Search results for: plant related to bacillus bacteria.

Authors: Maryam Tabrizi, Shahrzad Aarup

Abstract:

Objectives- Understanding the close association between oral health and overall health for older adults at the right time and right place, a person, focus treatment through Project ECHO telementoring. Methodology- Data from monthly ECHO telementoring sessions were provided for three years. Sessions including case presentations, overall health conditions, considering medications, organ functions limitations, including the level of cognition. Contributions- Providing the specialist level of providing care to all elderly regardless of their location and other health conditions and decreasing oral health inequity by increasing workforce via Project ECHO telementoring program worldwide. By 2030, the number of adults in the USA over the age of 65 will increase more than 60% (approx.46 million) and over 22 million (30%) of 74 million older Americans will need specialized geriatrician care. In 2025, a national shortage of medical geriatricians will be close to 27,000. Most individuals 65 and older do not receive oral health care due to lack of access, availability, or affordability. One of the main reasons is a significant shortage of Oral Health (OH) education and resources for the elderly, particularly in rural areas. Poor OH is a social stigma, a thread to quality and safety of overall health of the elderly with physical and cognitive decline. Poor OH conditions may be costly and sometimes life-threatening. Non-traumatic dental-related emergency department use in Texas alone was over $250 M in 2016. Most elderly over the age of 65 present with at least one or multiple chronic diseases such as arthritis, diabetes, heart diseases, and chronic obstructive pulmonary disease (COPD) are at higher risk to develop gum (periodontal) disease, yet they are less likely to get dental care. In addition, most older adults take both prescription and over-the-counter drugs; according to scientific studies, many of these medications cause dry mouth. Reduced saliva flow due to aging and medications may increase the risk of cavities and other oral conditions. Most dental schools have already increased geriatrics OH in their educational curriculums, but the aging population growth worldwide is faster than growing geriatrics dentists. However, without the use of advanced technology and creating a network between specialists and primary care providers, it is impossible to increase the workforce, provide equitable oral health to the elderly. Project ECHO is a guided practice model that revolutionizes health education and increases the workforce to provide best-practice specialty care and reduce health disparities. Training oral health providers for utilizing the Project ECHO model is a logical response to the shortage and increases oral health access to the elderly. Project ECHO trains general dentists & hygienists to provide specialty care services. This means more elderly can get the care they need, in the right place, at the right time, with better treatment outcomes and reduces costs.

Keywords: geriatric, oral health, project echo, chronic disease, oral health

Procedia PDF Downloads 175

Authors: Kevin Baxter, Ron Grove, James Pitney, John Harrison, Ozlem Gumus

Abstract:

The purpose of this research is to determine the mediating effect of effectiveness of the training provided by Northwestern University’s School of Police Staff and Command (SPSC), on the ability of law enforcement mid-level managers to learn transformational and authentic leadership traits. This study will also evaluate the leadership styles, of course, graduates compared to non-attendees using a static group comparison design. The Louisiana State Police pay approximately $40,000 in salary, tuition, housing, and meals for each state police lieutenant attending the 10-week program of the SPSC. This school lists the development of transformational leaders as an increasing element. Additionally, the SPSC curriculum addresses all four components of authentic leadership - self-awareness, transparency, ethical/moral, and balanced processing. Upon return to law enforcement in roles of mid-level management, there are questions as to whether or not students revert to an “autocratic” leadership style. Insufficient evidence exists to support claims for the effectiveness of management training or leadership development. Though it is widely recognized that transformational styles are beneficial to law enforcement, there is little evidence that suggests police leadership styles are changing. Police organizations continue to hold to a more transactional style (i.e., most senior police leaders remain autocrats). Additionally, research in the application of transformational, transactional, and laissez-faire leadership related to police organizations is minimal. The population of the study is law enforcement mid-level managers from various states within the United States who completed leadership training presented by the SPSC. The sample will be composed of 66 active law enforcement mid-level managers (lieutenants and captains) who have graduated from SPSC and 65 active law enforcement mid-level managers (lieutenants and captains) who have not attended SPSC. Participants will answer demographics questions, Multifactor Leadership Questionnaire, Authentic Leadership Questionnaire, and the Kirkpatrick Hybrid Evaluation Survey. Analysis from descriptive statistics, group comparison, one-way MANCOVA, and the Kirkpatrick Evaluation Model survey will be used to determine training effectiveness in the four levels of reaction, learning, behavior, and results. Independent variables are SPSC graduates (two groups: upper and lower) and no-SPSC attendees, and dependent variables are transformational and authentic leadership scores. SPSC graduates are expected to have higher MLQ scores for transformational leadership traits and higher ALQ scores for authentic leadership traits than SPSC non-attendees. We also expect the graduates to rate the efficacy of SPSC leadership training as high. This study will validate (or invalidate) the benefits, costs, and resources required for leadership development from a nationally recognized police leadership program, and it will also help fill the gap in the literature that exists between law enforcement professional development and transformational and authentic leadership styles.

Keywords: training effectiveness, transformational leadership, authentic leadership, law enforcement mid-level manager

Procedia PDF Downloads 106

Authors: Laura C. Loaiza, Elodie Salager, Nicolas Louvain, Athmane Boulaoued, Antonella Iadecola, Patrik Johansson, Lorenzo Stievano, Vincent Seznec, Laure Monconduit

Abstract:

Lithium-ion batteries (LIBs) have an important place among energy storage devices due to their high capacity and good cyclability. However, the advancements in portable and transportation applications have extended the research towards new horizons, and today the development is hampered, e.g., by the capacity of the electrodes employed. Silicon and germanium are among the considered modern anode materials as they can undergo alloying reactions with lithium while delivering high capacities. It has been demonstrated that silicon in its highest lithiated state can deliver up to ten times more capacity than graphite (372 mAh/g): 4200 mAh/g for Li₂₂Si₅ and 3579 mAh/g for Li₁₅Si₄, respectively. On the other hand, germanium presents a capacity of 1384 mAh/g for Li₁₅Ge₄, and a better electronic conductivity and Li ion diffusivity as compared to Si. Nonetheless, the commercialization potential of Ge is limited by its cost. The synergetic effect of Si₁₋ₓGeₓ alloys has been proven, the capacity is increased compared to Ge-rich electrodes and the capacity retention is increased compared to Si-rich electrodes, but the exact performance of this type of electrodes will depend on factors like specific capacity, C-rates, cost, etc. There are several reports on various formulations of Si₁₋ₓGeₓ alloys with promising LIB anode performance with most work performed on complex nanostructures resulting from synthesis efforts implying high cost. In the present work, we studied the electrochemical mechanism of the Si₀.₅Ge₀.₅ alloy as a realistic micron-sized electrode formulation using carboxymethyl cellulose (CMC) as the binder. A combination of a large set of in situ and operando techniques were employed to investigate the structural evolution of Si₀.₅Ge₀.₅ during lithiation and delithiation processes: powder X-ray diffraction (XRD), X-ray absorption spectroscopy (XAS), Raman spectroscopy, and 7Li solid state nuclear magnetic resonance spectroscopy (NMR). The results have presented a whole view of the structural modifications induced by the lithiation/delithiation processes. The Si₀.₅Ge₀.₅ amorphization was observed at the beginning of discharge. Further lithiation induces the formation of a-Liₓ(Si/Ge) intermediates and the crystallization of Li₁₅(Si₀.₅Ge₀.₅)₄ at the end of the discharge. At really low voltages a reversible process of overlithiation and formation of Li₁₅₊δ(Si₀.₅Ge₀.₅)₄ was identified and related with a structural evolution of Li₁₅(Si₀.₅Ge₀.₅)₄. Upon charge, the c-Li₁₅(Si₀.₅Ge₀.₅)₄ was transformed into a-Liₓ(Si/Ge) intermediates. At the end of the process an amorphous phase assigned to a-SiₓGey was recovered. Thereby, it was demonstrated that Si and Ge are collectively active along the cycling process, upon discharge with the formation of a ternary Li₁₅(Si₀.₅Ge₀.₅)₄ phase (with a step of overlithiation) and upon charge with the rebuilding of the a-Si-Ge phase. This process is undoubtedly behind the enhanced performance of Si₀.₅Ge₀.₅ compared to a physical mixture of Si and Ge.

