Search results for: end stage renal failure
Commenced in January 2007
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Edition: International
Paper Count: 5841

Search results for: end stage renal failure

4461 The Impact of Quality Cost on Revenue Sharing in Supply Chain Management

Authors: Fayza M. Obied-Allah

Abstract:

Customer’ needs, quality, and value creation while reducing costs through supply chain management provides challenges and opportunities for companies and researchers. In the light of these challenges, modern ideas must contribute to counter these challenges and exploit opportunities. Perhaps this paper will be one of these contributions. This paper discusses the impact of the quality cost on revenue sharing as a most important incentive to configure business networks. No doubt that the costs directly affect the size of income generated by a business network, so this paper investigates the impact of quality costs on business networks revenue, and their impact on the decision to participate the revenue among the companies in the supply chain. This paper develops the quality cost approach to align with the modern era, the developed model includes five categories besides the well-known four categories (namely prevention costs, appraisal costs, internal failure costs, and external failure costs), a new category has been developed in this research as a new vision of the relationship between quality costs and innovations of industry. This new category is Recycle Cost. This paper is organized into six sections, Section I shows quality costs overview in the supply chain. Section II discusses revenue sharing between the parties in supply chain. Section III investigates the impact of quality costs in revenue sharing decision between partners in supply chain. The fourth section includes survey study and presents statistical results. Section V discusses the results and shows future opportunities for research. Finally, Section VI summarizes the theoretical and practical results of this paper.

Keywords: quality cost, recycle cost, revenue sharing, supply chain management

Procedia PDF Downloads 445
4460 Multilevel of Factors Affected Optimal Adherence to Antiretroviral Therapy and Viral Suppression amongst HIV-Infected Prisoners in South Ethiopia: A Prospective Cohort Study

Authors: Terefe Fuge, George Tsourtos , Emma Miller

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Objectives: Maintaining optimal adherence and viral suppression in people living with HIV (PLWHA) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of adherence and viral suppression, as well as its associated factors in incarcerated populations in low-income countries is unknown. This study aimed to determine the prevalence of non-adherence and viral failure, and contributing factors to this amongst prisoners in South Ethiopia. Methods: A prospective cohort study was conducted between June 1, 2019 and July 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWHA. The study involved 74 inmates living with HIV (ILWHA) and 296 non-incarcerated PLWHA. Background information including sociodemographic, socioeconomic, psychosocial, behavioural, and incarceration-related characteristics was collected using a structured questionnaire. Adherence was determined based on participants’ self-report and pharmacy refill records, and plasma viral load measurements which were undertaken within the study period were prospectively extracted to determine viral suppression. Various univariate and multivariate regression models were used to analyse data. Results: Self-reported dose adherence was approximately similar between ILWHA and non-incarcerated PLWHA (81% and 83% respectively), but ILWHA had a significantly higher medication possession ratio (MPR) (89% vs 75%). The prevalence of viral failure (VF) was slightly higher (6%) in ILWHA compared to non-incarcerated PLWHA (4.4%). The overall dose non-adherence (NA) was significantly associated with missing ART appointments, level of satisfaction with ART services, patient’s ability to comply with a specified medication schedule and types of methods used to monitor the schedule. In ILWHA specifically, accessing ART services from a hospital compared to a health centre, an inability to always attend clinic appointments, experience of depression and a lack of social support predicted NA. VF was significantly higher in males, people of age 31-35 years and in those who experienced social stigma, regardless of their incarceration status. Conclusions: This study revealed that HIV-infected prisoners in South Ethiopia were more likely to be non-adherent to doses and so to develop viral failure compared to their non-incarcerated counterparts. A multitude of factors was found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

Keywords: Adherence , Antiretroviral therapy, Incarceration, South Ethiopia, Viral suppression

Procedia PDF Downloads 135
4459 Correlation Between Diastolic Function and Lower GLS in Hypertensive Patients

Authors: A. Kherraf, S. Ouarrak, L. Azzouzi, R. Habbal

Abstract:

Introduction: Preserved LVEF heart failure is an important cause of mortality and morbidity in hypertensive patients. A strong correlation between impaired diastolic function and longitudinal systolic dysfunction. could have several explanations, first, the diastole is an energy dependent process, especially during its first phase, it also includes active systolic components during the phase of iso volumetric relaxation, in addition, the impairment of the intrinsic myocytic function is part of hypertensive pathology as evidenced by recent studies. METHODS AND MATERIALS: This work consists of performing in a series of 333 hypertensive patients (aged 25 to 75 years) a complete echocardiographic study, including LVEF by Simpson biplane method, the calculation of the indexed left ventricular mass, the analysis of the diastolic function, and finally, the study of the longitudinal deformation of the LV by the technique of speckletracking (calculation of the GLS). Patients with secondary hypertension, leaky or stenosing valve disease, arrhythmia, and a history of coronary insufficiency were excluded from this study. RESULTS: Of the 333 hypertensive patients, 225 patients (67.5%) had impaired diastolic function, of which 60 patients (18%) had high filling pressures. 49.39% had echocardigraphic HVG, Almost all of these patients (60 patients) had low GLS. There is a statistically very significant relationship between lower GLS and increased left ventricular filling pressures in hypertensive patients. These results suggest that increased filling pressures are closely associated with atrioventricular interaction in patients with hypertension, with a strong correlation with impairment of longitudinal systolic function and diastolic function CONCLUSION: Overall, a linear relationship is established between increased left ventricular mass, diastolic dysfunction, and longitudinal LV systolic dysfunction

Keywords: hypertension, diastolic function, left ventricle, heart failure

Procedia PDF Downloads 126
4458 Numerical Analysis for Soil Compaction and Plastic Points Extension in Pile Drivability

Authors: Omid Tavasoli, Mahmoud Ghazavi

Abstract:

A numerical analysis of drivability of piles in different geometry is presented. In this paper, a three-dimensional finite difference analysis for plastic point extension and soil compaction in the effect of pile driving is analyzed. Four pile configurations such as cylindrical pile, fully tapered pile, T-C pile consists of a top tapered segment and a lower cylindrical segment and C-T pile has a top cylindrical part followed by a tapered part are investigated. All piles which driven up to a total penetration depth of 16 m have the same length with equivalent surface area and approximately with identical material volumes. An idealization for pile-soil system in pile driving is considered for this approach. A linear elastic material is assumed to model the vertical pile behaviors and the soil obeys the elasto-plastic constitutive low and its failure is controlled by the Mohr-Coulomb failure criterion. A slip which occurred at the pile-soil contact surfaces along the shaft and the toe in pile driving procedures is simulated with interface elements. All initial and boundary conditions are the same in all analyses. Quiet boundaries are used to prevent wave reflection in the lateral and vertical directions for the soil. The results obtained from numerical analyses were compared with available other numerical data and laboratory tests, indicating a satisfactory agreement. It will be shown that with increasing the angle of taper, the permanent piles toe settlement increase and therefore, the extension of plastic points increase. These are interesting phenomena in pile driving and are on the safe side for driven piles.

