Search results for: multi objective linear programming problem
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 19225

Search results for: multi objective linear programming problem

4795 Research on the Renewal and Utilization of Space under the Bridge in Chongqing Based on Spatial Potential Evaluation

Authors: Xvelian Qin

Abstract:

Urban "organic renewal" based on the development of existing resources in high-density urban areas has become the mainstream of urban development in the new era. As an important stock resource of public space in high-density urban areas, promoting its value remodeling is an effective way to alleviate the shortage of public space resources. However, due to the lack of evaluation links in the process of underpass space renewal, a large number of underpass space resources have been left idle, facing the problems of low space conversion efficiency, lack of accuracy in development decision-making, and low adaptability of functional positioning to citizens' needs. Therefore, it is of great practical significance to construct the evaluation system of under-bridge space renewal potential and explore the renewal mode. In this paper, some of the under-bridge spaces in the main urban area of Chongqing are selected as the research object. Through the questionnaire interviews with the users of the built excellent space under the bridge, three types of six levels and twenty-two potential evaluation indexes of "objective demand factor, construction feasibility factor and construction suitability factor" are selected, including six levels of land resources, infrastructure, accessibility, safety, space quality and ecological environment. The analytical hierarchy process and expert scoring method are used to determine the index weight, construct the potential evaluation system of the space under the bridge in high-density urban areas of Chongqing, and explore the direction of renewal and utilization of its suitability. To provide feasible theoretical basis and scientific decision support for the use of under bridge space in the future.

Keywords: high density urban area, potential evaluation, space under bridge, updated using

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4794 Arc Interruption Design for DC High Current/Low SC Fuses via Simulation

Authors: Ali Kadivar, Kaveh Niayesh

Abstract:

This report summarizes a simulation-based approach to estimate the current interruption behavior of a fuse element utilized in a DC network protecting battery banks under different stresses. Due to internal resistance of the battries, the short circuit current in very close to the nominal current, and it makes the fuse designation tricky. The base configuration considered in this report consists of five fuse units in parallel. The simulations are performed using a multi-physics software package, COMSOL® 5.6, and the necessary material parameters have been calculated using two other software packages.The first phase of the simulation starts with the heating of the fuse elements resulted from the current flow through the fusing element. In this phase, the heat transfer between the metallic strip and the adjacent materials results in melting and evaporation of the filler and housing before the aluminum strip is evaporated and the current flow in the evaporated strip is cut-off, or an arc is eventually initiated. The initiated arc starts to expand, so the entire metallic strip is ablated, and a long arc of around 20 mm is created within the first 3 milliseconds after arc initiation (v_elongation = 6.6 m/s. The final stage of the simulation is related to the arc simulation and its interaction with the external circuitry. Because of the strong ablation of the filler material and venting of the arc caused by the melting and evaporation of the filler and housing before an arc initiates, the arc is assumed to burn in almost pure ablated material. To be able to precisely model this arc, one more step related to the derivation of the transport coefficients of the plasma in ablated urethane was necessary. The results indicate that an arc current interruption, in this case, will not be achieved within the first tens of milliseconds. In a further study, considering two series elements, the arc was interrupted within few milliseconds. A very important aspect in this context is the potential impact of many broken strips parallel to the one where the arc occurs. The generated arcing voltage is also applied to the other broken strips connected in parallel with arcing path. As the gap between the other strips is very small, a large voltage of a few hundred volts generated during the current interruption may eventually lead to a breakdown of another gap. As two arcs in parallel are not stable, one of the arcs will extinguish, and the total current will be carried by one single arc again. This process may be repeated several times if the generated voltage is very large. The ultimate result would be that the current interruption may be delayed.

Keywords: DC network, high current / low SC fuses, FEM simulation, paralle fuses

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4793 A Settlement Strategy for Health Facilities in Emerging Countries: A Case Study in Brazil

Authors: Domenico Chizzoniti, Monica Moscatelli, Letizia Cattani, Piero Favino, Luca Preis

Abstract:

A settlement strategy is to anticipate and respond the needs of existing and future communities through the provision of primary health care facilities in marginalized areas. Access to a health care network is important to improving healthcare coverage, often lacking, in developing countries. The study explores that a good sanitary system strategy of rural contexts brings advantages to an existing settlement: improving transport, communication, water and social facilities. The objective of this paper is to define a possible methodology to implement primary health care facilities in disadvantaged areas of emerging countries. In this research, we analyze the case study of Lauro de Freitas, a municipality in the Brazilian state of Bahia, part of the Metropolitan Region of Salvador, with an area of 57,662 km² and 194.641 inhabitants. The health localization system in Lauro de Freitas is an integrated process that involves not only geographical aspects, but also a set of factors: population density, epidemiological data, allocation of services, road networks, and more. Data were collected also using semi-structured interviews and questionnaires to the local population. Synthesized data suggest that moving away from the coast where there is the greatest concentration of population and services, a network of primary health care facilities is able to improve the living conditions of small-dispersed communities. Based on the health service needs of populations, we have developed a methodological approach that is particularly useful in rural and remote contexts in emerging countries.

Keywords: healthcare, settlement strategy, urban health, rural

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4792 Arsenic Removal from Drinking Water by Hybrid Hydrogel-Biochar Matrix: An Understanding of Process Parameters

Authors: Vibha Sinha, Sumedha Chakma

Abstract:

Arsenic (As) contamination in drinking water is a serious concern worldwide resulting in severe health maladies. To tackle this problem, several hydrogel based matrix which selectively uptake toxic metals from contaminated water has increasingly been examined as a potential practical method for metal removal. The major concern in hydrogels is low stability of matrix, resulting in poor performance. In this study, the potential of hybrid hydrogel-biochar matrix synthesized from natural plant polymers, specific for As removal was explored. Various compositional and functional group changes of the elements contained in the matrix due to the adsorption of As were identified. Moreover, to resolve the stability issue in hydrogel matrix, optimum and effective mixing of hydrogel with biochar was studied. Mixing varied proportions of matrix components at the time of digestion process was tested. Preliminary results suggest that partial premixing methods may increase the stability and reduce cost. Addition of nanoparticles and specific catalysts with different concentrations of As(III) and As(V) under batch conditions was performed to study their role in performance enhancement of the hydrogel matrix. Further, effect of process parameters, optimal uptake conditions and detailed mechanism derived from experimental studies were suitably conducted. This study provides an efficient, specific and a low-cost As removal method that offers excellent regeneration abilities which can be reused for value.