Keywords: lithium ion battery, silicon germanium anode, in situ characterization, X-Ray diffraction

Procedia PDF Downloads 286

Authors: Ines Oliveira, Ana Reis

Abstract:

Magnetic Pulse Welding (MPW) is a cold solid-state welding process, accomplished by the electromagnetically driven, high-speed and low-angle impact between two metallic surfaces. It has the same working principle of Explosive Welding (EXW), i.e. is based on the collision of two parts at high impact speed, in this case, propelled by electromagnetic force. Under proper conditions, i.e., flyer velocity and collision point angle, a permanent metallurgical bond can be achieved between widely dissimilar metals. MPW has been considered a promising alternative to the conventional welding processes and advantageous when compared to other impact processes. Nevertheless, MPW current applications are mostly academic. Despite the existing knowledge, the lack of consensus regarding several aspects of the process calls for further investigation. As a result, the mechanical resistance, morphology and structure of the weld interface in MPW of Al/Cu dissimilar pair were investigated. The effect of process parameters, namely gap, standoff distance and energy, were studied. It was shown that welding only takes place if the process parameters are within an optimal range. Additionally, the formation of intermetallic phases cannot be completely avoided in the weld of Al/Cu dissimilar pair by MPW. Depending on the process parameters, the intermetallic compounds can appear as continuous layer or small pockets. The thickness and the composition of the intermetallic layer depend on the processing parameters. Different intermetallic phases can be identified, meaning that different temperature-time regimes can occur during the process. It is also found that lower pulse energies are preferred. The relationship between energy increase and melting is possibly related to multiple sources of heating. Higher values of pulse energy are associated with higher induced currents in the part, meaning that more Joule heating will be generated. In addition, more energy means higher flyer velocity, the air existing in the gap between the parts to be welded is expelled, and this aerodynamic drag (fluid friction) is proportional to the square of the velocity, further contributing to the generation of heat. As the kinetic energy also increases with the square of velocity, the dissipation of this energy through plastic work and jet generation will also contribute to an increase in temperature. To reduce intermetallic phases, porosity, and melt pockets, pulse energy should be minimized. The bond formation is affected not only by the gap, standoff distance, and energy but also by the mandrel’s surface conditions. No correlation was clearly identified between surface roughness/scratch orientation and joint strength. Nevertheless, the aspect of the interface (thickness of the intermetallic layer, porosity, presence of macro/microcracks) is clearly affected by the surface topology. Welding was not established on oil contaminated surfaces, meaning that the jet action is not enough to completely clean the surface.

Keywords: bonding mechanisms, impact welding, intermetallic compounds, magnetic pulse welding, wave formation

Procedia PDF Downloads 211

Authors: Ralph Nyadu-Addo, Francis Matambalya, Utz Dornberger

Abstract:

The global music industry is a multi-billion dollar sector. The potential of Africa’s music industry is widely recognised in the socio-economic development milieu. It has impacted positively on several sectors including most especially the tourism, media and information, communication technology (ICT) among others. It is becoming increasingly clear that even in Africa (as demonstrated in Nigeria) that in addition to its intrinsic value, the sector has significant economic returns. UNCTAD observed, the creative industries offer some of the best prospects for high growth in least developed countries. The statistics from Africa may be far lower than similar sectors in developed countries but it goes to give further credence to several UNCTAD publications which say the creative industry is under researched and its potential under-estimated but holds the key to its rapid development The emerging creative economy (music in particular) has become a leading component of economic growth, employment, trade, innovation, and social cohesion in many countries. In line with these developments, the Ghana government recognizes the potential that the Creative Industries have to shape and reinforce Ghana’s economic growth. Creative sectors, particularly music, tend to rely less on sophisticated infrastructure or capital-intensive investment. Potential is particularly abundant in Africa, where musical creativity is rich, diverse, well-loved, and constantly evolving while drawing on strong traditions. The development of a popular music industry thus represents low-hanging fruit for most African economies says the World Bank. As we shift towards economic diversification using the creative industry, value is increasingly created at the intersection of arts, business and technology. Cultural and creative entrepreneurs are leading this trend. It is one of the areas where value is captured within the country as emerging trends have shown in Nigeria and Ghana among others. Yet, evidence shows that the potential of the cultural and creative sectors remains largely untapped. Furthermore, its socio-economic impact remains under-researched in many developing countries and its dynamics unknown. Despite its huge influence on music repertoire across the globe, most countries in Africa have not historically been significant markets for the international music industry. Today, that is beginning to change. Generally, reliable and adequate literature about music in the sub-region is difficult to obtain. The growing interests in academia and business cycles about a reliable data on the growing music industry in developing countries have called for an urgent need to undertake this research. Research questions: i. Who are the major stakeholders in the music value chain in Ghana? ii. How much of value is captured domestically iii. What is the economic impact of the Ghanaian music industry iv. How has the advent of ICT (internet) impacted on the music landscape? Research sources will be mainly through interviews of major stakeholders, baseline study of the industry by KPMG and content analysis of related newspapers and magazines.

Keywords: economic impact, information communications technology (ICT), music-industry, value chain

Procedia PDF Downloads 296

Authors: O. Bilbao, I. Loizaga, F. A. Girot, A. Torregaray

Abstract:

The current energetical situation and the high competitiveness in industrial sectors as the automotive one have become the development of new manufacturing processes with less energy and raw material consumption a real necessity. As consequence, new forming processes related with high temperature hot forging in closed dies have emerged in the last years as new solutions to expand the possibilities of hot forging and iron casting in the automotive industry. These technologies are mid-way between hot forging and semi-solid metal processes, working at temperatures higher than the hot forging but below the solidus temperature or the semi solid range, where no liquid phase is expected. This represents an advantage comparing with semi-solid forming processes as thixoforging, by the reason that no so high temperatures need to be reached in the case of high melting point alloys as steels, reducing the manufacturing costs and the difficulties associated to semi-solid processing of them. Comparing with hot forging, this kind of technologies allow the production of parts with as forged properties and more complex and near-net shapes (thinner sidewalls), enhancing the possibility of designing lightweight components. From the process viewpoint, the forging forces are significantly decreased, and a significant reduction of the raw material, energy consumption, and the forging steps have been demonstrated. Despite the mentioned advantages, from the material behavior point of view, the expansion of these technologies has shown the necessity of developing new material flow behavior models in the process working temperature range to make the simulation or the prediction of these new forming processes feasible. Moreover, the knowledge of the material flow behavior at the working temperature range also allows the design of the new closed dies concept required. In this work, the flow behavior characterization in the mentioned temperature range of the widely used in automotive commercial components 42CrMo4 steel has been studied. For that, hot compression tests have been carried out in a thermomechanical tester in a temperature range that covers the material behavior from the hot forging until the NDT (Nil Ductility Temperature) temperature (1250 ºC, 1275 ºC, 1300 ºC, 1325 ºC, 1350ºC, and 1375 ºC). As for the strain rates, three different orders of magnitudes have been considered (0,1 s-1, 1s-1, and 10s-1). Then, results obtained from the hot compression tests have been treated in order to adapt or re-write the Spittel model, widely used in automotive commercial softwares as FORGE® that restrict the current existing models up to 1250ºC. Finally, the obtained new flow behavior model has been validated by the process simulation in a commercial automotive component and the comparison of the results of the simulation with the already made experimental tests in a laboratory cellule of the new technology. So as a conclusion of the study, a new flow behavior model for the 42CrMo4 steel in the new working temperature range and the new process simulation in its application in automotive commercial components has been achieved and will be shown.

Keywords: 42CrMo4 high temperature flow behavior, high temperature hot forging in closed dies, simulation of automotive commercial components, spittel flow behavior model

Procedia PDF Downloads 129

Authors: Priyanka Manghani, Manthan Patel, Rahul Peddawad

Abstract:

Cervical Cancer is a major public health hurdle in the area of women’s health. The most common cause of Cervical Cancer is the Human Papilloma Virus (HPV). Human papilloma virus has various genotypes, with HPV 16 and HPV 18 being the major etiological factor causing carcinoma of the Cervix. Early screening and detection by Papanicolaou Smears (PAP) is an effective method for identifying premalignant and malignant lesions. In case of existing pre- malignant lesions /cervical dysplasia’s found with HPV 16 or 18, appropriate follow up can be done to prevent it from developing into a neoplasm. Aims and Objectives: Primary Aim; To study various abnormal cervical cytology reports as detected by Pap Smear Tests, using the Bethesda System in women at a Tertiary Care Hospital. Secondary Aim; To discuss the importance of Pap smear in Cervical Cancer Screening Program. Materials and Methods: Our study is a prospective study, based on 101 women who attended the Out-patient department of Obstetrics and Gynecology at a tertiary care hospital in age group 20-40 years with chief complaints of white/foul vaginal discharge, post-coital Bleeding, low back pain, irregular menstruation, etc. 60 women, who were tested, of the total no of women, were commercial sex workers, thus being a high-risk group for HPV infection. All women underwent conventional cytology. For all the abnormal smears, further cervical biopsies were done, and the final diagnosis was done on the basis of histopathology (gold standard). Results: In all these patients, 16 patients presented with normal smears out of which 2 belonged to the category of commercial sex workers (3.33%) and 14 being from the normal/control group (34.15%). 44 women presented with inflammatory smears out of which 30 were commercial sex workers (50%) and 14 from the control Group (34.15%). A total of 11 women presented with infectious etiology with 6 being commercial sex workers (10%) and 5 (12.2%) being in the control group. A total of 8 patients presented with low-grade squamous intra epithelial lesion (LSIL) with 7 (11.7%) being commercial sex workers and 1(2.44%) patient belonging to the control group. A Total of 7 patients presented with high-grade squamous intraepithelial lesion (HSIL) with 6 (10%) being commercial sex workers and 1 (2.44%) belonging to the control group. 9 patients in total presented with atypical squamous cells of undetermined significance (ASCUS) with 6(10%) being commercial sex workers and 3 (7.32%) belonging to the control group. Squamous cell carcinoma(SCC) presence was found only in 1(1.7%) commercial sex worker. Conclusion – We conclude that HSIL, LSIL, SCC and sexually related infections are comparatively more common in vulnerable groups such as sex workers due to a variety of factors such as multiple sexual partners and poor genital hygiene. Early screening and follow up interventions are highly needed for them along with Health education for risk factors and to emphasize on the importance of Pap smear screening.

