Search results for: noninvasive neurally adjusted ventilatory assist

Authors: Hai Chien Pham, Thi Phuong Anh Vo, Chansik Park

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Risks management in construction projects is important to ensure the positive feasibility of the projects in which financial risks are most concerned while construction projects always run on a credit basis. Credit risks, therefore, require unique and technical tools to be well managed. Underwriting technique in credit risks, in its most basic sense, refers to the process of evaluating the risks and the potential exposure of losses. Risks analysis and underwriting are applied as a must in banks and financial institutions who are supporters for constructions projects when required. Recently, construction organizations, especially contractors, have recognized the significant increasing of credit risks which caused negative impacts to project performance and profit of construction firms. Despite the successful application of underwriting in banks and financial institutions for many years, there are few contractors who are applying this technique to analyze and mitigate the credit risks of their potential owners before signing contracts with them for delivering their performed services. Thus, contractors have taken credit risks during project implementation which might be not materialized due to the bankruptcy and/or protracted default made by their owners. With this regard, this study proposes a model using the underwriting technique for contractors to analyze and assess credit risks of their owners before making final decisions for the potential construction contracts. Contractor’s underwriters are able to analyze and evaluate the subjects such as owner, country, sector, payment terms, financial figures and their related concerns of the credit limit requests in details based on reliable information sources, and then input into the proposed model to have the Overall Assessment Score (OAS). The OAS is as a benchmark for the decision makers to grant the proper limits for the project. The proposed underwriting model is validated by 30 subjects in Asia Pacific region within 5 years to achieve their OAS, and then compare output OAS with their own practical performance in order to evaluate the potential of underwriting model for analyzing and assessing credit risks. The results revealed that the underwriting would be a powerful method to assist contractors in making precise decisions. The contribution of this research is to allow the contractors firstly to develop their own credit risk management model for proactively preventing the credit risks of construction projects and continuously improve and enhance the performance of this function during project implementation.

Keywords: underwriting technique, credit risk, risk management, construction project

Procedia PDF Downloads 188

Authors: Thiago Ribeiro de Alencar, Jacyro Gramulia Junior, Patricia Teixeira Leite

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The area of the electricity sector that deals with energy needs by the hydroelectric in a coordinated manner is called Operation Planning of Hydrothermal Power Systems (OPHPS). The purpose of this is to find a political operative to provide electrical power to the system in a given period, with reliability and minimal cost. Therefore, it is necessary to determine an optimal schedule of generation for each hydroelectric, each range, so that the system meets the demand reliably, avoiding rationing in years of severe drought, and that minimizes the expected cost of operation during the planning, defining an appropriate strategy for thermal complementation. Several optimization algorithms specifically applied to this problem have been developed and are used. Although providing solutions to various problems encountered, these algorithms have some weaknesses, difficulties in convergence, simplification of the original formulation of the problem, or owing to the complexity of the objective function. An alternative to these challenges is the development of techniques for simulation optimization and more sophisticated and reliable, it can assist the planning of the operation. Thus, this paper presents the development of a computational tool, namely Hydro-IA for solving optimization problem identified and to provide the User an easy handling. Adopted as intelligent optimization technique is Genetic Algorithm (GA) and programming language is Java. First made the modeling of the chromosomes, then implemented the function assessment of the problem and the operators involved, and finally the drafting of the graphical interfaces for access to the User. The results with the Genetic Algorithms were compared with the optimization technique nonlinear programming (NLP). Tests were conducted with seven hydroelectric plants interconnected hydraulically with historical stream flow from 1953 to 1955. The results of comparison between the GA and NLP techniques shows that the cost of operating the GA becomes increasingly smaller than the NLP when the number of hydroelectric plants interconnected increases. The program has managed to relate a coherent performance in problem resolution without the need for simplification of the calculations together with the ease of manipulating the parameters of simulation and visualization of output results.

Keywords: energy, optimization, hydrothermal power systems, artificial intelligence and genetic algorithms

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Authors: Binh Thanh Ta, Elizabeth Sturgiss

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Central to patient-centered care is the idea of treating a patient as a person and understanding their perspectives regarding their health conditions and care preferences. Surprisingly, little is known about how GPs can understand their patients’ perspectives. This paper addresses the challenge of understanding patient perspectives in behavior change consultations by adopting Conversation Analysis (CA), which is an empirical research approach that allows both researchers and the audience to examine patients’ perspectives as displayed in GP-patient interaction. To understand people’s perspectives, CA researchers do not rely on what they say but instead on how they demonstrate their endogenous orientations to social norms when they interact with each other. Underlying CA is the notion that social interaction is orderly by all means. (It is important to note that social orders should not be treated as exogenous sets of rules that predetermine human behaviors. Rather social orders are constructed and oriented by social members through their interactional practices. Also, note that these interactional practices are the resources shared by all social members). As CA offers tools to uncover the orderliness of interactional practices, it not only allows us to understand the perspective of a particular patient in a particular medical encounter but, more importantly, enables us to recognise the shared interactional practice for signifying a particular perspective. Drawing on the 10 video-recorded consultations on behavior change in primary care, we have discovered the orderliness of patient laughter when reporting health behaviors, which signifies their orientation to the problematic nature of the reported behaviors. Among 24 cases where patients reported their health behaviors, we found 19 cases in which they laughed while speaking. In the five cases where patients did not laugh, we found that they explicitly framed their behavior as unproblematic. This finding echoes the CA body research on laughter, which suggests that laughter produced by first speakers (as opposed to laughing in response to what has been said earlier) normally indicates some sort of problems oriented to the self (e.g. self-tease, self-depreciation, etc.). This finding points to the significance of understanding when and why patients laugh; such understanding would assist GPs to recognise whether patients treat their behavior as problematic or not, thereby producing responses sensitive to patient perspectives.

Keywords: patient centered care, laughter, conversation analysis, primary care, behaviour change consultations

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Authors: Jasmeet Kaur, Anup Singh, Shashikant Iyengar, Arun Kumar, Ira Sahay

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Latent autoimmune diabetes in adults (LADA) is an irreversible autoimmune disease that affects insulin production. LADA is characterized by the production of Glutamic acid decarboxylase (GAD) antibodies, which is similar to type 1 diabetes. Individuals with LADA may eventually develop overt diabetes and require insulin. In this condition, the pancreas produces little or no insulin, which is a hormone used by the body to allow glucose to enter cells and produce energy. While type 1 diabetes was traditionally associated with children and teenagers, its prevalence has increased in adults as well. LADA is frequently misdiagnosed as type 2 diabetes, especially in adulthood when type 2 diabetes is more common. LADA develops in adulthood, usually after age 30. Managing LADA involves metabolic control with exogenous insulin and prolonging the life of surviving beta cells, thereby slowing the disease's progression. This case study examines the impact of approximately 3 months of low-carbohydrate dietary intervention in a 42-year-old woman with LADA who was initially misdiagnosed as having type 2 diabetes. Her c-peptide was 0.13 and her HbA1c was 9.3% when this trial began. Low-carbohydrate interventions have been shown to improve blood sugar levels, including fasting, post-meal, and random blood sugar levels, as well as haemoglobin levels, blood pressure, energy levels, sleep quality, and satiety levels. The use of low-carbohydrate dietary intervention significantly reduces both hypo- and hyperglycaemia events. During the 3 months of the study, there were 2 to 3 hyperglycaemic events owing to physical stress and a single hypoglycaemic event. Low-carbohydrate dietary therapies lessen insulin dose inaccuracy, which explains why there were fewer hyperglycaemic and hypoglycaemic events. In three months, the glycated haemoglobin (HbA1c) level was reduced from 9.3% to 6.3%. These improvements occur without the need for caloric restriction or physical activity. Stress management was crucial aspect of the treatment plan as stress-induced neuroendocrine hormones can cause immunological dysregulation. Additionally, supplements that support immune system and reduce inflammation were used as part of the treatment during the trial. Long-term studies are needed to track disease development and corroborate the claim that such dietary treatments can prolong the honeymoon phase in LADA. Various factors can contribute to additional autoimmune attacks, so measuring c-peptide is crucial on a regular basis to determine whether insulin levels need to be adjusted.