Keywords: arsenic, catalysts, hybrid hydrogel-biochar, water purification

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4791 The Role of Public Management Development in Enhancing Public Service Delivery in the South African Local Government

Authors: Andrew Enaifoghe

Abstract:

The study examined the role of public management development in enhancing public service delivery in the South African local government. The study believes that the ultimate empowerment of the third tier sphere of governments in South Africa remains the instrument required to enhance both national and continental development. This over the year has been overwhelmed with problems and imbalance related to ethical practice, accountability and the functional local government system and the machinery itself. The study finds that imbalances are being strengthened by a lack of understanding and unanimity as to what a public management development in a democratic system is and how it should work to achieve the dividends of democracy in delivering public goods. Studies indicated that the magnitudes are widespread corruption and misrepresentations of government priorities; both of which weaken the ability of governments to enhance broad-based economic growth and social well-being of the people. This study addressed the problem of public management and accountable local government. The study indicates the need for citizens’ participation in the decision-making process in delivering public service in South Africa and how its accountability mechanism supports good governance. The study concludes that good and ethical watersheds in South Africa have since reached such proportions that social pressure, the pressure from the government and various institutions have to re-consider where they stand regarding ethics, ethical behaviour, accountability and professionalism in delivering public goods to the people at the local municipal government.

Keywords: accountability, development, democratic system, South Africa

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4790 Dental Ethics versus Malpractice, as Phenomenon with a Growing Trend

Authors: Saimir Heta, Kers Kapaj, Rialda Xhizdari, Ilma Robo

Abstract:

Dealing with emerging cases of dental malpractice with justifications that stem from the clear rules of dental ethics is a phenomenon with an increasing trend in today's dental practice. Dentists should clearly understand how far the limit of malpractice goes, with or without minimal or major consequences, for the affected patient, which can be justified as a complication of dental treatment, in support of the rules of dental ethics in the dental office. Indeed, malpractice can occur in cases of lack of professionalism, but it can also come as a consequence of anatomical and physiological limitations in the implementation of the dental protocols, predetermined and indicated by the patient in the paragraph of the treatment plan in his personal card. This study is of the review type with the aim of the latest findings published in the literature about the problem of dealing with these phenomena. The combination of keywords is done in such a way with the aim to give the necessary space for collecting the right information in the networks of publications about this field, always first from the point of view of the dentist and not from that of the lawyer or jurist. From the findings included in this article, it was noticed the diversity of approaches towards the phenomenon depends on the different countries based on the legal basis that these countries have. There is a lack of or a small number of articles that touch on this topic, and these articles are presented with a limited number of data on the same topic. Conclusions: Dental malpractice should not be hidden under the guise of various dental complications that we justify with the strict rules of ethics for patients treated in the dental chair. The individual experience of dental malpractice must be published with the aim of serving as a source of experience for future generations of dentists.

Keywords: dental ethics, malpractice, professional protocol, random deviation

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4789 Towards the Enhancement of Thermoelectric Properties by Controlling the Thermoelectrical Nature of Grain Boundaries in Polycrystalline Materials

Authors: Angel Fabian Mijangos, Jaime Alvarez Quintana

Abstract:

Waste heat occurs in many areas of daily life because world’s energy consumption is inefficient. In general, generating 1 watt of power requires about 3 watt of energy input and involves dumping into the environment the equivalent of about 2 watts of power in the form of heat. Therefore, an attractive and sustainable solution to the energy problem would be the development of highly efficient thermoelectric devices which could help to recover this waste heat. This work presents the influence on the thermoelectric properties of metallic, semiconducting, and dielectric nanoparticles added into the grain boundaries of polycrystalline antimony (Sb) and bismuth (Bi) matrixes in order to obtain p- and n-type thermoelectric materials, respectively, by hot pressing methods. Results show that thermoelectric properties are significantly affected by the electrical and thermal nature as well as concentration of nanoparticles. Nevertheless, by optimizing the amount of the nanoparticles on the grain boundaries, an oscillatory behavior in ZT as function of the concentration of the nanoscale constituents is present. This effect is due to energy filtering mechanism which module the quantity of charge transport in the system and affects thermoelectric properties. Accordingly, a ZTmax can be accomplished through the addition of the appropriate amount of nanoparticles into the grain boundaries region. In this case, till three orders of amelioration on ZT is reached in both systems compared with the reference sample of each one. This approach paves the way to pursuit high performance thermoelectric materials in a simple way and opens a new route towards the enhancement of the thermoelectric figure of merit.

Keywords: energy filtering, grain boundaries, thermoelectric, nanostructured materials

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4788 Hemodynamic Effects of Magnesium Sulphate Therapy in Critically Ill Infants and Children with Wheezy Chest

Authors: Yasmin Sayed, Hala Hamdy, Hafez Bazaraa, Hanaa Rady, Sherif Elanwary

Abstract:

Intravenous and inhaled magnesium sulfate (MgSO₄) had been recently used as an adjuvant therapy in cases suffering from the wheezy chest. Objective: We aimed to determine the possible change in the hemodynamic state in cases received intravenous or inhaled MgSO₄ in comparison to cases received standard treatment in critically ill infants and children with the wheezy chest. Methods: A randomized controlled trial comprised 81 patients suffering from wheezy chest divided into 3 groups. In addition to bronchodilators and systemic steroids, MgSO₄ was given by inhalation in group A, intravenously in group B, and group C didn't receive MgSO₄. The hemodynamic state was determined by assessment of blood pressure, heart rate, capillary refill time and the need for shock therapy or inotropic support just before and 24 hours after receiving treatment in 3 groups. Results: There was no significant difference in the hemodynamic state of the studied groups before and after treatment. Means of blood pressure were 102.2/63.2, 105.1/64.8 before and after inhaled MgSO₄; respectively. Means of blood pressure were 105.5/64.2, 104.1/64.9 before and after intravenous MgSO₄; respectively. Means of blood pressure were 107.4/62.8, 104.4/62.1 before and after standard treatment, respectively. There was a statistically insignificant reduction of the means of the heart rate in group A and group B after treatment rather than group C. There was no associated prolongation in capillary refill time and/or the need for inotropic support or shock therapy after treatment in the studied groups. Conclusion: MgSO₄ is a safe adjuvant therapy and not associated with significant alteration in the hemodynamic state in critically ill infants and children with the wheezy chest.

