Search results for: median duration
642 Nonlinear Aerodynamic Parameter Estimation of a Supersonic Air to Air Missile by Using Artificial Neural Networks
Authors: Tugba Bayoglu
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Aerodynamic parameter estimation is very crucial in missile design phase, since accurate high fidelity aerodynamic model is required for designing high performance and robust control system, developing high fidelity flight simulations and verification of computational and wind tunnel test results. However, in literature, there is not enough missile aerodynamic parameter identification study for three main reasons: (1) most air to air missiles cannot fly with constant speed, (2) missile flight test number and flight duration are much less than that of fixed wing aircraft, (3) variation of the missile aerodynamic parameters with respect to Mach number is higher than that of fixed wing aircraft. In addition to these challenges, identification of aerodynamic parameters for high wind angles by using classical estimation techniques brings another difficulty in the estimation process. The reason for this, most of the estimation techniques require employing polynomials or splines to model the behavior of the aerodynamics. However, for the missiles with a large variation of aerodynamic parameters with respect to flight variables, the order of the proposed model increases, which brings computational burden and complexity. Therefore, in this study, it is aimed to solve nonlinear aerodynamic parameter identification problem for a supersonic air to air missile by using Artificial Neural Networks. The method proposed will be tested by using simulated data which will be generated with a six degree of freedom missile model, involving a nonlinear aerodynamic database. The data will be corrupted by adding noise to the measurement model. Then, by using the flight variables and measurements, the parameters will be estimated. Finally, the prediction accuracy will be investigated.Keywords: air to air missile, artificial neural networks, open loop simulation, parameter identification
Procedia PDF Downloads 270641 Oestrous Synchronization: A Technical Note for Nepalese Goat Farmers
Authors: Pravin Mishra, Ajeet K. Jha, Pankaj K. Jha
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This technical note is aimed at providing a brief information on goat breeds, its breeding seasonality and different methods of oestrous synchronization for Nepalese goat farmers. It was observed that, these goats are seasonal breeder and showed oestrous during mainly two season; December- February and March-May. This leads to an irregular supply of goat to market and a wide variations in market price. Oestrus synchronization is only an alternative reproductive tool to overcome this scarcity by enhancing production and productivity. This technique enables goat producers breed their animals within a short pre-determined period and permits breeding round the year. The principle of oestrus synchronisation is based on controlling of the luteal phase of the oestrous cycle. There are two basic mechanisms; one by shortening the luteal life (premature luteolysis) using prostaglandins or its analogues and the other by prolonging the luteal life (simulating the activity of natural progesterone produced by the corpus luteum) using exogenous progesterone source. The former is easy to apply and only effective during breeding season, whereas the latter is advantageous when the reproductive status of the goat flock is unknown. The common hormonal products easily available in Nepal includes; prostaglandins or its analogues (Oviprost® Dinoprost® Lutalyse® and Estrumate®), exogenous progesterone (Fluorogestone acetate® and Controlled Internal Drug Release®, CIDR) devices). However, before practicing the oestrous synchronization protocol, it needs to be validated for oestrous response rate, time to onset of oestrous, duration of oestrous and pregnancy rates at farmer’s field. In conclusion, application of oestrus synchronisation practice enhanced goat production and surplus the goat meat demand in Nepal.Keywords: goat, Nepal, oestrous, synchronization
Procedia PDF Downloads 147640 Advantages of Computer Navigation in Knee Arthroplasty
Authors: Mohammad Ali Al Qatawneh, Bespalchuk Pavel Ivanovich
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Computer navigation has been introduced in total knee arthroplasty to improve the accuracy of the procedure. Computer navigation improves the accuracy of bone resection in the coronal and sagittal planes. It was also noted that it normalizes the rotational alignment of the femoral component and fully assesses and balances the deformation of soft tissues in the coronal plane. The work is devoted to the advantages of using computer navigation technology in total knee arthroplasty in 62 patients (11 men and 51 women) suffering from gonarthrosis, aged 51 to 83 years, operated using a computer navigation system, followed up to 3 years from the moment of surgery. During the examination, the deformity variant was determined, and radiometric parameters of the knee joints were measured using the Knee Society Score (KSS), Functional Knee Society Score (FKSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scales. Also, functional stress tests were performed to assess the stability of the knee joint in the frontal plane and functional indicators of the range of motion. After surgery, improvement was observed in all scales; firstly, the WOMAC values decreased by 5.90 times, and the median value to 11 points (p < 0.001), secondly KSS increased by 3.91 times and reached 86 points (p < 0.001), and the third one is that FKSS data increased by 2.08 times and reached 94 points (p < 0.001). After TKA, the axis deviation of the lower limbs of more than 3 degrees was observed in 4 patients at 6.5% and frontal instability of the knee joint just in 2 cases at 3.2%., The lower incidence of sagittal instability of the knee joint after the operation was 9.6%. The range of motion increased by 1.25 times; the volume of movement averaged 125 degrees (p < 0.001). Computer navigation increases the accuracy of the spatial orientation of the endoprosthesis components in all planes, reduces the variability of the axis of the lower limbs within ± 3 °, allows you to achieve the best results of surgical interventions, and can be used to solve most basic tasks, allowing you to achieve excellent and good outcomes of operations in 100% of cases according to the WOMAC scale. With diaphyseal deformities of the femur and/or tibia, as well as with obstruction of their medullary canal, the use of computer navigation is the method of choice. The use of computer navigation prevents the occurrence of flexion contracture and hyperextension of the knee joint during the distal sawing of the femur. Using the navigation system achieves high-precision implantation for the endoprosthesis; in addition, it achieves an adequate balance of the ligaments, which contributes to the stability of the joint, reduces pain, and allows for the achievement of a good functional result of the treatment.Keywords: knee joint, arthroplasty, computer navigation, advantages
Procedia PDF Downloads 82639 Surgical Management of Distal Femur Fracture Using Locking Compression Plate: Our Experience in a Rural Tertiary Care Centre in India
Authors: Pagadaplly Girish, P. V. Manohar
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Introduction: Management of distal femur fractures is challenging. Recently, treatment has evolved towards indirect reduction and minimally invasive techniques. Objectives: To assess the fracture union and functional outcome following open reduction and internal fixation of distal femur fractures with locking compression plate and to achieve restoration of the anatomical alignment of fracture fragments and stable internal fixation. Methodology: Patients with distal femur fracture treated by locking compression during Oct 2011 to April 2013 were assessed prospectively. Patients below 18 years and those with neuro-vascular deficits were excluded. Age, sex of the patient, type of fracture, mechanism of injury, type of implant used, operative time and postoperative complications were analysed. The Neer’s scale was used to assess the outcome of the patients. Results: The total number of patients was 30; 28 males and 2 females; mean age was 41.53 years. Road traffic accidents were the major causes of injury followed by falls. The average duration of hospital stay was 21.3 days. The overall complication rate note was 23.33%. The mean range of movement around the knee joint after 6 months of follow-up was 114.330. The average time for the radiological union was 14 weeks. Excellent to good results were noted in 26 patients (86.6%) and average to poor results were observed in 4 (13.33%) patients. Conclusions: The locking compression plate gives a rigid fixation for the fracture. It also provides a good purchase in osteoporotic bones. LCP is simple and a reliable implant appropriate for fixation of femoral fractures with promising results.Keywords: distal femur fractures, locking compression plate, Neer’s criteria, neuro-vascular deficits