Keywords: pile driving, finite difference method, non-uniform piles, pile geometry, pile set, plastic points, soil compaction

Procedia PDF Downloads 484
4457 Costume Design Influenced by Seventeenth Century Color Palettes on a Contemporary Stage

Authors: Michele L. Dormaier

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The purpose of the research was to design costumes based on historic colors used by artists during the seventeenth century. The researcher investigated European art, primarily paintings and portraiture, as well as the color palettes used by the artists. The methodology examined the artists, their work, the color palettes used in their work, and the practices of color usage within their palettes. By examining portraits of historic figures, as well as paintings of ordinary scenes, subjects, and people, further information about color palettes was revealed. Related to the color palettes, was the use of ‘broken colors’ which was a relatively new practice, dating from the sixteenth century. The color palettes used by the artists of the seventeenth century had their limitations due to available pigments. With an examination of not only their artwork, and with a closer look at their palettes, the researcher discovered the exciting choices they made, despite those restrictions. The research was also initiated with the historical elements of the era’s clothing, as well as that of available materials and dyes. These dyes were also limited in much the same manner as the pigments which the artist had at their disposal. The color palettes of the paintings have much to tell us about the lives, status, conditions, and relationships from the past. From this research, informed decisions regarding color choices for a production on a contemporary stage of a period piece could then be made. The designer’s choices were a historic gesture to the colors which might have been worn by the character’s real-life counterparts of the era.

Keywords: broken color palette, costume color research, costume design, costume history, seventeenth century color palette, sixteenth century color palette

Procedia PDF Downloads 176
4456 Complex Management of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

Authors: Fahad Almehmadi, Abdullah Alrajhi, Bader K. Alaslab, Abdullah A. Al Qurashi, Hattan A. Hassani

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Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) is an uncommon, inheritable cardiac disorder characterized by the progressive substitution of cardiac myocytes by fibro-fatty tissues. This pathologic substitution predisposes patients to ventricular arrhythmias and right ventricular failure. The underlying genetic defect predominantly involves genes encoding for desmosome proteins, particularly plakophilin-2 (PKP2). These aberrations lead to impaired cell adhesion, heightening the susceptibility to fibrofatty scarring under conditions of mechanical stress. Primarily, ARVD/C affects the right ventricle, but it can also compromise the left ventricle, potentially leading to biventricular heart failure. Clinical presentations can vary, spanning from asymptomatic individuals to those experiencing palpitations, syncopal episodes, and, in severe instances, sudden cardiac death. The establishment of a diagnostic criterion specifically tailored for ARVD/C significantly aids in its accurate diagnosis. Nevertheless, the task of early diagnosis is complicated by the disease's frequently asymptomatic initial stages, and the overall rarity of ARVD/C cases reported globally. In some cases, as exemplified by the adult female patient in this report, the disease may advance to terminal stages, rendering therapies like Ventricular Tachycardia (VT) ablation ineffective. This case underlines the necessity for increased awareness and understanding of ARVD/C to aid in its early detection and management. Through such efforts, we aim to decrease morbidity and mortality associated with this challenging cardiac disorder.

Keywords: ARVD/C, cardiology, interventional cardiology, cardiac electrophysiology

Procedia PDF Downloads 63
4455 Nonlinear Finite Element Analysis of Optimally Designed Steel Angelina™ Beams

Authors: Ferhat Erdal, Osman Tunca, Serkan Tas, Serdar Carbas

Abstract:

Web-expanded steel beams provide an easy and economical solution for the systems having longer structural members. The main goal of manufacturing these beams is to increase the moment of inertia and section modulus, which results in greater strength and rigidity. Until recently, there were two common types of open web-expanded beams: with hexagonal openings, also called castellated beams, and beams with circular openings referred to as cellular beams, until the generation of sinusoidal web-expanded beams. In the present research, the optimum design of a new generation beams, namely sinusoidal web-expanded beams, will be carried out and the design results will be compared with castellated and cellular beam solutions. Thanks to a reduced fabrication process and substantial material savings, the web-expanded beam with sinusoidal holes (Angelina™ Beam) meets the economic requirements of steel design problems while ensuring optimum safety. The objective of this research is to carry out non-linear finite element analysis (FEA) of the web-expanded beam with sinusoidal holes. The FE method has been used to predict their entire response to increasing values of external loading until they lose their load carrying capacity. FE model of each specimen that is utilized in the experimental studies is carried out. These models are used to simulate the experimental work to verify of test results and to investigate the non-linear behavior of failure modes such as web-post buckling, shear buckling and vierendeel bending of beams.

Keywords: steel structures, web-expanded beams, angelina beam, optimum design, failure modes, finite element analysis

Procedia PDF Downloads 281
4454 Protection of Steel Bars in Reinforce Concrete with Zinc Based Coverings

Authors: Hamed Rajabzadeh Gatabi, Soroush Dastgheibifard, Mahsa Asnafi

Abstract:

There is no doubt that reinforced concrete is known as one of the most significant materials which is used in construction industry for many years. Although, some natural elements in dealing with environment can contribute to its corrosion or failure. One of which is bar or so-called reinforcement failure. So as to combat this problem, one of the oxidization prevention methods investigated was the barrier protection method implemented over the application of an organic coating, specifically fusion-bonded epoxy. In this study comparative method is prepared on two different kinds of covered bars (zinc-riches epoxy and polyamide epoxy coated bars) and also uncoated bar. With the aim of evaluate these reinforced concretes, the stickiness, toughness, thickness and corrosion performance of coatings were compared by some tools like Cu/CuSo4 electrodes, EIS and etc. Different types of concretes were exposed to the salty environment (NaCl 3.5%) and their durability was measured. As stated by the experiments in research and investigations, thick coatings (named epoxies) have acceptable stickiness and strength. Polyamide epoxy coatings stickiness to the bars was a bit better than that of zinc-rich epoxy coatings; nonetheless it was stiffer than the zinc rich epoxy coatings. Conversely, coated bars with zinc-rich epoxy showed more negative oxidization potentials, which take revenge protection of bars by zinc particles. On the whole, zinc-rich epoxy coverings is more corrosion-proof than polyamide epoxy coatings due to consuming zinc elements and some other parameters, additionally if the epoxy coatings without surface defects are applied on the rebar surface carefully, it can be said that the life of steel structures is subjected to increase dramatically.