Keywords: critically ill infants and children, inhaled MgSO₄, intravenous MgSO₄, wheezy chest

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4787 Organizational Commitment and Job Satisfaction of Job Order Personnel in the Overseas Workers Welfare Administration Regional Welfare Office Caraga

Authors: Anne Jane M. Hallasgo

Abstract:

This study assessed the level of job satisfaction and organizational commitment among job order personnel at the Overseas Workers Welfare Administration (OWWA) Regional Welfare Office Caraga. The primary objective of the study was to determine a correlation between the employees’ level of organizational commitment, job satisfaction, and their work performance. A carefully selected sample of twenty-five job orders from the OWWA Regional Welfare Office Caraga participated in the study. These individuals were chosen to represent the organization’s job order workforce. For accuracy and dependability, various types of statistical methods and instruments were employed, including advanced statistical tests like the independent sample T-test, one-way analysis of variance (ANOVA), and Spearman's rank correlation coefficient, as well as descriptive statistics like mean, frequency, and percentage. The study found an acceptable level of job satisfaction regarding work performance. It revealed a significant relationship between affective commitment and job satisfaction concerning leadership and coworkers. A correlation was observed between normative commitment and work performance. The findings suggest that organizations emphasizing positive leadership, fostering supportive coworker relationships, aligning with employee values, and promoting a culture of commitment are likely to enhance both affective and normative commitment, thereby improving overall employee satisfaction. The study recommends designing and implementing a holistic employee well-being program that addresses physical, mental, and emotional health contributing to increased job satisfaction and organizational commitment, creating a healthier and engaged workforce. This research contributes to the understanding of the dynamics of organizational commitment and job satisfaction among job order employees in the public sector.

Keywords: affective commitment, continuous commitment, normative commitment, job satisfaction

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4786 Passive Solar-Driven Membrane Distiller for Desalination: Effect of Middle Layer Material and Thickness on Desalination Performance

Authors: Glebert C. Dadol, Camila Flor Y. Lobarbio, Noel Peter B. Tan

Abstract:

Water scarcity is a global problem. One of the promising solutions to this challenge is the use of membrane-based desalination technologies. In this study, a passive solar-driven membrane (PSDM) distillation was employed to test its desalination performance. The PSDM was fabricated using a TiNOX sheet solar absorber, cellulose-based hydrophilic top and bottom layers, and a middle layer. The effects of the middle layer material and thickness on the desalination performance in terms of distillate flow rate, productivity, and salinity were investigated. An air-gap screen mesh (2 mm, 4 mm, 6 mm thickness) and a hydrophobic PTFE membrane (0.3 mm thickness) were used as middle-layer materials. Saltwater input (35 g/L NaCl) was used for the PSDM distiller on a rooftop setting at the University of San Carlos, Cebu City, Philippines. The highest distillate flow rate and productivity of 1.08 L/m²-h and 1.47 L/kWh, respectively, were achieved using a 2 mm air-gap middle layer, but it also resulted in a high salinity of 25.20 g/L. Increasing the air gap lowered the salinity but also decreased the flow rate and productivity. The lowest salinity of 1.07 g/L was achieved using 6 mm air gap, but the flow rate and productivity were reduced to 0.08 L/m²-h and 0.17 L/kWh, respectively. The use of a hydrophobic PTFE membrane, on the other hand, did not offer a significant improvement in its performance. A PDSM distiller with a thick air gap as the middle layer can deliver a distillate with low salinity and is preferred over a thin hydrophobic PTFE membrane. Various modifications and optimizations to the distiller can be done to improve its performance further.

Keywords: desalination, membrane distillation, passive solar-driven membrane distiller, solar distillation

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4785 Resilience and Urban Transformation: A Review of Recent Interventions in Europe and Turkey

Authors: Bilge Ozel

Abstract:

Cities are high-complex living organisms and are subjects to continuous transformations produced by the stress that derives from changing conditions. Today the metropolises are seen like “development engines” of the countries and accordingly they become the centre of better living conditions that encourages demographic growth which constitutes the main reason of the changes. Indeed, the potential for economic advancement of the cities directly represents the economic status of their countries. The term of “resilience”, which sees the changes as natural processes and represents the flexibility and adaptability of the systems in the face of changing conditions, becomes a key concept for the development of urban transformation policies. The term of “resilience” derives from the Latin word ‘resilire’, which means ‘bounce’, ‘jump back’, refers to the ability of a system to withstand shocks and still maintain the basic characteristics. A resilient system does not only survive the potential risks and threats but also takes advantage of the positive outcomes of the perturbations and ensures adaptation to the new external conditions. When this understanding is taken into the urban context - or rather “urban resilience” - it delineates the capacity of cities to anticipate upcoming shocks and changes without undergoing major alterations in its functional, physical, socio-economic systems. Undoubtedly, the issue of coordinating the urban systems in a “resilient” form is a multidisciplinary and complex process as the cities are multi-layered and dynamic structures. The concept of “urban transformation” is first launched in Europe just after World War II. It has been applied through different methods such as renovation, revitalization, improvement and gentrification. These methods have been in continuous advancement by acquiring new meanings and trends over years. With the effects of neoliberal policies in the 1980s, the concept of urban transformation has been associated with economic objectives. Subsequently this understanding has been improved over time and had new orientations such as providing more social justice and environmental sustainability. The aim of this research is to identify the most applied urban transformation methods in Turkey and its main reasons of being selected. Moreover, investigating the lacking and limiting points of the urban transformation policies in the context of “urban resilience” in a comparative way with European interventions. The emblematic examples, which symbolize the breaking points of the recent evolution of urban transformation concepts in Europe and Turkey, are chosen and reviewed in a critical way.

