the model included four indicators (self-confidence, interests, self-regulation, and attitude toward digital learning) under the latent variable of learners’ affective domain. Secondly, the CFA was used to determine the suitability of data and research models, so all data from the present study was used to assess model fits. Lastly, the model also included individual learner factors as covariates and five constructs selected were learners’ gender, the level of English proficiency, the duration of English learning, the period of using digital devices, and previous experience of digital English learning. The results verified from SEM analysis proposed a theoretical model that showed the structural relationships between Korean students’ use of DELS and their affective domains. Therefore, the results of this study help ESL/EFL teachers understand how learners use and develop appropriate learning strategies in digital learning contexts. The pedagogical implication and suggestions for the further study will be also presented.Keywords: Digital English Learning Strategy, DELS, individual variables, learners' affective domains, Structural Equation Modeling, SEM
Procedia PDF Downloads 116347 Changes in the Lives of Families Having a Child with Cancer
Authors: Ilknur Kahriman, Hacer Kobya Bulut, Birsel C. Demirbag
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Introduction and Aim: One of the most challenging aspects of being parents of a child diagnosed with cancer is to balance their normal family life with the child's health needs and treatment requirements. Cancer covers an important part of family life and gets ahead of other matters. Families mostly feel that everything has changed in their lives with the cancer diagnosis and are obliged to make a number of adjustments in their lives. Their normal family life suddenly begins to include treatments, hospital appointments and hospitalizations. This study is a descriptive research conducted to determine the changes in the lives of families who had a child with cancer. Methods: This study was carried out with 65 families having children diagnosed with cancer in 0-17 age group at outpatient pediatric oncology clinic and polyclinic of a university hospital in Trabzon. Data were collected through survey method from August to November, 2015. In the analysis of the data, numbers, percentage and chi-square test were used. Findings: It was found out that the average age of mothers was 35.33 years, most of them were primary school graduates (44.6%) and housewives (89.2%) and the average age of fathers was 39.30 years, most of them were high school graduates (29.2%) and self-employed (43.8% ). The majority of their children were boys and their average age was 7.74 years and 77% had Acute lymphocytic leukemia (ALL) diagnosis. 87.5% of the mothers who had a child with cancer had increased fears in their lives, 84.4% had increased workload at home, 82.8% had more stressful life and 82.8% felt themselves physically tired. The mothers indicated that their healthy children could not do the social activities they had used to do before (56.5%), they no longer fed their healthy children with the food they loved eating so that the sick child did not aspire (52.3%) and their healthy children were more furious than before (53.2%). As for the fathers, the fundamental change they had was increased workload at home (82.3%), had more stressful life (80.6%) and could no longer allocate time to the activities they had been interested in and done before (77.8%). There was not a significant difference between the sick children gender and the changes in their parents lives. The communication between the mothers and their healthy children were determined to be positively affected in the families in which the sick child's disease duration was under 12 months (X2 = 6.452, p = 0.011). Conclusion: This study showed that parents having a child with cancer had more workload at home, had more stressful lives, could not allocate time to social activities, had increased fears, felt themselves tired and their healthy children became more furious and their social activities reduced.Keywords: child, cancer, changes in lives, family
Procedia PDF Downloads 216346 Tick Induced Facial Nerve Paresis: A Narrative Review
Authors: Jemma Porrett
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Background: We present a literature review examining the research surrounding tick paralysis resulting in facial nerve palsy. A case of an intra-aural paralysis tick bite resulting in unilateral facial nerve palsy is also discussed. Methods: A novel case of otoacariasis with associated ipsilateral facial nerve involvement is presented. Additionally, we conducted a review of the literature, and we searched the MEDLINE and EMBASE databases for relevant literature published between 1915 and 2020. Utilising the following keywords; 'Ixodes', 'Facial paralysis', 'Tick bite', and 'Australia', 18 articles were deemed relevant to this study. Results: Eighteen articles included in the review comprised a total of 48 patients. Patients' ages ranged from one year to 84 years of age. Ten studies estimated the possible duration between a tick bite and facial nerve palsy, averaging 8.9 days. Forty-one patients presented with a single tick within the external auditory canal, three had a