Procedia PDF Downloads 244638 Assessing Economic Losses Of 2104 Flood Disaster: A Case Study on Dabong, Kelantan, Malaysia
Authors: Ahmad Hamidi Mohamed, Jamaluddin Othman, Mashitah Suid, Mohd Zaim Mohd Shukri
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Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a 'tsunami-like disaster'. A study has been conducted with the objectives to assess the economic impact of the flood to the resident of Dabong area in Kelantan Darul Naim, Malaysia. This area was selected due to the severity during the flood. The impacts of flood on local people were done by conducting structured interviews with the use of questionnaires. The questionnaire was intended to acquire information on losses faced by Dabong residence. Questionnaires covered various areas of inconveniences suffered with respect to health effects, including illnesses suffered, their intensities, duration and their associated costs. Loss of productivity and quality of life was also assessed. Inquiries were made to Government agencies to obtain relevant statistical data regarding the loss due to the flood tragedy. The data collected by giving formal request to the governmental agencies and formal meetings were done. From the study a staggering amount of losses were calculated. This figure comes from losses of property, Farmers/Agriculture, Traders/Business, Health, Insurance and Governmental losses. Flood brings hardship to the people of Dabong and these losses of home will cause inconveniences to the society. The huge amount of economic loss extracted from this study shows that federal and state government of Kelantan need to find out the cause of the major flood in 2014. Fast and effective measures have to be planned and implemented in flood prone area to prevent same tragedy happens in the future.Keywords: economic impact, flood tragedy, Malaysia, property losses
Procedia PDF Downloads 262637 Optimization of Digestive Conditions of Opuntia ficus-indica var. Saboten using Food-Grade Enzymes
Authors: Byung Wook Yang, Sae Kyul Kim, Seung Il Ahn, Jae Hee Choi, Heejung Jung, Yejin Choi, Byung Yong Kim, Young Tae Hahm
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Opuntia ficus-indica is a member of the Cactaceae family that is widely grown in all the semiarid countries throughout the world. Opuntia ficus-indica var. Saboten (OFS), commonly known as prickly pear cactus, is commercially cultivated as a dietary foodstuffs and medicinal stuffs in Jeju Island, Korea. Owing to high viscosity of OFS’ pad, its application to the commercial field has been limited. When the low viscosity of OFS’s pad is obtained, it is useful for the manufacture of healthy food in the related field. This study was performed to obtain the optimal digestion conditions of food-grade enzymes (Pectinex, Viscozyme and Celluclast) with the powder of OFS stem. And also, the contents of water-soluble dietary fiber (WSDF) of the dried powder prepared by the extraction of OFS stem were monitored and optimized using the response surface methodology (RSM), which included 20 experimental points with 3 replicates for two independent variables (fermentation temperature and time). A central composite design was used to monitor the effect of fermentation temperature (30-90 °C, X1) and fermentation time (1-10h, X2) on dependent variables, such as viscosity (Y1), water-soluble dietary fiber (Y2) and dietary fiber yield (Y3). Estimated maximum values at predicted optimum conditions were in agreement with experimental values. Optimum temperature and duration were 50°C and 12 hours, respectively. Viscosity value reached 3.4 poise. Yield of water-soluble dietary fiber is determined in progress.Keywords: Opuntia ficus-indica var. saboten, enzymatic fermentation, response surface methodology, water-soluble dietary fiber, viscosity
Procedia PDF Downloads 341636 Prediction of Rotating Machines with Rolling Element Bearings and Its Components Deterioration
Authors: Marimuthu Gurusamy
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In vibration analysis (with accelerometers) of rotating machines with rolling element bearing, the customers are interested to know the failure of the machine well in advance to plan the spare inventory and maintenance. But in real world most of the machines fails before the prediction of vibration analyst or Expert analysis software. Presently the prediction of failure is based on ISO 10816 vibration limits only. But this is not enough to monitor the failure of machines well in advance. Because more than 50% of the machines will fail even the vibration readings are within acceptable zone as per ISO 10816.Hence it requires further detail analysis and different techniques to predict the failure well in advance. In vibration Analysis, the velocity spectrum is used to analyse the root cause of the mechanical problems like unbalance, misalignment and looseness etc. The envelope spectrum are used to analyse the bearing frequency components, hence the failure in inner race, outer race and rolling elements are identified. But so far there is no correlation made between these two concepts. The author used both velocity spectrum and Envelope spectrum to analyse the machine behaviour and bearing condition to correlated the changes in dynamic load (by unbalance, misalignment and looseness etc.) and effect of impact on the bearing. Hence we could able to predict the expected life of the machine and bearings in the rotating equipment (with rolling element bearings). Also we used process parameters like temperature, flow and pressure to correlate with flow induced vibration and load variations, when abnormal vibration occurs due to changes in process parameters. Hence by correlation of velocity spectrum, envelope spectrum and process data with 20 years of experience in vibration analysis, the author could able to predict the rotating Equipment and its component’s deterioration and expected duration for maintenance.Keywords: vibration analysis, velocity spectrum, envelope spectrum, prediction of deterioration
Procedia PDF Downloads 442635 Awareness on Risk Factors of Cardiovascular Disease among Patients with Diabetes Mellitus Attending Diabetic Clinic of B. P. Koirala Institute of Health Sciences
Authors: Ram Sharan Mehta, Dina Khanal, Pushpa Parajuli, Gayanand Mandal, Bijaya Bartuala
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Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Adequate awareness of risk factors of CVD is the first step towards effective preventive strategies to combat the CVD burden in diabetes patients.This study aims to assess the awareness on risk factors of CVD among patients with diabetes mellitus attending diabetic clinic of BPKIHS and to find the association between awareness with their selected socio demographic variables. Methods and Material: A descriptive cross sectional study was conducted among 112 patients with diabetes in diabetic clinic of BPKIHS. Convenient sampling technique was used for data collection over duration of one month using interview schedule by HDFQ II tool. Data were analyzed by using descriptive and inferential statistics. (Chi square). Results: The mean age of respondents was 55.4±12.13 years. That mean HDFQ score was 14.31± 5.08. Only 33% of the respondents had adequate level of awareness whereas majority of the respondents (67%) had inadequate level of awareness. Majority of the respondent (83.9%) were aware about smoking, (78.6%) physical activity, (75%) increasing age, (75.9%) high blood pressure, (71.4%) overweight respectively. Whereas most of the respondents were not aware of high cholesterol, fatty diet, preventive strategies and association of diabetes with CVD. Awareness was statistically significant with (p=0.043) educational status, (p=0.025) monthly income, (p=0.05) residence, (p=0.006) CVD information received and (p=0.022) co morbid condition as a heart disease. Conclusion: The findings of this study concluded most of the respondents had an inadequate level of awareness on risk factors of CVD. So Effective education and appropriate preventive strategies of CVD are indeed important to reduce CVD burden in diabetes patients.Keywords: cardiovascular disease, awareness, diabetes patients, risk
Procedia PDF Downloads 126634 Spectrum and Prevalence of Candida Infection in Diabetic Foot Ulcers
Authors: Seyed Reza Aghili, Tahereh Shokohi, Lotfollah Davoodi, Zahra Kashi, Azam Moslemi, Mahdi Abastabar, Iman Haghani, Sabah Mayahi, Asoudeh A.