Keywords: autoimmune, diabetes, LADA, low_carb, nutrition

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Authors: Mustafa M. Donma, Orkide Donma

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The examination of both serum lipid fractions and body’s lipid composition are quite informative during the evaluation of obesity stages. Within this context, alterations in lipid parameters are commonly observed. The variations in the fat distribution of the body are also noteworthy. Total cholesterol (TC), triglycerides (TRG), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C) are considered as the basic lipid fractions. Fat deposited in trunk and extremities may give considerable amount of information and different messages during discrete health states. Ratios are also derived from distinct fat distribution in these areas. Trunk-to-leg fat ratio (TLFR) and trunk-to-appendicular fat ratio (TAFR) are the most recently introduced ratios. In this study, lipid fractions and TLFR, as well as TAFR, were evaluated, and the distinctions among healthy, obese (OB), and morbid obese (MO) groups were investigated. Three groups [normal body mass index (N-BMI), OB, MO] were constituted from a population aged 6 to 18 years. Ages and sexes of the groups were matched. The study protocol was approved by the Non-interventional Ethics Committee of Tekirdag Namik Kemal University. Written informed consent forms were obtained from the parents of the participants. Anthropometric measurements (height, weight, waist circumference, hip circumference, head circumference, neck circumference) were obtained and recorded during the physical examination. Body mass index values were calculated. Total, trunk, leg, and arm fat mass values were obtained by TANITA Bioelectrical Impedance Analysis. These values were used to calculate TLFR and TAFR. Systolic (SBP) and diastolic blood pressures (DBP) were measured. Routine biochemical tests including TC, TRG, LDL-C, HDL-C, and insulin were performed. Data were evaluated using SPSS software. p value smaller than 0.05 was accepted as statistically significant. There was no difference among the age values and gender ratios of the groups. Any statistically significant difference was not observed in terms of DBP, TLFR as well as serum lipid fractions. Higher SBP values were measured both in OB and MO children than those with N-BMI. TAFR showed a significant difference between N-BMI and OB groups. Statistically significant increases were detected between insulin values of N-BMI group and OB as well as MO groups. There were bivariate correlations between LDL and TLFR (r=0.396; p=0.037) as well as TAFR values (r=0.413; p=0.029) in MO group. When adjusted for SBP and DBP, partial correlations were calculated as (r=0.421; p=0.032) and (r=0.438; p=0.025) for LDL-TLFR as well as LDL-TAFR, respectively. Much stronger partial correlations were obtained for the same couples (r=0.475; p=0.019 and r=0.473; p=0.020, respectively) upon controlling for TRG and HDL-C. Much stronger partial correlations observed in MO children emphasize the potential transition from morbid obesity to metabolic syndrome. These findings have concluded that LDL-C may be suggested as a discriminating parameter between OB and MO children.

Keywords: children, lipid parameters, obesity, trunk-to-leg fat ratio, trunk-to-appendicular fat ratio

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Authors: Morteza Sharifhasan, Davoud Hosseini, Mohammad. R. Salimpour

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The geothermal energy is considered as a worldwide important renewable energy in recent years due to rising environmental pollution concerns. Low- and medium-grade geothermal heat (< 200 ºC) is commonly employed for space heating and in domestic hot water supply. However, there is also much interest in converting the abundant low- and medium-grade geothermal heat into electrical power. The Iranian Ministry of Power - through the Iran Renewable Energy Organization (SUNA) – is going to build the first Geothermal Power Plant (GPP) in Iran in the Sabalan area in the Northwest of Iran. This project is a 5.5 MWe single flash steam condensing power plant. The efficiency of GPPs is low due to the relatively low pressure and temperature of the saturated steam. In addition to GPPs, Gas Turbines (GTs) are also known by their relatively low efficiency. The Iran ministry of Power is trying to increase the efficiency of these GTs by adding bottoming steam cycles to the GT to form what is known as combined gas/steam cycle. One of the most effective methods for increasing the efficiency is combined heat and power (CHP). This paper investigates the feasibility of superheating the saturated steam that enters the steam turbine of the Sabalan GPP (SGPP-1) to improve the energy efficiency and power output of the GPP. This purpose is achieved by combining the GPP with two 3.5 MWe GTs. In this method, the hot gases leaving GTs are utilized through a superheater similar to that used in the heat recovery steam generator of combined gas/steam cycle. Moreover, brine separated in the separator, hot gases leaving GTs and superheater are used for the supply of domestic hot water (in this paper, the cycle combined of GTs and CHP systems is named the modified SGPP-1) . In this research, based on the Heat Balance presented in the basic design documents of the SGPP-1, mathematical/numerical model of the power plant are developed together with the mentioned GTs and CHP systems. Based on the required hot water, the amount of hot gasses needed to pass through CHP section directly can be adjusted. For example, during summer when hot water is less required, the hot gases leaving both GTs pass through the superheater and CHP systems respectively. On the contrary, in order to supply the required hot water during the winter, the hot gases of one of the GTs enter the CHP section directly, without passing through the super heater section. The results show that there is an increase in thermal efficiency up to 40% through using the modified SGPP-1. Since the gross efficiency of SGPP-1 is 9.6%, the achieved increase in thermal efficiency is significant. The power output of SGPP-1 is increased up to 40% in summer (from 5.5MW to 7.7 MW) while the GTs power output remains almost unchanged. Meanwhile, the combined-cycle power output increases from the power output of the two separate plants of 12.5 MW [5.5+ (2×3.5)] to the combined-cycle power output of 14.7 [7.7+(2×3.5)]. This output is more than 17% above the output of the two separate plants. The modified SGPP-1 is capable of producing 215 T/Hr hot water ( 90 ºC ) for domestic use in the winter months.

Keywords: combined cycle, chp, efficiency, gas turbine, geothermal power plant, gas turbine, power output

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Authors: Som Pal Baliyan

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Dairy enterprise has been a major source of employment and income generation in most of the economies worldwide. Botswana government has also identified dairy as one of the agricultural sectors towards diversification of the mineral dependent economy of the country. The huge gap between local demand and supply of milk and milk products indicated that there are not only constraints but also; opportunities exist in this sub sector of agriculture. Therefore, this study was an attempt to identify constraints and opportunities in dairy production industry in Botswana. The possible ways to mitigate the constraints were also identified. The findings should assist the stakeholders especially, policy makers in the formulation of effective policies for the growth of dairy sector in the country. This quantitative study adopted a survey research design. A final survey followed by a pilot survey was conducted for data collection. The purpose of the pilot survey was to collect basic information on the nature and extent of the constraints, opportunities and ways to mitigate the constraints in dairy production. Based on the information from pilot survey, a four point Likert’s scale type questionnaire was constructed, validated and tested for its reliability. The data for the final survey were collected from purposively selected twenty five dairy farms. The descriptive statistical tools were employed to analyze data. Among the twelve constraints identified; high feed costs, feed shortage and availability, lack of technical support, lack of skilled manpower, high prevalence of pests and diseases and, lack of dairy related technologies were the six major constraints in dairy production. Grain feed production, roughage feed production, manufacturing of dairy feed, establishment of milk processing industry and, development of transportation systems were the five major opportunities among the eight opportunities identified. Increasing production of animal feed locally, increasing roughage feed production locally, provision of subsidy on animal feed, easy access to sufficient financial support, training of the farmers and, effective control of pests and diseases were identified as the six major ways to mitigate the constraints. It was recommended that the identified constraints and opportunities as well as the ways to mitigate the constraints need to be carefully considered by the stakeholders especially, policy makers during the formulation and implementation of the policies for the development of dairy sector in Botswana.