single tick located on the temple or forehead region, three had post-auricular ticks, and one patient had a remarkable 44 ticks removed from the face, scalp, neck, back, and limbs. A complete ipsilateral facial nerve palsy was present in 45 patients, notably, in 16 patients, this occurred following tick removal. House-Brackmann classification was utilised in 7 patients; four patients with grade 4, one patient with grade three, and two patients with grade 2 facial nerve palsy. Thirty-eight patients had complete recovery of facial palsy. Thirteen studies were analysed for time to recovery, with an average time of 19 days. Six patients had partial recovery at the time of follow-up. One article reported improvement in facial nerve palsy at 24 hours, but no further follow-up was reported. One patient was lost to follow up, and one article failed to mention any resolution of facial nerve palsy. One patient died from respiratory arrest following generalized paralysis. Conclusions: Tick paralysis is a severe but preventable disease. Careful examination of the face, scalp, and external auditory canal should be conducted in patients presenting with otalgia and facial nerve palsy, particularly in tropical areas, to exclude the possibility of tick infestation.Keywords: facial nerve palsy, tick bite, intra-aural, Australia
Procedia PDF Downloads 95345 Cost Overruns in Mega Projects: Project Progress Prediction with Probabilistic Methods
Authors: Yasaman Ashrafi, Stephen Kajewski, Annastiina Silvennoinen, Madhav Nepal
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Mega projects either in construction, urban development or energy sectors are one of the key drivers that build the foundation of wealth and modern civilizations in regions and nations. Such projects require economic justification and substantial capital investment, often derived from individual and corporate investors as well as governments. Cost overruns and time delays in these mega projects demands a new approach to more accurately predict project costs and establish realistic financial plans. The significance of this paper is that the cost efficiency of megaprojects will improve and decrease cost overruns. This research will assist Project Managers (PMs) to make timely and appropriate decisions about both cost and outcomes of ongoing projects. This research, therefore, examines the oil and gas industry where most mega projects apply the classic methods of Cost Performance Index (CPI) and Schedule Performance Index (SPI) and rely on project data to forecast cost and time. Because these projects are always overrun in cost and time even at the early phase of the project, the probabilistic methods of Monte Carlo Simulation (MCS) and Bayesian Adaptive Forecasting method were used to predict project cost at completion of projects. The current theoretical and mathematical models which forecast the total expected cost and project completion date, during the execution phase of an ongoing project will be evaluated. Earned Value Management (EVM) method is unable to predict cost at completion of a project accurately due to the lack of enough detailed project information especially in the early phase of the project. During the project execution phase, the Bayesian adaptive forecasting method incorporates predictions into the actual performance data from earned value management and revises pre-project cost estimates, making full use of the available information. The outcome of this research is to improve the accuracy of both cost prediction and final duration. This research will provide a warning method to identify when current project performance deviates from planned performance and crates an unacceptable gap between preliminary planning and actual performance. This warning method will support project managers to take corrective actions on time.Keywords: cost forecasting, earned value management, project control, project management, risk analysis, simulation
Procedia PDF Downloads 386344 Early Age Behavior of Wind Turbine Gravity Foundations
Authors: Janet Modu, Jean-Francois Georgin, Laurent Briancon, Eric Antoinet
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The current practice during the repowering phase of wind turbines is deconstruction of existing foundations and construction of new foundations to accept larger wind loads or once the foundations have reached the end of their service lives. The ongoing research project FUI25 FEDRE (Fondations d’Eoliennes Durables et REpowering) therefore serves to propose scalable wind turbine foundation designs to allow reuse of the existing foundations. To undertake this research, numerical models and laboratory-scale models are currently being utilized and implemented in the GEOMAS laboratory at INSA Lyon following instrumentation of a reference wind turbine situated in the Northern part of France. Sensors placed within both the foundation and the underlying soil monitor the evolution of stresses from the foundation’s early age to stresses during service. The results from the instrumentation form the basis of validation for both the laboratory and numerical works conducted throughout the project duration. The study currently focuses on the effect of coupled mechanisms (Thermal-Hydro-Mechanical-Chemical) that induce stress during the early age of the reinforced