Keywords: cervical cancer, papanicolaou (pap) smear, bethesda system, neoplasm

Procedia PDF Downloads 224

Authors: M. Sirhan, S. Bekhor, A. Sidess

Abstract:

In-service pavements deteriorate with time due to traffic wheel loads, environment, and climate conditions. Pavement deterioration leads to a reduction in their serviceability and structural behavior. Consequently, proper maintenance and rehabilitation (M&R) are necessary actions to keep the in-service pavement network at the desired level of serviceability. Due to resource and financial constraints, the pavement management system (PMS) prioritizes roads most in need of maintenance and rehabilitation action. It recommends a suitable action for each pavement based on the performance and surface condition of each road in the network. The pavement performance and condition are usually quantified and evaluated by different types of roughness-based and stress-based indices. Examples of such indices are Pavement Serviceability Index (PSI), Pavement Serviceability Ratio (PSR), Mean Panel Rating (MPR), Pavement Condition Rating (PCR), Ride Number (RN), Profile Index (PI), International Roughness Index (IRI), and Pavement Condition Index (PCI). PCI is commonly used in PMS as an indicator of the extent of the distresses on the pavement surface. PCI values range between 0 and 100; where 0 and 100 represent a highly deteriorated pavement and a newly constructed pavement, respectively. The PCI value is a function of distress type, severity, and density (measured as a percentage of the total pavement area). PCI is usually calculated iteratively using the 'Paver' program developed by the US Army Corps. The use of soft computing techniques, especially Artificial Neural Network (ANN), has become increasingly popular in the modeling of engineering problems. ANN techniques have successfully modeled the performance of the in-service pavements, due to its efficiency in predicting and solving non-linear relationships and dealing with an uncertain large amount of data. Typical regression models, which require a pre-defined relationship, can be replaced by ANN, which was found to be an appropriate tool for predicting the different pavement performance indices versus different factors as well. Subsequently, the objective of the presented study is to develop and train an ANN model that predicts the PCI values. The model’s input consists of percentage areas of 11 different damage types; alligator cracking, swelling, rutting, block cracking, longitudinal/transverse cracking, edge cracking, shoving, raveling, potholes, patching, and lane drop off, at three severity levels (low, medium, high) for each. The developed model was trained using 536,000 samples and tested on 134,000 samples. The samples were collected and prepared by The National Transport Infrastructure Company. The predicted results yielded satisfactory compliance with field measurements. The proposed model predicted PCI values with relatively low standard deviations, suggesting that it could be incorporated into the PMS for PCI determination. It is worth mentioning that the most influencing variables for PCI prediction are damages related to alligator cracking, swelling, rutting, and potholes.

Keywords: artificial neural networks, computer programming, pavement condition index, pavement management, performance prediction

Procedia PDF Downloads 138

Authors: Nirmani Wijenayake, Louise Lutze-Mann, Lucy Jo, John Wilson, Vivian Yeung, Dean Lovett, Kim Snepvangers

Abstract:

Sessional academic staff at universities have the most influence and impact on student learning, engagement, and experience as they have the most direct contact with undergraduate students. A blended technology-enhanced program was created for the development and support of sessional staff to ensure adequate training is provided to deliver quality educational outcomes for the students. This program combines innovative mixed media educational modules, a peer-driven support forum, and face-to-face workshops to provide a comprehensive training and support package for staff. Additionally, the program encourages the development of learning communities and peer mentoring among the sessional staff to enhance their support system. In 2018, the program was piloted on 100 sessional staff in the School of Biotechnology and Biomolecular Sciences to evaluate the effectiveness of this model. As part of the program, rotoscope animations were developed to showcase ‘typical’ interactions between staff and students. These were designed around communication, confidence building, consistency in grading, feedback, diversity awareness, and mental health and wellbeing. When surveyed, 86% of sessional staff found these animations to be helpful in their teaching. An online platform (Moodle) was set up to disseminate educational resources and teaching tips, to host a discussion forum for peer-to-peer communication and to increase critical thinking and problem-solving skills through scenario-based lessons. The learning analytics from these lessons were essential in identifying difficulties faced by sessional staff to further develop supporting workshops to improve outcomes related to teaching. The face-to-face professional development workshops were run by expert guest speakers on topics such as cultural diversity, stress and anxiety, LGBTIQ and student engagement. All the attendees of the workshops found them to be useful and 88% said they felt these workshops increase interaction with their peers and built a sense of community. The final component of the program was to use an adaptive e-learning platform to gather feedback from the students on sessional staff teaching twice during the semester. The initial feedback provides sessional staff with enough time to reflect on their teaching and adjust their performance if necessary, to improve the student experience. The feedback from students and the sessional staff on this model has been extremely positive. The training equips the sessional staff with knowledge and insights which can provide students with an exceptional learning environment. This program is designed in a flexible and scalable manner so that other faculties or institutions could adapt components for their own training. It is anticipated that the training and support would help to build the next generation of educators who will directly impact the educational experience of students.

Keywords: designing effective instruction, enhancing student learning, implementing effective strategies, professional development

Procedia PDF Downloads 128

Authors: Fabio L. Vieira, Micaelle F. C. Lemos, Luciano C. Lemos, Rafaela S. Oliveira, Ian A. Cunha

Abstract:

Brazil has some challenges ahead related to population oral health, most of them associated with the need of expanding into the local level its promotion and prevention activities, offer equal access to services and promote changes in the lifestyle of the population. The program implemented an oral health initiative in public schools in the city of Salvador, Bahia. The mission was to improve oral health among students on primary and secondary education, from 2 to 15 years old, using the school as a pathway to increase access to healthcare. The main actions consisted of a team's visit to the schools with educational sessions for dental cavity prevention and individual assessment. The program incorporated a clinical surveillance component through a dental evaluation of every student searching for dental disease and caries, standardization of the dentists’ team to reach uniform classification on the assessments, and the use of an online platform to register data directly from the schools. Sequentially, the students with caries were referred for free clinical treatment on the program’s Health Centre. The primary purpose of this study was to analyze the effects and outcomes of this school-based oral health program. The study sample was composed by data of a period of 3 years - 2015 to 2017 - from 13 public schools on the suburb of the city of Salvador with a total number of assessments of 9,278 on this period. From the data collected the prevalence of children with decay on permanent teeth was chosen as the most reliable indicator. The prevalence was calculated for each one of the 13 schools using the number of children with 1 or more dental caries on permanent teeth divided by the total number of students assessed for school each year. Then the percentage change per year was calculated for each school. Some schools presented a higher variation on the total number of assessments in one of the three years, so for these, the percentage change calculation was done using the two years with less variation. The results show that 10 of the 13 schools presented significative improvements for the indicator of caries in permanent teeth. The mean for the number of students with caries percentage reduction on the 13 schools was 26.8%, and the median was 32.2% caries in permanent teeth institution. The highest percentage of improvement reached a decrease of 65.6% on the indicator. Three schools presented a rise in caries prevalence (8.9, 18.9 and 37.2% increase) that, on an initial analysis, seems to be explained with the students’ cohort rotation among other schools, as well as absenteeism on the treatment. In conclusion, the program shows a relevant impact on the reduction of caries in permanent teeth among students and the need for the continuity and expansion of this integrated healthcare approach. It has also been evident the significative of the articulation between health and educational systems representing a fundamental approach to improve healthcare access for children especially in scenarios such as presented in Brazil.

Keywords: primary care, public health, oral health, school-based oral health, data management

Procedia PDF Downloads 136

Authors: Nourah Almulhim

Abstract:

This paper takes a critical discourse analysis (CDA) approach to investigate discourse and ideology in political blogs, focusing in particular on the Conservative Home blog from the UK’s current governing party. The Conservative party member’s discourse strategies as the blogger, alongside the discourse used by members of the public who reply to the blog in the below-the-lines comments, will be examined. The blog discourse reflects the writer's political identity and authorial voice. The analysis of the below-the-lines comments enables members of the public to engage in creating adversative positions, introducing different language users who bring their own individual and collective identities. These language users can play the role of news reporters, political analysts, protesters or supporters of a specific agenda and current socio-political topics or events. This study takes a qualitative approach to analyze the discriminatory context towards Islam/Muslims in ' The Conservative Home' blog. A cognitive approach is adopted and an analysis of dominant discourses in the blog text and the below-the-line comments is used. The focus of the study is, firstly, on the construction of self/ collective national identity in comparison to Muslim identity, highlighting the in-group and out-group construction. Second, the type of attitudes, whether feelings or judgments, related to these social actors as they are explicated to draw on the social values. Third, the role of discursive strategies in justifying and legitimizing those Islamophobic discriminatory practices. Therefore, the analysis is based on the systematic analysis of social actors drawing on actors, actions, and arguments to explicate identity construction and its development in the different discourses. A socio-semantic categorization of social actors is implemented to draw on the discursive strategies in addition to using literature to understand these strategies. An appraisal analysis is further used to classify attitudes and elaborate on core values in both genres. Finally, the grammar of othering is applied to explain how discriminatory dichotomies of 'Us' Vs. ''Them' actions are carried in discourse. Some of the key findings of the analysis can be summarized in two main points. First, the discursive practice used to represent Muslims/Islam as different from ‘Us’ are different in both genres as the blogger uses a covert voice while the commenters generally use an overt voice. This is to say that the blogger uses a mitigated strategy to represent the Muslim identity, for example, using the noun phrase ‘British Muslim’ but then representing them as ‘radical’ and ‘terrorists'. Contrary to this is in below the lines comments, where a direct strategy with an active declarative voice is used to negatively represent the Muslim identity as ‘oppressors’ and ‘terrorists’ with no inclusion of the noun phrase ‘British Muslims’. Second, the negotiation of the ‘British’ identity and values, such as culture and democracy, are prominent in the comment section as being unique and under threat by Muslims, while in the article, these standpoints are not represented.