Keywords: dairy enterprise, milk production, opportunities, production constraints

Procedia PDF Downloads 372

Authors: Mohanad Rezeq, Tarik Aouam, Frederik Gailly

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In times of armed conflicts, various security checkpoints are placed by authorities to control the flow of merchandise into and within areas of conflict. The flow of humanitarian trucks that is added to the regular flow of commercial trucks, together with the complex security procedures, creates congestion and long waiting times at the security checkpoints. This causes distribution costs to increase and shortages of relief aid to the affected people to occur. Our research proposes a decision-support tool to assist planners and policymakers in building efficient plans for the distribution of relief aid, taking into account congestion at security checkpoints. The proposed tool is built around a multi-item humanitarian distribution planning model based on multi-phase design science methodology that has as its objective to minimize distribution and back ordering costs subject to capacity constraints that reflect congestion effects using nonlinear clearing functions. Using the 2014 Gaza War as a case study, we illustrate the application of the proposed tool, model the underlying relief-aid humanitarian supply chain, estimate clearing functions at different security checkpoints, and conduct computational experiments. The decision support tool generated a shipment plan that was compared to two benchmarks in terms of total distribution cost, average lead time and work in progress (WIP) at security checkpoints, and average inventory and backorders at distribution centers. The first benchmark is the shipment plan generated by the fixed capacity model, and the second is the actual shipment plan implemented by the planners during the armed conflict. According to our findings, modeling and optimizing supply chain flows reduce total distribution costs, average truck wait times at security checkpoints, and average backorders when compared to the executed plan and the fixed-capacity model. Finally, scenario analysis concludes that increasing capacity at security checkpoints can lower total operations costs by reducing the average lead time.

Keywords: humanitarian distribution planning, relief-aid distribution, congestion, clearing functions

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Authors: Memory Ranga, Phillip Pretorious

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The South African Government has invested a lot of money in Information Technology Governance (ITG) within the Government departments. The ITG framework was spearheaded by the Department of Public Service and Administration (DPSA). This led to the development of a governing ITG DPSA framework and later the Government Wide Enterprise Architecture (GWEA) Framework for assisting the departments to implement ITG. In addition to this, the government departments have adopted the Information Systems Audit and Control Association (ISACA) Control Objectives for Information and Related Technology (COBIT) for ITG processes. Despite all these available frameworks, departments fail to fully capitalise and improve the ITG processes mainly as these are too generic and difficult to apply for specific governance needs. There has been less research done to evaluate the progress on ITG initiatives within the government departments. This paper aims to evaluate the existing ITG frameworks within selected government departments in South Africa. A quantitative research approach was used in this study. Data was collected through an online questionnaire targeting ICT Managers and Directors from government departments. The study is undertaken within a case study and only the Eastern Cape Province was selected for the research. Document review mainly on ITG framework and best practices was also used. Data was analysed using the Google Analytic tools and SPSS. A one–sample Chi-Squared Test was used to verity the evaluation findings. Findings show that there is evidence that the current guiding National governance framework (DPSA) is out dated and does not accommodate the new changes in other governance frameworks. The Eastern Cape Government Departments have spent huge amount of money on ITG but not yet able to identify the benefits of the ITG initiatives. The guiding framework is rigid and does to address some of the departmental needs making it difficult to be flexible and apply the DPSA framework. Furthermore, despite the large budget on ITG, the departments still find themselves with many challenges and unable to improve some of the processes and services. All the engaged Eastern Cape departments have adopted the COBIT framework, but none has been conducting COBIT maturity Assessment which is a functionality of COBIT. There is evidence of too many the ITG frameworks and underutilisation of these frameworks. The study provides a comprehensive evaluation of the ITG frameworks that have been adopted by the South African Government Departments in the Eastern Cape Province. The evaluation guides and recommends the government departments to rethink and adopt ITG frameworks that could be customised to accommodate their needs. The adoption and application of ITG by government departments should assist in better governance and service delivery to the citizens.

Keywords: information technology governance, COBIT, evaluate, framework, governance, DPSA framework

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Authors: Nemat Mohammadi, Yuki Nakayama

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After occurring Great East Japan earthquake and as a consequence the invasion of an extremely large Tsunami to the city, obligated many local governments to take into account certainly these kinds of issues. Poor preparation of local governments to deal with such kinds of disasters at that time and consequently lack of assistance delivery for local residents caused thousands of civilian casualties as well as billion dollars of economic damages. Those local governments who are responsible for governing such coastal areas, have to consider some countermeasures to deal with these natural disasters, prepare a comprehensive evacuation plan and contrive some feasible emergency plans for the purpose of victims’ reduction as much as possible. Under this evacuation plan, the local government should contemplate more about the traffic congestion during wide-area evacuation operation and estimate the minimum essential time to evacuate the whole city completely. This challenge will become more complicated for the government when the people who are affected by disasters are not only limited to the normal informed citizens but also some pregnant women, physically handicapped persons, old age citizens and foreigners or tourists who are not familiar with that conditions as well as local language are involved. The important issue to deal with this challenge is that how to inform these people to take a proper action right away noticing the Tsunami is coming. After overcoming this problem, next significant challenge is even more considerable. Next challenge is to evacuate the whole residents in a short period of time from the threated area to the safer shelters. In fact, most of the citizens will use their own vehicles to evacuate to the designed shelters and some of them will use the shuttle buses which are provided by local governments. The problem will arise when all residents want to escape from the threated area simultaneously and consequently creating a traffic jam on evacuation routes which will cause to prolong the evacuation time. Hence, this research mostly aims to calculate the minimum essential time to evacuate each region inside the threated area and find the evacuation start point for each region separately. This result will help the local government to visualize the situations and conditions during disasters and assist them to reduce the possible traffic jam on evacuation routes and consequently suggesting a comprehensive wide-area evacuation plan during natural disasters.

Keywords: BPR formula, disaster scenarios, evacuation completion time, wide-area evacuation

Procedia PDF Downloads 191

Authors: Bilha Paryente, Rivi Frei Landau

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Autoethnography - a combination of autobiography and ethnography - focuses on the intersection of personal experiences and the culture in which they take place and is considered a viable method for exploring human experiences. The Russo-Ukrainian war has resulted in millions of forcibly displaced asylum-seeking refugees facing ambiguous loss. Whereas much is known about refugees' support needs, little is known about the needs and experiences of the humanitarian delegation members (HDM) who assist them. Through a debrief-based co-autoethnographic account of a female HDM who supported Ukrainian refugee mothers and children on the Polish borders, we explored the lived experiences involved in such a mission. Specifically, we conducted a transnational dyadic autoethnography debrief-based co-autoethnography which included both verbal and photo-based debriefing (8 two-hour sessions) alongside a reflexive (10-day) field diary analysis. Content analysis revealed cognitive dilemmas, emotional struggles, and practical adaptations occurring within the HDM's three identity-related domains: personal, professional (psychologist), and ethnic. The methodology presented and demonstrated in this paper enhances our theoretical understanding of the challenges faced by HDMs and may contribute to better future design of HDM training. Practically, the findings of the current study suggest the need for a three-stage accompaniment for HDMs relating to their personal, professional, and ethnic identities and considering their cognitive, emotional, and adaptive aspects. First, before leaving, HDMs should be briefed on personal and professional aspects of their experiences and ways of coping with them, as well as ethnic and religious affiliation issues. Second, while volunteering every evening their dilemmas, emotional struggles, and ways of adapting should be addressed for the three layers of identities. And finally, shortly after their return, there should be a final meeting to discuss all aspects of their identities and layers of personality. In this way, HDMs can become more effective in the important mission they fulfill. We hope that future HDMs and the bodies that send them on humanitarian missions of paramount importance will adopt these recommendations and generate proactive insights for members of future delegations.

Keywords: autoethnography, refugees, humanitarian delegation, ambiguous loss, Russo-Ukraine War, parenting

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Authors: H. Chabalala, A. Grootboom, M. Tang

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The innovative development, production, and clinical utilisation of African natural medicines requires frameworks from systematisation, innovation, registration. Afrika faces challenges when it comes to these sectors. The opposite is the case as is is evident in ancient Asian (Traditional Chinese Medicine and Indian Ayurveda and Siddha) medical systems, which are interfaced into their respective national health and educational systems. Afrikan Natural Medicines (ANMs) are yet to develop systematisation frameworks, i.e. disease characterisation and medicines classification. This paper explores classical medical systems drawn from Afrikan and Chinese experts in natural medicines. An Afrikological research methodology was used to conduct in-depth interviews with 20 key respondents selected through purposeful sampling technique. Data was summarised into systematisation frameworks for classical disease theories, patient categorisation, medicine classification, aetiology and pathogenesis of disease, diagnosis and prognosis techniques and treatment methods. It was discovered that ancient Afrika had systematic medical cosmologies, remnants of which are evident in most Afrikan cultural health practices. Parallels could be drawn from classical medical concepts of antiquity, like Chinese Taoist and Indian tantric health systems. Data revealed that both the ancient and contemporary ANM systems were based on living medical cosmologies. The study showed that African Natural Healing Systems have etiological systems, general pathogenesis knowledge, differential diagnostic techniques, comprehensive prognosis and holistic treatment regimes. Systematisation models were developed out of these frameworks, and this could be used for evaluation of clinical research, medical application including development of curriculum for high-education. It was envisaged that frameworks will pave way towards the development, production and commercialisation of ANMs. This was piloted in inclusive innovation, technology transfer and commercialisation of South African natural medicines, cosmeceuticals, nutraceuticals and health infusions. The central model presented here in will assist in curriculum development and establishment of Afrikan Medicines Hospitals and Pharmaceutical Industries.