concrete foundation, and scale factor considerations in the replication of the reference wind turbine foundation at laboratory-scale. Using THMC 3D models on COMSOL Multi-physics software, the numerical analysis performed on both the laboratory-scale and the full-scale foundations simulate the thermal deformation, hydration, shrinkage (desiccation and autogenous) and creep so as to predict the initial damage caused by internal processes during concrete setting and hardening. Results show a prominent effect of early age properties on the damage potential in full-scale wind turbine foundations. However, a prediction of the damage potential at laboratory scale shows significant differences in early age stresses in comparison to the full-scale model depending on the spatial position in the foundation. In addition to the well-known size effect phenomenon, these differences may contribute to inaccuracies encountered when predicting ultimate deformations of the on-site foundation using laboratory scale models.Keywords: cement hydration, early age behavior, reinforced concrete, shrinkage, THMC 3D models, wind turbines
Procedia PDF Downloads 168343 Effect of Motor Imagery of Truncal Exercises on Trunk Function and Balance in Early Stroke: A Randomized Controlled Trial
Authors: Elsa Reethu, S. Karthik Babu, N. Syed
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Background: Studies in the past focused on the additional benefits of action observation in improving upper and lower limb functions and improving activities of daily living when administered along with conventional therapy. Nevertheless, there is a paucity of literature proving the effects of motor imagery of truncal exercise in improving trunk control in patients with stroke. Aims/purpose: To study the effect of motor imagery of truncal exercises on trunk function and balance in early stroke. Methods: A total of 24 patients were included in the study. 12 were included in the experimental group and 12 were included in control group Trunk function was measured using Trunk Control Test (TCT), Trunk Impairment Scale Verheyden (TIS Verheyden) and Trunk Impairment Scale Fujiwara (TIS Fujiwara). The balance was assessed using Brunel Balance Assessment (BBA) and Tinetti POMA. For the experimental group, each session was for 30 minutes of physical exercises and 15 minutes of motor imagery, once a day, six times a week for 3 weeks and prior to the exercise session, patients viewed a video tape of all the trunk exercises to be performed for 15minutes. The control group practiced the trunk exercises alone for the same duration. Measurements were taken before, after and 4 weeks after intervention. Results: The effect of treatment in motor imagery group showed better improvement when compared with control group when measured after 3 weeks on values of static sitting balance, dynamic balance, total TIS (Verheyden) score, BBA, Tinetti balance and gait with a large effect size of 0.86, 1.99, 1.69, 1.06, 1.63 and 0.97 respectively. The moderate effect size was seen in values of TIS Fujiwara (0.58) and small effect size was seen on TCT (0.12) and TIS coordination component (0.13).at the end of 4 weeks after intervention, the large effect size was identified on values of dynamic balance (2.06), total TIS score (1.59) and Tinetti balance (1.24). The moderate effect size was observed on BBA (0.62) and Tinetti gait (0.72). Conclusion: Trunk motor imagery is effective in improving trunk function and balance in patients with stroke and has a carryover effect in the aspects of mobility. The therapy gain that was observed during the time of discharge was seen to be maintained at the follow-up levels.Keywords: stroke, trunk rehabilitation, trunk function, balance, motor imagery
Procedia PDF Downloads 296342 The Conundrum of Marital Rape in Malawi: The Past, the Present and the Future
Authors: Esther Gumboh
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While the definition of rape has evolved over the years and now differs from one jurisdiction to another, at the heart of the offence remains the absence of consent on the part of the victim. In simple terms, rape consists in non-consensual sexual intercourse. Therefore, the core issue is whether the accused acted with the consent of the victim. Once it is established that the act was consensual, a conviction of rape cannot be secured. Traditionally, rape within marriage was impossible because it was understood that a woman gave irrevocable consent to sex with her husband throughout the duration of the marriage. This position has since changed in most jurisdictions. Indeed, Malawian law now recognises the offence of marital rape. This is a victory for women’s rights and gender equality. Curiously, however, the definition of marital rape endorsed differs from the standard understanding of rape as non-consensual sex. Instead, the law has introduced the concept of unreasonableness of the refusal to engage in sex as a defence to an accused. This is an alarming position that undermines the protection sought to be derived from the criminalisation of rape within marriage. Moreover, in the Malawian context where rape remains an offence only men can commit against women, the current legal framework for marital rape perpetuates the societal misnomer that a married woman gives a once-off consent