Keywords: resilience, urban dynamics, urban resilience, urban transformation

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4784 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

Abstract:

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

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4783 Activity-Based Safety Assessment of Real Estate Projects in Western India

Authors: Patel Parul, Harsh Ganvit

Abstract:

The construction industry is the second highest industry after agriculture provides employment in India. In developing countries like India, many construction projects are coming up to meet the demand. On the one hand, construction projects are increasing; on the other hand still, construction companies are struggling with many problems. One of the major problems is to ensure safe working conditions at the construction site. Due to a lack of safety awareness and ignorance of safety aspects, many fatal accidents are very common at the construction site in India. One of the key success factors for construction projects is “Accident-Free Construction Projects”. The construction projects can be divided into various categories like Infrastructure projects, industrial construction and real estate construction. Real estate projects are mainly comprised of commercial and residential projects. In the construction industry, private sectors play a huge role in urban and rural development and also contribute significantly to the growth of the nation. Infrastructure and Industrial projects are mainly executed by well-qualified construction contractors. For such projects, ensuring safety at construction projects is inevitable and probably one of the major clauses of contract documents as well. These projects are monitored from time to time by national agencies and researchers, too. However, Real estate projects are rarely monitored for safety aspects. No systematic contract system is followed for these projects. Safety is the most neglected aspect of these projects. In the current research projects, an attempt is made to carry out safety auditing for about 75 real estate projects. The objective of this work is to collect the activity-based safety survey of real estate projects in western India. The analysis of activity-based safety implementation for real estate projects is discussed in the present work. The activities are divided into three categories based on the data collected. The findings of this work will help local monitoring authorities to implement a safety management plan for real estate projects.

Keywords: construction safety, safety assessment, activity-based safety, real estate projects

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4782 Characterization of Natural Polymers for Guided Bone Regeneration Applications

Authors: Benedetta Isella, Aleksander Drinic, Alissa Heim, Phillip Czichowski, Lisa Lauts, Hans Leemhuis

Abstract:

Introduction: Membranes for guided bone regeneration are essential to perform a barrier function between the soft and the regenerating bone tissue. Bioabsorbable membranes are desirable in this field as they do not require a secondary surgery for removal, decreasing patient surgical risk. Collagen was the first bioabsorbable alternative introduced on the market, but its degradation time may be too fast to guarantee bone regeneration, and optimisation is needed. Silk fibroin, being biocompatible, slowly bioabsorbable, and processable into different scaffold types, could be a promising alternative. Objectives: The objective is to compare the general performance of a silk fibroin membrane for guided bone regeneration to current collagen alternatives developing suitable standardized tests for the mechanical and morphological characterization. Methods: Silk fibroin and collagen-based membranes were compared from the morphological and chemical perspective, with techniques such as SEM imaging and from the mechanical point of view with techniques such as tensile and suture retention strength (SRS) tests. Results: Silk fibroin revealed a high degree of reproducibility in surface density. The SRS of silk fibroin (0.76 ± 0.04 N), although lower than collagen, was still comparable to native tissues such as the internal mammary artery (0.56 N), and the same can be extended to general mechanical behaviour in tensile tests. The SRS could be increased by an increase in thickness. Conclusion: Silk fibroin is a promising material in the field of guided bone regeneration, covering the interesting position of not being considered a product containing cells or tissues of animal origin from the regulatory perspective and having longer degradation times with respect to collagen.

Keywords: guided bone regeneration, mechanical characterization, membrane, silk fibroin

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4781 Non-Destructive Static Damage Detection of Structures Using Genetic Algorithm

Authors: Amir Abbas Fatemi, Zahra Tabrizian, Kabir Sadeghi

Abstract:

To find the location and severity of damage that occurs in a structure, characteristics changes in dynamic and static can be used. The non-destructive techniques are more common, economic, and reliable to detect the global or local damages in structures. This paper presents a non-destructive method in structural damage detection and assessment using GA and static data. Thus, a set of static forces is applied to some of degrees of freedom and the static responses (displacements) are measured at another set of DOFs. An analytical model of the truss structure is developed based on the available specification and the properties derived from static data. The damages in structure produce changes to its stiffness so this method used to determine damage based on change in the structural stiffness parameter. Changes in the static response which structural damage caused choose to produce some simultaneous equations. Genetic Algorithms are powerful tools for solving large optimization problems. Optimization is considered to minimize objective function involve difference between the static load vector of damaged and healthy structure. Several scenarios defined for damage detection (single scenario and multiple scenarios). The static damage identification methods have many advantages, but some difficulties still exist. So it is important to achieve the best damage identification and if the best result is obtained it means that the method is Reliable. This strategy is applied to a plane truss. This method is used for a plane truss. Numerical results demonstrate the ability of this method in detecting damage in given structures. Also figures show damage detections in multiple damage scenarios have really efficient answer. Even existence of noise in the measurements doesn’t reduce the accuracy of damage detections method in these structures.

Keywords: damage detection, finite element method, static data, non-destructive, genetic algorithm

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4780 Trends in Preoperative Self-Disclosure of Cannabis Use in Adult and Adolescent Orthopedic Surgical Patients: An Institutional Retrospective Study

Authors: Spencer Liu, William Chan, Marlena Komatz, Tommy Ramos, Mark Trentalange, Faye Rim, Dae Kim, Mary Kelly, Samuel Schuessler, Roberta Stack, Justas Lauzadis, Kathryn DelPizzo, Seth Waldman, Alexandra Sideris

Abstract:

Background & Significance: The increasing prevalence of cannabis use in the United States has important safety considerations in the perioperative setting, as chronic or heavy preoperative cannabis use may increase the risk of intraoperative complications, postoperative nausea and vomiting (PONV), increased postoperative pain levels, and acute side effects associated with cannabis use cessation. In this retrospective chart review study, we sought to determine the prevalence of self-reported cannabis use in the past 5-years at a single institution in New York City. We hypothesized that there is an increasing prevalence of preoperative self-reported cannabis use among adult and adolescent patients undergoing orthopedic surgery. Methods: After IRB approval for this retrospective study, surgical cases performed on patients 12 years of age and older at the hospital’s main campus and two ambulatory surgery centers between January 1st, 2018, and December 31st, 2023, with preoperatively self-disclosed cannabis use entered in the social history intake form were identified using the tool SlicerDicer in Epic. Case and patient characteristics were extracted, and trends in utilization over time were assessed by the Cochran-Armitage trend test. Results: Overall, the prevalence of self-reported cannabis use increased from 6.6% in 2018 to 10.6% in 2023. By age group, the prevalence of self-reported cannabis use among adolescents remained consistently low (2018: 2.6%, 2023: 2.6%) but increased with significant evidence for a linear trend (p < 0.05) within every adult age group. Among adults, patients who were 18-24 years old (2018: 18%, 2023: 20.5%) and 25-34 years old (2018: 15.9%, 2023: 24.2%) had the highest prevalences of disclosure, whereas patients who were 75 years of age or older had the lowest prevalence of disclosure (2018: 1.9%, 2023: 4.6%). Patients who were 25-34 years old had the highest percent difference in disclosure rates of 8.3%, which corresponded to a 52.2% increase from 2018 to 2023. The adult age group with the highest percent change was patients who were 75 years of age or older, with a difference of 2.7%, which corresponded to a 142.1% increase from 2018 to 2023. Conclusions: These trends in preoperative self-reported cannabis use among patients undergoing orthopedic surgery have important implications for perioperative care and clinical outcomes. Efforts are underway to refine and standardize cannabis use data capture at our institution.