Keywords: African Natural Medicines, Indigenous Knowledge Systems, Medical Cosmology, Clinical Application

Procedia PDF Downloads 107

Authors: C. M. Choi, H. C. Tsang, W. K. Fong, Y. K. Cheng, T. K. Chui, L. Y. Chan, K. W. Lee, C. K. Yuen, P. W. Lau, Y. L. To, K. C. Chow

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Six-minute walk test (6MWT) is a sub-maximal exercise test to assess aerobic capacity and exercise tolerance of patients with chronic respiratory disease and heart failure. This has been proven to be a reliable and valid tool and commonly used in clinical situations. Traditional 6MWT is labour-intensive and time-consuming especially for patients who require assistance in ambulation and oxygen use. When performing the test with these patients, one staff will assist the patient in walking (with or without aids) while another staff will need to manually record patient’s oxygen saturation, heart rate and walking distance at every minute and/or carry oxygen cylinder at the same time. Physiotherapist will then have to document the test results in bed notes in details. With the use of electronic 6MWT (E-6MWT), patients wear a wireless oximeter that transfers data to a tablet PC via Bluetooth. Real-time recording of oxygen saturation, heart rate, and distance are displayed. No manual work on recording is needed. The tablet will generate a comprehensive report which can be directly attached to the patient’s bed notes for documentation. Data can also be saved for later patient follow up. This study was carried out in North District Hospital. Patients who followed commands and required 6MWT assessment were included. Patients were assigned to study or control groups. In the study group, patients adopted the E-6MWT while those in control group adopted the traditional 6MWT. Manpower and time consumed were recorded. Physiotherapists also completed a questionnaire about the use of E-6MWT. Total 12 subjects (Study=6; Control=6) were recruited during 11-12/2017. An average number of staff required and time consumed in traditional 6MWT were 1.67 and 949.33 seconds respectively; while in E-6MWT, the figures were 1.00 and 630.00 seconds respectively. Compared to traditional 6MWT, E-6MWT required 67.00% less manpower and 50.10% less in time spent. Physiotherapists (n=7) found E-6MWT is convenient to use (mean=5.14; satisfied to very satisfied), requires less manpower and time to complete the test (mean=4.71; rather satisfied to satisfied), has better data management (mean=5.86; satisfied to very satisfied) and is recommended to be used clinically (mean=5.29; satisfied to very satisfied). It is proven that E-6MWT requires less manpower input with higher efficiency and better data management. It is welcomed by the clinical frontline staff.

Keywords: electronic, physiotherapy, six-minute walk test, 6MWT

Procedia PDF Downloads 127

Authors: Pernille K. Christiansen, Mette Maria Skjøth, Line Lorenzen, Eva Draborg, Christina Anne Vinter, Trine Kjær, Mette Juel Rothmann

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Background and aims: Overweight and obesity are an increasing challenge on a global level. In Denmark, more than one-third of all pregnant women are overweight or obese, and many women exceed the gestational weight gain recommendations from the Institute of Medicine. Being overweight or obese, is associated with a higher risk of adverse maternal and fetal outcomes, including gestational diabetes and childhood obesity. Thus, it is important to focus on the women’s lifestyles between their pregnancies to lower the risk of gestational weight retention in the long run. The objective of this study was to explorer what barriers and challenges postpartum women experience with respect to healthy lifestyles during the postpartum period and to access whether an Information Technology based intervention might be a supportive tool to assist and motivate postpartum women to a healthy lifestyle. Materials and methods: The method is inspired by participatory design. A systematic text condensation was applied to semi-structured focus groups. Five focus group interviews were carried out with a total of 17 postpartum women and two interviews with a total of six health professionals. Participants were recruited through the municipality in Svendborg, Denmark, and at Odense University Hospital in Odense, Denmark, during a four-month period in early 2018. Results: From the women’s perspective, better assistance is needed from the health professionals to obtain or maintain a healthy lifestyle. The women need tools that inform and help them understand and prioritise their own health-related risks, and to motivate them to plan and take care of their own health. As the women use Information Technology on a daily basis, the solution could be delivered through Information Technology. Finally, there is room for engaging the partner more in the communication related to the baby and family’s lifestyle. Conclusion: Postpartum women need tools that inform and motivate a healthy lifestyle postpartum. The tools should allow access to high-quality information from health care professionals, when the information is needed, and also allow engagement from the partner. Finally, Information Technology is a potential tool for delivering tools.

Keywords: information technology, lifestyle, overweight, postpartum

Procedia PDF Downloads 119

Authors: Atara Shriki, Ilana Lavy

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Teaching for the first time an online course dealing with the history of mathematics, we were struggling with questions related to the design of a proper learning environment (LE). Thirteen high school mathematics teachers, M.Ed. students, attended the course. The teachers were engaged in independent reading of mathematical texts, a task that is recognized as complex due to the unique characteristics of such texts. In order to support the learning processes and develop skills that are essential for succeeding in learning online (e.g. self-regulated learning skills, meta-cognitive skills, reflective ability, and self-assessment skills), the LE comprised of three components aimed at “scaffolding” the learning: (1) An online "self-feedback" questionnaires that included drill-and-practice questions. Subsequent to responding the questions the online system provided a grade and the teachers were entitled to correct their answers; (2) Open-ended questions aimed at stimulating critical thinking about the mathematical contents; (3) Reflective questionnaires designed to assist the teachers in steering their learning. Using a mixed-method methodology, an inquiry study examined the learning processes, the learners' difficulties in reading the mathematical texts and on the unique contribution of each component of the LE to the ability of teachers to comprehend the mathematical contents, and support the development of their learning skills. The results indicate that the teachers found the online feedback as most helpful in developing self-regulated learning skills and ability to reflect on deficiencies in knowledge. Lacking previous experience in expressing opinion on mathematical ideas, the teachers had troubles in responding open-ended questions; however, they perceived this assignment as nurturing cognitive and meta-cognitive skills. The teachers also attested that the reflective questionnaires were useful for steering the learning. Although in general the teachers found the LE as supportive, most of them indicated the need to strengthen instructor-learners and learners-learners interactions. They suggested to generate an online forum to enable them receive direct feedback from the instructor, share ideas with other learners, and consult with them about solutions. Apparently, within online LE, supporting learning merely with respect to cognitive aspects is not sufficient. Leaners also need an emotional support and sense a social presence.