to sexual intercourse by virtue of marriage. This takes us back to the old common law position which many countries have moved away from. The present definition of marital rape under Malawian law also sits at odd with the nature of rape that is applicable to all other instances of non-consensual sexual intercourse. Consequently, the law fails to protect married women from unwanted sexual relations at the hands of their husbands. This paper critically examines the criminalisation of marital rape in Malawi. It commences with a historical account of the conceptualisation of rape and then looks at judgments that rejected the validity of marital rape. The discussion then moves to the debates that preceded the criminalisation of marital rape in Malawi and how the Law Commission reasoned to finally make a recommendation in its favour. Against this background, the paper analyses the legal framework for marital rape and what this means for the elements of the offence and defences that may be raised by an accused. In the final analysis, this contribution recommends that there is need to amend the definition of marital rape. Better still, the law should simply state that the fact of marriage is not a defence to a charge of rape, or, in other words, that there is no marital rape exemption. This would automatically mean that husbands are subjected to the same criminal law principles as their unmarried counterparts when it comes to non-consensual sexual intercourse with their wives.Keywords: criminal law, gender, Malawi, marital rape, rape, sexual intercourse
Procedia PDF Downloads 334341 Perception of Nursing Students’ Engagement With Emergency Remote Learning During COVID 19 Pandemic
Authors: Jansirani Natarajan, Mickael Antoinne Joseph
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The COVID-19 pandemic has interrupted face-to-face education and forced universities into an emergency remote teaching curriculum over a short duration. This abrupt transition in the Spring 2020 semester left both faculty and students without proper preparation for continuing higher education in an online environment. Online learning took place in different formats, including fully synchronous, fully asynchronous, and blended in our university through the e-learning platform MOODLE. Studies have shown that students’ engagement, is a critical factor for optimal online teaching. Very few studies have assessed online engagement with ERT during the COVID-19 pandemic. Purpose: Therefore, this study, sought to understand how the sudden transition to emergency remote teaching impacted nursing students’ engagement with online courses in a Middle Eastern public university. Method: A cross-sectional descriptive research design was adopted in this study. Data were collected through a self-reported online survey using Dixon’s online students’ engagement questionnaire from a sample of 177 nursing students after the ERT learning semester. Results The maximum possible engagement score was 95, and the maximum scores in the domains of skills engagement, emotional engagement, participation engagement, and performance engagement were 30, 25, 30, and 10 respectively. Dixson (2010) noted that a mean item score of ≥3.5 (total score of ≥66.5) represents a highly engaged student. The majority of the participants were females (71.8%) and 84.2% were regular BSN students. Most of them (32.2%) were second-year students and 52% had a CGPA between 2 and 3. Most participants (56.5%) had low engagement scores with ERT learning during the COVID lockdown. Among the four engagement domains, 78% had low engagement scores for the participation domain. There was no significant association found between the engagement and the demographic characteristics of the participants. Conclusion The findings supported the importance of engaging students in all four categories skill, emotional, performance, and participation. Based on the results, training sessions were organized for faculty on various strategies for engaging nursing students in all domains by using the facilities available in the MOODLE (online e-learning platform). It added value as a dashboard of information regarding ERT for the administrators and nurse educators to introduce numerous active learning strategies to improve the quality of teaching and learning of nursing students in the University.Keywords: engagement, perception, emergency remote learning, COVID-19
Procedia PDF Downloads 49340 Cardio-respiratory Rehabilitation in Patients With Chronic or Post-acute Cardiomyopathy and COPD
Authors: Ledi Neçaj