Keywords: orthopedic surgery, cannabis, postoperative pain, postoperative nausea

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4779 Effects of Dust Storm Events on Tuberculosis Incidence Rate in Northwest of China

Authors: Yun Wang, Ruoyu Wang, Tuo Chen, Guangxiu Liu, Guodong Chen, Wei Zhang

Abstract:

Tuberculosis (TB) is a major public health problem in China. China has the world's second largest tuberculosis epidemic (after India). Xinjiang almost has the highest annual attendance rate of TB in China, and the province is also famous because of its severe dust storms. The epidemic timing starts in February and ends in July, and the dust storm mainly distribute throughout the spring and early summer, which strongly indicate a close linkage between causative agent of TB and dust storm events. However, mechanisms responsible for the observed patterns are still not clearly indentified. By comparing the information on cases of TB from Centers for Disease Control of China annual reports with dust storm atmosphere datasets, we constructed the relationship between the large scale annual occurrence of TB in Xinjiang, a Northwest province of China, and dust storm occurrence. Regional atmospheric indexes of dust storm based on surface wind speed show a clear link between population dynamics of the disease and the climate disaster: the onset of epidemics and the dust storm defined by the atmospheric index share the same mean year. This study is the first that provides a clear demonstration of connections that exist between TB epidemics and dust storm events in China. The development of this study will undoubtedly help early warning for tuberculosis epidemic onset in China and help nationwide and international public health institutions and policy makers to better control TB disease in Norwest China.

Keywords: dust storm, tuberculosis, Xinjiang province, epidemic

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4778 Flood Mapping Using Height above the Nearest Drainage Model: A Case Study in Fredericton, NB, Canada

Authors: Morteza Esfandiari, Shabnam Jabari, Heather MacGrath, David Coleman

Abstract:

Flood is a severe issue in different places in the world as well as the city of Fredericton, New Brunswick, Canada. The downtown area of Fredericton is close to the Saint John River, which is susceptible to flood around May every year. Recently, the frequency of flooding seems to be increased, especially after the fact that the downtown area and surrounding urban/agricultural lands got flooded in two consecutive years in 2018 and 2019. In order to have an explicit vision of flood span and damage to affected areas, it is necessary to use either flood inundation modelling or satellite data. Due to contingent availability and weather dependency of optical satellites, and limited existing data for the high cost of hydrodynamic models, it is not always feasible to rely on these sources of data to generate quality flood maps after or during the catastrophe. Height Above the Nearest Drainage (HAND), a state-of-the-art topo-hydrological index, normalizes the height of a basin based on the relative elevation along with the stream network and specifies the gravitational or the relative drainage potential of an area. HAND is a relative height difference between the stream network and each cell on a Digital Terrain Model (DTM). The stream layer is provided through a multi-step, time-consuming process which does not always result in an optimal representation of the river centerline depending on the topographic complexity of that region. HAND is used in numerous case studies with quite acceptable and sometimes unexpected results because of natural and human-made features on the surface of the earth. Some of these features might cause a disturbance in the generated model, and consequently, the model might not be able to predict the flow simulation accurately. We propose to include a previously existing stream layer generated by the province of New Brunswick and benefit from culvert maps to improve the water flow simulation and accordingly the accuracy of HAND model. By considering these parameters in our processing, we were able to increase the accuracy of the model from nearly 74% to almost 92%. The improved model can be used for generating highly accurate flood maps, which is necessary for future urban planning and flood damage estimation without any need for satellite imagery or hydrodynamic computations.

Keywords: HAND, DTM, rapid floodplain, simplified conceptual models

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4777 Public Policy for Quality School Lunch Development in Thailand

Authors: W. Kongnoo, J. Loysongkroa, S. Chotivichien, N. Viriyautsahakul, N. Saiwongse

Abstract:

Obesity, stunting and wasting problems among Thai school-aged children are increasing due to inappropriate food consumption behavior and poor environments for desirable nutritional behavior. Because of a low school lunch budget of only 0.40 USD per person per day, food quality is not up to nutritional standards. Therefore, the Health Department with the Education Ministry and the Thai Health Promotion Foundation have developed a quality school lunch project during 2009–2013. The program objectives were development and management of public policy to increase school lunch budget. The methods used a healthy public policy motivation process and movement in 241 local administrative organizations and 538 schools. The problem and solution research was organized to study school food and nutrition management, create a best practice policy mobilization model and hold a public hearing to motivate an increase of school meal funding. The results showed that local public policy has been motivated during 2009-2011 to increase school meal budget using local budgets. School children with best food consumption behavior and exercise increased from 13.2% in 2009 to 51.6% in 2013 and stunting decreased from 6.0% in 2009 to 4.7% in 2013. As the result of national policy motivation (2012-2013), the cabinet meeting on October 22, 2013 has approved an increase of school lunch budget from 0.40 USD to 0.62 USD per person per day. Thus, 5,800,469 school children nationwide have benefited from the budget increase.

Keywords: public policy, quality school lunch, Thailand, obesity

Procedia PDF Downloads 343
4776 A Legal Opinion on Mitigation and Adaptation on Air Pollution Strategies for Local Governments in South Africa

Authors: Marjone Van Der Bank, C. M. Van Der Bank

Abstract:

This paper presents an overview of the foundation and evolution of environmental related problems in local governments with specific reference on air pollution in South Africa. Local government has a direct mandate in terms of the Constitution of the Republic of South Africa, 1996 (hereafter, the Constitution). This mandate to protect, fulfil, respect and promote the Bill of Rights by local governments in respect of the powers and functions creates confusion around the role of where a local government fits in, in addressing the problem of climate change in South Africa. A reflection of the evolving legislations, developments, and processes regarding climate change that shaped local government dispensation in South Africa is addressed by the notion of developmental local governments. This paper seeks to examine the advances for mitigation and adaptation regulation of air pollution and application in South Africa. This study involves a qualitative approach that will involve South African national legislation as well as an interpretation of international strategies. A literature review study was conducted to undertake the various aspects of law in order to support the argument undertaken of mitigation and adaptation strategies. The paper presents a detailed discussion of the current legislation and the position as it currently stands, as well as the relevant protections as outlined in the National Environmental Management Act and the National Environmental Management: Air Quality Act. It then proceeds to outline the responsibilities of local governments in South Africa to mitigate and adapt to air pollution strategies.

