Search results for: variable acoustics
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2252

Search results for: variable acoustics

662 Investigating the Relative Priority of the Factors Affecting Customer Satisfaction in Gaining the Competitive Advantage in Pars-Khazar Company

Authors: Samaneh Pouyanfar, Michael Oliff

Abstract:

The industry of home appliances may beone of theindustries which has the highest competition, and actually what can guarantee the survival of this industry is discovering the superior services. A trend to provide quality products and services plays an important role in this industry because discovering the services is counted as a vital affair for Manufacturing Organizations’ survival and profitability. Given the importance of the topic, this paper attempts to investigate the relative priority of the factors influencing the customer satisfaction in gaining the competitive advantage in Pars-Khazar Company. In sum, 96 executives of Pars-Khazar Company where investigated in a census. For this purpose, after reviewing the research literature and performing deep interviews between pundits and experts active in the industry, the research questionnaire was made based on variables affecting customer satisfaction and components determining business competitive advantage. Determining the content validity took place by judgement of the experts. The reliability of each structure was measured based on Cronbach’s alpha coefficient. Since the value of Cronbach's alpha was higher than 0.7 for each structure, internal consistency of statements was high and the reliability of the questionnaire was acceptable. The data analysis was also done with Kulmgrf-asmyrnf test and Friedman test using SPSS software. The results showed that in dimension of factors affecting customer satisfaction, the History of trade name (brand), Familiarity with the product brand, Brand reputation and Safety have the highest value of priority respectively, and the variable of firm growth has the highest value of priority among the components determining the performance of competitive advantage.

Keywords: customer satisfaction, competitive advantage, brand history, safety, growth

Procedia PDF Downloads 230
661 Fabrication of Superhydrophobic Galvanized Steel by Sintering Zinc Nanopowder

Authors: Francisco Javier Montes Ruiz-Cabello, Guillermo Guerrero-Vacas, Sara Bermudez-Romero, Miguel Cabrerizo Vilchez, Miguel Angel Rodriguez-Valverde

Abstract:

Galvanized steel is one of the widespread metallic materials used in industry. It consists on a iron-based alloy (steel) coated with a layer of zinc with variable thickness. The zinc is aimed to prevent the inner steel from corrosion and staining. Its production is cheaper than the stainless steel and this is the reason why it is employed in the construction of materials with large dimensions in aeronautics, urban/ industrial edification or ski-resorts. In all these applications, turning the natural hydrophilicity of the metal surface into superhydrophobicity is particularly interesting and would open a wide variety of additional functionalities. However, producing a superhydrophobic surface on galvanized steel may be a very difficult task. Superhydrophobic surfaces are characterized by a specific surface texture which is reached either by coating the surface with a material that incorporates such texture, or by conducting several roughening methods. Since galvanized steel is already a coated material, the incorporation of a second coating may be undesired. On the other hand, the methods that are recurrently used to incorporate the surface texture leading to superhydrophobicity in metals are aggressive and may damage their surface. In this work, we used a novel strategy which goal is to produce superhydrophobic galvanized steel by a two-step non-aggressive process. The first process is aimed to create a hierarchical structure by incorporating zinc nanoparticles sintered on the surface at a temperature slightly lower than the zinc’s melting point. The second one is a hydrophobization by a thick fluoropolymer layer deposition. The wettability of the samples is characterized in terms of tilting plate and bouncing drop experiments, while the roughness is analyzed by confocal microscopy. The durability of the produced surfaces was also explored.

Keywords: galvanaized steel, superhydrophobic surfaces, sintering nanoparticles, zinc nanopowder

Procedia PDF Downloads 150
660 Analytical Slope Stability Analysis Based on the Statistical Characterization of Soil Shear Strength

Authors: Bernardo C. P. Albuquerque, Darym J. F. Campos

Abstract:

Increasing our ability to solve complex engineering problems is directly related to the processing capacity of computers. By means of such equipments, one is able to fast and accurately run numerical algorithms. Besides the increasing interest in numerical simulations, probabilistic approaches are also of great importance. This way, statistical tools have shown their relevance to the modelling of practical engineering problems. In general, statistical approaches to such problems consider that the random variables involved follow a normal distribution. This assumption tends to provide incorrect results when skew data is present since normal distributions are symmetric about their means. Thus, in order to visualize and quantify this aspect, 9 statistical distributions (symmetric and skew) have been considered to model a hypothetical slope stability problem. The data modeled is the friction angle of a superficial soil in Brasilia, Brazil. Despite the apparent universality, the normal distribution did not qualify as the best fit. In the present effort, data obtained in consolidated-drained triaxial tests and saturated direct shear tests have been modeled and used to analytically derive the probability density function (PDF) of the safety factor of a hypothetical slope based on Mohr-Coulomb rupture criterion. Therefore, based on this analysis, it is possible to explicitly derive the failure probability considering the friction angle as a random variable. Furthermore, it is possible to compare the stability analysis when the friction angle is modelled as a Dagum distribution (distribution that presented the best fit to the histogram) and as a Normal distribution. This comparison leads to relevant differences when analyzed in light of the risk management.

Keywords: statistical slope stability analysis, skew distributions, probability of failure, functions of random variables

Procedia PDF Downloads 338
659 Myomectomy and Blood Loss: A Quality Improvement Project

Authors: Ena Arora, Rong Fan, Aleksandr Fuks, Kolawole Felix Akinnawonu

Abstract:

Introduction: Leiomyomas are benign tumors that are derived from the overgrowth of uterine smooth muscle cells. Women with symptomatic leiomyomas who desire future fertility, myomectomy should be the standard surgical treatment. Perioperative hemorrhage is a common complication in myomectomy. We performed the study to investigate blood transfusion rate in abdominal myomectomies, risk factors influencing blood loss and modalities to improve perioperative blood loss. Methods: Retrospective chart review was done for patients who underwent myomectomy from 2016 to 2022 at Queens hospital center, New York. We looked at preoperative patient demographics, clinical characteristics, intraoperative variables, and postoperative outcomes. Mann-Whitney U test were used for parametric and non-parametric continuous variable comparisons, respectively. Results: A total of 159 myomectomies were performed between 2016 and 2022, including 1 laparoscopic, 65 vaginal and 93 abdominal. 44 patients received blood transfusion during or within 72 hours of abdominal myomectomy. The blood transfusion rate was 47.3%. Blood transfusion rate was found to be twice higher than the average documented rate in literature which is 20%. Risk factors identified were black race, preoperative hematocrit<30%, preoperative blood transfusion within 72 hours, large fibroid burden, prolonged surgical time, and abdominal approach. Conclusion: Preoperative optimization with iron supplements or GnRH agonists is important for patients undergoing myomectomy. Interventions to decrease intra operative blood loss should include cell saver, tourniquet, vasopressin, misoprostol, tranexamic acid and gelatin-thrombin matrix hemostatic sealant.