Keywords: xenophobia, blogs, identity, critical discourse analysis

Procedia PDF Downloads 96

Authors: Henry Lau, Dilupa Nakandala, Li Zhao

Abstract:

In today’s business, it is well-recognized that risk is an important factor that needs to be taken into consideration before a decision is made. Studies indicate that both the number of risks faced by organizations and their potential consequences are growing. Supply chain risk management has become one of the major concerns for practitioners and researchers. Supply chain leaders and scholars are now focusing on the importance of managing supply chain risk. In order to meet the challenge of managing and mitigating supply chain risk (SCR), we must first identify the different dimensions of SCR and assess its relevant probability and severity. SCR has been classified in many different ways, and there are no consistently accepted dimensions of SCRs and several different classifications are reported in the literature. Basically, supply chain risks can be classified into two dimensions namely disruption risk and operational risk. Disruption risks are those caused by events such as bankruptcy, natural disasters and terrorist attack. Operational risks are related to supply and demand coordination and uncertainty, such as uncertain demand and uncertain supply. Disruption risks are rare but severe and hard to manage, while operational risk can be reduced through effective SCM activities. Other SCRs include supply risk, process risk, demand risk and technology risk. In fact, the disorganized classification of SCR has created confusion for SCR scholars. Moreover, practitioners need to identify and assess SCR. As such, it is important to have an overarching framework tying all these SCR dimensions together for two reasons. First, it helps researchers use these terms for communication of ideas based on the same concept. Second, a shared understanding of the SCR dimensions will support the researchers to focus on the more important research objective: operationalization of SCR, which is very important for assessing SCR. In general, fresh food supply chain is subject to certain level of risks, such as supply risk (low quality, delivery failure, hot weather etc.) and demand risk (season food imbalance, new competitors). Effective strategies to mitigate fresh food supply chain risk are required to enhance operations. Before implementing effective mitigation strategies, we need to identify the risk sources and evaluate the risk level. However, assessing the supply chain risk is not an easy matter, and existing research mainly use qualitative method, such as risk assessment matrix. To address the relevant issues, this paper aims to analyze the risk factor of the fresh food supply chain using an approach comprising both fuzzy logic and hierarchical holographic modeling techniques. This novel approach is able to take advantage the benefits of both of these well-known techniques and at the same time offset their drawbacks in certain aspects. In order to develop this integrated approach, substantial research work is needed to effectively combine these two techniques in a seamless way, To validate the proposed integrated approach, a case study in a fresh food supply chain company was conducted to verify the feasibility of its functionality in a real environment.

Keywords: fresh food supply chain, fuzzy logic, hierarchical holographic modelling, operationalization, supply chain risk

Procedia PDF Downloads 244

Authors: Christina Y. P. Ting

Abstract:

Migration is a global phenomenon with movements of migrants from developed and developing countries to the host societies. Migrants have changed the host countries’ demography – its population structure and also its ethnic cultural diversity. Acculturation of migrants in terms of their adoption of the host culture is seen as important to ensure that they ‘fit into’ their adopted country so as to participate in everyday public life. However, this research found that the increase of the China-born migrants’ post-migration consumption level had impact on Australia’s environment reflected not only because of their adoption of elements of the host culture, but also retention of aspects of Chinese culture – indicating that the influence of bi-culturalism was in operation. This research, which was based on the face-to-face interview with 61 China-born migrants in the suburb of Box Hill, Melbourne, investigated the pattern of change in the migrants’ consumption upon their settlement in Australia. Using an ecological footprint calculator, their post-migration footprints were found to be larger than pre-migration footprint. The uniquely-derived CALD (Culturally and Linguistically Diverse) Index was used to measure individuals’ strength of connectedness to ethnic culture. Multi-variant analysis was carried out to understand which independent factors that influence consumption best explain the change in footprint (which is the difference between pre-and post-migration footprints, as a dependent factor). These independent factors ranged from socio-economic and demographics to the cultural context, that is, the CALD Index and indicators of acculturation. The major findings from the analysis were: Chinese culture (as measured by the CALD Index) and indicators of acculturation such as length of residency and using English in communications besides the traditional factors such as age, income and education level made significant contributions to the large increase in the China-born group’s post-migration consumption level. This paper as part of a larger study found that younger migrants’ large change in their footprint were related to high income and low level of education. This group of migrants also practiced bi-cultural consumption in retaining ethnic culture and adopting the host culture. These findings have importantly highlighted that for a host society to tackle environmental crisis, governments need not only to understand the relationship between age and consumption behaviour, but also to understand and embrace the migrants’ ethnic cultures, which may act as bridges and/or fences in relationships. In conclusion, for governments to deal with national issues such as environmental crisis within a cultural diverse population, it necessitates an understanding of age and aspects of ethnic culture that may act as bridges and fences. This understanding can aid in putting in place policies that enable the co-existence of a hybrid of the ethnic and host cultures in order to create and maintain a harmonious and secured living environment for population groups.

Keywords: bicultural consumer, CALD index, consumption, ethnic culture, migrants

Procedia PDF Downloads 247

Authors: H. Alqunayeer, S. Zamir

Abstract:

Blended learning, an ideal amalgamation of online learning and face to face traditional approach is a new approach that may result in outstanding outcomes in the realm of teaching and learning. The dexterity and effectiveness offered by e-learning experience cannot be guaranteed in a traditional classroom, whereas one-to-one interaction the essential element of learning that can only be found in a traditional classroom. In recent years, a spectacular expansion in the incorporation of technology in language teaching and learning is observed in many universities of Saudi Arabia. Some universities recognize the importance of blending face-to-face with online instruction in language pedagogy, Qassim University is one of the many universities adopting Blackboard Learning Management system (LMS). The university has adopted this new mode of teaching/learning in year 2015. Although the experience is immature; however great pedagogical transformations are anticipated in the university through this new approach. This paper examines the role of blended language learning with particular reference to the influence of Blackboard Learning Management System on the development of English language learning for EFL learners registered in Bachelors of English language program. This paper aims at exploring three main areas: (i) the present status of Blended learning in the educational process in Saudi Arabia especially in Qassim University by providing a survey report on the number of training courses on Blackboard LMS conducted for the male and female teachers at various colleges of Qassim University, (ii) a survey on teachers perception about the utility, application and the outcome of using blended Learning approach in teaching English language skills courses, (iii) the students’ views on the efficiency of Blended learning approach in learning English language skills courses. Besides, analysis of students’ limitations and challenges related to the experience of blended learning via Blackboard, the suggestion and recommendations offered by the language learners have also been thought-out. The study is empirical in nature. In order to gather data on the afore mentioned areas survey questionnaire method has been used: in order to study students’ perception, a 5 point Likert-scale questionnaire has been distributed to 200 students of English department registered in Bachelors in English program (level 5 through level 8). Teachers’ views have been surveyed with the help of interviewing 25 EFL teachers skilled in using Blackboard LMS in their lectures. In order to ensure the validity and reliability of questionnaire, the inter-rater approach and Cronbach’s Alpha analysis have been used respectively. Analysis of variance (ANOVA) has been used to analyze the students’ perception about the productivity of the Blended approach in learning English language skills. The analysis of feedback by Saudi teachers and students about the usefulness, ingenuity, and productivity of Blended Learning via Blackboard LMS highlights the need of encouraging and expanding the implementation of this new approach into the field of English language teaching in Saudi Arabia, in order to augment congenial learning aura. Furthermore, it is hoped that the propositions and practical suggestions offered by the study will be functional for other similar learning environments.