Keywords: cognitive and meta-cognitive skills, independent reading of mathematical texts, online learning environment, self-regulated learning skills

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Authors: Ahmet Ozcan, Onder Alparslan, Anil Sezgin, Omer Cetin

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The use of unmanned systems for different purposes has become very popular over the past decade. Expectations from these systems have also shown an incredible increase in this parallel. But meeting the demands of the tasks are often not possible with the usage of a single unmanned vehicle in a mission, so it is necessary to use multiple autonomous vehicles with different abilities together in coordination. Therefore the usage of the same type of vehicles together as a swarm is helped especially to satisfy the time constraints of the missions effectively. In other words, it allows sharing the workload by the various numbers of homogenous platforms together. Besides, it is possible to say there are many kinds of problems that require the usage of the different capabilities of the heterogeneous platforms together cooperatively to achieve successful results. In this case, cooperative working brings additional problems beyond the homogeneous clusters. In the scenario presented as an example problem, it is expected that an autonomous ground vehicle, which is lack of its position information, manage to perform point-to-point navigation without losing its way in a previously unknown labyrinth. Furthermore, the ground vehicle is equipped with very limited sensors such as ultrasonic sensors that can detect obstacles. It is very hard to plan or complete the mission for the ground vehicle by self without lost its way in the unknown labyrinth. Thus, in order to assist the ground vehicle, the autonomous air drone is also used to solve the problem cooperatively. The autonomous drone also has limited sensors like downward looking camera and IMU, and it also lacks computing its global position. In this context, it is aimed to solve the problem effectively without taking additional support or input from the outside, just benefiting capabilities of two autonomous vehicles. To manage the point-to-point navigation in a previously unknown labyrinth, the platforms have to work together coordinated. In this paper, cooperative work of heterogeneous unmanned systems is handled in an applied sample scenario, and it is mentioned that how to work together with an autonomous ground vehicle and the autonomous flying platform together in a harmony to take advantage of different platform-specific capabilities. The difficulties of using heterogeneous multiple autonomous platforms in a mission are put forward, and the successful solutions are defined and implemented against the problems like spatially distributed tasks planning, simultaneous coordinated motion, effective communication, and sensor fusion.

Keywords: unmanned systems, heterogeneous autonomous vehicles, coordination, task planning

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Authors: Kyriacos Clerides, Panagiotis Herodotou, Constantina Polycarpou, Evagoras Xydas

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Background: Musculoskeletal disorders (MSDs) in the workplace is a very common problem in Europe which are caused by multiple risk factors. In recent years, wearable devices and exoskeletons for the workplace have been trying to address the various risk factors that are associated with strenuous tasks in the workplace. The logistics sector is a huge sector that includes warehousing, storage, and transportation. However, the task associated with logistics is not well-studied in terms of MSDs risk. This study was aimed at looking into the MSDs affecting workers of logistics companies. It compares the prevalence of MSDs among workers and evaluates multiple risk factors that contribute to the development of MSDs. Moreover, this study seeks to obtain user feedback on the adoption of exoskeletons in such a work environment. Materials and Methods: The study was conducted among workers in logistics companies in Nicosia, Cyprus, from July to September 2022. A set of standardized questionnaires was used for collecting different types of data. Results: A high proportion of logistics professionals reported MSDs in one or more other body regions, the lower back being the most commonly affected area. Working in the same position for long periods, working in awkward postures, and handling an excessive load, were found to be the most commonly reported job risk factor that contributed to the development of MSDs, in this study. A significant number of participants consider the back region as the most to be benefited from a wearable exoskeleton device. Half of the participants would like to have at least a 50% reduction in their daily effort. The most important characteristics for the adoption of exoskeleton devices were found to be how comfortable the device is and its weight. Conclusion: Lower back and posture were the highest risk factors among all logistics professionals assessed in this study. A larger scale study using quantitative analytical tools may give a more accurate estimate of MSDs, which would pave the way for making more precise recommendations to eliminate the risk factors and thereby prevent MSDs. A follow-up study using exoskeletons in the workplace should be done to assess whether they assist in MSD prevention.

Keywords: musculoskeletal disorders, occupational health, safety, occupational risk, logistic companies, workers, Cyprus, industrial exoskeletons, wearable devices

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Authors: María Cárdenas Gaudry, Gonzalo Ramces Fano Miranda

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Sediment removal is very important in the purification of water, not only for reasons of visual perception but also because of its association with odor and taste problems. The Cuchoquesera reservoir, which is in the Andean region of Ayacucho (Peru) at an altitude of 3,740 meters above sea level, visually presents suspended particles and organic impurities indicating that it contains water of dubious quality to deduce that it is suitable for direct consumption of human beings. In order to quantitatively know the degree of impurities, water quality monitoring was carried out from February to August 2018, in which four sampling stations were established in the reservoir. The selected measured parameters were electrical conductivity, total dissolved solids, pH, color, turbidity, and sludge volume. The indicators of the studied parameters exceed the permissible limits except for electrical conductivity (190 μS/cm) and total dissolved solids (255 mg/L). In this investigation, the best combination and the optimal doses of reagents were determined that allowed the removal of sediments from the waters of the Cuchoquesera reservoir, through the physicochemical process of coagulation-flocculation. In order to improve this process during the rainy season, six combinations of reagents were evaluated, made up of three coagulants (ferric chloride, ferrous sulfate, and aluminum sulfate) and two natural flocculants: prickly pear powder (Opuntia ficus-indica) and tara gum (Caesalpinia spinoza). For each combination of reagents, jar tests were developed following the central composite experimental design (CCED), where the design factors were the doses of coagulant and flocculant and the initial turbidity. The results of the jar tests were adjusted to mathematical models, obtaining that to treat the water from the Cuchoquesera reservoir, with a turbidity of 150 UTN and a color of 137 U Pt-Co, 27.9 mg/L of the coagulant aluminum sulfate with 3 mg/L of the natural tara gum flocculant to produce a purified water quality of 1.7 UTN of turbidity and 3.2 U Pt-Co of apparent color. The estimated cost of the dose of coagulant and flocculant found was 0.22 USD/m³. This is how “grey-green” technologies can be used as a combination in nature-based solutions in water treatment, in this case, to achieve potability, making it more sustainable, especially economically, if green technology is available at the site of application of the nature-based hybrid solution. This research is a demonstration of the compatibility of natural coagulants/flocculants with other treatment technologies in the integrated/hybrid treatment process, such as the possibility of hybridizing natural coagulants with other types of coagulants.

Keywords: prickly pear powder, tara gum, nature-based solutions, aluminum sulfate, jar test, turbidity, coagulation, flocculation

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Authors: Ghita Benayad

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Asset allocation, which affects the long-term profitability of portfolios by distributing assets to fulfill a range of investment objectives, is the cornerstone of investment management in the dynamic and complicated world of financial markets. This paper offers a technique for optimizing strategic asset allocation with the goal of improving portfolio performance by addressing the inherent complexity and uncertainty of the market through the use of Principal Component Analysis (PCA) in a multi-objective modeling framework. The study's first section starts with a critical evaluation of conventional asset allocation techniques, highlighting how poorly they are able to capture the intricate relationships between assets and the volatile nature of the market. In order to overcome these challenges, the project suggests a PCA-driven methodology that isolates important characteristics influencing asset returns by decreasing the dimensionality of the investment universe. This decrease provides a stronger basis for asset allocation decisions by facilitating a clearer understanding of market structures and behaviors. Using a multi-objective optimization model, the project builds on this foundation by taking into account a number of performance metrics at once, including risk minimization, return maximization, and the accomplishment of predetermined investment goals like regulatory compliance or sustainability standards. This model provides a more comprehensive understanding of investor preferences and portfolio performance in comparison to conventional single-objective optimization techniques. While applying the PCA-driven multi-objective optimization model to historical market data, aiming to construct portfolios better under different market situations. As compared to portfolios produced from conventional asset allocation methodologies, the results show that portfolios optimized using the proposed method display improved risk-adjusted returns, more resilience to market downturns, and better alignment with specified investment objectives. The study also looks at the implications of this PCA technique for portfolio management, including the prospect that it might give investors a more advanced framework for navigating financial markets. The findings suggest that by combining PCA with multi-objective optimization, investors may obtain a more strategic and informed asset allocation that is responsive to both market conditions and individual investment preferences. In conclusion, this capstone project improves the field of financial engineering by creating a sophisticated asset allocation optimization model that integrates PCA with multi-objective optimization. In addition to raising concerns about the condition of asset allocation today, the proposed method of portfolio management opens up new avenues for research and application in the area of investment techniques.