Keywords: myomectomy, perioperative blood loss, cell saver, tranexamic acid

Procedia PDF Downloads 85
658 The Status of Precision Agricultural Technology Adoption on Row Crop Farms vs. Specialty Crop Farms

Authors: Shirin Ghatrehsamani

Abstract:

Higher efficiency and lower environmental impact are the consequence of using advanced technology in farming. They also help to decrease yield variability by diminishing weather variability impact, optimizing nutrient and pest management as well as reducing competition from weeds. A better understanding of the pros and cons of applying technology and finding the main reason for preventing the utilization of the technology has a significant impact on developing technology adoption among farmers and producers in the digital agriculture era. The results from two surveys carried out in 2019 and 2021 were used to investigate whether the crop types had an impact on the willingness to utilize technology on the farms. The main focus of the questionnaire was on utilizing precision agriculture (PA) technologies among farmers in some parts of the united states. Collected data was analyzed to determine the practical application of various technologies. The survey results showed more similarities in the main reason not to use PA between the two crop types, but the present application of using technology in specialty crops is generally five times larger than in row crops. GPS receiver applications were reported similar for both types of crops. Lack of knowledge and high cost of data handling were cited as the main problems. The most significant difference was among using variable rate technology, which was 43% for specialty crops while was reported 0% for row crops. Pest scouting and mapping were commonly used for specialty crops, while they were rarely applied for row crops. Survey respondents found yield mapping, soil sampling map, and irrigation scheduling were more valuable for specialty crops than row crops in management decisions. About 50% of the respondents would like to share the PA data in both types of crops. Almost 50 % of respondents got their PA information from retailers in both categories, and as the second source, using extension agents were more common in specialty crops than row crops.

Keywords: precision agriculture, smart farming, digital agriculture, technology adoption

Procedia PDF Downloads 114
657 Effects of IMUNO-2865® as Immune Supplement for the Aquaculture Industry

Authors: Ivan Zupan, Tomislav Saric, Suzana Tkalcic

Abstract:

IMUNO-2865® is a commercially available, β–glucan based, natural hemicellulose compound with proven immunostimulative properties in people, domestic and some aquatic animals. During the experimental feeding trial with IMUNO-2865® in juvenile wild-caught chub under laboratory conditions, supplementation resulted in overall higher growth performance for all experimental groups regardless of the concentration of the added compound. The maximum, 5% concentration of the supplement, resulted in highest weight gain and calculated specific growth rate. In sea bream, as economically most important species in the Mediterranean aquaculture, significant increases in numbers of monocytes and heterophils were observed in the group supplemented with 2.5 % of IMUNO-2865® in the feed. An overall increase of erythrocytes was noted by the end of the experiment, although with variable distribution among groups. Blood Ca++ levels, total proteins, and total NH₃ were significantly higher after 60 days of feeding in all treatment groups compared to the control and remained elevated in the treated group following the secession of supplementation. Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and serum paraoxonase PON1 (U/L) showed similar trends. All these parameters are playing a significant role in either oxygen supplementation of tissues, or anabolic and catabolic processes that on molecular levels contribute to the overall health and immune-building capacity of cells and tissues. The complete lack of mortality in sea bream and presented increases in cellular, biochemical and oxidative stress parameters in the blood suggest that the IMUNO-2865® represents a safe dietary supplement for in aquaculture, with an overall positive and potentially immunostimulative effect on farmed fish.

Keywords: IMUNO-2865®, β–glucans, Mediterranean aquaculture, fish imunnostimulans

Procedia PDF Downloads 142
656 Pretherapy Initial Dosimetry Results in Prostat Cancer Radionuclide Therapy with Lu-177-PSMA-DOTA-617

Authors: M. Abuqebitah, H. Tanyildizi, N. Yeyin, I. Cavdar, M. Demir, L. Kabasakal

Abstract:

Aim: Targeted radionuclide therapy (TRT) is an increasingly used treatment modality for wide range of cancers. Presently dosimetry is highly required either to plan treatment or to ascertain the absorbed dose delivered to critical organs during treatment. Methods and Materials: The study comprised 7 patients suffered from prostate cancer with progressive disease and candidate to undergo Lu-177-DOTA-617 therapy following to PSMA- PET/CT imaging for all patients. (5.2±0.3 mCi) was intravenously injected. To evaluate bone marrow absorbed dose 2 cc blood samples were withdrawn in short variable times (3, 15, 30, 60, 180 minutes) after injection. Furthermore, whole body scans were performed using scintillation gama camera in 4, 24, 48, and 120 hours after injection and in order to quantify the activity taken up in the body, kidneys , liver, right parotid, and left parotid the geometric mean of anterior and posterior counts were determined through ROI analysis, after that background subtraction and attenuation correction were applied using patients PSMA- PET/CT images taking in a consideration: organ thickness, body thickness, and Hounsfield unites from CT scan. OLINDA/EXM dosimetry program was used for curve fitting, residence time calculation, and absorbed dose calculations. Findings: Absorbed doses of bone marrow, left kidney, right kidney, liver, left parotid, right parotid, total body were 1.28±0.52, 32.36±16.36, 32.7±13.68, 10.35±3.45, 38.67±21.29, 37.55±19.77, 2.25±0.95 (mGy/mCi), respectively. Conclusion: Our first results clarify that Lu-177-DOTA-617 is safe and reliable therapy as there were no complications seen. In the other hand, the observable variation in the absorbed dose of the critical organs among the patients necessitate patient-specific dosimetry approach to save body organs and particularly highly exposed kidneys and parotid gland.

Keywords: Lu-177-PSMA, prostate cancer, radionuclide therapy

Procedia PDF Downloads 480
655 Transformation of Hexagonal Cells into Auxetic in Core Honeycomb Furniture Panels

Authors: Jerzy Smardzewski

Abstract:

Structures with negative Poisson's ratios are called auxetic. They are characterized by better mechanical properties than conventional structures, especially shear strength, the ability to better absorb energy and increase strength during bending, especially in sandwich panels. Commonly used paper cores of cellular boards are made of hexagonal cells. With isotropic facings, these cells provide isotropic properties of the entire furniture board. Shelves made of such panels with a thickness similar to standard chipboards do not provide adequate stiffness and strength of the furniture. However, it is possible to transform the shape of hexagonal cells into polyhedral auxetic cells that improve the mechanical properties of the core. The work aimed to transform the hexagonal cells of the paper core into auxetic cells and determine their basic mechanical properties. Using numerical methods, it was decided to design the most favorable proportions of cells distinguished by the lowest Poisson's ratio and the highest modulus of linear elasticity. Standard cores for cellular boards commonly used to produce 34 mm thick furniture boards were used for the tests. Poisson's ratios, bending strength, and linear elasticity moduli were determined for such cores and boards. Then, the cells were transformed into auxetic structures, and analogous cellular boards were made for which mechanical properties were determined. The results of numerical simulations for which the variable parameters were the dimensions of the cell walls, wall inclination angles, and relative cell density were presented in the further part of the paper. Experimental tests and numerical simulations showed the beneficial effect of auxeticization on the mechanical quality of furniture panels. They allowed for the selection of the optimal shape of auxetic core cells.