Keywords: adaptation, climate change, disaster, local governments and mitigation

Procedia PDF Downloads 139
4775 Effects of Potential Chloride-Free Admixtures on Selected Mechanical Properties of Kenya Clay-Based Cement Mortars

Authors: Joseph Mwiti Marangu, Joseph Karanja Thiong'o, Jackson Muthengia Wachira

Abstract:

The mechanical performance of hydrated cements mortars mainly depends on its compressive strength and setting time. These properties are crucial in the construction industry. Pozzolana based cements are mostly characterized by low 28 day compressive strength and long setting times. These are some of the major impediments to their production and diverse uses despite numerous technological and environmental benefits associated with them. The study investigated the effects of potential chemical activators on calcined clay- Portland cement blends with an aim to achieve high early compressive strength and shorter setting times in cement mortar. In addition, standard consistency, soundness and insoluble residue of all cement categories was determined. The test cement was made by blending calcined clays with Ordinary Portland Cement (OPC) at replacement levels from 35 to 50 percent by mass of the OPC to make test cement labeled PCC for the purposes of this study. Mortar prisms measuring 40mmx40mmx160mm were prepared and cured in accordance with KS EAS 148-3:2000 standard. Solutions of Na2SO4, NaOH, Na2SiO3 and Na2CO3 containing 0.5- 2.5M were separately added during casting. Compressive strength was determined at 2rd, 7th, 28th and 90th day of curing. For comparison purposes, commercial Portland Pozzolana cement (PPC) and Ordinary Portland Cement (OPC) were also investigated without activators under similar conditions. X-Ray Florescence (XRF) was used for chemical analysis while X-Ray Diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR) were used for mineralogical analysis of the test samples. The results indicated that addition of activators significantly increased the 2nd and 7th day compressive strength but minimal increase on the 28th and 90th day compressive strength. A relatively linear relationship was observed between compressive strength and concentration of activator solutions up to 28th of curing. Addition of the said activators significantly reduced both initial and final setting time. Standard consistency and soundness varied with increased amount of clay in the test cement and concentration of activators. Amount of insoluble residues increased with increased replacement of OPC with calcined clays. Mineralogical studies showed that N-A-S-H is formed in addition to C-S-H. In conclusion, the concentration of 2 molar for all activator solutions produced the optimum compressive strength and greatly reduced the setting times for all cement mortars.

Keywords: activators, admixture, cement, clay, pozzolana

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4774 An AHP Study on The Migrant and Refugee Employees Occupational Health and Safety Issues in Turkey

Authors: Cengiz Akyildiz, Ismail Ekmekci

Abstract:

In the past 15 years, many people have sought refuge and emigrated to developed countries due to the civil war in Syria, terrorism and turmoil in Iraq, Iran and Afghanistan, hunger problems in Africa and the purpose of work. Many of these people came to Turkey. By the end of the 2019, in Turkey, regular and irregular migrants, asylum seekers and foreigners under international protection are about 6 million people. The majority of these people are Syrians. Approximately 2 800 000 immigrants and refugees are in the workforce. Migrant workers in our country constitute the largest proportion among all countries in the world according to the local labor force. 2.5 million of these employees, with a high rate of about 90%, work informally and do not have legal records and valid employment contracts as a workforce; They cannot benefit from Occupational Health and Safety (OHS) services. Migrant workers generally receive less wages than local workers, working longer hours and worse conditions; they are often subjected to human rights violations, harassment, human trafficking and violence. Migrant workers face problems such as OHS practices, environmental and occupational exposures, language / cultural barriers, access to health services, and lack of documentation. Therefore, the OHS problems of these employees are becoming an increasingly problematic area. However, there is not enough research, analysis and academic studies in this field. The order of importance should be known for the radical solution of the problems, because of the problems with high severity are also at high risk. In this study, for the first time, a Search Conference was held with the participation of 45 stakeholders to reveal the OHS problems of regular and irregular migrant workers in our country. The problems arising from this workshop were compared with the problems in the literature and the problems in this field were determined and weighted for our country. Later, to determine the significance levels of these problems, AHP study, which is a Multi Criteria Decision Making Method in which 15 experts participated, was conducted and the significance levels of these problems were determined. When the data obtained are evaluated, it has been seen that the OSH risks of migrant workers arise from 58% laws and government policies, 29% from employers, 13% from personal faults of employees. An academic study has been carried out for the first time in this field regarding the OHS problems of migrant workers, and an academic study has been created to guide which of the problems should be prioritized.

Keywords: environmental conditions, migrant workers, OHS issues, workplace conditions

Procedia PDF Downloads 144
4773 Visual Inspection of Road Conditions Using Deep Convolutional Neural Networks

Authors: Christos Theoharatos, Dimitris Tsourounis, Spiros Oikonomou, Andreas Makedonas

Abstract:

This paper focuses on the problem of visually inspecting and recognizing the road conditions in front of moving vehicles, targeting automotive scenarios. The goal of road inspection is to identify whether the road is slippery or not, as well as to detect possible anomalies on the road surface like potholes or body bumps/humps. Our work is based on an artificial intelligence methodology for real-time monitoring of road conditions in autonomous driving scenarios, using state-of-the-art deep convolutional neural network (CNN) techniques. Initially, the road and ego lane are segmented within the field of view of the camera that is integrated into the front part of the vehicle. A novel classification CNN is utilized to identify among plain and slippery road textures (e.g., wet, snow, etc.). Simultaneously, a robust detection CNN identifies severe surface anomalies within the ego lane, such as potholes and speed bumps/humps, within a distance of 5 to 25 meters. The overall methodology is illustrated under the scope of an integrated application (or system), which can be integrated into complete Advanced Driver-Assistance Systems (ADAS) systems that provide a full range of functionalities. The outcome of the proposed techniques present state-of-the-art detection and classification results and real-time performance running on AI accelerator devices like Intel’s Myriad 2/X Vision Processing Unit (VPU).