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Introduction: In diabetic foot ulcers, if fungal agents such as Candida species penetrate into the cutaneous or depth of ulcer, can increase the degree of the wound and cause Candia infection and make it more difficult to heal. Material & Methods: A cross-sectional study was performed on 100 diabetic foot ulcer patients in 2020 in Sari, Iran. patient's data and wound grade were recorded in a questionnaire. Candida infection was diagnosed with direct microscopic examination and culture of samples. Colony-PCR molecular method was used for ITS region of DNA and then PCR-RFLP with Msp1 enzyme and using HWP1 specific gene to determine species of Candida agent. Results: Of 100 patients, the mean age 62.1 ± 10.8 years, 95% type 2 diabetes, 83%>10 years duration diabetes, 59% male, 66%> poor education level, 99% married, 52% rural, 95% neuropathic symptoms, 88% using antibiotics, 69%HbA1C >9%, and mean ulcer degree 2.6±1.05 were. Candida infection was seen in 13% of the deep tissue of the wound and 7% cutaneous around the wound. The predominant Candida isolated was C. parapsilosis (71.5%), C .albicans (14.3%). Fungal infections caused by mold fungi were not detected. There was a statistically significant relationship between yeast infection and gender, rural, HbA1C and ulcer degree. Conclusion: Mycological evaluations often are ignored. Candida parapsilosis is the most common infectious agent in these patients and may require specific treatment. Therefore, more attention of physicians to Candida infections particularly, early diagnosis and effective treatment can help faster recovery and prevent amputation.Keywords: diabetic foot ulcer, candida infection, risk factors, c. parapsilosis
Procedia PDF Downloads 188633 Numerical Modeling of Air Shock Wave Generated by Explosive Detonation and Dynamic Response of Structures
Authors: Michał Lidner, Zbigniew SzcześNiak
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The ability to estimate blast load overpressure properly plays an important role in safety design of buildings. The issue of studying of blast loading on structural elements has been explored for many years. However, in many literature reports shock wave overpressure is estimated with simplified triangular or exponential distribution in time. This indicates some errors when comparing real and numerical reaction of elements. Nonetheless, it is possible to further improve setting similar to the real blast load overpressure function versus time. The paper presents a method of numerical analysis of the phenomenon of the air shock wave propagation. It uses Finite Volume Method and takes into account energy losses due to a heat transfer with respect to an adiabatic process rule. A system of three equations (conservation of mass, momentum and energy) describes the flow of a volume of gaseous medium in the area remote from building compartments, which can inhibit the movement of gas. For validation three cases of a shock wave flow were analyzed: a free field explosion, an explosion inside a steel insusceptible tube (the 1D case) and an explosion inside insusceptible cube (the 3D case). The results of numerical analysis were compared with the literature reports. Values of impulse, pressure, and its duration were studied. Finally, an overall good convergence of numerical results with experiments was achieved. Also the most important parameters were well reflected. Additionally analyses of dynamic response of one of considered structural element were made.Keywords: adiabatic process, air shock wave, explosive, finite volume method
Procedia PDF Downloads 181632 Physical Model Testing of Storm-Driven Wave Impact Loads and Scour at a Beach Seawall
Authors: Sylvain Perrin, Thomas Saillour
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The Grande-Motte port and seafront development project on the French Mediterranean coastline entailed evaluating wave impact loads (pressures and forces) on the new beach seawall and comparing the resulting scour potential at the base of the existing and new seawall. A physical model was built at ARTELIA’s hydraulics laboratory in Grenoble (France) to provide insight into the evolution of scouring overtime at the front of the wall, quasi-static and impulsive wave force intensity and distribution on the wall, and water and sand overtopping discharges over the wall. The beach was constituted of fine sand and approximately 50 m wide above mean sea level (MSL). Seabed slopes were in the range of 0.5% offshore to 1.5% closer to the beach. A smooth concrete structure will replace the existing concrete seawall with an elevated curved crown wall. Prior the start of breaking (at -7 m MSL contour), storm-driven maximum spectral significant wave heights of 2.8 m and 3.2 m were estimated for the benchmark historical storm event dated of 1997 and the 50-year return period storms respectively, resulting in 1 m high waves at the beach. For the wave load assessment, a tensor scale measured wave forces and moments and five piezo / piezo-resistive pressure sensors were placed on the wall. Light-weight sediment physical model and pressure and force measurements were performed with scale 1:18. The polyvinyl chloride light-weight particles used to model the prototype silty sand had a density of approximately 1 400 kg/m3 and a median diameter (d50) of 0.3 mm. Quantitative assessments of the seabed evolution were made using a measuring rod and also a laser scan survey. Testing demonstrated the occurrence of numerous impulsive wave impacts on the reflector (22%), induced not by direct wave breaking but mostly by wave run-up slamming on the top curved part of the wall. Wave forces of up to 264 kilonewtons and impulsive pressure spikes of up to 127 kilonewtons were measured. Maximum scour of -0.9 m was measured for the new seawall versus -0.6 m for the existing seawall, which is imputable to increased wave reflection (coefficient was 25.7 - 30.4% vs 23.4 - 28.6%). This paper presents a methodology for the setup and operation of a physical model in order to assess the hydrodynamic and morphodynamic processes at a beach seawall during storms events. It discusses the pros and cons of such methodology versus others, notably regarding structures peculiarities and model effects.Keywords: beach, impacts, scour, seawall, waves
Procedia PDF Downloads 147631 Global Positioning System Match Characteristics as a Predictor of Badminton Players’ Group Classification
Authors: Yahaya Abdullahi, Ben Coetzee, Linda Van Den Berg
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The study aimed at establishing the global positioning system (GPS) determined singles match characteristics that act as predictors of successful and less-successful male singles badminton players’ group classification. Twenty-two (22) male single players (aged: 23.39 ± 3.92 years; body stature: 177.11 ± 3.06cm; body mass: 83.46 ± 14.59kg) who represented 10 African countries participated in the study. Players were categorised as successful and less-successful players according to the results of five championships’ of the 2014/2015 season. GPS units (MinimaxX V4.0), Polar Heart Rate Transmitter Belts and digital video cameras were used to collect match data. GPS-related variables were corrected for match duration and independent t-tests, a cluster analysis and a binary forward stepwise logistic regression were calculated. A Receiver Operating Characteristic Curve (ROC) was used to determine the validity of the group classification model. High-intensity accelerations per second were identified as the only GPS-determined variable that showed a significant difference between groups. Furthermore, only high-intensity accelerations per second (p=0.03) and low-intensity efforts per second (p=0.04) were identified as significant predictors of group classification with 76.88% of players that could be classified back into their original groups by making use of the GPS-based logistic regression formula. The ROC showed a value of 0.87. The identification of the last-mentioned GPS-related variables for the attainment of badminton performances, emphasizes the importance of using badminton drills and conditioning techniques to not only improve players’ physical fitness levels but also their abilities to accelerate at high intensities.Keywords: badminton, global positioning system, match analysis, inertial movement analysis, intensity, effort