Keywords: auxetics, honeycomb, panels, simulation, experiment

Procedia PDF Downloads 11
654 Design and Development of High Strength Aluminium Alloy from Recycled 7xxx-Series Material Using Bayesian Optimisation

Authors: Alireza Vahid, Santu Rana, Sunil Gupta, Pratibha Vellanki, Svetha Venkatesh, Thomas Dorin

Abstract:

Aluminum is the preferred material for lightweight applications and its alloys are constantly improving. The high strength 7xxx alloys have been extensively used for structural components in aerospace and automobile industries for the past 50 years. In the next decade, a great number of airplanes will be retired, providing an obvious source of valuable used metals and great demand for cost-effective methods to re-use these alloys. The design of proper aerospace alloys is primarily based on optimizing strength and ductility, both of which can be improved by controlling the additional alloying elements as well as heat treatment conditions. In this project, we explore the design of high-performance alloys with 7xxx as a base material. These designed alloys have to be optimized and improved to compare with modern 7xxx-series alloys and to remain competitive for aircraft manufacturing. Aerospace alloys are extremely complex with multiple alloying elements and numerous processing steps making optimization often intensive and costly. In the present study, we used Bayesian optimization algorithm, a well-known adaptive design strategy, to optimize this multi-variable system. An Al alloy was proposed and the relevant heat treatment schedules were optimized, using the tensile yield strength as the output to maximize. The designed alloy has a maximum yield strength and ultimate tensile strength of more than 730 and 760 MPa, respectively, and is thus comparable to the modern high strength 7xxx-series alloys. The microstructure of this alloy is characterized by electron microscopy, indicating that the increased strength of the alloy is due to the presence of a high number density of refined precipitates.

Keywords: aluminum alloys, Bayesian optimization, heat treatment, tensile properties

Procedia PDF Downloads 119
653 An Assessment of Floodplain Vegetation Response to Groundwater Changes Using the Soil & Water Assessment Tool Hydrological Model, Geographic Information System, and Machine Learning in the Southeast Australian River Basin

Authors: Newton Muhury, Armando A. Apan, Tek N. Marasani, Gebiaw T. Ayele

Abstract:

The changing climate has degraded freshwater availability in Australia that influencing vegetation growth to a great extent. This study assessed the vegetation responses to groundwater using Terra’s moderate resolution imaging spectroradiometer (MODIS), Normalised Difference Vegetation Index (NDVI), and soil water content (SWC). A hydrological model, SWAT, has been set up in a southeast Australian river catchment for groundwater analysis. The model was calibrated and validated against monthly streamflow from 2001 to 2006 and 2007 to 2010, respectively. The SWAT simulated soil water content for 43 sub-basins and monthly MODIS NDVI data for three different types of vegetation (forest, shrub, and grass) were applied in the machine learning tool, Waikato Environment for Knowledge Analysis (WEKA), using two supervised machine learning algorithms, i.e., support vector machine (SVM) and random forest (RF). The assessment shows that different types of vegetation response and soil water content vary in the dry and wet seasons. The WEKA model generated high positive relationships (r = 0.76, 0.73, and 0.81) between NDVI values of all vegetation in the sub-basins against soil water content (SWC), the groundwater flow (GW), and the combination of these two variables, respectively, during the dry season. However, these responses were reduced by 36.8% (r = 0.48) and 13.6% (r = 0.63) against GW and SWC, respectively, in the wet season. Although the rainfall pattern is highly variable in the study area, the summer rainfall is very effective for the growth of the grass vegetation type. This study has enriched our knowledge of vegetation responses to groundwater in each season, which will facilitate better floodplain vegetation management.

Keywords: ArcSWAT, machine learning, floodplain vegetation, MODIS NDVI, groundwater

Procedia PDF Downloads 101
652 Proposed Organizational Development Interventions in Managing Occupational Stressors for Business Schools in Batangas City

Authors: Marlon P. Perez

Abstract:

The study intended to determine the level of occupational stress that was experienced by faculty members of private and public business schools in Batangas City with the end in view of proposing organizational development interventions in managing occupational stressors. Stressors such as factors intrinsic to the job, role in the organization, relationships at work, career development and organizational structure and climate were used as determinants of occupational stress level. Descriptive method of research was used as its research design. There were only 64 full-time faculty members coming from private and public business schools in Batangas City – University of Batangas, Lyceum of the Philippines University-Batangas, Golden Gate Colleges, Batangas State University and Colegio ng Lungsod ng Batangas. Survey questionnaire was used as data gathering instrument. It was found out that all occupational stressors were assessed stressful when grouped according to its classification of tertiary schools while response of subject respondents differs on their assessment of occupational stressors. Age variable has become significantly related to respondents’ assessments on factors intrinsic to the job and career development; however, it was not significantly related to role in the organization, relationships at work and organizational structure and climate. On the other hand, gender, marital status, highest educational attainment, employment status, length of service, area of specialization and classification of tertiary school were revealed to be not significantly related to all occupational stressors. Various organizational development interventions have been proposed to manage the occupational stressors that are experienced by business faculty members in the institution.

Keywords: occupational stress, business school, organizational development, intervention, stressors, faculty members, assessment, manage

Procedia PDF Downloads 431
651 Efficacy of Teachers' Cluster Meetings on Teachers' Lesson Note Preparation and Teaching Performance in Oyo State, Nigeria

Authors: Olusola Joseph Adesina, Sunmaila Oyetunji Raimi, Olufemi Akinloye Bolaji, Abiodun Ezekiel Adesina

Abstract:

The quality of education and the standard of a nation cannot rise above the quality of the teacher (NPE, 2004). Efforts at improving the falling standard of education in the country call for the need-based assessment of the primary tier of education in Nigeria. It was revealed that the teachers’ standard of performance and pupils’ achievement was below average. Teachers’ cluster meeting intervention was therefore recommended as a step towards enhancing the teachers’ professional competency, efficient and effective proactive and interactive lesson presentation. The study thus determined the impact of the intervention on teachers’ professional performance (lesson note preparation and teaching performance) in Oyo State, Nigeria. The main and interaction effects of the gender of the teachers as moderator variable were also determined. Three null hypotheses guided the study. Pre-test, posttest control group quazi experimental design was adopted for the study. Three hundred intact classes from three hundred different schools were randomly selected into treatment and control groups. Two response instruments-Classroom Lesson Note Preparation Checklist (CLNPC; r = 0.89) Cluster Lesson Observation Checklist (CLOC; r = 0.86) were used for data collection. Mean, Standard deviation and Analysis of Covariance (ANCOVA) were used to analyse the collected data. The results showed that the teachers’ cluster meeting have significant impact on teachers’ lesson note preparation (F(1,295) = 31.607; p < 0.05; η2 = .097) and teaching performance (F(1,295) = 20.849; p < 0.05; η2 = .066) in the core subjects of primary schools in Oyo State, Nigeria. The study therefore recommended among others that teachers’ cluster meeting should be sustained for teachers’ professional development in the State.