Keywords: asset allocation, portfolio optimization, principle component analysis, multi-objective modelling, financial market

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Authors: Zeinab Jafari A., Ali Sharifnezhad B., Mohammad Razi C., Mohammad Haghpanahi D., Arash Maghsoudi

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Background and Objective: Sports-related rupture of the anterior cruciate ligament (ACL) and following injuries have been associated with various disorders, such as long-lasting changes in muscle activation patterns in athletes, which might last after ACL reconstruction (ACLR). The rupture of the ACL might result in abnormal patterns of movement execution, extending the treatment period and delaying athletes’ return to sports (RTS). As ACL injury is especially prevalent among athletes, the lengthy treatment process and athletes’ absence from sports are of great concern to athletes and coaches. Thus, estimating safe time of RTS is of crucial importance. Therefore, using a deep neural network (DNN) to classify the health levels of ACL in injured athletes, this study aimed to estimate the safe time for athletes to return to competitions. Methods: Ten athletes with ACLR and fourteen healthy controls participated in this study. Three health levels of ACL were defined: healthy, six-month post-ACLR surgery and nine-month post-ACLR surgery. Athletes with ACLR were tested six and nine months after the ACLR surgery. During the course of this study, surface electromyography (sEMG) signals were recorded from five knee muscles, namely Rectus Femoris (RF), Vastus Lateralis (VL), Vastus Medialis (VM), Biceps Femoris (BF), Semitendinosus (ST), during single-leg drop landing (SLDL) and forward hopping (SLFH) tasks. The Pseudo-Wigner-Ville distribution (PWVD) was used to produce three-dimensional (3-D) images of the energy distribution patterns of sEMG signals. Then, these 3-D images were converted to two-dimensional (2-D) images implementing the heat mapping technique, which were then fed to a deep convolutional neural network (DCNN). Results: In this study, we estimated the safe time of RTS by designing a DCNN classifier with an accuracy of 90 %, which could classify ACL into three health levels. Discussion: The findings of this study demonstrate the potential of the DCNN classification technique using sEMG signals in estimating RTS time, which will assist in evaluating the recovery process of ACLR in athletes.

Keywords: anterior cruciate ligament reconstruction, return to sports, surface electromyography, deep convolutional neural network

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Authors: Oktia Woro Kasmini Handayani, Bambang Budi Raharjo, Efa Nugroho, Bertakalswa Hermawati

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Obesity prevalence and severe malnutrition in Indonesia has increased from 2007 to 2013. The utilization of local resources in nutritional program planning can be used to program efficiency and to reach the goal. The aim of this research is to plan a nutrition program based on local resources for urban fringe areas in a developing country. This research used a qualitative approach, with a focus on local resources including social capital, social system, cultural system. The study was conducted in Mijen, Central Java, as one of the urban fringe areas in Indonesia. Purposive and snowball sampling techniques are used to determine participants. A total of 16 participants took part in the study. Observation, interviews, focus group discussion, SWOT analysis, brainstorming and Miles and Huberman models were used to analyze the data. We have identified several local resources, such as the contributions from nutrition cadres, social organizations, social financial resources, as well as the cultural system and social system. The outstanding contribution of nutrition cadres is the participation and creativity to improve nutritional status. In addition, social organizations, like the role of the integrated health center for children (Pos Pelayanan Terpadu), can be engaged in the nutrition program planning. This center is supported by House of Nutrition to assist in nutrition program planning, and provide social support to families, neighbors and communities as social capitals. The study also reported that cultural systems that show appreciation for well-nourished children are a better way to improve the problem of balanced nutrition. Social systems such as teamwork and mutual cooperation can also be a potential resource to support nutritional programs and overcome associated problems. The impact of development in urban areas such as the introduction of more green areas which improve the perceived status of local people, as well as new health services facilitated by people and companies, can also be resources to support nutrition programs. Local resources in urban fringe areas can be used in the planning of nutrition programs. The expansion of partnership with all stakeholders, empowering the community through optimizing the roles of nutrition care centers for children as our recommendation with regard to nutrition program planning.

Keywords: developing country, local resources, nutrition program, urban fringe

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Authors: Rapuane Eric Jan Pule

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Sport participation plays a significant role in learners’ well-being and lifestyle. Learners spend most of their time in the school environment, where they are monitored, guided and advised by teachers. Teachers have a good relationship with the learners, therefore they can play a major role in promoting and influencing learners to participate in physical activities, both competitive and recreational purposes. Their influence and involvement could assist in increasing the number learners' involvement in physical activities, sport and recreation at Township schools. The national sport and recreation plan in South Africa, recommends that promotion of sport and physical activities at primary and secondary schools should play an important role in helping learners commit to a live-long participation in sport, recreational and physical activities. Schoolteachers could play an influential role in ensuring that learners spent their leisure time productively through physical and recreational activities. However, the role and the influence of teachers in promoting physical and recreational activities have been previously overlooked in the literature. Part of this study focuses on the in-depth challenges encountered by primary and secondary school teachers at Township schools in promoting and influencing learners’ involvement in sport, recreation and physical activities. 109 primary and secondary teachers at Township schools agreed to participate in the study through the provision of informed consent. The participants consisted of 49 primary school teachers and 60 secondary school teachers. Quantitative approach was followed using validated structured questionnaire comprising 12 close-ended items were used. Findings indicated that teachers' can play a significant role in influencing and encouraging learners to participate in sport, recreation or physical activities. Teachers view physical activity as an important developmental component for learners. Primary school teachers believe that they have a significant role to play in encouraging and promoting physical activities, sport and recreation, as compared to the secondary school teachers. Both group of teachers at primary and secondary schools, believe that infrastructure development, financial support, and extra incentives could motivate them to promote physical, recreational and sporting activities at schools. Teachers also acknowledge that schools are facing challenges in implementing and coordinating physical activities and recreational programmes as required by the Department of sport and recreation South Africa. It is recommended that the Department of Basic Education and Sport and Recreation South Africa revise their policies regarding the role of teachers in promoting and administering physical and recreational activities at schools.

Keywords: township, physical activities, sport and recreation participation, learners, teachers, primary and secondary schools, physical education

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Authors: Mustafa M. Donma, Orkide Donma

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Spexin, expressed in central nervous system, has attracted much interest in feeding behavior, obesity, diabetes, energy metabolism and cardiovascular functions. Fetuin A is known as negative acute phase reactant synthesized in the liver. So far, it has become a major concern of many studies in numerous clinical states. The relationship between the concentrations of spexin as well as fetuin A and the risk for cardiovascular diseases (CVDs) were also investigated. Eosinophils, suggested to be associated with the development of CVDs, are introduced as early indicators of cardiometabolic complications. Patients with elevated platelet count, associated with hypercoagulable state in the body, are also more liable to CVDs. In this study, the aim is to examine the profiles of spexin and fetuin A concomitant with the course of variations detected in eosinophil as well as platelet counts in morbid obese children. Thirty-four children with normal-body mass index (N-BMI) and fifty-one morbid obese (MO) children participated in the study. Written-informed consent forms were obtained prior to the study. Institutional ethics committee approved the study protocol. Age- and sex-adjusted BMI percentile tables prepared by World Health Organization were used to classify healthy and obese children. Mean age ± SEM of the children were 9.3 ± 0.6 years and 10.7 ± 0.5 years in N-BMI and MO groups, respectively. Anthropometric measurements of the children were taken. Body mass index values were calculated from weight and height values. Blood samples were obtained after an overnight fasting. Routine hematologic and biochemical tests were performed. Within this context, fasting blood glucose (FBG), insulin (INS), triglycerides (TRG), high density lipoprotein-cholesterol (HDL-C) concentrations were measured. Homeostatic model assessment for insulin resistance (HOMA-IR) values were calculated. Spexin and fetuin A levels were determined by enzyme-linked immunosorbent assay. Data were evaluated from the statistical point of view. Statistically significant differences were found between groups in terms of BMI, fat mass index, INS, HOMA-IR and HDL-C. In MO group, all parameters increased as HDL-C decreased. Elevated concentrations in MO group were detected in eosinophils (p<0.05) and platelets (p>0.05). Fetuin A levels decreased in MO group (p>0.05). However, decrease was statistically significant in spexin levels for this group (p<0.05). In conclusion, these results have suggested that increases in eosinophils and platelets exhibit behavior as cardiovascular risk factors. Decreased fetuin A behaved as a risk factor suitable to increased risk for cardiovascular problems associated with the severity of obesity. Along with increased eosinophils, increased platelets and decreased fetuin A, decreased spexin was the parameter, which reflects best its possible participation in the early development of CVD risk in MO children.