Keywords: surface coating, epoxy polyamide, reinforce concrete bars, salty environment

Procedia PDF Downloads 289
4453 Solar Liquid Desiccant Regenerator for Two Stage KCOOH Based Fresh Air Dehumidifier

Authors: M. V. Rane, Tareke Tekia

Abstract:

Liquid desiccant based fresh air dehumidifiers can be gainfully deployed for air-conditioning, agro-produce drying and in many industrial processes. Regeneration of liquid desiccant can be done using direct firing, high temperature waste heat or solar energy. Solar energy is clean and available in abundance; however, it is costly to collect. A two stage liquid desiccant fresh air dehumidification system can offer Coefficient of Performance (COP), in the range of 1.6 to 2 for comfort air conditioning applications. High COP helps reduce the size and cost of collectors required. Performance tests on high temperature regenerator of a two stage liquid desiccant fresh air dehumidifier coupled with seasonally tracked flat plate like solar collector will be presented in this paper. The two stage fresh air dehumidifier has four major components: High Temperature Regenerator (HTR), Low Temperature Regenerator (LTR), High and Low Temperature Solution Heat Exchangers and Fresh Air Dehumidifier (FAD). This open system can operate at near atmospheric pressure in all the components. These systems can be simple, maintenance-free and scalable. Environmentally benign, non-corrosive, moderately priced Potassium Formate, KCOOH, is used as a liquid desiccant. Typical KCOOH concentration in the system is expected to vary between 65 and 75%. Dilute liquid desiccant at 65% concentration exiting the fresh air dehumidifier will be pumped and preheated in solution heat exchangers before entering the high temperature solar regenerator. In the solar collector, solution will be regenerated to intermediate concentration of 70%. Steam and saturated solution exiting the solar collector array will be separated. Steam at near atmospheric pressure will then be used to regenerate the intermediate concentration solution up to a concentration of 75% in a low temperature regenerator where moisture vaporized be released in to atmosphere. Condensed steam can be used as potable water after adding a pinch of salt and some nutrient. Warm concentrated liquid desiccant will be routed to solution heat exchanger to recycle its heat to preheat the weak liquid desiccant solution. Evacuated glass tube based seasonally tracked solar collector is used for regeneration of liquid desiccant at high temperature. Temperature of regeneration for KCOOH is 133°C at 70% concentration. The medium temperature collector was designed for temperature range of 100 to 150°C. Double wall polycarbonate top cover helps reduce top losses. Absorber integrated heat storage helps stabilize the temperature of liquid desiccant exiting the collectors during intermittent cloudy conditions, and extends the operation of the system by couple of hours beyond the sunshine hours. This solar collector is light in weight, 12 kg/m2 without absorber integrated heat storage material, and 27 kg/m2 with heat storage material. Cost of the collector is estimated to be 10,000 INR/m2. Theoretical modeling of the collector has shown that the optical efficiency is 62%. Performance test of regeneration of KCOOH will be reported.

Keywords: solar, liquid desiccant, dehumidification, air conditioning, regeneration

Procedia PDF Downloads 348
4452 An Evaluation of Solubility of Wax and Asphaltene in Crude Oil for Improved Flow Properties Using a Copolymer Solubilized in Organic Solvent with an Aromatic Hydrocarbon

Authors: S. M. Anisuzzaman, Sariah Abang, Awang Bono, D. Krishnaiah, N. M. Ismail, G. B. Sandrison

Abstract:

Wax and asphaltene are high molecular weighted compounds that contribute to the stability of crude oil at a dispersed state. Transportation of crude oil along pipelines from the oil rig to the refineries causes fluctuation of temperature which will lead to the coagulation of wax and flocculation of asphaltenes. This paper focuses on the prevention of wax and asphaltene precipitate deposition on the inner surface of the pipelines by using a wax inhibitor and an asphaltene dispersant. The novelty of this prevention method is the combination of three substances; a wax inhibitor dissolved in a wax inhibitor solvent and an asphaltene solvent, namely, ethylene-vinyl acetate (EVA) copolymer dissolved in methylcyclohexane (MCH) and toluene (TOL) to inhibit the precipitation and deposition of wax and asphaltene. The objective of this paper was to optimize the percentage composition of each component in this inhibitor which can maximize the viscosity reduction of crude oil. The optimization was divided into two stages which are the laboratory experimental stage in which the viscosity of crude oil samples containing inhibitor of different component compositions is tested at decreasing temperatures and the data optimization stage using response surface methodology (RSM) to design an optimizing model. The results of experiment proved that the combination of 50% EVA + 25% MCH + 25% TOL gave a maximum viscosity reduction of 67% while the RSM model proved that the combination of 57% EVA + 20.5% MCH + 22.5% TOL gave a maximum viscosity reduction of up to 61%.

Keywords: asphaltene, ethylene-vinyl acetate, methylcyclohexane, toluene, wax

Procedia PDF Downloads 415
4451 Analysis of Secondary Stage Creep in Thick-Walled Composite Cylinders Subjected to Rotary Inertia

Authors: Tejeet Singh, Virat Khanna

Abstract:

Composite materials have drawn considerable attention of engineers due to their light weight and application at high thermo-mechanical loads. With regard to the prediction of the life of high temperature structural components like rotating cylinders and the evaluation of their deterioration with time, it is essential to have a full knowledge of creep characteristics of these materials. Therefore, in the present study the secondary stage creep stresses and strain rates are estimated in thick-walled composite cylinders subjected to rotary inertia at different angular speeds. The composite cylinder is composed of aluminum matrix (Al) and reinforced with silicon carbide (SiC) particles which are uniformly mixed. The creep response of the material of the cylinder is described by threshold stress based creep law. The study indicates that with the increase in angular speed, the radial, tangential, axial and effective stress increases to a significant value. However, the radial stress remains zero at inner radius and outer radius due to imposed boundary conditions of zero pressure. Further, the stresses are tensile in nature throughout the entire radius of composite cylinder. The strain rates are also influenced in the same manner as that of creep stresses. The creep rates will increase significantly with the increase of centrifugal force on account of rotation.