Keywords: teachers’ cluster meeting, teacher lesson note preparation, teaching performance, teachers’ gender, primary schools in Oyo state

Procedia PDF Downloads 345
650 Multiple-Material Flow Control in Construction Supply Chain with External Storage Site

Authors: Fatmah Almathkour

Abstract:

Managing and controlling the construction supply chain (CSC) are very important components of effective construction project execution. The goals of managing the CSC are to reduce uncertainty and optimize the performance of a construction project by improving efficiency and reducing project costs. The heart of much SC activity is addressing risk, and the CSC is no different. The delivery and consumption of construction materials is highly variable due to the complexity of construction operations, rapidly changing demand for certain components, lead time variability from suppliers, transportation time variability, and disruptions at the job site. Current notions of managing and controlling CSC, involve focusing on one project at a time with a push-based material ordering system based on the initial construction schedule and, then, holding a tremendous amount of inventory. A two-stage methodology was proposed to coordinate the feed-forward control of advanced order placement with a supplier to a feedback local control in the form of adding the ability to transship materials between projects to improve efficiency and reduce costs. It focused on the single supplier integrated production and transshipment problem with multiple products. The methodology is used as a design tool for the CSC because it includes an external storage site not associated with one of the projects. The idea is to add this feature to a highly constrained environment to explore its effectiveness in buffering the impact of variability and maintaining project schedule at low cost. The methodology uses deterministic optimization models with objectives that minimizing the total cost of the CSC. To illustrate how this methodology can be used in practice and the types of information that can be gleaned, it is tested on a number of cases based on the real example of multiple construction projects in Kuwait.

Keywords: construction supply chain, inventory control supply chain, transshipment

Procedia PDF Downloads 122
649 Association of Musculoskeletal and Radiological Features with Clinical and Serological Findings in Systemic Sclerosis: A Single-Centre Registry Study

Authors: Rezvan Hosseinian

Abstract:

Aim: Systemic sclerosis (SSc) is a chronic connective tissue disease with the clinical hallmark of skin thickening and tethering. The correlation of musculoskeletal features with other parameters should be considered in SSc patients. Methods: We reviewed the records of all patients who had more than one visit and standard anteroposterior radiography of hand. We used univariate analysis, and factors with p<0.05 were included in logistic regression to find out dependent factors. Results: Overall, 180 SSc patients were enrolled in our study, 161 (89.4%) of whom were women. The median age (IQR) was 47.0 years (16), and 52% had a diffuse subtype of the disease. In multivariate analysis, tendon friction rubs (TFRs) were associated with the presence of calcinosis, muscle tenderness, and flexion contracture (FC) on physical examination (p<0.05). Arthritis showed no differences in the two subtypes of the disease (p=0.98), and in multivariate analysis, there were no correlations between radiographic arthritis and serological and clinical features. The radiographic results indicated that disease duration correlated with joint erosion, acro-osteolysis, resorption of the distal ulna, calcinosis and radiologic FC (p< 0.05). Acro-osteolysis was more frequent in the dcSSc subtype, TFRs, and anti-TOPO I antibody. Radiologic FC showed an association with skin score, calcinosis and haematocrit <30% (p<0.05). Joint flexion on radiography was associated with disease duration, modified Rodnan skin score, calcinosis, and low hematocrit (P<0.01). Conclusion: Disease duration was a main dependent factor for developing joint erosion, acro-osteolysis, bone resorption, calcinosis, and flexion contracture on hand radiography. Acro-osteolysis presented in the severe form of the disease. Acro-osteolysis was the only dependent variable associated with bone demineralization.

Keywords: disease subsets, hand radiography, joint erosion, sclerosis

Procedia PDF Downloads 90
648 Association of Musculoskeletal and Radiological Features with Clinical and Serological Findings in Systemic Sclerosis: A Single-Centre Registry Study

Authors: Nasrin Azarbani

Abstract:

Aim: Systemic sclerosis (SSc) is a chronic connective tissue disease with the clinical hallmark of skin thickening and tethering. Correlation of musculoskeletal features with other parameters should be considered in SSc patients. Methods: We reviewed the records of all patients who had more than one visit and standard anteroposterior radiography of hand. We used univariate analysis, and factors with p<0.05 were included in logistic regression to find out dependent factors. Results: Overall, 180 SSc patients were enrolled in our study, 161 (89.4%) of whom were women. Median age (IQR) was 47.0 years (16), and 52% had diffuse subtype of the disease. In multivariate analysis, tendon friction rubs (TFRs) was associated with the presence of calcinosis, muscle tenderness, and flexion contracture (FC) on physical examination (p<0.05). Arthritis showed no differences in the two subtypes of the disease (p=0.98), and in multivariate analysis, there were no correlations between radiographic arthritis and serological and clinical features. The radiographic results indicated that disease duration correlated with joint erosion, acro-osteolysis, resorption of distal ulna, calcinosis and radiologic FC (p< 0.05). Acro-osteolysis was more frequent in the dcSSc subtype, TFRs, and anti-TOPO I antibody. Radiologic FC showed an association with skin score, calcinosis and haematocrit <30% (p<0.05). Joint flexion on radiography was associated with disease duration, modified Rodnan skin score, calcinosis, and low haematocrit (P<0.01). Conclusion: Disease duration was a main dependent factor for developing joint erosion, acro-osteolysis, bone resorption, calcinosis, and flexion contracture on hand radiography. Acro-osteolysis presented in the severe form of the disease. Acro-osteolysis was the only dependent variable associated with bone demineralization.

Keywords: sclerosis, disease subsets, joint erosion, musculoskeletal

Procedia PDF Downloads 66
647 Disclosure Extension of Oil and Gas Reserve Quantum

Authors: Ali Alsawayeh, Ibrahim Eldanfour

Abstract:

This paper examines the extent of disclosure of oil and gas reserve quantum in annual reports of international oil and gas exploration and production companies, particularly companies in untested international markets, such as Canada, the UK and the US, and seeks to determine the underlying factors that affect the level of disclosure on oil reserve quantum. The study is concerned with the usefulness of disclosure of oil and gas reserves quantum to investors and other users. Given the primacy of the annual report (10-k) as a source of supplemental reserves data about the company and as the channel through which companies disseminate information about their performance, the annual reports for one year (2009) were the central focus of the study. This comparative study seeks to establish whether differences exist between the sample companies, based on new disclosure requirements by the Securities and Exchange Commission (SEC) in respect of reserves classification and definition. The extent of disclosure of reserve is provided and compared among the selected companies. Statistical analysis is performed to determine whether any differences exist in the extent of disclosure of reserve under the determinant variables. This study shows that some factors would affect the extent of disclosure of reserve quantum in the above-mentioned countries, namely: company’s size, leverage and quality of auditor. Companies that provide reserves quantum in detail appear to display higher size. The findings also show that the level of leverage has affected companies’ reserves quantum disclosure. Indeed, companies that provide detailed reserves quantum disclosure tend to employ a ‘high-quality auditor’. In addition, the study found significant independent variable such as Profit Sharing Contracts (PSC). This factor could explain variations in the level of disclosure of oil reserve quantum between the contractor and host governments. The implementation of SEC oil and gas reporting requirements do not enhance companies’ valuation because the new rules are based only on past and present reserves information (proven reserves); hence, future valuation of oil and gas companies is missing for the market.