Procedia PDF Downloads 186630 A Histopathological Study on Leech (Hirudo medicinalis) Application in the Management of Vicarcikā (Eczema)
Authors: K. M. Pratap Shankar, Dattatreya Rao, Sai Prasad
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Background: Skin diseases are among the most common health problems worldwide and are associated with a considerable burden. Eczema is such a skin ailment which cause psychological, social and financial burden on the patient and their families. Management of eczema with antibiotics, antihistamines, steroids etc., are available but even after their use relapses, recurrences and other complications are very common. Aim: The aim of this study was to assess the efficacy of leech application in the management of vicarcikā (Eczema) with Histopathological study. Methods: For the present study 10 patients having the classical symptoms of Vicarcikā, were randomly selected as per the inclusion and exclusion criteria from O.P.D. & I.P.D. sections of Śalya department, S.V. Āyurvedic Hospital, Tirupati. Minimum 4 sittings of Leech application was carried out with seven days interval. Total duration of treatment was 6 weeks. Biopsy samples were collected from the lesion site before and after treatment. Histopathological examination was done by the pathologist. Results: In eczema (dermatitis) the leech application therapy gives excellent response by reducing the inflammatory component, hyperkeratosis, spongiosis, irregular acanthosis and by evoking a granulation tissue response in the dermis and in most of the cases with complete recovery from the lesion. Most of the cases in the study were chronic dermatitis and sebhoric keratosis, almost all local/focal pigmented lesions is totally relieved by leech therapy especially in cases of sebhoric keratosis. Conclusion: In the present study it was found that, leech application evokes significant changes at histological level specifically in reduction of inflammatory component, hyperkeratosis, spongiosis and irregular acanthosis. It was also found that there was a considerable formation of granulation tissue, which helps in formation of healthy new tissues.Keywords: acanthosis, eczema, hyperkeratosis, leech application, spongiosis
Procedia PDF Downloads 294629 Healthcare Professionals' Utilization of Physical Exercise as a Strategy to Prevent Non-Communicable Diseases in Ethiopian Public Sector Hospitals
Authors: Jeanne Grace, Melkamu D. Kassa
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Background: Despite the recognized benefits of physical exercise, including a reduction of health risk factor indicators, illness and deaths related to Non-Communicable Diseases (NCDs) like cardiovascular disease, diabetes, hypertension, and cancer, the extent of its recognition and use as a prevention strategy by healthcare professionals working in Ethiopian referral hospitals is unknown. Objective: This study explored healthcare professionals’ use of physical exercise as a non-communicable disease prevention strategy in the Ethiopian public sector healthcare system. Methods: In this cross-sectional study, a self-administered questionnaire was conducted after being piloted to ensure validity and reliability. For the study, 312 participants were selected from 13 purposively selected Ethiopian referral hospitals, these being 99 physicians who were purposively selected and 213 nurses who were proportionately and randomly selected. Results: The results indicated that three-quarters (78%) of healthcare professionals working in Ethiopian hospitals are not using physical exercise as a strategy to prevent NCDs. Increased specialization (AOR = 20.203, p < 0.001), longer service years (AOR = 0.041, p = 0.014), young age (AOR = 19.871, p < 0.001), and being male (AOR = 0.269, p < 0.001), were predictors of using physical exercise as a strategy for the prevention of NCDs. Conclusion: Healthcare professionals’ utilization of physical exercise as a strategy for NCDs prevention was inadequate in Ethiopia. Given the increasing burden of NCD disease in Ethiopia, training nurses, physicians and medical managers have to acknowledge the use of physical exercise as an NCD prevention strategy. The results of this study highlight the importance of formulating physical exercise intervention strategies for NCDs patients, and the need to incorporate training for healthcare professionals on the type, intensity, duration, and frequency of physical exercise to prevent NCDs in the Ethiopian healthcare system.Keywords: exercise, medical managers, nurses, physicians
Procedia PDF Downloads 167628 Demand Forecasting to Reduce Dead Stock and Loss Sales: A Case Study of the Wholesale Electric Equipment and Part Company
Authors: Korpapa Srisamai, Pawee Siriruk
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The purpose of this study is to forecast product demands and develop appropriate and adequate procurement plans to meet customer needs and reduce costs. When the product exceeds customer demands or does not move, it requires the company to support insufficient storage spaces. Moreover, some items, when stored for a long period of time, cause deterioration to dead stock. A case study of the wholesale company of electronic equipment and components, which has uncertain customer demands, is considered. The actual purchasing orders of customers are not equal to the forecast provided by the customers. In some cases, customers have higher product demands, resulting in the product being insufficient to meet the customer's needs. However, some customers have lower demands for products than estimates, causing insufficient storage spaces and dead stock. This study aims to reduce the loss of sales opportunities and the number of remaining goods in the warehouse, citing 30 product samples of the company's most popular products. The data were collected during the duration of the study from January to October 2022. The methods used to forecast are simple moving averages, weighted moving average, and exponential smoothing methods. The economic ordering quantity and reorder point are used to calculate to meet customer needs and track results. The research results are very beneficial to the company. The company can reduce the loss of sales opportunities by 20% so that the company has enough products to meet customer needs and can reduce unused products by up to 10% dead stock. This enables the company to order products more accurately, increasing profits and storage space.Keywords: demand forecast, reorder point, lost sale, dead stock
Procedia PDF Downloads 108627 Anthropometric and Physical Fitness Ability Profile of Elite and Non-Elite Boxers of Manipur
Authors: Anthropometric, Physical Fitness Ability Profile of Elite, Non-Elite Boxers of Manipur
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Background: Boxing is one of the oldest combat sports where different anthropological and fitness ability parameters determine performance. It is characterized by short duration, high intensity bursts of activity. The purpose of this research was to determine anthropometric and physical fitness profile of male elite and non-elite boxers of Manipur and to compare the two groups. Materials and Methods: Nineteen subjects were selected as elite boxers and twenty-four were non-elite boxers of Manipur. A cross-sectional study was conducted on anthropometric measurements and physical fitness ability tests on 33 subjects (elite and non-elite boxers). Statistical analysis was done using descriptive statistics, t-test and logistic regression with the help of SPSS version 15 software. Results: Results showed elite boxers have significantly reduced neck girth and calf girth as compare to non-elite boxers. Elite boxers have significantly lower sub scapular skin fold (SSF) and supra iliac skin fold (SISF) than their counterparts. Higher stature, larger BTB and lower percent fat are associated with higher performance in boxing. Sit ups (SU), standing Broad Jump (SBJ), Plat taping (PT), Sit and reach (SAR) and Harvard Step Test (HST) are predicted as most contributing factors enhancing performance level among the physical fitness components. Elite boxers are found to have more functional strength (sit ups), higher explosive strength (SBJ), more agility (PT), cardio-vascular endurance and flexibility (SAR) than non-elite boxers. Conclusion: In conclusion, lower fat, higher lean body mass, larger bi-trochantric breadth, high explosive strength, agility and flexibility are significantly associated with higher performance and chance of becoming elite boxers.Keywords: anthropometry, elite and non-elite boxers, Manipur, physical fitness