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Introduction: Cardio-respiratory rehabilitation is the set of coordinated interventions needed to provide the best physical, psychological, and social conditions so that patients with chronic or post-acute cardiopulmonary disease, with their efforts, maintain or resume optimal functioning in society through improved health behaviors. Purpose: To study the effectiveness of the application of Cardio-Respiratory Rehabilitation in the typology of patients with chronic or post-acute cardiomyopathy and chronic respiratory diseases in order to facilitate their therapeutic use and to improve the overall quality of life. Material and Method: This is a prospective study including patients with COPD and cardiac disease who were included in the rehabilitation program during the period January 2019 - November 2021. The study was conducted at the University Hospital Center "Mother Teresa" in Tirana, University Hospital "SHEFQET NDROQI", AMERICAN Hospital, HYGEA Hospital, and "Our Lady of Good Counsel, Tirana". An individual chart was used to collect sociodemographic, physical, clinical, and functional examinations for each patient. Results: The study included 253 patients, with a mean age of 62.1 (± 7.9) years, ranging from 48 to 82 years. (67.6%) of the patients were males, and (32.4%) female. Male patients predominated in all age groups, with a statistically significant difference with females (p<0.01). The most common cardiac pathologies are coronary artery bypass (24%), cerebral stroke (9%), myocardial infarction (17%), Stent placement (8%) (p<0.01). Correlation matrix of risk factors found a significant correlation of alcohol consumption with diabetes, smoking, dyslipidemia, sedentary life, obesity, AVC, and hypertension. Functional capacity estimated by change in metabolic equivalents (MET) improved by 46% from 4. ±2.2 to 7.2± .8 METs (p<0.01). Duration of exercise after rehabilitation was increased by 21% compared to baseline (p<0.01). The mean score of all three subscales of the questionnaire: symptoms (p=0.03), activity (p<0.01), and impact (p<0.01) after rehabilitation, was lower compared to pre-rehabilitation. Conclusions: The rehabilitation program has impacted on improving the quality of life, reducing symptoms, reducing the impact of negative factors on daily life, and reducing dyspnea during daily activities.Keywords: cardio-respiratory rehabilitation, physical exercise, quality of life, diseases
Procedia PDF Downloads 87339 In-Vitro Evaluation of the Long-Term Stability of PEDOT:PSS Coated Microelectrodes for Chronic Recording and Electrical Stimulation
Authors: A. Schander, T. Tessmann, H. Stemmann, S. Strokov, A. Kreiter, W. Lang
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For the chronic application of neural prostheses and other brain-computer interfaces, long-term stable microelectrodes for electrical stimulation are essential. In recent years many developments were done to investigate different appropriate materials for these electrodes. One of these materials is the electrical conductive polymer poly(3,4-ethylenedioxythiophene) (PEDOT), which has lower impedance and higher charge injection capacity compared to noble metals like gold and platinum. However the long-term stability of this polymer is still unclear. Thus this paper reports on the in-vitro evaluation of the long-term stability of PEDOT coated gold microelectrodes. For this purpose a highly flexible electrocorticography (ECoG) electrode array, based on the polymer polyimide, is used. This array consists of circular gold electrodes with a diameter of 560 µm (0.25 mm2). In total 25 electrodes of this array were coated simultaneously with the polymer PEDOT:PSS in a cleanroom environment using a galvanostatic electropolymerization process. After the coating the array is additionally sterilized using a steam sterilization process (121°C, 1 bar, 20.5 min) to simulate autoclaving prior to the implantation of such an electrode array. The long-term measurements were performed in phosphate-buffered saline solution (PBS, pH 7.4) at the constant body temperature of 37°C. For the in-vitro electrical stimulation a one channel bipolar current stimulator is used. The stimulation protocol consists of a bipolar current amplitude of 5 mA (cathodal phase first), a pulse duration of 100 µs per phase, a pulse pause of 50 µs and a frequency of 1 kHz. A PEDOT:PSS coated gold electrode with an area of 1 cm2 serves as the counter electrode. The electrical stimulation is performed continuously with a total amount of 86.4 million bipolar current pulses per day. The condition of the PEDOT coated electrodes is monitored in between with electrical impedance spectroscopy measurements. The results of this study demonstrate that the PEDOT coated electrodes are stable for more than 3.6 billion bipolar current pulses. Also the unstimulated electrodes show currently no degradation after the time period of 5 months. These results indicate an appropriate long-term stability of this electrode coating for chronic recording and electrical stimulation. The long-term measurements are still continuing to investigate the life limit of this electrode coating.Keywords: chronic recording, electrical stimulation, long-term stability, microelectrodes, PEDOT
Procedia PDF Downloads 578338 Numerical Study of Piled Raft Foundation Under Vertical Static and Seismic Loads
Authors: Hamid Oumer Seid