Keywords: comparison, company characteristics, disclosure, reserve quantum, regulation

Procedia PDF Downloads 405
646 Comparison of Analgesic Efficacy of Paracetamol and Tramadol for Pain Relief in Active Labor

Authors: Krishna Dahiya

Abstract:

Introduction: Labour pain has been described as the most severe pain experienced by women in their lives. Pain management in labour is one of the most important challenges faced by the obstetrician. The opioids are the primary treatment for patients with moderate and severe pain but these drugs are not always tolerated and are associated with dose-dependent side effects. Nonsteroidal anti-inflammatory drugs, too, are associated with variable adverse effects. Considering these factors, our study compared the efficacy and side effect of intravenous tramadol and paracetamol. Objective: To evaluate the efficacy and adverse effects of an intravenous infusion of 1000 mg of paracetamol as compared with an intravenous injection of 50mg of tramadol for intrapartum analgesia. Methods: In a randomized prospective study at Pt. BDS PGIMS, 200 women in active labor were allocated to received either paracetamol (n=100) or tramadol (n=100). The primary outcome was the efficacy of the drug to supply adequate analgesia as measured by a change in the visual analog scale (VAS) pain intensity score at various times after drug administration. The secondary outcomes included the need for additional rescue analgesia and the presence of adverse maternal or fetal events. Results: The mean age of cases were 25.55 ± 3.849 years and 25.60 ± 3.655 years respectively As recorded by the VAS score, there was significant pain reduction at 30 minutes, and at 1 and 2 hours in both groups (P<0.01). In comparison, between group I and II, a significantly higher rate of nausea and vomiting in tramadol group (14% vs 8%; P < 0.03) patients. Similarly, drowsiness (0% vs 11%; P<0.01), dry mouth (0% vs 8%; P<0.04) and dizziness (0% vs 9%; P<0.02) was also significant in group II. Conclusion: Due to difficulty in administering epidural analgesia to all parturients, administration of paracetamol and tramadol infusion for analgesia is simple and less invasive alternative. In the present study, both paracetamol and tramadol were equally effective for labour analgesia but paracetamol has emerged as safe alternative as compared to tramadol due to a low incidence of side effects.

Keywords: paracetamol, tramadol, labor, analgesia

Procedia PDF Downloads 291
645 Canada's "Flattened Curve": A Geospatail Temporal Analysis of Canada's Amelioration of The Sars-Cov-2 Pandemic Through Coordinated Government Intervention

Authors: John Ahluwalia

Abstract:

As an affluent first-world nation, Canada took swift and comprehensive action during the outbreak of the SARS-CoV-2 (COVID-19) pandemic compared to other countries in the same socio-economic cohort. The United States has stumbled to overcome obstacles most developed nations have faced, which has led to significantly more per capita cases and deaths. The initial outbreaks of COVID-19 occurred in the US and Canada within days of each other and posed similar potentially catastrophic threats to public health, the economy, and governmental stability. On a macro level, events that take place in the US have a direct impact on Canada. For example, both countries tend to enter and exit economic recessions at approximately the same time, they are each other’s largest trading partners, and their currencies are inexorably linked. Variables intrinsic to Canada’s national infrastructure have been instrumental in the country’s efforts to flatten the curve of COVID-19 cases and deaths. Canada’s coordinated multi-level governmental effort has allowed it to create and enforce policies related to COVID-19 at both the national and provincial levels. Canada’s policy of universal health care is another variable. Health care and public health measures are enforced on a provincial level, and it is within each province’s jurisdiction to dictate standards for public safety based on scientific evidence. Rather than introducing confusion and the possibility of competition for resources such as PPE and vaccines, Canada’s multi-level chain of government authority has provided consistent policies supporting national public health and local delivery of medical care. This paper will demonstrate that the coordinated efforts on provincial and federal levels have been the linchpin in Canada’s relative success in containing the deadly spread of the COVID-19 virus.

Keywords: COVID-19, canada, GIS, geospatial analysis

Procedia PDF Downloads 69
644 Quantifying Late Cenozoic Out‐of‐Sequence Thrusting at Chaura, Sutlej Valley, Himachal Pradesh, India

Authors: Rajkumar Ghosh

Abstract:

Out-of-sequence thrusts (OOST) are reported at different geographic locations with various local names along Siwalik Himalaya (SH), Lesser Himalaya (LH), Higher Himalaya (HH) from Bhutan, India, Nepal, and Pakistan Himalayan range. Most of OOSTs have been identified within the upper LH, and the lower HH based on geochronological age jump across. These thrusts activated from Late Miocene to recent. The Chaura Thrust (CT) was deciphered from age jump of Apatite Fission Track (AFT) and considered as blind thrust base on variable exhumation rates in Chaura region, Satluj river valley, Himachal Pradesh. CT is located north of Jhakri Thrust (JhT) and is also differently identified as Sarahan thrust (ST). Structural documentation from the rocks near the OOST in Chaura was not so far done. Detail structural study of the Jeori Group of rocks was carried out in this study to understand the manifestation of the Chaura thrust and associated structures in meso- to micro-scale. Box fold, scar fold, kink fold, crenulation cleavages, and boudins are developed in the Chaura region. These structures usually do not indicate shear sense. When studied under an optical microscope, the Chaura samples reveal that the mica fish are usually lenticular with aspect ratio (R) varying from 6–11 and inclination angle (α) from 15–40°. According to ‘R’ and ‘α’, elongated sigmoid shaped mica fish and parallelogram shaped mica fish were also documented. Asymmetric mica fish demonstrate top-to-S/SW ductile shear, which is similar as that of Chaura thrust. Grain boundary migration (GBM) structures in quartzo-feldspathic grains from Jeori Group of rocks indicate deformation temperature ranging from 400 to 650°C. This can indicate that the OOST at Chaura, i.e., the Chaura Thrust, underwent thrusting in the ductile regime.