Keywords: composite, creep, rotating cylinder, angular speed

Procedia PDF Downloads 445
4450 Association between Severe Acidemia before Endotracheal Intubation and the Lower First Attempt Intubation Success Rate

Authors: Keiko Naito, Y. Nakashima, S. Yamauchi, Y. Kunitani, Y. Ishigami, K. Numata, M. Mizobe, Y. Homma, J. Takahashi, T. Inoue, T. Shiga, H. Funakoshi

Abstract:

Background: A presence of severe acidemia, defined as pH < 7.2, is common during endotracheal intubation for critically ill patients in the emergency department (ED). Severe acidemia is widely recognized as a predisposing factor for intubation failure. However, it is unclear that acidemic condition itself actually makes endotracheal intubation more difficult. We aimed to evaluate if a presence of severe acidemia before intubation is associated with the lower first attempt intubation success rate in the ED. Methods: This is a retrospective observational cohort study in the ED of an urban hospital in Japan. The collected data included patient demographics, such as age, sex, and body mass index, presence of one or more factors of modified LEMON criteria for predicting difficult intubation, reasons for intubation, blood gas levels, airway equipment, intubation by emergency physician or not, and the use of the rapid sequence intubation technique. Those with any of the following were excluded from the analysis: (1) no blood gas drawn before intubation, (2) cardiopulmonary arrest, and (3) under 18 years of age. The primary outcome was the first attempt intubation success rates between a severe acidemic patients (SA) group and a non-severe acidemic patients (NA) group. Logistic regression analysis was used to test the first attempt success rates for intubations between those two groups. Results: Over 5 years, a total of 486 intubations were performed; 105 in the SA group and 381 in the NA group. The univariate analysis showed that the first attempt intubation success rate was lower in the SA group than in the NA group (71.4% vs 83.5%, p < 0.01). The multivariate logistic regression analysis identified that severe acidemia was significantly associated with the first attempt intubation failure (OR 1.9, 95% CI 1.03-3.68, p = 0.04). Conclusions: A presence of severe acidemia before endotracheal intubation lowers the first attempt intubation success rate in the ED.

Keywords: acidemia, airway management, endotracheal intubation, first-attempt intubation success rate

Procedia PDF Downloads 248
4449 Analysis of One-Way and Two-Way FSI Approaches to Characterise the Flow Regime and the Mechanical Behaviour during Closing Manoeuvring Operation of a Butterfly Valve

Authors: M. Ezkurra, J. A. Esnaola, M. Martinez-Agirre, U. Etxeberria, U. Lertxundi, L. Colomo, M. Begiristain, I. Zurutuza

Abstract:

Butterfly valves are widely used industrial piping components as on-off and flow controlling devices. The main challenge in the design process of this type of valves is the correct dimensioning to ensure proper mechanical performance as well as to minimise flow losses that affect the efficiency of the system. Butterfly valves are typically dimensioned in a closed position based on mechanical approaches considering uniform hydrostatic pressure, whereas the flow losses are analysed by means of CFD simulations. The main limitation of these approaches is that they do not consider either the influence of the dynamics of the manoeuvring stage or coupled phenomena. Recent works have included the influence of the flow on the mechanical behaviour for different opening angles by means of one-way FSI approach. However, these works consider steady-state flow for the selected angles, not capturing the effect of the transient flow evolution during the manoeuvring stage. Two-way FSI modelling approach could allow overcoming such limitations providing more accurate results. Nevertheless, the use of this technique is limited due to the increase in the computational cost. In the present work, the applicability of FSI one-way and two-way approaches is evaluated for the analysis of butterfly valves, showing that not considering fluid-structure coupling involves not capturing the most critical situation for the valve disc.

Keywords: butterfly valves, fluid-structure interaction, one-way approach, two-way approach

Procedia PDF Downloads 162
4448 Pavement Failures and Its Maintenance

Authors: Maulik L. Sisodia, Tirth K. Raval, Aarsh S. Mistry

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This paper summarizes the ongoing researches about the defects in both flexible and rigid pavement and the maintenance in both flexible and rigid pavements. Various defects in pavements have been identified since the existence of both flexible and rigid pavement. Flexible Pavement failure is defined in terms of decreasing serviceability caused by the development of cracks, ruts, potholes etc. Flexible Pavement structure can be destroyed in a single season due to water penetration. Defects in flexible pavements is a problem of multiple dimensions, phenomenal growth of vehicular traffic (in terms of no. of axle loading of commercial vehicles), the rapid expansion in the road network, non-availability of suitable technology, material, equipment, skilled labor and poor funds allocation have all added complexities to the problem of flexible pavements. In rigid pavements due to different type of destress the failure like joint spalling, faulting, shrinkage cracking, punch out, corner break etc. Application of correction in the existing surface will enhance the life of maintenance works as well as that of strengthening layer. Maintenance of a road network involves a variety of operations, i.e., identification of deficiencies and planning, programming and scheduling for actual implementation in the field and monitoring. The essential objective should be to keep the road surface and appurtenances in good condition and to extend the life of the road assets to its design life. The paper describes lessons learnt from pavement failures and problems experienced during the last few years on a number of projects in India. Broadly, the activities include identification of defects and the possible cause there off, determination of appropriate remedial measures; implement these in the field and monitoring of the results.

Keywords: Flexible Pavements, Rigid Pavements, Defects, Maintenance

Procedia PDF Downloads 172
4447 Services Sector: A Growth Catalyst for Indian Economy since Economic Reform

Authors: Richa Rai

Abstract:

The purpose of this study is to analyze the role of the services sector in economic development of Indian economy, especially in the post reform period. Due to adoption of liberalization policy in developing economy like India, international transaction in services has been increased at a rapid pace which compensated to the current account of Balance of Payment which was in a pitiable condition. But this increased share of services in GDP is not commensurate with share in employment, which is a matter of great concern for Indian economy. Although the increased share of service in GDP indicates the advanced stage of growth of the economy, but this theory is not applicable in context of Indian economy completely. In the preliminary stage, this study finds a positive correlation between growth of services and export earnings and gross domestic product and this growth of services is not equal in terms of all aspects on Indian economy, and also all components of services has not been increased at an equal rate. This paper seeks to examine the impact of liberalization in post reform era on the growth of services in India. The analysis is done for the period of 1991 to 2013. Data has been collected from the secondary sources, especially from the website of Reserve Bank of India, World Trade Organization, and United Nation Conference on Trade and Development. The data has been analyzed with the help of appropriate statistical tools (Causality Relation and Group t-test).