Procedia PDF Downloads 264626 Microplastics Accumulation and Abundance Standardization for Fluvial Sediments: Case Study for the Tena River
Authors: Mishell E. Cabrera, Bryan G. Valencia, Anderson I. Guamán
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Human dependence on plastic products has led to global pollution, with plastic particles ranging in size from 0.001 to 5 millimeters, which are called microplastics (hereafter, MPs). The abundance of microplastics is used as an indicator of pollution. However, reports of pollution (abundance of MPs) in river sediments do not consider that the accumulation of sediments and MPs depends on the energy of the river. That is, the abundance of microplastics will be underestimated if the sediments analyzed come from places where the river flows with a lot of energy, and the abundance will be overestimated if the sediment analyzed comes from places where the river flows with less energy. This bias can generate an error greater than 300% of the MPs value reported for the same river and should increase when comparisons are made between 2 rivers with different characteristics. Sections where the river flows with higher energy allow sands to be deposited and limit the accumulation of MPs, while sections, where the same river has lower energy, allow fine sediments such as clays and silts to be deposited and should facilitate the accumulation of MPs particles. That is, the abundance of MPs in the same river is underrepresented when the sediment analyzed is sand, and the abundance of MPs is overrepresented if the sediment analyzed is silt or clay. The present investigation establishes a protocol aimed at incorporating sample granulometry to calibrate MPs quantification and eliminate over- or under-representation bias (hereafter granulometric bias). A total of 30 samples were collected by taking five samples within six work zones. The slope of the sampling points was less than 8 degrees, referred to as low slope areas, according to the Van Zuidam slope classification. During sampling, blanks were used to estimate possible contamination by MPs during sampling. Samples were dried at 60 degrees Celsius for three days. A flotation technique was employed to isolate the MPs using sodium metatungstate with a density of 2 gm/l. For organic matter digestion, 30% hydrogen peroxide and Fenton were used at a ratio of 6:1 for 24 hours. The samples were stained with rose bengal at a concentration of 200 mg/L and were subsequently dried in an oven at 60 degrees Celsius for 1 hour to be identified and photographed in a stereomicroscope with the following conditions: Eyepiece magnification: 10x, Zoom magnification (zoom knob): 4x, Objective lens magnification: 0.35x for analysis in ImageJ. A total of 630 fibers of MPs were identified, mainly red, black, blue, and transparent colors, with an overall average length of 474,310 µm and an overall median length of 368,474 µm. The particle size of the 30 samples was calculated using 100 g per sample using sieves with the following apertures: 2 mm, 1 mm, 500 µm, 250 µm, 125 µm and 0.63 µm. This sieving allowed a visual evaluation and a more precise quantification of the microplastics present. At the same time, the weight of sediment in each fraction was calculated, revealing an evident magnitude: as the presence of sediment in the < 63 µm fraction increases, a significant increase in the number of MPs particles is observed.Keywords: microplastics, pollution, sediments, Tena River
Procedia PDF Downloads 68625 The Feasibility Evaluation Of The Compressed Air Energy Storage System In The Porous Media Reservoir
Authors: Ming-Hong Chen
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In the study, the mechanical and financial feasibility for the compressed air energy storage (CAES) system in the porous media reservoir in Taiwan is evaluated. In 2035, Taiwan aims to install 16.7 GW of wind power and 40 GW of photovoltaic (PV) capacity. However, renewable energy sources often generate more electricity than needed, particularly during winter. Consequently, Taiwan requires long-term, large-scale energy storage systems to ensure the security and stability of its power grid. Currently, the primary large-scale energy storage options are Pumped Hydro Storage (PHS) and Compressed Air Energy Storage (CAES). Taiwan has not ventured into CAES-related technologies due to geological and cost constraints. However, with the imperative of achieving net-zero carbon emissions by 2050, there's a substantial need for the development of a considerable amount of renewable energy. PHS has matured, boasting an overall installed capacity of 4.68 GW. CAES, presenting a similar scale and power generation duration to PHS, is now under consideration. Taiwan's geological composition, being a porous medium unlike salt caves, introduces flow field resistance affecting gas injection and extraction. This study employs a program analysis model to establish the system performance analysis capabilities of CAES. The finite volume model is then used to assess the impact of porous media, and the findings are fed back into the system performance analysis for correction. Subsequently, the financial implications are calculated and compared with existing literature. For Taiwan, the strategic development of CAES technology is crucial, not only for meeting energy needs but also for decentralizing energy allocation, a feature of great significance in regions lacking alternative natural resources.Keywords: compressed-air energy storage, efficiency, porous media, financial feasibility
Procedia PDF Downloads 60624 Infusion Pump Historical Development, Measurement and Parts of Infusion Pump
Authors: Samuel Asrat
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Infusion pumps have become indispensable tools in modern healthcare, allowing for precise and controlled delivery of fluids, medications, and nutrients to patients. This paper provides an overview of the historical development, measurement, and parts of infusion pumps. The historical development of infusion pumps can be traced back to the early 1960s when the first rudimentary models were introduced. These early pumps were large, cumbersome, and often unreliable. However, advancements in technology and engineering over the years have led to the development of smaller, more accurate, and user-friendly infusion pumps. Measurement of infusion pumps involves assessing various parameters such as flow rate, volume delivered, and infusion duration. Flow rate, typically measured in milliliters per hour (mL/hr), is a critical parameter that determines the rate at which fluids or medications are delivered to the patient. Accurate measurement of flow rate is essential to ensure the proper administration of therapy and prevent adverse effects. Infusion pumps consist of several key parts, including the pump mechanism, fluid reservoir, tubing, and control interface. The pump mechanism is responsible for generating the necessary pressure to push fluids through the tubing and into the patient's bloodstream. The fluid reservoir holds the medication or solution to be infused, while the tubing serves as the conduit through which the fluid travels from the reservoir to the patient. The control interface allows healthcare providers to program and adjust the infusion parameters, such as flow rate and volume. In conclusion, infusion pumps have evolved significantly since their inception, offering healthcare providers unprecedented control and precision in delivering fluids and medications to patients. Understanding the historical development, measurement, and parts of infusion pumps is essential for ensuring their safe and effective use in clinical practice. Procedia PDF Downloads 53623 Sensitivity Analysis of the Thermal Properties in Early Age Modeling of Mass Concrete
Authors: Farzad Danaei, Yilmaz Akkaya