Keywords: deep learning, convolutional neural networks, road condition classification, embedded systems

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4772 A Review of Effective Gene Selection Methods for Cancer Classification Using Microarray Gene Expression Profile

Authors: Hala Alshamlan, Ghada Badr, Yousef Alohali

Abstract:

Cancer is one of the dreadful diseases, which causes considerable death rate in humans. DNA microarray-based gene expression profiling has been emerged as an efficient technique for cancer classification, as well as for diagnosis, prognosis, and treatment purposes. In recent years, a DNA microarray technique has gained more attraction in both scientific and in industrial fields. It is important to determine the informative genes that cause cancer to improve early cancer diagnosis and to give effective chemotherapy treatment. In order to gain deep insight into the cancer classification problem, it is necessary to take a closer look at the proposed gene selection methods. We believe that they should be an integral preprocessing step for cancer classification. Furthermore, finding an accurate gene selection method is a very significant issue in a cancer classification area because it reduces the dimensionality of microarray dataset and selects informative genes. In this paper, we classify and review the state-of-art gene selection methods. We proceed by evaluating the performance of each gene selection approach based on their classification accuracy and number of informative genes. In our evaluation, we will use four benchmark microarray datasets for the cancer diagnosis (leukemia, colon, lung, and prostate). In addition, we compare the performance of gene selection method to investigate the effective gene selection method that has the ability to identify a small set of marker genes, and ensure high cancer classification accuracy. To the best of our knowledge, this is the first attempt to compare gene selection approaches for cancer classification using microarray gene expression profile.

Keywords: gene selection, feature selection, cancer classification, microarray, gene expression profile

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4771 Biosorption of Lead (II) from Lead Acid Battery Industry Wastewater by Immobilized Dead Isolated Bacterial Biomass

Authors: Harikrishna Yadav Nanganuru, Narasimhulu Korrapati

Abstract:

Over the past many years, many sites in the world have been contaminated with heavy metals, which are the largest class of contaminants. Lead is one of the toxic heavy metals contaminated in the environment. Lead is not biodegradable, that’s why it is accumulated in the human body and impacts all the systems of the human body when it has been taken by humans. The accumulation of lead in the water environment has been showing adverse effects on the public health. So the removal of lead from the water environment by the biosorption process, which is emerged as a potential method for the lead removal, is an efficient approach. This work was focused to examine the removal of Lead [Pb (II)] ions from aqueous solution and effluent from battery industry. Lead contamination in water is a widespread problem throughout the world and mainly results from lead acid battery manufacturing effluent. In this work, isolated bacteria from wastewater of lead acid battery industry has been utilized for the removal of lead. First effluent from the lead acid battery industry was characterized by the inductively coupled plasma atomic emission spectrometry (ICP – AES). Then the bacteria was isolated from the effluent and used it’s immobilized dead mass for the biosorption of lead. Scanning electron microscopic (SEM) and Atomic force microscopy (AFM) studies clearly suggested that the Lead (Pb) was adsorbed efficiently. The adsorbed percentage of lead (II) from waste was 97.40 the concentration of lead (II) is measured by Atomic Absorption Spectroscopy (AAS). From the result of AAS it can be concluded that immobilized isolated dead mass was well efficient and useful for biosorption of lead contaminated waste water.

Keywords: biosorption, ICP-AES, lead (Pb), SEM

Procedia PDF Downloads 374
4770 Wind Energy Harvester Based on Triboelectricity: Large-Scale Energy Nanogenerator

Authors: Aravind Ravichandran, Marc Ramuz, Sylvain Blayac

Abstract:

With the rapid development of wearable electronics and sensor networks, batteries cannot meet the sustainable energy requirement due to their limited lifetime, size and degradation. Ambient energies such as wind have been considered as an attractive energy source due to its copious, ubiquity, and feasibility in nature. With miniaturization leading to high-power and robustness, triboelectric nanogenerator (TENG) have been conceived as a promising technology by harvesting mechanical energy for powering small electronics. TENG integration in large-scale applications is still unexplored considering its attractive properties. In this work, a state of the art design TENG based on wind venturi system is demonstrated for use in any complex environment. When wind introduces into the air gap of the homemade TENG venturi system, a thin flexible polymer repeatedly contacts with and separates from electrodes. This device structure makes the TENG suitable for large scale harvesting without massive volume. Multiple stacking not only amplifies the output power but also enables multi-directional wind utilization. The system converts ambient mechanical energy to electricity with 400V peak voltage by charging of a 1000mF super capacitor super rapidly. Its future implementation in an array of applications aids in environment friendly clean energy production in large scale medium and the proposed design performs with an exhaustive material testing. The relation between the interfacial micro-and nano structures and the electrical performance enhancement is comparatively studied. Nanostructures are more beneficial for the effective contact area, but they are not suitable for the anti-adhesion property due to the smaller restoring force. Considering these issues, the nano-patterning is proposed for further enhancement of the effective contact area. By considering these merits of simple fabrication, outstanding performance, robust characteristic and low-cost technology, we believe that TENG can open up great opportunities not only for powering small electronics, but can contribute to large-scale energy harvesting through engineering design being complementary to solar energy in remote areas.

Keywords: triboelectric nanogenerator, wind energy, vortex design, large scale energy

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4769 An Empirical Study on the Effect of Physical Exercise and Outdoor Lighting on Pupils’ Eyesight

Authors: Zhang Jun Xiong

Abstract:

Objective: To explore the effect of physical exercise and outdoor lighting on the improvement of pupils' eyesight. Methods: A total of 208 first grade students in a primary school in Chengdu were enrolled in the study, 104 of whom were nearsighted and 104 had normal vision. They were randomly divided into indoor exercise group, outdoor exercise group, indoor control group and outdoor control group. Indoor and outdoor exercise groups performed moderate and high-intensity aerobic exercise three times a week, 60 minutes each time; The indoor and outdoor control groups had normal study and life during the experiment, without exercise intervention. The experiment lasted for one academic year, and the visual indicators of the subjects were tested before and after the experiment. Results: After the experiment, the visual fatigue index of the subjects with normal vision in the outdoor exercise group, indoor exercise group and outdoor control group decreased by 1.5 ± 2.89, 1.4 ± 3.05, 2.12 ± 2.66 respectively, and the diopter index decreased by 0.30D ± 0.09, 0.41D ± 0.16, 0.40D ± 0.19 respectively, while the visual fatigue score of the subjects with normal vision in the indoor control group increased by 2.3 ± 2.15, and the diopter decreased by 0.53D ± 0.22, There were significant differences in visual fatigue and diopter among the subjects with normal vision in each group (P<0.001). After the experiment, the visual fatigue index of the myopic subjects in the outdoor exercise group, indoor exercise group and outdoor control group decreased by 1.8 ± 1.95, 0.8 ± 1.81, 1.1 ± 1.85 respectively, and the diopter index decreased by 0.35D ± 0.21, 0.52D ± 0.24, 0.52D ± 0.15 respectively, while the visual fatigue score of the myopic subjects in the indoor control group increased by 1.3 ± 2.66, and the diopter decreased by 0.62D ± 0.29. There were significant differences between groups in visual fatigue and diopter (P<0.001). Conclusion: Both physical exercise and outdoor lighting can have a beneficial effect on children's vision, and the superposition effect of the two is better. It is suggested that outdoor physical exercise should be carried out more in primary school.

Keywords: physical exercise, outdoor lighting, pupil, vision, myopia

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4768 Investigating Non-suicidal Self-Injury Discussions on Twitter

Authors: Muhammad Abubakar Alhassan, Diane Pennington

Abstract:

Social networking sites have become a space for people to discuss public health issues such as non-suicidal self-injury (NSSI). There are thousands of tweets containing self-harm and self-injury hashtags on Twitter. It is difficult to distinguish between different users who participate in self-injury discussions on Twitter and how their opinions change over time. Also, it is challenging to understand the topics surrounding NSSI discussions on Twitter. We retrieved tweets using #selfham and #selfinjury hashtags and investigated those from the United kingdom. We applied inductive coding and grouped tweeters into different categories. This study used the Latent Dirichlet Allocation (LDA) algorithm to infer the optimum number of topics that describes our corpus. Our findings revealed that many of those participating in NSSI discussions are non-professional users as opposed to medical experts and academics. Support organisations, medical teams, and academics were campaigning positively on rais-ing self-injury awareness and recovery. Using LDAvis visualisation technique, we selected the top 20 most relevant terms from each topic and interpreted the topics as; children and youth well-being, self-harm misjudgement, mental health awareness, school and mental health support and, suicide and mental-health issues. More than 50% of these topics were discussed in England compared to Scotland, Wales, Ireland and Northern Ireland. Our findings highlight the advantages of using the Twitter social network in tackling the problem of self-injury through awareness. There is a need to study the potential risks associated with the use of social networks among self-injurers.

Keywords: self-harm, non-suicidal self-injury, Twitter, social networks

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4767 Development of Highly Repellent Silica Nanoparticles Treatment for Protection of Bio-Based Insulation Composite Material

Authors: Nadia Sid, Alan Taylor, Marion Bourebrab

Abstract:

The construction sector is on the critical path to decarbonise the European economy by 2050. In order to achieve this objective it must enable reducing its CO2 emission by 90% and its energy consumption by as much as 50%. For this reason, a new class of low environmental impact construction materials named “eco-material” are becoming increasingly important in the struggle against climate change. A European funded collaborative project ISOBIO coordinated by TWI is aimed at taking a radical approach to the use of bio-based aggregates to create novel construction materials that are usable in high volume in using traditional methods, as well as developing markets such as exterior insulation of existing house stocks. The approach taken for this project is to use finely chopped material protected from bio-degradation through the use of functionalized silica nanoparticles. TWI is exploring the development of novel inorganic-organic hybrid nano-materials, to be applied as a surface treatment onto bio-based aggregates. These nanoparticles are synthesized by sol-gel processing and then functionalised with silanes to impart multifunctionality e.g. hydrophobicity, fire resistance and chemical bonding between the silica nanoparticles and the bio-based aggregates. This talk will illustrate the approach taken by TWI to design the functionalized silica nanoparticles by using a material-by-design approach. The formulation and synthesize process will be presented together with the challenges addressed by those hybrid nano-materials. The results obtained with regards to the water repellence and fire resistance will be displayed together with preliminary public results of the ISOBIO project. (This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 641927).

Keywords: bio-sourced material, composite material, durable insulation panel, water repellent material

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4766 Identifying Physical and Psycho-Social Issues Facing Breast Cancer Survivors after Definitive Treatment for Early Breast Cancer: A Nurse-Led Clinic Model

Authors: A. Dean, M. Pitcher, L. Storer, K. Shanahan, I. Rio, B. Mann

Abstract:

Purpose: Breast cancer survivors are at risk of specific physical and psycho-social issues, such as arm swelling, fatigue, and depression. Firstly, we investigate symptoms reported by Australia breast cancer survivors upon completion of definitive treatment. Secondly, we evaluate the appropriateness and effectiveness of a multi-centre pilot program nurse-led clinic to identify these issues and make timely referrals to available services. Methods: Patients post-definitive treatment (excluding ongoing hormonal therapy) for early breast cancer or ductal carcinoma in situ were invited to participate. An hour long appointment with a breast care nurse (BCN) was scheduled. In preparation, patients completed validated quality-of-life surveys (FACT-B, Menopause Rating Scale, Distress Thermometer). During the appointment, issues identified in the surveys were addressed and referrals to appropriate services arranged. Results: 183 of 274 (67%) eligible patients attended a nurse-led clinic. Mean age 56.8 years (range 29-87 years), 181/183 women, 105/183 post-menopausal. 96 (55%) participants reported significant level of distress; 31 (18%) participants reported extreme distress or depression. Distress stemmed from a lack of energy (56/175); poor quality of sleep (50/176); inability to work or participate in household activities (35/172) and problems with sex life (28/89). 166 referrals were offered; 94% of patients accepted the referrals. 65% responded to a follow-up survey: the majority of women either strongly agreed or agreed that the BCN was overwhelmingly supportive, helpful in making referrals, and compassionate towards them. 39% reported making lifestyle changes as a result of the BCN. Conclusion: Breast cancer survivors experience a unique set of challenges, including low mood, difficulty sleeping, problems with sex life and fear of disease recurrence. The nurse-led clinic model is an appropriate and effective method to ensure physical and psycho-social issues are identified and managed in a timely manner. This model empowers breast cancer survivors with information about their diagnosis and available services.

Keywords: early breast cancer, survivorship, breast care nursing, oncology nursing and cancer care

Procedia PDF Downloads 392