Keywords: export earnings, GDP, gross domestic product, liberalization, services

Procedia PDF Downloads 136
4446 Avoidance of Brittle Fracture in Bridge Bearings: Brittle Fracture Tests and Initial Crack Size

Authors: Natalie Hoyer

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Bridges in both roadway and railway systems depend on bearings to ensure extended service life and functionality. These bearings enable proper load distribution from the superstructure to the substructure while permitting controlled movement of the superstructure. The design of bridge bearings, according to Eurocode DIN EN 1337 and the relevant sections of DIN EN 1993, increasingly requires the use of thick plates, especially for long-span bridges. However, these plate thicknesses exceed the limits specified in the national appendix of DIN EN 1993-2. Furthermore, compliance with DIN EN 1993-1-10 regulations regarding material toughness and through-thickness properties necessitates further modifications. Consequently, these standards cannot be directly applied to the selection of bearing materials without supplementary guidance and design rules. In this context, a recommendation was developed in 2011 to regulate the selection of appropriate steel grades for bearing components. Prior to the initiation of the research project underlying this contribution, this recommendation had only been available as a technical bulletin. Since July 2023, it has been integrated into guideline 804 of the German railway. However, recent findings indicate that certain bridge-bearing components are exposed to high fatigue loads, which necessitate consideration in structural design, material selection, and calculations. Therefore, the German Centre for Rail Traffic Research called a research project with the objective of defining a proposal to expand the current standards in order to implement a sufficient choice of steel material for bridge bearings to avoid brittle fracture, even for thick plates and components subjected to specific fatigue loads. The results obtained from theoretical considerations, such as finite element simulations and analytical calculations, are validated through large-scale component tests. Additionally, experimental observations are used to calibrate the calculation models and modify the input parameters of the design concept. Within the large-scale component tests, a brittle failure is artificially induced in a bearing component. For this purpose, an artificially generated initial defect is introduced at the previously defined hotspot into the specimen using spark erosion. Then, a dynamic load is applied until the crack initiation process occurs to achieve realistic conditions in the form of a sharp notch similar to a fatigue crack. This initiation process continues until the crack length reaches a predetermined size. Afterward, the actual test begins, which requires cooling the specimen with liquid nitrogen until a temperature is reached where brittle fracture failure is expected. In the next step, the component is subjected to a quasi-static tensile test until failure occurs in the form of a brittle failure. The proposed paper will present the latest research findings, including the results of the conducted component tests and the derived definition of the initial crack size in bridge bearings.

Keywords: bridge bearings, brittle fracture, fatigue, initial crack size, large-scale tests

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4445 Extra-Pulmonary Mycoplasma Pneumoniae Infection in a Healthy 25-Year-Old Female: A Case Report

Authors: Minna Chang

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Introduction: M. pneumoniae is a respiratory pathogen, which commonly causes upper and lower respiratory infections. It primarily affects children and young adults. Respiratory symptoms are well recognized, but extrapulmonary involvement is also common. Other systems that have been implicated in the disease include: skin, mucus membranes, central, peripheral nervous systems, cardiovascular, haematological, renal, and musculoskeletal systems. Here, we report a case of an otherwise healthy, young female with M. pneumonia, who presented with right upper quadrant abdominal pain. Case presentation: a healthy 25-year-old female was referred to A&E by her general practitioner, after presenting with fever, malaise, and right upper quadrant pain. M. pneumoniae was confirmed retrospectively by serology. The patient made a full recovery after a six-day course of doxycycline 100mg. Conclusion: M. pneumonia is a well-established cause of respiratory infections in children and young adults. Febrile illness with multisystem involvement, even in the absence of respiratory symptoms, should raise suspicion of M. pneumoniae infection in healthy, young adults. Our case illustrates the multi-system involvement of M. pneumoniae, which was initially missed, due to paucity of respiratory symptoms at presentation.

Keywords: infectious diseases, mycoplasma pneumoniae, respiratory infections, extra-pulmonary manifestations

Procedia PDF Downloads 143
4444 Laser Data Based Automatic Generation of Lane-Level Road Map for Intelligent Vehicles

Authors: Zehai Yu, Hui Zhu, Linglong Lin, Huawei Liang, Biao Yu, Weixin Huang

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With the development of intelligent vehicle systems, a high-precision road map is increasingly needed in many aspects. The automatic lane lines extraction and modeling are the most essential steps for the generation of a precise lane-level road map. In this paper, an automatic lane-level road map generation system is proposed. To extract the road markings on the ground, the multi-region Otsu thresholding method is applied, which calculates the intensity value of laser data that maximizes the variance between background and road markings. The extracted road marking points are then projected to the raster image and clustered using a two-stage clustering algorithm. Lane lines are subsequently recognized from these clusters by the shape features of their minimum bounding rectangle. To ensure the storage efficiency of the map, the lane lines are approximated to cubic polynomial curves using a Bayesian estimation approach. The proposed lane-level road map generation system has been tested on urban and expressway conditions in Hefei, China. The experimental results on the datasets show that our method can achieve excellent extraction and clustering effect, and the fitted lines can reach a high position accuracy with an error of less than 10 cm.

Keywords: curve fitting, lane-level road map, line recognition, multi-thresholding, two-stage clustering

Procedia PDF Downloads 128
4443 Geological and Geotechnical Investigation of a Landslide Prone Slope Along Koraput- Rayagada Railway Track Odisha, India: A Case Study

Authors: S. P. Pradhan, Amulya Ratna Roul

Abstract:

A number of landslides are occurring during the rainy season along Rayagada-Koraput Railway track for past three years. The track was constructed about 20 years ago. However, the protection measures are not able to control the recurring slope failures now. It leads to a loss to Indian Railway and its passengers ultimately leading to wastage of time and money. The slopes along Rayagada-Koraput track include both rock and soil slopes. The rock types include mainly Khondalite and Charnockite whereas soil slopes are mainly composed of laterite ranging from less weathered to highly weathered laterite. The field studies were carried out in one of the critical slope. Field study was followed by the kinematic analysis to assess the type of failure. Slake Durability test, Uniaxial Compression test, specific gravity test and triaxial test were done on rock samples to calculate and assess properties such as weathering index, unconfined compressive strength, density, cohesion, and friction angle. Following all the laboratory tests, rock mass rating was calculated. Further, from Kinematic analysis and Rock Mass Ratingbasic, Slope Mass Rating was proposed for each slope. The properties obtained were used to do the slope stability simulations using finite element method based modelling. After all the results, suitable protection measures, to prevent the loss due to slope failure, were suggested using the relation between Slope Mass Rating and protection measures.