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In many civil engineering applications, especially in the construction of large concrete structures, the early age behavior of concrete has shown to be a crucial problem. The uneven rise in temperature within the concrete in these constructions is the fundamental issue for quality control. Therefore, developing accurate and fast temperature prediction models is essential. The thermal properties of concrete fluctuate over time as it hardens, but taking into account all of these fluctuations makes numerical models more complex. Experimental measurement of the thermal properties at the laboratory conditions also can not accurately predict the variance of these properties at site conditions. Therefore, specific heat capacity and the heat conductivity coefficient are two variables that are considered constant values in many of the models previously recommended. The proposed equations demonstrate that these two quantities are linearly decreasing as cement hydrates, and their value are related to the degree of hydration. The effects of changing the thermal conductivity and specific heat capacity values on the maximum temperature and the time it takes for concrete to reach that temperature are examined in this study using numerical sensibility analysis, and the results are compared to models that take a fixed value for these two thermal properties. The current study is conducted in 7 different mix designs of concrete with varying amounts of supplementary cementitious materials (fly ash and ground granulated blast furnace slag). It is concluded that the maximum temperature will not change as a result of the constant conductivity coefficient, but variable specific heat capacity must be taken into account, also about duration when a concrete's central node reaches its max value again variable specific heat capacity can have a considerable effect on the final result. Also, the usage of GGBFS has more influence compared to fly ash.Keywords: early-age concrete, mass concrete, specific heat capacity, thermal conductivity coefficient
Procedia PDF Downloads 68622 Development of a Methodology for Surgery Planning and Control: A Management Approach to Handle the Conflict of High Utilization and Low Overtime
Authors: Timo Miebach, Kirsten Hoeper, Carolin Felix
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In times of competitive pressures and demographic change, hospitals have to reconsider their strategies as a company. Due to the fact, that operations are one of the main income and one of the primary cost drivers otherwise, a process-oriented approach and an efficient use of resources seems to be the right way for getting a consistent market position. Thus, the efficient operation room occupancy planning is an important cause variable for the success and continued the existence of these institutions. A high utilization of resources is essential. This means a very high, but nevertheless sensible capacity-oriented utilization of working systems that can be realized by avoiding downtimes and a thoughtful occupancy planning. This engineering approach should help hospitals to reach her break-even point. Firstly, the aim is to establish a strategy point, which can be used for the generation of a planned throughput time. Secondly, the operation planning and control should be facilitated and implemented accurately by the generation of time modules. More than 100,000 data records of the Hannover Medical School were analyzed. The data records contain information about the type of conducted operation, the duration of the individual process steps, and all other organizational-specific data such as an operating room. Based on the aforementioned data base, a generally valid model was developed by an analysis to define a strategy point which takes the conflict of capacity utilization and low overtime into account. Furthermore, time modules were generated in this work, which allows a simplified and flexible operation planning and control for the operation manager. By the time modules, it is possible to reduce a high average value of the idle times of the operation rooms. Furthermore, the potential is used to minimize the idle time spread.Keywords: capacity, operating room, surgery planning and control, utilization
Procedia PDF Downloads 247621 A Meta-Analysis on the Efficacy and Safety of TRC101/Veverimer 6g/Day in Increasing Serum Bicarbonate Levels of Chronic Kidney Disease Patients with Metabolic Acidosis
Authors: Hazel Ann Gianelli Cu, Stephanie Co, Radcliff Cobankiat
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Objectives: TRC101/Veverimer is an orally administered, non absorbed, sodium- and counterion-free hydrochloric acid binder for the treatment of metabolic acidosis associated with chronic kidney disease. The main objective of this study is to determine the efficacy of TRC 101/ Veverimer 6g/day in increasing serum bicarbonate levels of chronic kidney disease patients with metabolic acidosis. In this meta analysis, we also aim to look at safety outcomes, adverse effects and if the level of serum bicarbonate reached metabolic alkalosis when given TRC101/Veverimer. Methodology: Pubmed, Cochrane, Google Scholar and Science direct were used to search for randomized controlled trials about TRC101/Veverimer use in Chronic kidney disease patients with metabolic acidosis. Search strategy according to the Prisma checklist was done with evaluation of biases and synthesis of results using the Cochrane Review Manager software 5.4. Results: Two randomized controlled trials involving 371 chronic kidney disease patients were included in this study. Results show there was a significant increase in the serum bicarbonate level when given TRC101/Veverimer compared to the placebo. Both studies had a significant number of participants who completed the studies until the end. P value of <0.00001 was used in both studies with a confidence interval of 95%. Conclusion: TRC101/Veverimer 6g/day was shown to effectively and safely increase serum bicarbonate or achieve normalization in chronic kidney disease patients with metabolic acidosis as compared with a placebo. This was associated with delayed progression of kidney disease with improvement of physical functioning, however longer duration of future studies is ideal in order to assess further the long advantages and consequences of TRC 101/Veverimer.Keywords: chronic kidney disease, metabolic acidosis, Veverimer, TRC101
Procedia PDF Downloads 187620 Determinants of Consultation Time at a Family Medicine Center
Authors: Ali Alshahrani, Adel Almaai, Saad Garni
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Aim of the study: To explore duration and determinants of consultation time at a family medicine center. Methodology: This study was conducted at the Family Medicine Center in Ahad Rafidah City, at the southwestern part of Saudi Arabia. It was conducted on the working days of March 2013. Trained nurses helped in filling in the checklist. A total of 459 patients were included. A checklist was designed and used in this study. It included patient’s age, sex, diagnosis, type of visit, referral and its type, psychological problems and additional work-up. In addition, number of daily bookings, physician`s experience and consultation time. Results: More than half of patients (58.39%) had less than 10 minutes’ consultation (Mean+SD: 12.73+9.22 minutes). Patients treated by physicians with shortest experience (i.e., ≤5 years) had the longest consultation time while those who were treated with physicians with the longest experience (i.e., > 10 years) had the shortest consultation time (13.94±10.99 versus 10.79±7.28, p=0.011). Regarding patients’ diagnosis, those with chronic diseases had the longest consultation time (p<0.001). Patients who did not need referral had significantly shorter consultation time compared with those who had routine or urgent referral (11.91±8.42,14.60±9.03 and 22.42±14.81 minutes, respectively, p<0.001). Patients with associated psychological problems needed significantly longer consultation time than those without associated psychological problems (20.06±13.32 versus 12.45±8.93, p<0.001). Conclusions: The average length of consultation time at Ahad Rafidah Family Medicine Center is approximately 13 minutes. Less-experienced physicians tend to spend longer consultation times with patients. Referred patients, those with psychological problems, those with chronic diseases tend to have longer consultation time. Recommendations: Family physicians should be encouraged to keep their optimal consultation time. Booking an adequate number of patients per shift would allow the family physician to provide enough consultation time for each patient.Keywords: consultation, quality, medicine, clinics
Procedia PDF Downloads 280619 Considerations in Pregnancy Followed by Obesity Surgery
Authors: Maryam Nazari, Atefeh Ghanbari, Saghar Noorinia