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Piled raft foundation (PRF) is a union of pile and raft working together through the interaction of soil-pile, pile-raft, soil-raft and pile-pile to provide adequate bearing capacity and controlled settlement. A uniform pile positioning is used in PRF; however, there is a wide room for optimization through parametric study under vertical load to result in a safer and economical foundation. Addis Ababa is found in seismic zone 3 with a peak ground acceleration (PGA) above the threshold of damage, which makes investigating the performance of PRF under seismic load considering the dynamic kinematic soil structure interaction (SSI) vital. The study area is located in Addis Ababa around Mexico (commercial bank) and Kirkos (Nib, Zemen and United Bank) in which input parameters (pile length, pile diameter, pile spacing, raft area, raft thickness and load) are taken. A finite difference-based numerical software, FLAC3D V6, was used for the analysis. The Kobe (1995) and Northridge (1994) earthquakes were selected, and deconvolution analysis was done. A close load sharing between pile and raft was achieved at a spacing of 7D with different pile lengths and diameters. The maximum settlement reduction achieved is 9% for a pile of 2m diameter by increasing length from 10m to 20m, which shows pile length is not effective in reducing settlement. The installation of piles results in an increase in the negative bending moment of the raft compared with an unpiled raft. Hence, the optimized design depends on pile spacing and the raft edge length, while pile length and diameter are not significant parameters. An optimized piled raft configuration (𝐴𝐺/𝐴𝑅 = 0.25 at the center and piles provided around the edge) has reduced pile number by 40% and differential settlement by 95%. The dynamic analysis shows acceleration plot at the top of the piled raft has PGA of 0.25𝑚2/𝑠𝑒𝑐 and 0.63𝑚2/𝑠𝑒𝑐 for Northridge (1994) and Kobe (1995) earthquakes, respectively, due to attenuation of seismic waves. Pile head displacement (maximum is 2mm, and it is under the allowable limit) is affected by the PGA rather than the duration of an earthquake. End bearing and friction PRF performed similarly under two different earthquakes except for their vertical settlement considering SSI. Hence, PRF has shown adequate resistance to seismic loads.Keywords: FLAC3D V6, earthquake, optimized piled raft foundation, pile head department
Procedia PDF Downloads 12337 Change of Epidemiological Characteristics and Disease Burden of Varicella Due to Implementation of Mass Immunization Program in Taiwan from 2000 to 2012
Authors: En-Tzu Wang, Ting-Ann Wang, Yi-Hui Shen, Yu-Min Chou, Chi-Tai Fang, Chin-Hui Yang
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Background and purpose: A mass varicella immunization program was established to provide free 1-dose vaccination for all 1-year-old children throughout Taiwan since 2004. The epidemiological characteristics and disease burden of varicella from 2000 to 2012 was investigated and the results will be essential to refine the national immunization policy. Method: We included patients (n = 17,838–164,245) with ICD-9-CM codes 052 (chickenpox) from the 2000 to 2012 National Health Insurance Database. The age, period, and cohort-specific incidence of varicella were calculated. The hospital admission rate, medical costs and indirect costs from the societal perspective of varicella including travel costs to the medical facility, registration fee, productivity losses of the patients and caregivers were also estimated. Result: There were 979,252 patients for medical treatment due to varicella from 2000 to 2012 in Taiwan. The implementation of a routine childhood varicella vaccination program has resulted in 87% decline in morbidity (881.49 to 115.17 per 100,000). The average age of patients increased from 7.9 years to 16.3 years. The overall varicella-related hospital admission rate was 15.5 per 1000 patients, and peaked in the groups of infants younger than 1 year, adults aged from 20 to 39 years and elders over 70 years. Among patients admitted to hospital, 33.5% of them had one or more complications. Patients with underlying diseases had higher admission rate (241.6 per 1,000) and longer duration of hospital stay (6.61 days vs. 4.76 days). The annual varicella-related medical expense declined after 2002 and the proportion of medical costs for admission has increased to 42%. The annual indirect costs from the societal perspective of varicella were 5.29 to 9.63 times higher than varicella-related medical costs. Every one dollar invested in the varicella immunization program, 2.97 dollars of medical and social costs were saved on average. Conclusion: The dramatic decline in morbidity, hospitalization, medical and social costs of varicella can be directly attributed to the implementation of the mass immunization program. Two-dose vaccination is recommended for both children with underlying diseases and susceptible adults to prevent serious complications and hospitalizations.Keywords: disease burden, epidemiology, medical and social costs, varicella, varicella vaccine
Procedia PDF Downloads 394336 Familiarity with Engineering Project Management And Their Duties In Projects
Authors: Mokhtar Nikgoo