Keywords: landslides, slope stability, rock mass rating, slope mass rating, numerical simulation

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4442 Epidemiology of Primary Bronchopulmonary Cancer in Tunisia

Authors: Melliti Rihab, Zaeid Sonia, Khechine Wiem, Daldoul Amira

Abstract:

Introduction: Lung cancer is the leading cause of cancer death. Its incidence is increasing, and its prognosis remains pejorative. We present the clinical, pathological, and therapeutic characteristics of bronchopulmonary cancer (BPC) in Tunisia. Methods: Retrospective study including patients followed in the oncology department of the University Hospital of Monastir between April 2014 and December 2021 suffering from lung cancer. Results: These are 117 patients, including 86.3% men and 13.7% women (sex ratio 6.3). The average age was 64 years ± 9 (37-83), with 95.7% being over 50 years old. Patients were smokers in 82% of cases. The clinical signs were dominated by chest pain (27.5%) and dyspnea in 21.1% of cases. In 6 patients, an episode of COVID-19 infection revealed the diagnosis. Half of the patients had a PS between 0 and 1. Small cell lung cancer was present in 18 patients (15.4%). The majority of non small cell lung cancer was of the adenocarcinoma type (68.7%). The diagnosis was late (stage IV) in 62.4% of cases. BPC was metastatic to bone (52%), contralateral lung (25.9%), and brain (27.3%). Patients were oligometastatic in 26% of cases. Surgery and radiotherapy were performed respectively in 14.5% and 23.1% of cases. Three-quarters of the patients had had nutrition (75.2%). The ROS1 mutation was present in 1 patient. PDL-1 expression was >40% in 2 patients. Survival was mean eight months ± 7.4. Conclusion: Lung cancer is diagnosed at a late stage in Tunisia. The lack of molecular study for non-small cell PBC and the lack of marketing authorization for tyrosine kinase inhibitors in Tunisia make the management incomplete.

Keywords: SCLC, NCSLC, ROS1, PDL1

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4441 Follicular Thyroid Carcinoma in a Developing Country: A Retrospective Study of 10 Years

Authors: Abdul Aziz, Muhammad Qamar Masood, Saadia Sattar, Saira Fatima, Najmul Islam

Abstract:

Introduction: The most common endocrine tumor is thyroid cancer. Follicular Thyroid Carcinoma (FTC) accounts for 5%–10% of all thyroid cancers. Patients with FTC frequently present with more advanced stage diseases and a higher occurrence of distant metastases because of the propensity of vascular invasion. FTC is mainly treated with surgery, while radioactive iodine therapy is the main adjuvant therapy as per ATA guidelines. In many developing countries, surgical facilities and radioactive iodine are in short supply; therefore, understanding follicular thyroid cancer trends may help developing countries plan and use resources more effectively. Methodology: It was a retrospective observational study of FTC patients of age 18 years and above conducted at Aga Khan University Hospital, Karachi, from 1st January 2010 to 31st December 2019. Results: There were 404 patients with thyroid carcinoma, out of which forty (10.1%) were FTC. 50% of the patients were in the 41-60 years age group, and the female to male ratio was 1.5: 1. Twenty-four patients (60%) presented with complain of neck swelling followed by metastasis (20%) and compressive symptoms (20%). The most common site of metastasis was bone (87.5%), followed by lung (12.5%). The pre-operative thyroglobulin level was done in six out of eight metastatic patients (75%) in which it was elevated. This emphasizes the importance of checking thyroglobulin level in unusual presentation (bone pain, fractures) of a patient having neck swelling also to help in establishing the primary source of tumor. There was no complete documentation of ultrasound features of the thyroid gland in all the patients, which is an important investigation done in the initial evaluation of thyroid nodule. On FNAC, 50% (20 patients) had Bethesda category III-IV nodules, while 10% ( 4 patients ) had Bethesda category II. In sixteen patients, FNAC was not done as they presented with compressive symptoms or metastasis. Fifty percent had a total thyroidectomy and 50% had subtotal followed by completion thyroidectomy, plus ten patients had lymph node dissection, out of which seven had histopathological lymph node involvement. On histopathology, twenty-three patients (57.5%) had minimally invasive, while seventeen (42.5%) had widely invasive follicular thyroid carcinoma. The capsular invasion was present in thirty-three patients (82.5%); one patient had no capsular invasion, but there was a vascular invasion. Six patients' histopathology had no record of capsular invasion. In contrast, the lymphovascular invasion was present in twenty-six patients (65%). In this study, 65 % of the patients had clinical stage 1 disease, while 25% had stage 2 and 10% had clinical stage 4. Seventeen patients (42.5%) had received RAI 30-100 mCi, while ten patients (25%) received more than 100 mCi. Conclusion: FTC demographic and clinicopathological presentation are the same in Pakistan as compared to other countries. Surgery followed by RAI is the mainstay of treatment. Thus understanding the trend of FTC and proper planning and utilization of the resources will help the developing countries in effectively treating the FTC.

Keywords: thyroid carcinoma, follicular thyroid carcinoma, clinicopathological features, developing countries

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4440 Education Levels & University Student’s Income: Primary Data Analysis from the Universities of Punjab, Pakistan

Authors: Muhammad Ashraf

Abstract:

It is experimentally conceded reality that education not just promotes social and intellectual abilities yet, in addition, the incomes of people. The present study is directed to investigate the connection between education level and student income. Data of different education levels is acquired from 300 students through field review from four public sector Universities; two from upper Punjab (University of Gujarat and Government college university-Lahore) and two from lower Punjab (Islamia University-Bahawalpur and The University of Sahiwal). Two-phase estimation is based on the Mincerian human capital model. The first stage presents statistical/descriptive investigation, which shows positive linkage among higher education and income of the students. Econometric estimation is estimated in the second stage by applying Ordinary least Square Method (OLS). Econometric examination reaffirms the importance of higher education as the impact of higher education on students’ incomes accelerates as we move from lower-level education to higher-level education. Educational levels, experience, and working hours are sure and noteworthy with student’s income. Econometric estimation additionally investigated that M. Phil and Ph.D. students have a higher income than bachelor students. Concerning the students, the income profile study commended that the Government ought to give part-time jobs or internships to students as indicated to labor market demand.

Keywords: education, student’s income, experience, universities

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4439 Occurrence of the fall armyworm, Spodoptera frugiperda (J. E. Smith) (Lepidoptera, Noctuidae), on Maize in Katsina State, Nigeria and preliminary study of its Developmental Characteristics under Laboratory Conditions

Authors: Ibrahim Sani, Suleiman Mohammed., Salisu Sulaiman, Aminu Musa

Abstract:

The fall army worm (FAW), Spodoptera frugiperda (J. E. Smith) (Lepidoptera, Noctuidae) has recently become one of the major threats to maize production in the world. It is native to tropical and subtropical America and began to spread to many African and a few Asian Countries. A survey for the observation of infestation and collection of fall armyworm was conducted in field planted with maize in the northern part of Katsina state. Eggs and immature stages were collected, place in a plastic container and brought to the laboratory for observation and study of developmental stages. FAW was identified based on the morphological characteristics, i.e. the “Y” inverted shape on the head capsule and the patterns of black spots on the abdominal segments (square and trapezoidal forms). Different growing stage of maize are affected by fall armyworm, but the damage is greatest during the early growing phase of corn. Heavy infestation on the leaves also cause defoliation. Four developmental stages (eggs larvae, pupae and adults) of the FAW were studied when fed with young corn under laboratory conditions. Furthermore, effective scouting or monitoring of FAW could be practice at early stage of growth of maize.