Keywords: out-of-sequence thrust, chaura thrust, sarahan thrust, jakhri thrust, higher himalaya, s/c- fabric

Procedia PDF Downloads 78
643 Alumina Supported Copper-Manganese-Cobalt Catalysts for CO and VOCs Oxidation

Authors: Elitsa Kolentsova, Dimitar Dimitrov, Vasko Idakiev, Tatyana Tabakova, Krasimir Ivanov

Abstract:

Formaldehyde production by selective oxidation of methanol is an important industrial process. The main by-products in the waste gas are CO and dimethyl ether (DME). The idea of this study is to combine the advantages of both Cu-Mn and Cu-Co catalytic systems by obtaining a new mixed Cu-Mn-Co catalyst with high activity and selectivity at the simultaneous oxidation of CO, methanol, and DME. Two basic Cu-Mn samples with high activity were selected for further investigation: (i) manganese-rich Cu-Mn/γ–Al2O3 catalyst with Cu/Mn molar ratio 1:5 and (ii) copper-rich Cu-Mn/γ-Al2O3 catalyst with Cu/Mn molar ratio 2:1. Manganese in these samples was replaced by cobalt in the whole concentration region, and catalytic properties were determined. The results show a general trend of decreasing the activity toward DME oxidation and increasing the activity toward CO and methanol oxidation with the increase of cobalt up to 60% for both groups of catalyst. This general trend, however, contains specific features, depending on the composition of the catalyst and the nature of the oxidized gas. The catalytic activity of the sample with Cu/(Mn+Co) molar ratio of 2:1 is gradually changed with increasing the cobalt content. The activity of the sample with Cu/(Mn+Co) molar ratio of 1: 5 passes through a maximum at 60% manganese replacement by cobalt, probably due to the formation of highly dispersed Co-based spinel structures (Co3O4 and/or MnCo2O4). In conclusion, the present study demonstrates that the Cu-Mn-Co/γ–alumina supported catalysts have enhanced activity toward CO, methanol and DME oxidation. Cu/(Mn+Co) molar ratio 1:5 and Co/Mn molar ratio 1.5 in the active component can ensure successful oxidation of CO, CH3OH and DME. The active component of the mixed Cu-Mn-Co/γ–alumina catalysts consists of at least six compounds - CuO, Co3O4, MnO2, Cu1.5Mn1.5O4, MnCo2O4 and CuCo2O4, depending on the Cu/Mn/Co molar ratio. Chemical composition strongly influences catalytic properties, this effect being quite variable with regards to the different processes.

Keywords: Cu-Mn-Co catalysts, oxidation, carbon oxide, VOCs

Procedia PDF Downloads 222
642 Clinical Outcomes For Patients Diagnosed With DCIS Through The Breast Screening Programme

Authors: Aisling Eves, Andrew Pieri, Ross McLean, Nerys Forester

Abstract:

Background: DCIS accounts for 20% of malignancies diagnosed by the breast screening programme and is primarily managed by surgical excision. There is variable guidance on defining excision margins, and adjuvant treatments vary widely. This study aimed to investigate the clinical outcomes for patients following surgical excision of small volume DCIS. Methods: This single-centreretrospective cohort study of 101 consecutive breast screened patients diagnosed with DCIS who underwent surgical excision. All patients diagnosed with DCIS had radiological abnormalities <15mm. Clinical, radiological, and histological data were collected from patients who had been diagnosed within a 5 year period, and ASCO guidelines for margin involvement of <2mm was used to guide the need for re-excision. Outcomes included re-excision rates, radiotherapy usage, and the presence of invasive cancer. Results: Breast conservation surgery was performed in 94.1% (n=95). Following surgical excision, 74(73.27%)patients had complete DCIS excision (>2mm margin), 4(4.0%) had margins 1-2mm, and 17(16.84%)had margins <1mm. The median size of DCIS in the specimen sample was 4mm. In 86% of patients with involved margins (n=18), the mammogram underestimated the DCIS size by a median of 12.5mm (range: 1-42mm). Of the patients with involved margins, 11(10.9%)had a re-excision, and 6 of these (50%) required two re-excisions to completely excise the DCIS. Post-operative radiotherapy was provided to 53(52.48%)patients. Four (3.97%) patients were found to have invasive ductal carcinoma on surgical excision, which was not present on core biopsy – all had high-grade DCIS. Recurrence of DCIS was seen in the same site during follow-up in 1 patient (1%), 1 year after their first DCIS diagnosis. Conclusion: Breast conservation surgery is safe in patients with DCIS, with low rates of re-excision, recurrence, and upstaging to invasive cancer. Furthermore, the median size of DCIS found in the specimens of patients who had DCIS fully removed in surgery was low, suggesting it may be possible that total removal through VAE was possible for these patients.

Keywords: surgical excision, breast conservation surgery, DCIS, Re-excision, radiotherapy, invasive cancer

Procedia PDF Downloads 133
641 The Types of Annuities with Flexible Premium

Authors: Deniz Ünal Özpalamutcu, Burcu Altman

Abstract:

Actuaria uses mathematics, statistic and financial information when analyzing the financial impacts of uncertainties, risks, insurance and pension related issues. In other words, it deals with the likelihood of potential risks, their financial impacts and especially the financial measures. Handling these measures require some long-term payment and investments. So, it is obvious it is inevitable to plan the periodic payments with equal time intervals considering also the changing value of money over time. These series of payment made specific intervals of time is called annuity or rant. In literature, rants are classified based on start and end dates, start times, payments times, payments amount or frequency. Classification of rants based on payment amounts changes based on the constant, descending or ascending payment methods. The literature about handling the annuity is very limited. Yet in a daily life, especially in today’s world where the economic issues gained a prominence, it is very crucial to use the variable annuity method in line with the demands of the customers. In this study, the types of annuities with flexible payment are discussed. In other words, we focus on calculating payment amount of a period by adding a certain percentage of previous period payment was studied. While studying this problem, formulas were created considering both start and end period payments for cash value and accumulated. Also increase of each period payment by r interest rate each period payments calculated with previous periods increases. And the problem of annuities (rants) of which each period payment increased with previous periods’ increase by r interest rate has been analyzed. Cash value and accumulated value calculation of this problem were studied separately based on the period start/end and their relations were expressed by formulas.