Keywords: cardiovascular diseases , eosinophils , fetuin A , pediatric morbid obesity , platelets , spexin

Procedia PDF Downloads 160

Authors: Neha Gupta, Sonika Verma, Seema Puri, Nikhil Tandon, Narendra K. Arora

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The concurrent increasing prevalence of underweight and overweight/obesity among children with changing lifestyle and the rapid transitioning society has necessitated the need for a unifying/multi-level approach to understand the determinants of the problem. The present community-based cross-sectional research study was conducted to assess the associations between lifestyle behavior and food environment of the child at household, neighborhood, and school with the BMI of children (6-12 year old) (n=612) residing in three rural clusters of Palwal district, Haryana. The study used innovative and robust methods for assessing the lifestyle and various components of food environment in the study. The three rural clusters selected for the study were located at three different locations according to their access to highways in the SOMAARTH surveillance site. These clusters were significantly different from each other in terms of their socio-demographic and socio-economic profile, living conditions, environmental hygiene, health seeking behavior and retail density. Despite of being different, the quality of living conditions and environmental hygiene was poor across three clusters. The children had higher intakes of dietary energy and sugars; one-fifth share of the energy being derived from unhealthy foods, engagement in high levels of physical activity and significantly different food environment at home, neighborhood and school level. However, despite having a high energy intake, 22.5% of the recruited children were thin/severe thin, and 3% were overweight/obese as per their BMI-for-age categories. The analysis was done using multi-variate logistic regression at three-tier hierarchy including individual, household and community level. The factors significantly explained the variability in governing the risk of getting thin/severe thin among children in rural area (p-value: 0.0001; Adjusted R2: 0.156) included age (>10years) (OR: 2.1; 95% CI: 1.0-4.4), the interaction between minority category and poor SES of the household (OR: 4.4; 95% CI: 1.6-12.1), availability of sweets (OR: 0.9; 95% CI: 0.8-0.99) and cereals (OR: 0.9; 95% CI: 0.8-1.0) in the household and poor street condition (proxy indicator of the hygiene and cleanliness in the neighborhood) (OR: 0.3; 95% CI: 0.1-1.1). The homogeneity of other factors at neighborhood and school level food environment diluted the heterogeneity in the lifestyles and home environment of the recruited children and their households. However, it is evident that when various individual factors interplay at multiple levels amplifies the risk of undernutrition in a rural community. Conclusion: These rural areas in Haryana are undergoing developmental, economic and societal transition. In correspondence, no improvements in the nutritional status of children have happened. Easy access to the unhealthy foods has become a paradox.

Keywords: transition, food environment, lifestyle, undernutrition, overnutrition

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Authors: Ahmeda Ali, Mary Codd, Susan Brundage

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Importance: This research focuses on devising and improving Health Service Executive (HSE) policy and legislation and therefore improving patient trauma care and outcomes in Ireland. Objectives: The study measures components of the Trauma System in the district hospital setting of the Cavan/Monaghan Hospital Group (CMHG), HSE, Ireland, and uses the collected data to identify the strengths and weaknesses of the CMHG Trauma System organisation, to include governance, injury data, prevention and quality improvement, scene care and facility-based care, and rehabilitation. The information will be made available to local policy makers to provide objective situational analysis to assist in future trauma service planning and service provision. Design, setting and participants: From 28 April to May 28, 2016 a cross-sectional survey using World Health Organisation (WHO) Trauma System Assessment Tool (TSAT) was conducted among healthcare professionals directly involved in the level III trauma system of CMHG. Main outcomes: Identification of the strengths and weaknesses of the Trauma System of CMHG. Results: The participants who reported inadequate funding for pre hospital (62.3%) and facility based trauma care at CMHG (52.5%) were high. Thirty four (55.7%) respondents reported that a national trauma registry (TARN) exists but electronic health records are still not used in trauma care. Twenty one respondents (34.4%) reported that there are system wide protocols for determining patient destination and adequate, comprehensive legislation governing the use of ambulances was enforced, however, there is a lack of a reliable advisory service. Over 40% of the respondents reported uncertainty of the injury prevention programmes available in Ireland; as well as the allocated government funding for injury and violence prevention. Conclusions: The results of this study contributed to a comprehensive assessment of the trauma system organisation. The major findings of the study identified three fundamental areas: the inadequate funding at CMHG, the QI techniques and corrective strategies used, and the unfamiliarity of existing prevention strategies. The findings direct the need for further research to guide future development of the trauma system at CMHG (and in Ireland as a whole) in order to maximise best practice and to improve functional and life outcomes.

Keywords: trauma, education, management, system

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Authors: Alana E. Jansen

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With such a large proportion of organisations relying on the use of team-based structures, it is surprising that so few teams would be classified as high-performance teams. While the impact of team composition on performance has been researched frequently, there have been conflicting findings as to the effects, particularly when examined alongside other team factors. To broaden the theoretical perspectives on this topic and potentially explain some of the inconsistencies in research findings left open by other various models of team effectiveness and high-performing teams, the present study aims to use the Job-Demands-Resources model, typically applied to burnout and engagement, as a framework to examine how team composition factors (particularly diversity in team member characteristics) can facilitate or hamper team effectiveness. This study used a virtual interview design where participants were asked to both rate and describe their experiences, in one high-performing and one low-performing team, over several factors relating to demands, resources, team composition, and team effectiveness. A semi-structured interview protocol was developed, which combined the use of the Likert style and exploratory questions. A semi-targeted sampling approach was used to invite participants ranging in age, gender, and ethnic appearance (common surface-level diversity characteristics) and those from different specialties, roles, educational and industry backgrounds (deep-level diversity characteristics). While the final stages of data analyses are still underway, thematic analysis using a grounded theory approach was conducted concurrently with data collection to identify the point of thematic saturation, resulting in 35 interviews being completed. Analyses examine differences in perceptions of demands and resources as they relate to perceived team diversity. Preliminary results suggest that high-performing and low-performing teams differ in perceptions of the type and range of both demands and resources. The current research is likely to offer contributions to both theory and practice. The preliminary findings suggest there is a range of demands and resources which vary between high and low-performing teams, factors which may play an important role in team effectiveness research going forward. Findings may assist in explaining some of the more complex interactions between factors experienced in the team environment, making further progress towards understanding the intricacies of why only some teams achieve high-performance status.

Keywords: diversity, high-performing teams, job demands and resources, team effectiveness

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Authors: Samuel N. Forjuoh, Marcia G. Ory, Jaewoong Won, Samuel D. Towne, Suojin Wang, Chanam Lee

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The public health burden of obesity is well established as is the influence of physical activity (PA) on the health and wellness of individuals who are obese. This study examined the influence of selected demographic, health, and socioenvironmental factors on the walking behaviors of middle-aged and older overweight and obese adults. Online and paper surveys were administered to community-dwelling overweight and obese adults aged ≥ 50 years residing in four cities in central Texas and seen by a family physician in the primary care clinic from October 2013 to June 2014. Descriptive statistics were used to characterize participants’ anthropometric and demographic data as well as their health conditions and walking, socioenvironmental, and more broadly defined PA behaviors. Then Pearson chi-square tests were used to assess differences between participants who reported walking the recommended ≥ 150 minutes for any purpose in a typical week as a proxy to meeting the U.S. Centers for Disease Control and Prevention’s PA guidelines and those who did not. Finally, logistic regression was used to predict walking the recommended ≥ 150 minutes for any purpose, controlling for covariates. The analysis was conducted in 2016. Of the total sample (n=253, survey response rate of 6.8%), the majority were non-Hispanic white (81.7%), married (74.5%), male (53.5%), and reported an annual household income of ≥ $50,000 (65.7%). Approximately, half were employed (49.6%), or had at least a college degree (51.8%). Slightly more than 1 in 5 (n=57, 22.5%) reported walking the recommended ≥150 minutes for any purpose in a typical week. The strongest predictors of walking the recommended ≥ 150 minutes for any purpose in a typical week in adjusted analysis were related to education and a high favorable perception of the neighborhood environment. Compared to those with a high school diploma or some college, participants with at least a college degree were five times as likely to walk the recommended ≥ 150 minutes for any purpose (OR=5.55, 95% CI=1.79-17.25). Walking the recommended ≥ 150 minutes for any purpose was significantly associated with participants who disagreed that there were many distracted drivers (e.g., on the cell phone while driving) in their neighborhood (OR=4.08, 95% CI=1.47-11.36) and those who agreed that there are sidewalks or protected walkways (e.g., walking trails) in their neighborhood (OR=3.55, 95% CI=1.10-11.49). Those employed were less likely to walk the recommended ≥ 150 minutes for any purpose compared to those unemployed (OR=0.31, 95% CI=0.11-0.85) as were those who reported some difficulty walking for a quarter of a mile (OR=0.19, 95% CI=0.05-0.77). Other socio-environmental factors such as having care-giver responsibilities for elders, someone to walk with, or a dog in the household as well as Walk Score™ were not significantly associated with walking the recommended ≥ 150 minutes for any purpose in a typical week. Neighborhood perception appears to be an important factor associated with the walking behaviors of middle-aged and older overweight and obese individuals. Enhancing the neighborhood environment (e.g., providing walking trails) may promote walking among these individuals.