Keywords: infestation, katsina, maize, fall armyworm

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4438 Supervised Machine Learning Approach for Studying the Effect of Different Joint Sets on Stability of Mine Pit Slopes Under the Presence of Different External Factors

Authors: Sudhir Kumar Singh, Debashish Chakravarty

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Slope stability analysis is an important aspect in the field of geotechnical engineering. It is also important from safety, and economic point of view as any slope failure leads to loss of valuable lives and damage to property worth millions. This paper aims at mitigating the risk of slope failure by studying the effect of different joint sets on the stability of mine pit slopes under the influence of various external factors, namely degree of saturation, rainfall intensity, and seismic coefficients. Supervised machine learning approach has been utilized for making accurate and reliable predictions regarding the stability of slopes based on the value of Factor of Safety. Numerous cases have been studied for analyzing the stability of slopes using the popular Finite Element Method, and the data thus obtained has been used as training data for the supervised machine learning models. The input data has been trained on different supervised machine learning models, namely Random Forest, Decision Tree, Support vector Machine, and XGBoost. Distinct test data that is not present in training data has been used for measuring the performance and accuracy of different models. Although all models have performed well on the test dataset but Random Forest stands out from others due to its high accuracy of greater than 95%, thus helping us by providing a valuable tool at our disposition which is neither computationally expensive nor time consuming and in good accordance with the numerical analysis result.

Keywords: finite element method, geotechnical engineering, machine learning, slope stability

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4437 Fast Switching Mechanism for Multicasting Failure in OpenFlow Networks

Authors: Alaa Allakany, Koji Okamura

Abstract:

Multicast technology is an efficient and scalable technology for data distribution in order to optimize network resources. However, in the IP network, the responsibility for management of multicast groups is distributed among network routers, which causes some limitations such as delays in processing group events, high bandwidth consumption and redundant tree calculation. Software Defined Networking (SDN) represented by OpenFlow presented as a solution for many problems, in SDN the control plane and data plane are separated by shifting the control and management to a remote centralized controller, and the routers are used as a forwarder only. In this paper we will proposed fast switching mechanism for solving the problem of link failure in multicast tree based on Tabu Search heuristic algorithm and modifying the functions of OpenFlow switch to fasts switch to the pack up sub tree rather than sending to the controller. In this work we will implement multicasting OpenFlow controller, this centralized controller is a core part in our multicasting approach, which is responsible for 1- constructing the multicast tree, 2- handling the multicast group events and multicast state maintenance. And finally modifying OpenFlow switch functions for fasts switch to pack up paths. Forwarders, forward the multicast packet based on multicast routing entries which were generated by the centralized controller. Tabu search will be used as heuristic algorithm for construction near optimum multicast tree and maintain multicast tree to still near optimum in case of join or leave any members from multicast group (group events).

Keywords: multicast tree, software define networks, tabu search, OpenFlow

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4436 Metamorphic Approach in Architecture Studio to Re-Imagine Drawings in Acknowledgement of Architectural/Artistic Identity

Authors: Hassan Wajid, Syed T. Ahmed, Syed G. Haider Jr., Razia Latif, Ahsan Ali, Maira Anam

Abstract:

The phenomenon of Metamorphosis can be associated with any object, organism, or structure gradually and progressively going through the change of systemic or morphological form. This phenomenon can be integrated while teaching drawing to architecture students. In architectural drawings, metamorphosis’s main focus and purpose are not to completely imitate any object. In the process of drawing, the changes in systemic or morphological form happen until the complete process, and the visuals of the complete process change the drawing, opening up possibilities for the imagination of the perceivers. Metamorphosis in architectural drawings begins with an initial form and, through various noticeable stages, ends up final form or manifestation. How much of the initial form is manifested in the final form and progressively among various intermediate stages becomes an indication of the nature of metamorphosis as a phenomenon. It is important at this stage to clarify that the term metamorphosis is presently being coopted from its original domain, usually in life sciences. In this current exercise, the architectural drawings are to act as an operative analog process transforming one image of art and/or architecture in its broadest sense. That composition is claimed to have come from one source (individual work, a cultural artifact, civilizational remain). It dialectically meets, opposes, or confronts some carefully chosen alien opposites from a different domain. As an example, the layers of a detailed drawing of a Turkish prayer rug of 5 x 7 ratio over a detailed architectural plan of a religious, historical complex can be observed such that the two drawings, though at markedly different scales could dialectically converse with one another and through their mutual congruencies. In the final stage, the idea concludes contradictions across the scales to initiate the analogous roles of metamorphosed third reality, which suggests the previous un-acknowledged architectural or artistic identity. The proposed paper explores the trajectory of reproduction by analyzing drawings through detailed drawing stages and analyzes challenges as well as opportunities in the discovered realm of imagination. This description further aims at identifying factors influencing creativity and innovation in producing architectural drawings through the process of observing drawings from inception to the concluding stage.

Keywords: architectural drawings, metamorphosis, perceptions, discovery

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4435 Stochastic Fleet Sizing and Routing in Drone Delivery

Authors: Amin Karimi, Lele Zhang, Mark Fackrell

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Rural-to-urban population migrations are a global phenomenon, with projections indicating that by 2050, 68% of the world's population will inhabit densely populated urban centers. Concurrently, the popularity of e-commerce shopping has surged, evidenced by a 51% increase in total e-commerce sales from 2017 to 2021. Consequently, distribution and logistics systems, integral to effective supply chain management, confront escalating hurdles in efficiently delivering and distributing products within bustling urban environments. Additionally, events like environmental challenges and the COVID-19 pandemic have indicated that decision-makers are facing numerous sources of uncertainty. Therefore, to design an efficient and reliable logistics system, uncertainty must be considered. In this study, it examine fleet sizing and routing while considering uncertainty in demand rate. Fleet sizing is typically a strategic-level decision, while routing is an operational-level one. In this study, a carrier must make two types of decisions: strategic-level decisions regarding the number and types of drones to be purchased, and operational-level decisions regarding planning routes based on available fleet and realized demand. If the available fleets are insufficient to serve some customers, the carrier must outsource that delivery at a relatively high cost, calculated per order. With this hierarchy of decisions, it can model the problem using two-stage stochastic programming. The first-stage decisions involve planning the number and type of drones to be purchased, while the second-stage decisions involve planning routes. To solve this model, it employ logic-based benders decomposition, which decomposes the problem into a master problem and a set of sub-problems. The master problem becomes a mixed integer programming model to find the best fleet sizing decisions, and the sub-problems become capacitated vehicle routing problems considering battery status. Additionally, it assume a heterogeneous fleet based on load and battery capacity, and it consider that battery health deteriorates over time as it plan for multiple periods.