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Today's industrial world has undergone tremendous changes in certain periods. These changes are called environmental changes. And they have a direct impact on organizations and bodies. Therefore, the importance of knowing these changes is clear. This importance has caused the manufacturing organizations to move towards multiple products and constantly change and expand their system. This research tries to show how the organization moves in this category by defining the basic steps of implementing a project. One of the most important features of a hard-to-order production organization is the definition of different production projects from different customers. Therefore, the lack of sufficient understanding of the type of work causes the project to be defined for the organization in question, and the managers of the organization (in every organizational level) are constantly involved with different projects. In the implementation of the production project of the aforementioned organizations, directing the facilities and people of the organization towards the implementation of the project is of particular importance. Therefore, it is felt necessary to define the project manager and his basic duties. Considering the importance of this topic, the project chapter deals with project management and its importance and examines all the different issues in that category from the perspective of implementation. A project includes certain activities of the organization that require the use of different resources and all the activities of the organization in order to implement the project with defined facilities and at the designated times. Project management is planning, organizing and controlling the organization's resources for a short-term goal that has been created for short-term and medium-term goals and objectives. Project management has the important task of centering and integrating (coordinating) task and line managers. In other words, project management requires having a strong and appropriate relationship with the internal people of the system to carry out the assigned activities and must have a general and technical knowledge related to various activities in the project environment. It seems that everything with project management in It is communication. One of the characteristics of production organizations under the order is the relationship between the customer (customers) and the organization until the completion of the defined project. Due to the nature of the work, it is necessary for a person to establish this relationship between the client and the organization's people and to establish this relationship in such a way that it does not cause a lack of coordination in the organization's activities. Therefore, project management has a very important role at this stage, because the relationship between the client and his organization will be any problems and problems and points of view that the client has, he must inform the management so that he can implement the cases with its analysis and special processes. To be transferred to other departments and line managers.Keywords: project management, crisis management, project delays bill, project duration
Procedia PDF Downloads 43335 Development of an Instrument for Measurement of Thermal Conductivity and Thermal Diffusivity of Tropical Fruit Juice
Authors: T. Ewetumo, K. D. Adedayo, Festus Ben
Abstract:
Knowledge of the thermal properties of foods is of fundamental importance in the food industry to establish the design of processing equipment. However, for tropical fruit juice, there is very little information in literature, seriously hampering processing procedures. This research work describes the development of an instrument for automated thermal conductivity and thermal diffusivity measurement of tropical fruit juice using a transient thermal probe technique based on line heat principle. The system consists of two thermocouple sensors, constant current source, heater, thermocouple amplifier, microcontroller, microSD card shield and intelligent liquid crystal. A fixed distance of 6.50mm was maintained between the two probes. When heat is applied, the temperature rise at the heater probe measured with time at time interval of 4s for 240s. The measuring element conforms as closely as possible to an infinite line source of heat in an infinite fluid. Under these conditions, thermal conductivity and thermal diffusivity are simultaneously measured, with thermal conductivity determined from the slope of a plot of the temperature rise of the heating element against the logarithm of time while thermal diffusivity was determined from the time it took the sample to attain a peak temperature and the time duration over a fixed diffusivity distance. A constant current source was designed to apply a power input of 16.33W/m to the probe throughout the experiment. The thermal probe was interfaced with a digital display and data logger by using an application program written in C++. Calibration of the instrument was done by determining the thermal properties of distilled water. Error due to convection was avoided by adding 1.5% agar to the water. The instrument has been used for measurement of thermal properties of banana, orange and watermelon. Thermal conductivity values of 0.593, 0.598, 0.586 W/m^o C and thermal diffusivity values of 1.053 ×〖10〗^(-7), 1.086 ×〖10〗^(-7), and 0.959 ×〖10〗^(-7) 〖m/s〗^2 were obtained for banana, orange and water melon respectively. Measured values were stored in a microSD card. The instrument performed very well as it measured the thermal conductivity and thermal diffusivity of the tropical fruit juice samples with statistical analysis (ANOVA) showing no significant difference (p>0.05) between the literature standards and estimated averages of each sample investigated with the developed instrument.Keywords: thermal conductivity, thermal diffusivity, tropical fruit juice, diffusion equation
Procedia PDF Downloads 345