Keywords: actuaria, annuity, flexible payment, rant

Procedia PDF Downloads 221
640 Fem Models of Glued Laminated Timber Beams Enhanced by Bayesian Updating of Elastic Moduli

Authors: L. Melzerová, T. Janda, M. Šejnoha, J. Šejnoha

Abstract:

Two finite element (FEM) models are presented in this paper to address the random nature of the response of glued timber structures made of wood segments with variable elastic moduli evaluated from 3600 indentation measurements. This total database served to create the same number of ensembles as was the number of segments in the tested beam. Statistics of these ensembles were then assigned to given segments of beams and the Latin Hypercube Sampling (LHS) method was called to perform 100 simulations resulting into the ensemble of 100 deflections subjected to statistical evaluation. Here, a detailed geometrical arrangement of individual segments in the laminated beam was considered in the construction of two-dimensional FEM model subjected to in four-point bending to comply with the laboratory tests. Since laboratory measurements of local elastic moduli may in general suffer from a significant experimental error, it appears advantageous to exploit the full scale measurements of timber beams, i.e. deflections, to improve their prior distributions with the help of the Bayesian statistical method. This, however, requires an efficient computational model when simulating the laboratory tests numerically. To this end, a simplified model based on Mindlin’s beam theory was established. The improved posterior distributions show that the most significant change of the Young’s modulus distribution takes place in laminae in the most strained zones, i.e. in the top and bottom layers within the beam center region. Posterior distributions of moduli of elasticity were subsequently utilized in the 2D FEM model and compared with the original simulations.

Keywords: Bayesian inference, FEM, four point bending test, laminated timber, parameter estimation, prior and posterior distribution, Young’s modulus

Procedia PDF Downloads 283
639 Impact of Ventilation Systems on Indoor Air Quality in Swedish Primary School Classrooms

Authors: Sarka Langer, Despoina Teli, Blanka Cabovska, Jan-Olof Dalenbäck, Lars Ekberg, Gabriel Bekö, Pawel Wargocki, Natalia Giraldo Vasquez

Abstract:

The aim of the study was to investigate the impact of various ventilation systems on indoor climate, air pollution, chemistry, and perception. Measurements of thermal environment and indoor air quality were performed in 45 primary school classrooms in Gothenburg, Sweden. The classrooms were grouped into three categories according to their ventilation system: category A) natural or exhaust ventilation or automated window opening; category B) balanced mechanical ventilation systems with constant air volume (CAV); and category C) balanced mechanical ventilation systems with variable air volume (VAV). A questionnaire survey about indoor air quality, perception of temperature, odour, noise and light, and sensation of well-being, alertness focus, etc., was distributed among the 10-12 years old children attending the classrooms. The results (medians) showed statistically significant differences between ventilation category A and categories B and C, but not between categories B and C in air change rates, median concentrations of carbon dioxide, individual volatile organic compounds formaldehyde and isoprene, in-door-to-outdoor ozone ratios and products of ozonolysis of squalene, a constituent of human skin oils, 6-methyl-5-hepten-2-one and decanal. Median ozone concentration, ozone loss -a difference between outdoor and indoor ozone concentrations- were different only between categories A and C. Median concentration of total VOCs and a perception index based on survey responses on perceptions and sensations indoors were not significantly different. In conclusion, ventilation systems have an impact on air change rates, indoor air quality, and chemistry, but the Swedish primary school children’s perception did not differ with the ventilation systems of the classrooms.

Keywords: indoor air pollutants, indoor climate, indoor chemistry, air change rate, perception

Procedia PDF Downloads 62
638 Y-Y’ Calculus in Physical Sciences and Engineering with Particular Reference to Fundamentals of Soil Consolidation

Authors: Sudhir Kumar Tewatia, Kanishck Tewatia, Anttriksh Tewatia

Abstract:

Advancements in soil consolidation are discussed, and further improvements are proposed with particular reference to Tewatia’s Y-Y’ Approach, which is called the Settlement versus Rate of Settlement Approach in consolidation. A branch of calculus named Y-Y' (or y versus dy/dx) is suggested (as compared to the common X-Y', x versus dy/dx, dy/dx versus x or Newton-Leibniz branch) that solves some complicated/unsolved theoretical and practical problems in physical sciences (Physics, Chemistry, Mathematics, Biology, and allied sciences) and engineering in an amazingly simple and short manner, particularly when independent variable X is unknown and X-Y' Approach can’t be used. Complicated theoretical and practical problems in 1D, 2D, 3D Primary and Secondary consolidations with non-uniform gradual loading and irregularly shaped clays are solved with elementary school level Y-Y' Approach, and it is interesting to note that in X-Y' Approach, equations become more difficult while we move from one to three dimensions, but in Y-Y' Approach even 2D/3D equations are very simple to derive, solve, and use; rather easier sometimes. This branch of calculus will have a far-reaching impact on understanding and solving the problems in different fields of physical sciences and engineering that were hitherto unsolved or difficult to be solved by normal calculus/numerical/computer methods. Some particular cases from soil consolidation that basically creeps and diffusion equations in isolation and in combination with each other are taken for comparison with heat transfer. The Y-Y’ Approach can similarly be applied in wave equations and other fields wherever normal calculus works or fails. Soil mechanics uses mathematical analogies from other fields of physical sciences and engineering to solve theoretical and practical problems; for example, consolidation theory is a replica of the heat equation from thermodynamics with the addition of the effective stress principle. An attempt is made to give them mathematical analogies.

Keywords: calculus, clay, consolidation, creep, diffusion, heat, settlement

Procedia PDF Downloads 95
637 Performance of Non-Deterministic Structural Optimization Algorithms Applied to a Steel Truss Structure

Authors: Ersilio Tushaj

Abstract:

The efficient solution that satisfies the optimal condition is an important issue in the structural engineering design problem. The new codes of structural design consist in design methodology that looks after the exploitation of the total resources of the construction material. In recent years some non-deterministic or meta-heuristic structural optimization algorithms have been developed widely in the research community. These methods search the optimum condition starting from the simulation of a natural phenomenon, such as survival of the fittest, the immune system, swarm intelligence or the cooling process of molten metal through annealing. Among these techniques the most known are: the genetic algorithms, simulated annealing, evolution strategies, particle swarm optimization, tabu search, ant colony optimization, harmony search and big bang crunch optimization. In this study, five of these algorithms are applied for the optimum weight design of a steel truss structure with variable geometry but fixed topology. The design process selects optimum distances and size sections from a set of commercial steel profiles. In the formulation of the design problem are considered deflection limitations, buckling and allowable stress constraints. The approach is repeated starting from different initial populations. The design problem topology is taken from an existing steel structure. The optimization process helps the engineer to achieve good final solutions, avoiding the repetitive evaluation of alternative designs in a time consuming process. The algorithms used for the application, the results of the optimal solutions, the number of iterations and the minimal weight designs, will be reported in the paper. Based on these results, it would be estimated, the amount of the steel that could be saved by applying structural analysis combined with non-deterministic optimization methods.