Keywords: drone-delivery, stochastic demand, VRP, fleet sizing

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4434 Cultural Adjustment Problems in Academic and Social Life Experienced by Indonesian Postgraduate Students Studying in London

Authors: Erizal Lugman

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An increasing number of students from Indonesia study in universities in the UK. Because of the substantial cultural differences between the Western and Indonesian cultures, this study investigates the issues in academic and social life experienced by Indonesian postgraduate students, with a sample of 11 Indonesian postgraduate students (8 male, 3 female) studying in London during the cultural adjustment stage. This research made use of a semi-structured interview and was analyzed qualitatively using thematic content analysis to reveal key areas of concern in the academic setting, social life, and language-related issues. The findings confirm that the most challenging aspects experienced by the participants are the use of academic English in academic situations and the students’ lack of critical thinking. Nine out of 11 students agreed that they had problems with writing essays during the cultural adjustment stage. Because of the collectivist culture in Indonesia, making friends with locals was the most concerning issue in the participants’ sociocultural adjustment, followed by difficulty in finding places to pray, looking for Halal food and using the Western toilet system The findings suggest recommendations that the students must be more aware of the cultural differences between Indonesian and Western cultures, including in the academic setting and social life. Also, the lecturers should pay more attention to their speech in the British accent which is sometimes difficult to understand.

Keywords: academic adjustment, cultural adjustment, indonesian culture, intercultural communication

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4433 Human Identification and Detection of Suspicious Incidents Based on Outfit Colors: Image Processing Approach in CCTV Videos

Authors: Thilini M. Yatanwala

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CCTV (Closed-Circuit-Television) Surveillance System is being used in public places over decades and a large variety of data is being produced every moment. However, most of the CCTV data is stored in isolation without having integrity. As a result, identification of the behavior of suspicious people along with their location has become strenuous. This research was conducted to acquire more accurate and reliable timely information from the CCTV video records. The implemented system can identify human objects in public places based on outfit colors. Inter-process communication technologies were used to implement the CCTV camera network to track people in the premises. The research was conducted in three stages and in the first stage human objects were filtered from other movable objects available in public places. In the second stage people were uniquely identified based on their outfit colors and in the third stage an individual was continuously tracked in the CCTV network. A face detection algorithm was implemented using cascade classifier based on the training model to detect human objects. HAAR feature based two-dimensional convolution operator was introduced to identify features of the human face such as region of eyes, region of nose and bridge of the nose based on darkness and lightness of facial area. In the second stage outfit colors of human objects were analyzed by dividing the area into upper left, upper right, lower left, lower right of the body. Mean color, mod color and standard deviation of each area were extracted as crucial factors to uniquely identify human object using histogram based approach. Color based measurements were written in to XML files and separate directories were maintained to store XML files related to each camera according to time stamp. As the third stage of the approach, inter-process communication techniques were used to implement an acknowledgement based CCTV camera network to continuously track individuals in a network of cameras. Real time analysis of XML files generated in each camera can determine the path of individual to monitor full activity sequence. Higher efficiency was achieved by sending and receiving acknowledgments only among adjacent cameras. Suspicious incidents such as a person staying in a sensitive area for a longer period or a person disappeared from the camera coverage can be detected in this approach. The system was tested for 150 people with the accuracy level of 82%. However, this approach was unable to produce expected results in the presence of group of people wearing similar type of outfits. This approach can be applied to any existing camera network without changing the physical arrangement of CCTV cameras. The study of human identification and suspicious incident detection using outfit color analysis can achieve higher level of accuracy and the project will be continued by integrating motion and gait feature analysis techniques to derive more information from CCTV videos.

Keywords: CCTV surveillance, human detection and identification, image processing, inter-process communication, security, suspicious detection

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4432 An Engaged Approach to Developing Tools for Measuring Caregiver Knowledge and Caregiver Engagement in Juvenile Type 1 Diabetes

Authors: V. Howard, R. Maguire, S. Corrigan

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Background: Type 1 Diabetes (T1D) is a chronic autoimmune disease, typically diagnosed in childhood. T1D puts an enormous strain on families; controlling blood-glucose in children is difficult and the consequences of poor control for patient health are significant. Successful illness management and better health outcomes can be dependent on quality of caregiving. On diagnosis, parent-caregivers face a steep learning curve as T1D care requires a significant level of knowledge to inform complex decision making throughout the day. The majority of illness management is carried out in the home setting, independent of clinical health providers. Parent-caregivers vary in their level of knowledge and their level of engagement in applying this knowledge in the practice of illness management. Enabling researchers to quantify these aspects of the caregiver experience is key to identifying targets for psychosocial support interventions, which are desirable for reducing stress and anxiety in this highly burdened cohort, and supporting better health outcomes in children. Currently, there are limited tools available that are designed to capture this information. Where tools do exist, they are not comprehensive and do not adequately capture the lived experience. Objectives: Development of quantitative tools, informed by lived experience, to enable researchers gather data on parent-caregiver knowledge and engagement, which accurately represents the experience/cohort and enables exploration of questions that are of real-world value to the cohort themselves. Methods: This research employed an engaged approach to address the problem of quantifying two key aspects of caregiver diabetes management: Knowledge and engagement. The research process was multi-staged and iterative. Stage 1: Working from a constructivist standpoint, literature was reviewed to identify relevant questionnaires, scales and single-item measures of T1D caregiver knowledge and engagement, and harvest candidate questionnaire items. Stage 2: Aggregated findings from the review were circulated among a PPI (patient and public involvement) expert panel of caregivers (n=6), for discussion and feedback. Stage 3: In collaboration with the expert panel, data were interpreted through the lens of lived experience to create a long-list of candidate items for novel questionnaires. Items were categorized as either ‘knowledge’ or ‘engagement’. Stage 4: A Delphi-method process (iterative surveys) was used to prioritize question items and generate novel questions that further captured the lived experience. Stage 5: Both questionnaires were piloted to refine wording of text to increase accessibility and limit socially desirable responding. Stage 6: Tools were piloted using an online survey that was deployed using an online peer-support group for caregivers for Juveniles with T1D. Ongoing Research: 123 parent-caregivers completed the survey. Data analysis is ongoing to establish face and content validity qualitatively and through exploratory factor analysis. Reliability will be established using an alternative-form method and Cronbach’s alpha will assess internal consistency. Work will be completed by early 2024. Conclusion: These tools will enable researchers to gain deeper insights into caregiving practices among parents of juveniles with T1D. Development was driven by lived experience, illustrating the value of engaged research at all levels of the research process.

Keywords: caregiving, engaged research, juvenile type 1 diabetes, quantified engagement and knowledge

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