Keywords: blended learning, black board learning management system, English as foreign language (EFL) learners, EFL teachers

Procedia PDF Downloads 156

Authors: Cinzia Russi, Chiyo Nishida

Abstract:

Using data from online corpora (Spanish CREA, Italian CORIS), this paper examines the relatively understudied use of Spanish se and Italian si exemplified in (1) and (2), respectively. (1) El rojo es … el que se come a los demás. ‘The red (bottle) is the one that outshines/*eats the rest.’(2) … ebbe anche la saggezza di mangiarsi tutto il suo patrimonio. ‘… he even had the wisdom to squander/*eat all his estate.’ In these sentences, se/si accompanies the consumption verb comer/mangiare ‘to eat’, without which the sentences would not be interpreted appropriately. This se/si cannot readily be attributed to any of the multiple functions so far identified in the literature: reflexive, ergative, middle/passive, inherent, benefactive, and complete consumptive. In particular, this paper argues against the feasibility of a recent construction-based analysis of sentences like (1) and (2), which situates se/si within a prototype-based network of meanings all deriving from the central meaning of 'COMPLETE CONSUMPTION' (e.g., Alice se comió toda la torta/Alicesi è mangiata tutta la torta ‘John ate the whole cake’). Clearly, the empirical adequacy of such an account is undermined by the fact that the events depicted in the se/si-sentences at issue do not always entail complete consumption because they may lack an INCREMENTAL THEME, the distinguishing property of complete consumption. Alternatively, it is proposed that the sentences under analysis represent instances of verbal METAPHORICAL EXTENSION: se/si represents an explicit marker of this cognitive process, which has independently developed from the complete consumptive se/si, and the meaning extension is captured by the general tenets of Conceptual Metaphor Theory (CMT). Two conceptual domains, Source (DS) and target (DT), are related by similarity, assigning an appropriate metaphorical interpretation to DT. The domains paired here are comer/mangiare (DS) and comerse/mangiarsi (DT). The eating event (DS) involves (a) the physical process of xEATER grinding yFOOD-STUFF into pieces and swallowing it; and (b) the aspect of xEATER savoring yFOOD-STUFF and being nurtured by it. In the physical act of eating, xEATER has dominance and exercises his force over yFOOD-STUFF. This general sense of dominance and force is mapped onto DT and is manifested in the ways exemplified in (1) and (2), and many others. According to CMT, two other properties are observed in each pair of DS & DT. First, DS tends to be more physical and concrete and DT more abstract, and systematic mappings are established between constituent elements in DS and those in DT: xEATER corresponds to the element that destroys and yFOOD-STUFF to the element that is destroyed in DT, as exemplified in (1) and (2). Though the metaphorical extension marker se/si appears by far most frequently with comer/mangiare in the corpora, similar systematic mappings are observed in several other verb pairs, for example, jugar/giocare ‘to play (games)’ and jugarse/giocarsi ‘to jeopardize/risk (life, reputation, etc.)’, perder/perdere ‘to lose (an object)’ and perderse/perdersi ‘to miss out on (an event)’, etc. Thus, this study provides evidence that languages may indeed formally mark metaphor using means available to them.

Keywords: complete consumption value, conceptual metaphor, Italian si/Spanish se, metaphorical extension.

Procedia PDF Downloads 54

Authors: Hsin-Hung Lin, Janet Chang, Te-Yi Chang, You-Sheng Huang

Abstract:

The natural and men-made disasters have become huge challenges for tourism destinations as well as emphasizing the fragility of the industry. Hot springs, among all destinations, are prone to disasters due to their dependence on natural resources and locations. After the COVID-19 outbreak, hot spring destinations have experienced not only the loss of businesses but also the psychological trauma. However, evidence has also shown that the impacts may not necessarily reduce the resilience for people but may be converted into posttraumatic growth. In Taiwan, a large proportion of hot springs are located in rural or indigenous areas. As a result, hot spring resources are associated with community cohesion for local residents. Yet prior research on hot spring destinations has mainly focused on visitors, whereas residents have been overlooked. More specifically, the relationship between hot springs resources and resident resilience in the face of the COVID-19 impacts remains unclear. To fulfill this knowledge gap, this paper aims to explore the COVID-19 impacts on residents’ hot spring experiences as well as individual and community resilience from the perspective of posttraumatic growth. A total of 315 residents of 13 hot spring destinations that are most popular in Taiwan were recruited. Online questionnaires were distributed over travel forums and social networks after the COVID-19. This paper subsequently used Partial Least Squares Structural Equation Modeling for data analysis as the technique offers significant advantages in addressing nonnormal data and small sample sizes. A preliminary test was conducted, and the results showed acceptable internal consistency and no serious common method variance. The path analysis demonstrated that the COVID-19 impacts strengthened residents’ perceptions of hot spring resources and experiences, implying that the pandemic had propelled the residents to visit hot springs for the healing benefits. In addition, the COVID-19 impacts significantly enhanced residents’ individual and community resilience, which indicates that the residents at hot springs are more resilient thanks to their awareness of external risks. Thirdly, residents’ individual resilience was positively associated with hot spring experiences, while community resilience was not affected by hot spring experiences. Such findings may suggest that hot spring experiences are more related to individual-level experiences and, consequently, have insignificant influence on community resilience. Finally, individual resilience was proved to be the most relevant factor that help foster community resilience. To conclude, the authorities may consider exploiting the hot spring resources so as to increase individual resilience for local residents. Such implications can be used as a reference for other post-disaster tourist destinations as well. As for future research, longitudinal studies with qualitative methods are suggested to better understand how the hot spring experiences have changed individuals and communities over the long term. It should be noted that the main subjects of this paper were focused on the hot spring communities in Taiwan. Therefore, the results cannot be generalized for all types of tourism destinations. That is, more diverse tourism destinations may be investigated to provide a broader perspective of post-disaster recovery.

Keywords: community resilience, hot spring destinations, individual resilience, posttraumatic growth

Procedia PDF Downloads 85

Authors: Monkiz Khasreen

Abstract:

In the context of the global trend towards reducing new buildings carbon footprint, the design team is required to make early decisions that have a major influence on embodied and operational carbon. Sustainability strategies should be clear during early stages of building design process, as changes made later can be extremely costly. Life-Cycle Assessment (LCA) could be used as the vehicle to carry other tools and processes towards achieving the requested improvement. Although LCA is the ‘golden standard’ to evaluate buildings from 'cradle to grave', lack of details available on the concept design makes LCA very difficult, if not impossible, to be used as an estimation tool at early stages. Issues related to transparency and accessibility of information in the building industry are affecting the credibility of LCA studies. A verified database derived from LCA case studies is required to be accessible to researchers, design professionals, and decision makers in order to offer guidance on specific areas of significant impact. This database could be the build-up of data from multiple sources within a pool of research held in this context. One of the most important factors that affects the reliability of such data is the temporal factor as building materials, components, and systems are rapidly changing with the advancement of technology making production more efficient and less environmentally harmful. Recent LCA studies on different building functions, types, and structures are always needed to update databases derived from research and to form case bases for comparison studies. There is also a need to make these studies transparent and accessible to designers. The work in this paper sets out to address this need. This paper also presents life-cycle case study of a new-build educational building in England. The building utilised very current construction methods and technologies and is rated as BREEAM excellent. Carbon emissions of different life-cycle stages and different building materials and components were modelled. Scenario and sensitivity analyses were used to estimate the future of new educational buildings in England. The study attempts to form an indicator during the early design stages of similar buildings. Carbon dioxide emissions of this case study building, when normalised according to floor area, lie towards the lower end of the range of worldwide data reported in the literature. Sensitivity analysis shows that life cycle assessment results are highly sensitive to future assumptions made at the design stage, such as future changes in electricity generation structure over time, refurbishment processes and recycling. The analyses also prove that large savings in carbon dioxide emissions can result from very small changes at the design stage.

Keywords: architecture, building, carbon dioxide, construction, educational buildings, England, environmental impact, life-cycle assessment

Procedia PDF Downloads 113

Authors: Baguma Daniel Kajura

Abstract:

The study explores socio-economic factors, health related and individual factors that influence the breastfeeding habits of mothers and their effect on the nutritional status of their infants in the Rwenzori region of Western Uganda. A cross-sectional research design was adopted, and it involved the use of self-administered questionnaires, interview guides, and focused group discussion guides to assess the extent to which socio-demographic factors associated with breastfeeding practices influence child malnutrition. Using this design, data was collected from 276 mother-paired infants out of the selected 318 mother-paired infants over a period of ten days. Using a sample size formula by Kish Leslie for cross-sectional studies N= Zα2 P (1- P) / δ2, where N= sample size estimate of paired mother paired infants. P= assumed true population prevalence of mother–paired infants with malnutrition cases, P = 29.3%. 1-P = the probability of mother-paired infants not having malnutrition, so 1-P = 70.7% Zα = Standard normal deviation at 95% confidence interval corresponding to 1.96.δ = Absolute error between the estimated and true population prevalence of malnutrition of 5%. The calculated sample size N = 1.96 × 1.96 (0.293 × 0.707) /0,052= 318 mother paired infants. Demographic and socio-economic data for all mothers were entered into Microsoft Excel software and then exported to STATA 14 (StataCorp, 2015). Anthropometric measurements were taken for all children by the researcher and the trained assistants who physically weighed the children. The use of immunization card was used to attain the age of the child. The bivariate logistic regression analysis was used to assess the relationship between socio-demographic factors associated with breastfeeding practices and child malnutrition. The multivariable regression analysis was used to draw a conclusion on whether or not there are any true relationships between the socio-demographic factors associated with breastfeeding practices as independent variables and child stunting and underweight as dependent variables in relation to breastfeeding practices. Descriptive statistics on background characteristics of the mothers were generated and presented in frequency distribution tables. Frequencies and means were computed, and the results were presented using tables, then, we determined the distribution of stunting and underweight among infants by the socioeconomic and demographic factors. Findings reveal that children of mothers who used milk substitutes besides breastfeeding are over two times more likely to be stunted compared to those whose mothers exclusively breastfed them. Feeding children with milk substitutes instead of breastmilk predisposes them to both stunting and underweight. Children of mothers between 18 and 34 years of age are less likely to be underweight, as were those who were breastfed over ten times a day. The study further reveals that 55% of the children were underweight, and 49% were stunted. Of the underweight children, an equal number (58/151) were either mildly or moderately underweight (38%), and 23% (35/151) were severely underweight. Empowering community outreach programs by increasing knowledge and increased access to services on integrated management of child malnutrition is crucial to curbing child malnutrition in rural areas.