Keywords: determinants of walking, obesity, older adults, physical activity

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Authors: Jutharat Attawet, Alex Y. Wang, Cindy M. Farquhar, Elizabeth A. Sullivan

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Background: Adverse maternal and perinatal outcomes of multiple pregnancies resulting from multiple embryo transfers (ET) has become significant concerns. This is particularly relevant for gestational carriers since they usually do not have infertility issues. Single embryo transfer (SET) therefore has been encouraged to assist reproductive technology (ART) practice in order to reduce multiple pregnancies. Objectives: This systematic review aims to investigate the pregnancy and birth outcomes of SET and multiple ET in surrogacy arrangements. Search methods: This study is a systematic review. Electronic databases were searched from CINAHL, Medline, Embase, Scopus and ProQuest for studies from 1980 to 2017. Cross-references and national ART reports were also manual searchings. Articles without restriction of English language and study types were accessed. Carrier cycles involving in SET and multiple ET were identified in database searching. The main outcome measures including clinical pregnancy, live delivery and multiple deliveries per gestational carrier cycle were compared between SET and multiple ET. Mantel-Haenzel risk ratios (RRs) with 95% confidence intervals (CIs), using the numbers of outcome events in SET and multiple ET of each study were calculated suing RevMan5.3. Outcomes: The search returned 97 articles of which 5 met the inclusion criteria. Approximately 50% of carrier cycles were transferred a single embryo and 50% were transferred more than one embryo. The clinical pregnancy rate (CPR) was 39% for SET and 53% for multiple ET, which was not significantly different with RR = 0.83 (95% CI: 0.67-1.03). The live delivery rate was 33% for SET and 57% for multiple ET which was not significantly different with RR = 0.78 (95% CI: 0.61-1.00). The multiple delivery rate per carrier was greater risks in the multiple ET carrier cycles (RR =0.4, 95% CI: 0.01-0.26). There were 104 sets of twins (including one set of twins selectively reduced from triplets to twins) and 1 set of triples in the multiple ET carrier cycle. In the SET carrier cycles, there were 2 sets of twins. Significance of the study: SET should be advocated among surrogate carriers to prevent multiple pregnancies and subsequent adverse outcomes for both carrier and baby. Surrogacy practice should be reviewed and surrogate carriers should be fully informed of the risk of adverse maternal and birth outcome of multiple pregnancies due to multiple embryo transfers.

Keywords: assisted reproduction, birth outcomes, carrier, gestational surrogacy, multiple embryo transfer, multiple pregnancy, pregnancy outcomes, single embryo transfer, surrogate mother, systematic review

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Authors: Diego F. Camacho, Cristian J. Mejia, Carlos Duque-Daza

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The recent widespread use of Unmanned Aerial Vehicles (UAVs) has fueled a renewed interest in efficiency and performance of airfoils, particularly for applications at low and moderate Reynolds numbers, typical of this kind of vehicles. Most of previous efforts in the aeronautical industry, regarding aerodynamic efficiency, had been focused on high Reynolds numbers applications, typical of commercial airliners and large size aircrafts. However, in order to increase the levels of efficiency and to boost the performance of these UAV, it is necessary to explore new alternatives in terms of airfoil design and application of drag reduction techniques. The objective of the present work is to carry out the analysis and comparison of performance levels between a standard NACA0012 profile against another one featuring a wall protuberance or surface perturbation. A computational model, based on the finite volume method, is employed to evaluate the effect of the presence of geometrical distortions on the wall. The performance evaluation is achieved in terms of variations of drag and lift coefficients for the given profile. In particular, the aerodynamic performance of the new design, i.e. the airfoil with a surface perturbation, is examined under conditions of incompressible and subsonic flow in transient state. The perturbation considered is a shaped protrusion prescribed as a small surface deformation on the top wall of the aerodynamic profile. The ultimate goal by including such a controlled smooth artificial roughness was to alter the turbulent boundary layer. It is shown in the present work that such a modification has a dramatic impact on the aerodynamic characteristics of the airfoil, and if properly adjusted, in a positive way. The computational model was implemented using the unstructured, FVM-based open source C++ platform OpenFOAM. A number of numerical experiments were carried out at Reynolds number 5x104, based on the length of the chord and the free-stream velocity, and angles of attack 6° and 12°. A Large Eddy Simulation (LES) approach was used, together with the dynamic Smagorinsky approach as subgrid scale (SGS) model, in order to account for the effect of the small turbulent scales. The impact of the surface perturbation on the performance of the airfoil is judged in terms of changes in the drag and lift coefficients, as well as in terms of alterations of the main characteristics of the turbulent boundary layer on the upper wall. A dramatic change in the whole performance can be appreciated, including an arguably large level of lift-to-drag coefficient ratio increase for all angles and a size reduction of laminar separation bubble (LSB) for a twelve-angle-of-attack.

Keywords: CFD, LES, Lift-to-drag ratio, LSB, NACA 0012 airfoil

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Authors: Aleksandra Dudkowska, Gabriela Gic-Grusza

Abstract:

Wind wave-induced sediment transport is an important multidimensional and multiscale dynamic process affecting coastal seabed changes and coastline evolution. The knowledge about sediment transport rate is important to solve many environmental and geotechnical issues. There are many types of sediment transport models but none of them is widely accepted. It is bacause the process is not fully defined. Another problem is a lack of sufficient measurment data to verify proposed hypothesis. There are different types of models for longshore sediment transport (LST, which is discussed in this work) and cross-shore transport which is related to different time and space scales of the processes. There are models describing bed-load transport (discussed in this work), suspended and total sediment transport. LST models use among the others the information about (i) the flow velocity near the bottom, which in case of wave-currents interaction in coastal zone is a separate problem (ii) critical bed shear stress that strongly depends on the type of sediment and complicates in the case of heterogeneous sediment. Moreover, LST rate is strongly dependant on the local environmental conditions. To organize existing knowledge a series of sediment transport models intercomparisons was carried out as a part of the project “Development of a predictive model of morphodynamic changes in the coastal zone”. Four classical one-grid-point models were studied and intercompared over wide range of bottom shear stress conditions, corresponding with wind-waves conditions appropriate for coastal zone in polish marine areas. The set of models comprises classical theories that assume simplified influence of turbulence on the sediment transport (Du Boys, Meyer-Peter & Muller, Ribberink, Engelund & Hansen). It turned out that the values of estimated longshore instantaneous mass sediment transport are in general in agreement with earlier studies and measurements conducted in the area of interest. However, none of the formulas really stands out from the rest as being particularly suitable for the test location over the whole analyzed flow velocity range. Therefore, based on the models discussed a new unified formula for longshore sediment transport rate estimation is introduced, which constitutes the main original result of this study. Sediment transport rate is calculated based on the bed shear stress and critical bed shear stress. The dependence of environmental conditions is expressed by one coefficient (in a form of constant or function) thus the model presented can be quite easily adjusted to the local conditions. The discussion of the importance of each model parameter for specific velocity ranges is carried out. Moreover, it is shown that the value of near-bottom flow velocity is the main determinant of longshore bed-load in storm conditions. Thus, the accuracy of the results depends less on the sediment transport model itself and more on the appropriate modeling of the near-bottom velocities.

Keywords: bedload transport, longshore sediment transport, sediment transport models, coastal zone

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