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Obesity, as an abnormal or excessive accumulation of fat, is caused by genetic, behavioral and environmental factors. Recently, obesity surgeries, such as bariatric surgery, as the last measure to control obesity, have attracted experts and society, especially women, attention, so knowing the possible complications of this major surgery and their control in reproductive age is of particular importance due to its effects on pregnancy outcomes. Bariatric surgery reduces the risk of diabetes and high blood pressure associated with pregnancy, premature birth, macrosomia, stillbirth and dumping syndrome. Although in the first months after surgery, nausea and vomiting caused by changes in intra-abdominal pressure are associated with an increased risk of malabsorption of micronutrients such as folic acid, iron, vitamin B1, D, calcium, selenium and phosphorus and finally, fetal growth disorder. Moreover, serum levels of micronutrients such as vitamin D, calcium, and iron in mothers who used to have bariatric surgery and their babies have been shown to be lower than in mothers without a history of bariatric surgery. Moreover, vitamin A deficiency is shown to be more widespread in pregnancies after bariatric surgery, which leads to visual problems in newborns and premature delivery. However, complications such as the duration of hospitalization of newborns in the NICU, disease rate in the first 28 days of life and congenital anomalies are not significantly different in babies born to mothers undergoing bariatric surgery compared to the control group. In spite of the vast advantages following obesity surgeries, due to the catabolic conditions and severe weight loss followed by such major intervention and the probability of nutrients malnutrition in a pregnant woman and her baby, after having surgery, at least 12 to 18 months should be considered to get pregnant as a recovery period. In addition, taking essential supplements before and at least 6 months after this approach is recommended.Keywords: bariatric surgery, pregnancy, malnutrition, vitamin and mineral deficiency
Procedia PDF Downloads 84618 Intracranial Hypertension without CVST in Apla Syndrome: An Unique Association
Authors: Camelia Porey, Binaya Kumar Jaiswal
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BACKGROUND: Antiphospholipid antibody (APLA) syndrome is an autoimmune disorder predisposing to thrombotic complications affecting CNS either by arterial vasooclusion or venous thrombosis. Cerebral venous sinus thrombosis (CVST) secondarily causes raised intracranial pressure (ICP). However, intracranial hypertension without evidence of CVST is a rare entity. Here we present two cases of elevated ICP with absence of identifiable CVST. CASE SUMMARY: Case 1, 28-year female had a 2 months history of holocranial headache followed by bilateral painless vision loss reaching lack of light perception over 20 days. CSF opening pressure was elevated. Fundoscopy showed bilateral grade 4 papilledema. MRI revealed a partially empty sella with bilateral optic nerve tortuosity. Idiopathic intracranial hypertension (IIH) was diagnosed. With acetazolamide, there was complete resolution of the clinical and radiological abnormalities. 5 months later she presented with acute onset right-sided hemiparesis. MRI was suggestive of acute left MCA infarct.MR venogram was normal. APLA came positive with high titres of Anticardiolipin and Beta 2 glycoprotein both IgG and IgM. Case 2, 23-year female, presented with headache and diplopia of 2 months duration. CSF pressure was elevated and Grade 3 papilledema was seen. MRI showed bilateral optic nerve hyperintensities with nerve head protrusion with normal MRV. APLA profile showed elevated beta 2 glycoprotein IgG and IgA. CONCLUSION: This is an important non thrombotic complication of APLA syndrome and requires further large-scale study for insight into the pathogenesis and early recognition to avoid future complications.Keywords: APLA syndrome, idiopathic intracranial hypertension, MR venogram, papilledema
Procedia PDF Downloads 168617 Oral Betahistine Versus Intravenous Diazepam in Acute Peripheral Vertigo: A Randomized, Double-Blind Controlled Trial
Authors: Saeed Abbasi, Davood Farsi, Soudabeh Shafiee Ardestani, Neda Valizadeh
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Objectives: Peripheral vertigo is a common complaint of patients who are visited in emergency departments. In our study, we wanted to evaluate the effect of betahistine as an oral drug vs. intravenous diazepam for the treatment of acute peripheral vertigo. We also wanted to see the possibility of substitution of parenteral drug with an oral one with fewer side effects. Materials and Methods: In this randomized, double-blind study, 101 patients were enrolled in the study. The patients were divided in two groups in a double-blind randomized manner. Group A took oral placebo and 10 mg of intravenous diazepam. Group B received 8mg of oral betahistine and intravenous placebo. Patients’ symptoms and signs (Vertigo severity, Nausea, Vomiting, Nistagmus and Gate) were evaluated after 0, 2, 4, 6 hours by emergency physicians and data were collected by a questionnaire. Results: In both groups, there was significant improvement in vertigo (betahistine group P=0.02 and Diazepam group P=0.03). Analysis showed more improvement in vertigo severity after 4 hours of treatment in betahistine group comparing to diazepam group (P=0.02). Nausea and vomiting were significantly lower in patients receiving diazepam after 2 and 6 hours (P=0.02 & P=0.03).No statistically significant differences were found between the groups in nistagmus, equilibrium & vertigo duration. Conclusion: The results of this randomized trial showed that both drugs had acceptable therapeutic effects in peripheral vertigo, although betahistine was significantly more efficacious after 4 hours of drug intake. As for higher nausea and vomiting in betahistine group, physician should consider these side effects before drug prescription.Keywords: acute peripheral vertigo, betahistine, diazepam, emergency department
Procedia PDF Downloads 380616 Optical and Near-UV Spectroscopic Properties of Low-Redshift Jetted Quasars in the Main Sequence in the Main Sequence Context
Authors: Shimeles Terefe Mengistue, Ascensión Del Olmo, Paola Marziani, Mirjana Pović, María Angeles Martínez-Carballo, Jaime Perea, Isabel M. Árquez
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Quasars have historically been classified into two distinct classes, radio-loud (RL) and radio-quiet (RQ), taking into account the presence and absence of relativistic radio jets, respectively. The absence of spectra with a high S/N ratio led to the impression that all quasars (QSOs) are spectroscopically similar. Although different attempts were made to unify these two classes, there is a long-standing open debate involving the possibility of a real physical dichotomy between RL and RQ quasars. In this work, we present new high S/N spectra of 11 extremely powerful jetted quasars with radio-to-optical flux density ratio > 1000 that concomitantly cover the low-ionization emission of Mgii𝜆2800 and Hbeta𝛽 as well as the Feii blends in the redshift range 0.35 < z < 1, observed at Calar Alto Observatory (Spain). This work aims to quantify broad emission line differences between RL and RQ quasars by using the four-dimensional eigenvector 1 (4DE1) parameter space and its main sequence (MS) and to check the effect of powerful radio ejection on the low ionization broad emission lines. Emission lines are analysed by making two complementary approaches, a multicomponent non-linear fitting to account for the individual components of the broad emission lines and by analysing the full profile of the lines through parameters such as total widths, centroid velocities at different fractional intensities, asymmetry, and kurtosis indices. It is found that broad emission lines show large reward asymmetry both in Hbeta𝛽 and Mgii2800A. The location of our RL sources in a UV plane looks similar to the optical one, with weak Feii UV emission and broad Mgii2800A. We supplement the 11 sources with large samples from previous work to gain some general inferences. The result shows, compared to RQ, our extreme RL quasars show larger median Hbeta full width at half maximum (FWHM), weaker Feii emission, larger 𝑀BH, lower 𝐿bol/𝐿Edd, and a restricted space occupation in the optical and UV MS planes. The differences are more elusive when the comparison is carried out by restricting the RQ population to the region of the MS occupied by RL quasars, albeit an unbiased comparison matching 𝑀BH and 𝐿bol/𝐿Edd suggests that the most powerful RL quasars show the highest redward asymmetries in Hbeta.Keywords: galaxies, active, line, profiles, quasars, emission lines, supermassive black holes