Keywords: infant and young child feeding, breastfeeding, child malnutrition, maternal health

Procedia PDF Downloads 24

Authors: Stephanie P. Nigro

Abstract:

The Exhale Breath Hold (EBH) technique presents a promising approach to enhance the precision and efficacy of External Beam Radiation Therapy (EBRT) for abdominal tumours, which include liver, pancreas, kidney, and adrenal glands. These tumours are challenging to treat due to their proximity to organs at risk (OARs) and the significant motion induced by respiration and physiological variations, such as stomach filling. Respiratory motion can cause up to 40mm of displacement in abdominal organs, complicating accurate targeting. While current practices like limiting fasting help reduce motion related to digestive processes, they do not address respiratory motion. 4DCT scans are used to assess this motion, but they require extensive workflow time and expose patients to higher doses of radiation. The EBH technique, which involves holding the breath in an exhale with no air in the lungs, stabilizes internal organ motion, thereby reducing respiratory-induced motion. The primary benefit of EBH is the reduction in treatment volume sizes, specifically the Internal Target Volume (ITV) and Planning Target Volume (PTV), as demonstrated by smaller ITVs when gated in EBH. This reduction also improves the quality of 3D Cone Beam CT (CBCT) images by minimizing respiratory artifacts, facilitating soft tissue matching akin to stereotactic treatments. Patients suitable for EBH must meet criteria including the ability to hold their breath for at least 15 seconds and maintain a consistent breathing pattern. For those who do not qualify, the traditional 4DCT protocol will be used. The implementation involves an EBH planning scan and additional short EBH scans to ensure reproducibility and assist in contouring and volume expansions, with a Free Breathing (FB) scan used for setup purposes. Treatment planning on EBH scans leads to smaller PTVs, though intrafractional and interfractional breath hold variations must be accounted for in margins. The treatment decision process includes performing CBCT in EBH intervals, with careful matching and adjustment based on soft tissue and fiducial markers. Initial studies at two sites will evaluate the necessity of multiple CBCTs, assessing shifts and the benefits of initial versus mid-treatment CBCT. Considerations for successful implementation include thorough patient coaching, staff training, and verification of breath holds, despite potential disadvantages such as longer treatment times and patient exhaustion. Overall, the EBH technique offers significant improvements in the accuracy and quality of abdominal EBRT, paving the way for more effective and safer treatments for patients.

Keywords: abdominal cancers, exhale breath hold, radiation therapy, respiratory motion

Procedia PDF Downloads 28

Authors: Jérôme de Reffye, Marc Antoni

Abstract:

Following the development of the ERTMS system, we think it is interesting to develop another software-based track circuit system which would fit secondary railway lines with an easy-to-work implementation and a low sensitivity to rail-wheel impedance variations. We called this track circuit 'Track Railway by Automatic Circuits.' To be internationally implemented, this system must not have any mechanical component and must be compatible with existing track circuit systems. For example, the system is independent from the French 'Joints Isolants Collés' that isolate track sections from one another, and it is equally independent from component used in Germany called 'Counting Axles,' in French 'compteur d’essieux.' This track circuit is fully interoperable. Such universality is obtained by replacing the train detection mechanical system with a space-time filtering of train position. The various track sections are defined by the frequency of a continuous signal. The set of frequencies related to the track sections is a set of orthogonal functions in a Hilbert Space. Thus the failure probability of track sections separation is precisely calculated on the basis of signal-to-noise ratio. SNR is a function of the level of traction current conducted by rails. This is the reason why we developed a very powerful algorithm to reject noise and jamming to obtain an SNR compatible with the precision required for the track circuit and SIL 4 level. The SIL 4 level is thus reachable by an adjustment of the set of orthogonal functions. Our major contributions to railway engineering signalling science are i) Train space localization is precisely defined by a calibration system. The operation bypasses the GSM-R radio system of the ERTMS system. Moreover, the track circuit is naturally protected against radio-type jammers. After the calibration operation, the track circuit is autonomous. ii) A mathematical topology adapted to train space localization by following the train through a linear time filtering of the received signal. Track sections are numerically defined and can be modified with a software update. The system was numerically simulated, and results were beyond our expectations. We achieved a precision of one meter. Rail-ground and rail-wheel impedance sensitivity analysis gave excellent results. Results are now complete and ready to be published. This work was initialised as a research project of the French Railways developed by the Pi-Ramses Company under SNCF contract and required five years to obtain the results. This track circuit is already at Level 3 of the ERTMS system, and it will be much cheaper to implement and to work. The traffic regulation is based on variable length track sections. As the traffic growths, the maximum speed is reduced, and the track section lengths are decreasing. It is possible if the elementary track section is correctly defined for the minimum speed and if every track section is able to emit with variable frequencies.

Keywords: track section, track circuits, space-time crossing, adaptive track section, automatic railway signalling

Procedia PDF Downloads 333

Authors: Rongrong Liu, Li Wang, Hui Xu, Jianpei Fang, Sixi Liu, Xiaolin Yin, Junbin Liang, Gaohui Yan, Yaoyun Li, Yali Zhou, Xinyu Li, Yue Li, Lei Shi, Yongrong Lai, Junjiu Huang, Xinhua Zhang

Abstract:

Background: Beta-Thalassemia is caused by reduced (β+) or absent (β0) synthesis of the β-globin chains of hemoglobin. Transfusions and oral iron chelation therapy have improved the quality of life for patients with Transfusion-Dependent thalassemia (TDT). Recent advances in genome editing platforms of CRISPR-Cas9 have paved the way for induction of HbF by reactivating expression of γ-chain.Aims: We performed CRISPR-Cas9-mediated genome editing of hematopoietic stem cells to mutate HBG1/HBG2 promoter sequence, thereby representing a naturally occurring HPFH-liked mutation, producing RM-001. Here, we present an initial assessment of safety and efficacy of RM-001 in patients with TDT. Methods: Patients (6–35 y of age) with TDT receiving packed red blood cell (pRBC) transfusions of ≥100 mL/kg/y or ≥10 units/y in the previous 2 y were eligible. CD34+ cells were edited with CRISPR-Cas9 using a guide RNA specific for the binding site of BCL11A on the HBG1/2 promoter. Prior to RM-001 product infusion (day 0), patients received myeloablative conditioning with Busulfan from day-7 to day-4. Patients were monitored for AEs Hb expression.Results: Data cut as of 28 Feb 2024, 16 TDT patients have been treated with RM-001 and followed ≥3 months. 5 of these 16 patients had finished their 24 months follow up. Eleven patients have β0/β0 genotype and five patients have β0/β+ genotype. In addition to β-thalassemia, two patients had α- deletion with the genotype of --/αα. Efficacy:All patients received a single dose intravenous infusion of RM-001 cells. 5 of them had been followed 24 months or longer. All patients achieved transfusion-independent (TI, total Hb continued ≥ 9g/dL) (Figure1). Patients demonstrated sustained and clinically meaningful increases in HbF levels since 4 month post-RM-001 infusion (Figure.2). Total hemoglobin in all patients was stable at 10-12g/dL during the follow-up period. Safety:The adverse events observed after RM-001 infusion were consistent with those that are typical of Busulfan-based myeloablation. The allelic editing analysis at 6-month visit showed that the on-target allelic editing frequency in bone marrow cells was 73.44% (64.65% to 84.6%, n=13).Summary/Conclusion: This interim analysis, in which all the 19 patients age from 7.9 to 25yo met the success criteria for the trial with respect to transfusion independence, showed that autologous HBG1/2 promoter-modified CD34+ HSPCs gene therapy resulted in an adequate amount of HbF as early as 2 months after infusion led to near-normal hemoglobin levels, remained transfusion-free through the reported period without product related SAE. After RM-001 infusion, high levels of HbF proportion and on-target editing in bone marrow cells were maintained. Submitted on behalf of the RM-001 Investigators.

Keywords: thalassemian, genetherapy, CRISPR/Cas9, HbF

Procedia PDF Downloads 25

Authors: Hsin-Hung Lin, Janet Chang, Te-Yi Chang, You-Sheng Huang

Abstract:

The natural and men-made disasters have become huge challenges for tourism destinations as well as emphasizing the fragility of the industry. Hot springs, among all destinations, are prone to disasters due to their dependence on natural resources and locations. After the COVID-19 outbreak, hot spring destinations have experienced not only the loss of businesses but also the psychological trauma. However, evidence has also shown that the impacts may not necessarily reduce the resilience for people but may be converted into posttraumatic growth. In Taiwan, a large proportion of hot springs are located in rural or indigenous areas. As a result, hot spring resources are associated with community cohesion for local residents. Yet prior research on hot spring destinations has mainly focused on visitors, whereas residents have been overlooked. More specifically, the relationship between hot springs resources and resident resilience in the face of the COVID-19 impacts remains unclear. To fulfill this knowledge gap, this paper aims to explore the COVID-19 impacts on residents’ hot spring experiences as well as individual and community resilience from the perspective of posttraumatic growth. A total of 315 residents of 13 hot spring destinations that are most popular in Taiwan were recruited. Online questionnaires were distributed over travel forums and social networks after the COVID-19. This paper subsequently used Partial Least Squares Structural Equation Modeling for data analysis as the technique offers significant advantages in addressing nonnormal data and small sample sizes. A preliminary test was conducted, and the results showed acceptable internal consistency and no serious common method variance. The path analysis demonstrated that the COVID-19 impacts strengthened residents’ perceptions of hot spring resources and experiences, implying that the pandemic had propelled the residents to visit hot springs for the healing benefits. In addition, the COVID-19 impacts significantly enhanced residents’ individual and community resilience, which indicates that the residents at hot springs are more resilient thanks to their awareness of external risks. Thirdly, residents’ individual resilience was positively associated with hot spring experiences, while community resilience was not affected by hot spring experiences. Such findings may suggest that hot spring experiences are more related to individual-level experiences and, consequently, have insignificant influence on community resilience. Finally, individual resilience was proved to be the most relevant factor that help foster community resilience. To conclude, the authorities may consider exploiting the hot spring resources so as to increase individual resilience for local residents. Such implications can be used as a reference for other post-disaster tourist destinations as well.As for future research, longitudinal studies with qualitative methods are suggested to better understand how the hot spring experiences have changed individuals and communities over the long term. It should be noted that the main subjects of this paper were focused on the hot spring communities in Taiwan. Therefore, the results cannot be generalized for all types of tourism destinations. That is, more diverse tourism destinations may be investigated to provide a broader perspective of post-disaster recovery.