Keywords: structural optimization, non-deterministic methods, truss structures, steel truss

Procedia PDF Downloads 230
636 The Effect of Vertical Integration on Operational Performance: Evaluating Physician Employment in Hospitals

Authors: Gary Young, David Zepeda, Gilbert Nyaga

Abstract:

This study investigated whether vertical integration of hospitals and physicians is associated with better care for patients with cardiac conditions. A dramatic change in the U.S. hospital industry is the integration of hospital and physicians through hospital acquisition of physician practices. Yet, there is little evidence regarding whether this form of vertical integration leads to better operational performance of hospitals. The study was conducted as an observational investigation based on a pooled, cross-sectional database. The study sample comprised over hospitals in the State of California. The time frame for the study was 2010 to 2012. The key performance measure was hospitals’ degree of compliance with performance criteria set out by the federal government for managing patients with cardiac conditions. These criteria relate to the types of clinical tests and medications that hospitals should follow for cardiac patients but hospital compliance requires the cooperation of a hospital’s physicians. Data for this measure was obtained from a federal website that presents performance scores for U.S. hospitals. The key independent variable was the percentage of cardiologists that a hospital employs (versus cardiologists who are affiliated but not employed by the hospital). Data for this measure was obtained from the State of California which requires hospitals to report financial and operation data each year including numbers of employed physicians. Other characteristics of hospitals (e.g., information technology for cardiac care, volume of cardiac patients) were also evaluated as possible complements or substitutes for physician employment by hospitals. Additional sources of data included the American Hospital Association and the U.S. Census. Empirical models were estimated with generalized estimating equations (GEE). Findings suggest that physician employment is positively associated with better hospital performance for cardiac care. However, findings also suggest that information technology is a substitute for physician employment.

Keywords: physician employment, hospitals, verical integration, cardiac care

Procedia PDF Downloads 395
635 Effects of Destination Image, Perceived Value, Tourist Satisfaction and Service Quality on Destination Loyalty

Authors: Mahadzirah Mohamad, Nur Izzati Ab Ghani

Abstract:

Worldwide, tourism sustained growth and remained to be one of the fast-growing sectors. Malaysia tourism industry experienced an unstable and declining pattern of international tourist arrival’s growth rate. The situation suggested that the industry was competitive and denoted the need to study factors that influence tourist loyalty. The primary purpose of this study was to develop a model that examined how destination image, perceived value, service quality and tourist satisfaction affect destination loyalty. The study was conducted at the Kuala Lumpur International Airport and Kota Kinabalu International Airport. The respondents were international tourists from United Kingdom and Australia and they were selected using simple random sampling method. A total of 337 respondents were subjected to data analysis using structural equation modelling. The study uncovered that perceived value and destination image was highly correlated and the model suggested that these constructs should be treated as one construct. The construct was labelled as overall destination image. Overall image had significant direct effect on service quality, satisfaction and loyalty. Service quality had a significant indirect effect on loyalty through satisfaction as a moderating variable. However, satisfaction had no mediating effect on the relationship between overall destination image and loyalty. The study suggested that more efforts should be focused on portraying the image of experiencing joy with many interesting natural scenic places to see whilst on a holiday to Malaysia. In addition, the destination management office should promote tourist visiting to Malaysia would enjoy quality service related to accommodation, information facilities, health, and shopping. Tourist satisfaction empirically proved to be an important construct that influenced destination loyalty. This study contributed to the extended knowledge that postulated overall image of a destination was measured by perceived value and destination image.

Keywords: destination image, destination loyalty, structural equation modelling, tourist satisfaction

Procedia PDF Downloads 398
634 A Prospective Randomised Observational Study of Obstructed Total Anamalous Pulmonary Venous Connection (TAPVC) Repair Patients

Authors: Sanjeev Singh

Abstract:

Background: Obstructed total anomalous pulmonary venous connection (OTAPVC) typically presents with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. The aim of this study was to determine the outcome of patients with high pulmonary arterial pressure (PAP) with milrinone alone and a combination of milrinone and inhaled nitric oxide (INO). Material and Methods: After the approval of the ethical committee, this single-center prospective randomized and observational study was conducted over a period of two years among eighty-six patients with obstructed TAPVC repair with severe PAH. Group-I patients received milrinone, and Group-II patients received both milrinone (after aortic cross-clamp removal) and INO during the post-operative period at the cardiac care unit (CCU). Clinical outcomes such as ventilation time, length of stay (LOS) in the CCU, LOS in the hospital, complications, and hospital mortality were compared between the two groups. Result: The average ventilation time, LOS in CCU, and LOS in hospital for group I were 96.82 ± 19.46 hours, 10.91 ± 7.53 days, and 14.46 ± 7.58 days, respectively, and for group II, it was 85.14 ± 15.79 hours, 7.28 ± 3.68 days, and 10.21 ± 3.14 days, respectively, which was statistically significantly lower for group II. Reintubation, RV dysfunction, and hospital mortality were 16.3%, 37.2%, and 6.9% in group I, and 4.8%, 14.6%, and 2.4% in group II, respectively. The P value for each variable was significant < 0.05 (except mortality). Conclusion: Preoperative obstruction is a risk factor for postoperative obstruction, as 235 patients with obstructed TAPVC had severe PAH (39.98%) in this study. Management of severe PAH with a combination of milrinone and INO had a better outcome than milrinone alone.

Keywords: inhaled nitric oxide, milrinone, pulmonary artery hypertension, total anomalous pulmonary venous connection

Procedia PDF Downloads 21
633 Radiofrequency Ablation: A Technique in the Management of Low Anal Fistula

Authors: R. Suresh, C. B. Singh, A. K. Sarda

Abstract:

Background: Over the decades, several surgical techniques have been developed to treat anal fistulas with variable success rates and complications. Large amount of work has been done in radiofrequency excision of the fistula for several years but no work has been done for ablating the tract. Therefore one can consider for obliteration ofanal fistula by Radiofrequency ablation (RFA). Material and Methods: A randomized controlled clinical trial was conducted at Lok Nayak Hospital, where a total of 40 patients were enrolled in the study and they were randomly assigned to Group I (fistulectomy)(n=20) and Group II (RFA) (n=20). Aim of the study was to compare the efficacy of RFA of fistula versus fistulectomy in the treatment of a low anal fistula and to evaluate RFA as an effective alternative to fistulectomy with respect to time taken for wound healing as primary outcome and post-operative pain, time taken to return to work as secondary outcomes. Patients with simple low anal fistulas, single internal and external opening, not more than two secondary tracts were included. Patients with high complex fistula, fistulas communicating with cavity, fistula due to condition like tuberculosis, Crohn's, malignancy were excluded from the study. Results: Both groups were comparable with respect to age, sex ratio, type of fistula. Themean healing time was significantly shorter in group II (41.02 days) than in group I(62.68 days).The mean operative time was significantly shorter in groupII (21.40 min) than in group I(28.50 min). The mean time taken to return to work was significantly shorter in group II(8.30 days)than in group I(12.01 days).There was no significant difference in the post operative hospital stay, mean postoperative pain score, wound infection and recurrence between the two groups. Conclusion: The patients who underwent RFA of fistula had shorter wound healing time, operative time and time taken to return to work when compared to those who underwent fistulectomy and therefore RFA shows outcome comparable to fistulectomy in the treatment of low anal fistula.

Keywords: fistulectomy, low anal fistula, radio frequency ablation, wound healing

Procedia PDF Downloads 344