Procedia PDF Downloads 55615 A Vaccination Program to Control an Outbreak of Acute Hepatitis A among MSM in Taiwan, 2016
Authors: Ying-Jung Hsieh, Angela S. Huang, Chu-Ming Chiu, Yu-Min Chou, Chin-Hui Yang
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Background and Objectives: Hepatitis A is primarily acquired by the fecal-oral route through person-to-person contact or ingestion of contaminated food or water. During 2010 to 2014, an average of 83 cases of locally-acquired disease was reported to Taiwan’s notifiable disease system. Taiwan Centers for Disease Control (TCDC) identified an outbreak of acute hepatitis A which began in June 2015. Of the 126 cases reported in 2015, 103 (82%) cases were reported during June–December and 95 cases (92%) of them were male. The average age of all male cases was 31 years (median, 29 years; range, 15–76 years). Among the 95 male cases, 49 (52%) were also infected with HIV, and all reported to have had sex with other men. To control this outbreak, TCDC launched a free hepatitis A vaccination program in January 2016 for close contacts of confirmed hepatitis A cases, including family members, sexual partners, and household contacts. Effect of the vaccination program was evaluated. Methods: All cases of hepatitis A reported to the National Notifiable Disease Surveillance System were included. A case of hepatitis A was defined as a locally-acquired disease in a person who had acute clinical symptoms include fever, malaise, loss of appetite, nausea or abdominal discomfort compatible with hepatitis, and tested positive for anti-HAV IgM during June 2015 to June 2016 in Taiwan. The rate of case accumulation was calculated using a simple regression model. Results: During January–June 2016, there were 466 cases of hepatitis A reported; of the 243 (52%) who were also infected with HIV, 232 (95%) had a history of having sex with men. Of the 346 cases that were followed up, 259 (75%) provided information on contacts but only 14 (5%) of them provided the name of their sexual partners. Among the 602 contacts reported, 349 (58%) were family members, 14 (2%) were sexual partners, and 239 (40%) were other household contacts. Among the 602 contacts eligible for free hepatitis A vaccination, 440 (73%) received the vaccine. There were 87 (25%) cases that refused to disclose their close contacts. The average case accumulation rate during January–June 2016 was 21.7 cases per month, which was 6.8 times compared to the average case accumulation rate during June–December 2015 of 3.2 cases per month. Conclusions: Despite vaccination program aimed to provide free hepatitis A vaccine to close contacts of hepatitis A patients, the outbreak continued and even gained momentum in transmission. Refusal by hepatitis A patients to provide names of their close contacts and rejection of contacts to take the hepatitis A vaccine may have contributed to the poor effect of the program. Targeted vaccination efforts of all MSM may be needed to control the outbreak among this population in the short term. In the long term, universal vaccination program is needed to prevent the infection of hepatitis A.Keywords: hepatitis A, HIV, men who have sex with men, vaccination
Procedia PDF Downloads 251614 Screening for Diabetes in Patients with Chronic Pancreatitis: The Belfast Trust Experience
Authors: Riyas Peringattuthodiyil, Mark Taylor, Ian Wallace, Ailish Nugent, Mike Mitchell, Judith Thompson, Allison McKee, Philip C. Johnston
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Aim of Study: The purpose of the study was to screen for diabetes through HbA1c in patients with chronic pancreatitis (CP) within the Belfast Trust. Background: Patients with chronic pancreatitis are at risk of developing diabetes, earlier diagnosis with subsequent multi-disciplinary input has the potential to improve clinical outcomes. Methods: Clinical and laboratory data of patients with chronic pancreatitis were obtained through the Northern Ireland Electronic Healthcare Record (NIECR), specialist hepatobiliary, and gastrointestinal clinics. Patients were invited to have a blood test for HbA1c. Newly diagnosed patients with diabetes were then invited to attend a dedicated Belfast City Hospital (BCH) specialist chronic pancreatitis and diabetes clinic for follow up. Results: A total of 89 chronic pancreatitis patients were identified; Male54; Female:35, mean age 52 years, range 12-90 years. Aetiology of CP included alcohol 52/89 (58%), gallstones 18/89 (20%), idiopathic 10/89 11%, 2 were genetic, 1: post ECRP, 1: IgG autoimmune, 1: medication induced, 1: lipoprotein lipase deficiency 1: mumps, 1: IVDU and 1: pancreatic divisum. No patients had pancreatic carcinoma. Mean duration of CP was nine years, range 3-30 years. 15/89 (16%) of patients underwent previous pancreatic surgery/resections. Recent mean BMI was 25.1 range 14-40 kg/m². 62/89 (70%) patients had HbA1c performed. Mean HbA1c was 42 mmol/mol, range 27-97mmol/mol, 42/62 (68%) had normal HbA1c (< 42 mmol/mol) 13/62 (21%) had pre-diabetes (42-47mmol/mol) and 7/62 (11%) had diabetes (≥ 48 mmol/mol). Conclusions: Of those that participated in the screening program around one-third of patients with CP had glycaemic control in the pre and diabetic range. Potential opportunities for improving screening rates for diabetes in this cohort could include regular yearly testing at gastrointestinal and hepatobiliary clinics.Keywords: pancreatogenic diabetes, screening, chronic pancreatitis, trust experience
Procedia PDF Downloads 154613 Rituximab Therapy for Musculoskeletal Involvement in Systemic Sclerosis
Authors: Liudmila Garzanova, Lidia Ananyeva, Olga Koneva, Olga Ovsyannikova, Oxana Desinova, Mayya Starovoytova, Rushana Shayahmetova, Anna Khelkovskaya-Sergeeva
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Objectives. There is very few data on changes of the musculoskeletal manifestations (artritis, arthralgia, muscle weakness, etc.) in systemic sclerosis (SSc) on rituximab (RTX) therapy. The aim of our study was to assess the severity of the musculoskeletal involvement in SSc patients (pts) and its changes during RTX therapy. Methods. Our study included 103 pts with SSc. The mean followup period was 12.6±10.7 months. The mean age was 47±12.9 years, female-87 pts (84%), the diffuse cutaneous subset of the disease had 55 pts (53%). The mean disease duration was 6.2±5.5 years. All pts had interstitial lung disease (ILD) and were positive for ANA, 67% of them were positive for antitopoisomerase-1. All patients received prednisolone at a dose of 11.3±4.5 mg/day, immunosuppressants at inclusion received 47% of them. Pts received RTX due to the ineffectiveness of previous therapy for ILD. The cumulative mean dose of RTX was 1.7±0.6 grams. Arthritis was observed in 22 pts (21%), arthralgias in 47 pts (46%). Muscle weakness was observed in 17 pts (17%). Tendon friction rubs was established in 7 pts (7%). The results at baseline and at the end of the follow up are presented in the form of mean values. Results. There was an improvement of all outcome parameters and musculoskeletal manifestations on RTX therapy. There was a decrease in the number of pts with arthritis from 22 (21%) to 10 (9%), a decrease in the number of pts with arthralgias from 47 (46%) to 31 (30%). The number of pts with muscle weakness decreased from 17 (17%) to 7 (7%). The number of pts with tendon friction rubs decreased from 7 (7%) to 3 (3%). The creatine phosphokinase decreased from 365.5±186 to 70.8±50.4 (p=0.00006). The C-reactive protein (CRP) decreased from 23.2±31.3 to 8.62±7.4 (p=0.001). The dose of prednisolone was reduced from 11.3±4.5 to 9.8±3.5 mg/day (p=0.0004). Conclusion. In our study, musculoskeletal involvement was detected in almost half of the patients with SSc-ILD. There was an improvement of musculoskeletal manifestations despite a small cumulative dose of RTX. We also managed to reduce the dose of glucocorticosteroids. The improvement of musculoskeletal manifestations was accompanied by a decrease in laboratory parameters - creatine phosphokinase and CRP. RTX is effective option for treatment of musculoskeletal manifestations in SSc.Keywords: arthritis, musculoskeletal involvement, systemic sclerosis, rituximab
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