Keywords: community resilience, hot spring destinations, individual resilience, posttraumatic growth (PTG)

Procedia PDF Downloads 75

Authors: Arzu Firlarer, Duygu Gocmen, Gokhan Uysal

Abstract:

There is currently a growing trend among universities towards blended learning. Blended learning is becoming increasingly important in higher education, with the aims of better accomplishing course learning objectives, meeting students’ changing needs and promoting effective learning both in a theoretical and practical dimension like interior architecture discipline. However, the practical dimension of the discipline cannot be supported in the university environment. During the undergraduate program, the practical training which is tried to be supported by two different internship programs cannot fully meet the requirements of the blended learning. The lack of education program frequently expressed by our graduates and employers is revealed in the practical knowledge and skills dimension of the profession. After a series of meetings for curriculum studies, interviews with the chambers of profession, meetings with interior architects, a gap between the theoretical and practical training modules is seen as a problem in all interior architecture departments. It is thought that this gap can be solved by a new education model which is formed by the cooperation of University-Industry in the concept of blended learning. In this context, it is considered that theoretical and applied knowledge accumulation can be provided by the creation of industry-supported educational environments at the university. In the application process of the Interior Architecture discipline, the use of materials and technical competence will only be possible with the cooperation of industry and participation of students in the production/manufacture processes as observers and practitioners. Wood manufacturing is an important part of interior architecture applications. Wood productions is a sustainable structural process where production details, material knowledge, and process details can be observed in the most effective way. From this point of view, after theoretical training about wooden materials, wood applications and production processes are given to the students, practical training for production/manufacture planning is supported by active participation and observation in the processes. With this blended model, we aimed to develop a training model in which theoretical and practical knowledge related to the production of wood works will be conveyed in a meaningful, lasting way by means of university-industry cooperation. The project is carried out in Ankara with Arcora Architecture and Furniture Company and Başkent University Department of Interior Design where university-industry cooperation is realized. Within the scope of the project, every week the video of that week’s lecture is recorded and prepared to be disseminated by digital medias such as Udemy. In this sense, the program is not only developed by the project participants, but also other institutions and people who are trained and practiced in the field of design. Both academicians from University and at least 15-year experienced craftsmen in the wood metal and dye sectors are preparing new training reference documents for interior architecture undergraduate programs. These reference documents will be a model for other Interior Architecture departments of the universities and will be used for creating an online education module.

Keywords: blended learning, interior design, sustainable training, effective learning.

Procedia PDF Downloads 136

Authors: Ali Reza Vaezi, Ouldouz Bakhshi Rad

Abstract:

Gully erosion is a widespread and often dramatic form of soil erosion caused by water during and immediately after heavy rainfall. It occurs when flowing surface water is channelled across unprotected land and washes away the soil along the drainage lines. The formation of gully is influenced by various factors, including climate, drainage surface area, slope gradient, vegetation cover, land use, and soil properties. It is a very important problem in semi-arid regions, where soils have lower organic matter and are weakly aggregated. Intensive agriculture and tillage along the slope can accelerate soil erosion by water in the region. There is little information on the development of gully erosion in agricultural rainfed areas. Therefore, this study was carried out to investigate the relationship between gully erosion and morphometric characteristics of the drainage area and the effects of soil properties and soil management factors (land use and tillage method) on gully development. A field study was done in a 900 km2 agricultural area in Hshtroud township located in the south of East Azarbijan province, NW Iran. Toward this, two hundred twenty-two gullies created in rainfed lands were found in the area. Some properties of gullies, consisting of length, width, depth, height difference, cross section area, and volume, were determined. Drainage areas for each or some gullies were determined, and their boundaries were drawn. Additionally, the surface area of each drainage, land use, tillage direction, and soil properties that may affect gully formation were determined. The soil erodibility factor (K) defined in the Universal Soil Loss Equation (USLE) was estimated based on five soil properties (silt and very fine sand, coarse sand, organic matter, soil structure code, and soil permeability). Gully development in each drainage area was quantified using its volume and soil loss. The dependency of gully development on drainage area characteristics (surface area, land use, tillage direction, and soil properties) was determined using correlation matrix analysis. Based on the results, gully length was the most important morphometric characteristic indicating the development of gully erosion in the lands. Gully development in the area was related to slope gradient (r= -0.26), surface area (r= 0.71), the area of rainfed lands (r= 0.23), and the area of rainfed tilled along the slope (r= 0.24). Nevertheless, its correlation with the area of pasture and soil erodibility factor (K) was not significant. Among the characteristics of drainage area, surface area is the major factor controlling gully volume in the agricultural land. No significant correlation was found between gully erosion and soil erodibility factor (K) estimated by the Universal Soil Loss Equation (USLE). It seems the estimated soil erodibility can’t describe the susceptibility of the study soils to the gully erosion process. In these soils, aggregate stability and soil permeability are the two soil physical properties that affect the actual soil erodibility and in consequence, these soil properties can control gully erosion in the rainfed lands.

Keywords: agricultural area, gully properties, soil structure, USLE

Procedia PDF Downloads 78

Authors: John Toussaint

Abstract:

Objective: Our society is suffering from an epidemic of body image dissatisfaction, and related disorders appear to be increasing globally for children. There is much to indicate that children's body image and eating attitudes are being affected negatively by socio-cultural factors such as parents, peers and media. Most studies and theories, however, have focused extensively on the daughter-mother relationship. Very few studies have investigated the role of attachment to the father as an important factor in the development of girls’ and women’s attitudes towards themselves and their bodies. Recently, data have shown that the father’s parenting style, as well as the quality of the relationship with him is crucial for the understanding of the development and persistence of body image disorders. This presentation is based on samples of participants with self-defined body image dissatisfaction, and the self-reported measures of their fathers’ parental behaviours, emotional warmth, support, or protection. Attachment theory does offer support in exploring these relationships and it is used in this presentation to assist in understanding the relationship between the father and his daughter in relation to body image and mental health. Clinical implications are also offered in respect to work with body image, eating disorders and relational therapy. Methods: As awareness of the increasing frequency of body image concerns in children grows, so too does the need for a simple, valid and reliable measure of body image. The Children's Body Image Scale (CBIS) designed in Australia, depicts seven male and females figures from which children are to choose their perceived body type and ideal body type. This was compared with a range of international body mass index (BMI) reference standards. These measures together with individual one-on-one interviews were completed by 158 children aged 7-12 years. Results: A high frequency of body image dissatisfaction was indicated in the children's responses. 55% of girls and 41% of boys said they would like to be thinner, and wished for an ideal BMI figure below the 10th percentile. This is an unhealthy and unattainable level of body fatness for the majority of children when considered in relation to the reported secular trend of their increasing average body size. Thin children were generally ranked as best and perceived as kind, happy, academically skilled, and socially successful. Fat children were perceived as unintelligent, lazy, greedy, unpopular, and unable to play physical games. Conclusions: Body image ideals and fat stereotypes are well entrenched among children. There is much to indicate that children's body image and eating attitudes are being affected negatively by sociocultural factors such as parents, peers and media. Teachers and health professionals could promote intervention programs for children involving knowledge and acceptance of genetic influences on body type; the dangerous effects of weight loss dieting; the importance of physical activity and eating healthy; and scepticism and critical analysis of mass media messages.

Keywords: body image, father attachment, mental health, eating disorders

Procedia PDF Downloads 263

Authors: Chih-Rong Shyr, Chi-Ping Huang

Abstract:

Intravesical BCG is the gold-standard therapy for high risk non-muscle invasive bladder cancer (NMIBC) after TURBT, but if not responsive to BCG, these BCG unresponsive patients face cystectomy that causes morbidity and comes with a morality risk. To provide the bladder sparing options for patients with BCG-unresponsive NMIBC, several new treatments have been developed to salvage the bladders and prevent progression to muscle invasive or metastatic, but however, most approved or developed treatments still fail in a significant proportion of patients without long term success. Thus more treatment options and the combination of different therapeutic modalities are urgently needed to change the outcomes. Xenogeneic rejection has been proposed to a mechanism of action to induce anti-tumor immunity for the treatment of cancers due to the similarities between rejection mechanism to xenoantigens (proteins, glycans and lipids) and anti-tumor immunities to tumor specific antigens (neoantigens, tumor associated carbohydrates and lipids). Xenogeneic urothelial cells (XUC) of porcine origin have been shown to induce anti-tumor immune responses to inhibit bladder tumor progression in mouse bladder cancer models. To further demonstrate the efficacy of the distinct intravesical XUC treatment in NMIBC, and the combined effects with chemotherapy and immune checkpoint inhibitors (ICIs) as a alternate therapeutic option, this study investigated the therapeutic effects and mechanisms of intravesical XUC immunotherapy in an orthotopic mouse immune competent model of NMIBC, generated from a mouse bladder cancer cell line. We found that the tumor progression was inhibited by intravescial XUC treatment and there was a synergy between intravesical XUC with intravesical chemotherapeutic agent, gemcitabine or systemic ICI, anti-PD1 antibody treatment. The cancer cell proliferation was decreased but the cell death was increased by the intravecisal XUC treatment. Most importantly, the mechanisms of action of intravesical XUC immunotherapy were found to be linked to enhanced infiltration of CD4+ and CD8+ T-cell as well as NK cells, but decreased presence of myeloid immunosuppressive cells in XUC treated tumors. The increased stimulation of immune cells of XUC treated mice to xenogeneic urothelial cells and mouse bladder cancer cells in immune cell proliferation and cytokine secretion were observed both as a monotherapy and in combination with intravesical gemcitabine or systemic anti PD-L1 treatment. In sum, we identified the effects of intravesical XUC treatment in monotherapy and combined therapy on tumor progression and its cellular and molecular events related to immune activation to understand the anti-tumoral mechanisms behind intravesical XUC immunotherapy for NMIBC. These results contribute to the understanding of the mechanisms behind successful xenogeneic cell immunotherapy against NMIBC and characterize a novel therapeutic approach with a new xenogeneic cell modality for BCG-unresponsive NMIBC.

Keywords: xenoantigen, neoantigen, rejection, immunity

Procedia PDF Downloads 12

Authors: Farnaz Jafari

Abstract:

The surge in mass timber construction represents a pivotal moment in sustainable building practices, yet the lack of comprehensive education in construction management poses a challenge in harnessing this innovation effectively. This research endeavors to bridge this gap by developing a curriculum framework integrating mass timber construction into undergraduate and industry certificate programs. To optimize learning outcomes, the study explores the impact of two prototype formats -Virtual Reality (VR) simulations and physical mock-ups- on students' understanding and skill development. The curriculum framework aims to equip future construction managers with a holistic understanding of mass timber, covering its unique properties, construction methods, building codes, and sustainable advantages. The study adopts a mixed-methods approach, commencing with a systematic literature review and leveraging surveys and interviews with educators and industry professionals to identify existing educational gaps. The iterative development process involves incorporating stakeholder feedback into the curriculum. The evaluation of prototype impact employs pre- and post-tests administered to participants engaged in pilot programs. Through qualitative content analysis and quantitative statistical methods, the study seeks to compare the effectiveness of VR simulations and physical mock-ups in conveying knowledge and skills related to mass timber construction. The anticipated findings will illuminate the strengths and weaknesses of each approach, providing insights for future curriculum development. The curriculum's expected contribution to sustainable construction education lies in its emphasis on practical application, bridging the gap between theoretical knowledge and hands-on skills. The research also seeks to establish a standard for mass timber construction education, contributing to the field through a unique comparative analysis of VR simulations and physical mock-ups. The study's significance extends to the development of best practices and evidence-based recommendations for integrating technology and hands-on experiences in construction education. By addressing current educational gaps and offering a comparative analysis, this research aims to enrich the construction management education experience and pave the way for broader adoption of sustainable practices in the industry. The envisioned curriculum framework is designed for versatile integration, catering to undergraduate programs and industry training modules, thereby enhancing the educational landscape for aspiring construction professionals. Ultimately, this study underscores the importance of proactive educational strategies in preparing industry professionals for the evolving demands of the construction landscape, facilitating a seamless transition towards sustainable building practices.

Keywords: curriculum framework, mass timber construction, physical vs. virtual prototypes, sustainable building practices

Procedia PDF Downloads 73

Authors: Shailendra M. Pradhan, Upendra M. Pradhan

Abstract:

Disasters are perennial features of human civilization. The recurring earthquakes, floods, cyclones, among others, that result in massive loss of lives and devastation, is a grim reminder of the fact that, despite all our success stories of development, and progress in science and technology, human society is perennially at risk to disasters. The apparent threat of climate change and global warming only severe our disaster risks. Darjeeling hills, situated along Eastern Himalayan region of India, and famous for its three Ts – tea, tourism and toy-train – is also equally notorious for its disasters. The recurring landslides and earthquakes, the cyclone Aila, and the Ambootia landslides, considered as the largest landslide in Asia, are strong evidence of the vulnerability of Darjeeling hills to natural disasters. Given its geographical location along the Hindu-Kush Himalayas, the region is marked by rugged topography, geo-physically unstable structure, high-seismicity, and fragile landscape, making it prone to disasters of different kinds and magnitudes. Most of the studies on disasters in Darjeeling hills are, however, scientific and geographical in orientation that focuses on the underlying geological and physical processes to the neglect of social and political conditions. This has created a tendency among the researchers and policy-makers to endorse and promote a particular type of discourse that does not consider the social and political aspects of disasters in Darjeeling hills. Disaster, this paper argues, is a complex phenomenon, and a result of diverse factors, both physical and human. The hazards caused by the physical and geological agents, and the vulnerabilities produced and rooted in political, economic, social and cultural structures of a society, together result in disasters. In this sense, disasters are as much a result of political and economic conditions as it is of physical environment. The human aspect of disasters, therefore, compels us to address intricating social and political challenges that ultimately determine our resilience and vulnerability to disasters. Set within the above milieu, the aims of the paper are twofold: a) to provide a political and sociological account of disasters in Darjeeling hills; and, b) to identify and address the root causes of its vulnerabilities to disasters. In situating disasters in Darjeeling Hills, the paper adopts the Pressure and Release Model (PAR) that provides a theoretical insight into the study of social and political aspects of disasters, and to examine myriads of other related issues therein. The PAR model conceptualises risk as a complex combination of vulnerabilities, on the one hand, and hazards, on the other. Disasters, within the PAR framework, occur when hazards interact with vulnerabilities. The root causes of vulnerability, in turn, could be traced to social and political structures such as legal definitions of rights, gender relations, and other ideological structures and processes. In this way, the PAR model helps the present study to identify and unpack the root causes of vulnerabilities and disasters in Darjeeling hills that have largely remained neglected in dominant discourses, thereby providing a more nuanced and sociologically sensitive understanding of disasters.

Keywords: Darjeeling, disasters, PAR, vulnerabilities

Procedia PDF Downloads 273

Authors: Anum Rafiq

Abstract:

Adolescence is a vulnerable period for youth across the world. It is a period of new learning with opportunities to understand and develop perspectives on health and well-being. With youth beginning to engage in intimate relationships at an earlier age in the 21st century, concentrating on the learning opportunity they have in school is paramount. The nature of what has been deemed important to teach in schools has changed throughout history, and the focus has shifted from home/family skills to teaching youth how to be competitive in the job market. Amidst this emphasis, opportunities for them exist to learn about building healthy intimate relationships, one of the foundational elements of most people’s lives. Using an Institutional Ethnography (IE), the lived experiences of youth in how they understand intimate relationships and how their learning experience is organized through the high school Health and Physical Education (H&PE) course is explored. An empirical inquiry into how the actual work of teachers and youth are socially organized by a biomedical, employment-related, and efficiency-based discourse is provided. Through thirty-two qualitative interviews with teachers and youth, a control of ruling relations such as institutional accountability circuits, performance reports, and timetabling over the experience of teachers and youth is found. One of the facets of the institutional accountability circuit is through the social organization of teaching and learning about healthy intimate relationships being framed through a biomedical discourse. In addition, the role of a hyper-focus on performance and evaluation is found as paramount in situating healthy intimacy discussions as inferior to neoliberally charged productivity measures such as employment skills. Lastly, due to the nature of institutional policies such as regulatory guidelines, teachers are largely influenced to avoid diving into discussions deemed risky or taboo by society, such as healthy intimacy in adolescence. The findings show how texts such as the H&PE curriculum, the Ontario College of Teachers (OCT) guidelines, Ministry of Education Performance Reports, and the timetable organize the day-to-day activities of teachers and students and reproduce different disjunctures for youth. This disjuncture includes some of their experiences being subordinated, difficulty relating to curriculum, and an experience of healthy living discussions being skimmed over across sites. The findings detail that the experience of youth in learning about healthy intimate relationships is not akin to the espoused vision outlined in policy documents such as the H&PE (2015) curriculum policy. These findings have implications for policymakers, activists, and school administration alike, which call for an investigation into who is in power when it comes to youth’s learning needs, as a pivotal period where youth can be equipped with life-changing knowledge is largely underutilized. A restructuring of existing institutional practices that allow for the social and institutional flexibility required to broach the topic of healthy intimacy in a comprehensive manner is required.

Keywords: health policy, intimate relationships, youth, education, ruling relations, sexual education, violence prevention

Procedia PDF Downloads 71

Authors: Shreya Saxena

Abstract:

Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

Procedia PDF Downloads 98