Search results for: previous enclaves
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2964

Search results for: previous enclaves

1314 Motivation Among Arab Learners of English in the UK

Authors: Safa Kaka

Abstract:

As more and more students are travelling to different countries to study and, in particular, to study English, the question of what motivates them to make such a large move has come under question. This is particularly pertinent in the case of Arab students who make up nearly 15% of the foreign student body in the UK. Given that the cultural differences between the UK and Arab nations are extremely wide, the decision to come to this country to study English must be driven by strong motivational forces. Numerous previous studies have considered what motivates foreign students to travel to the UK and other countries for their education or language learning but the specific motivators of Arab students have yet to be explored. This study undertakes to close that gap by examining the concepts and theories of motivation, both in general terms and in relation to English learning and foreign study. 70 Arab students currently studying in the UK were asked to participate in an online questionnaire which asked about their motivations for coming to the UK and for studying and learning English. A further six individuals were interviewed on a face to face basis. The outcomes have indicated that the factors which motivate the decision to come to the UK are similar to those that motivate the desire to learn English. In particular a motivation for self-improvement, career advancement and potential future benefits were cited by a number of respondents. Other indications were the ease of accessibility to the UK as an English speaking country, a motivation to experience different cultures and lifestyles and even political freedoms. Overall the motivations of Arab students were not found to be conspicuously different from those of other foreign students, although it was noted that their motivations did change, both positively and negatively following a period of time in the country. These changes were based on the expectations of the students pre-arrival and their actual experience of the country and its teaching approaches and establishments and were, as indicated both good and bad. The implications for the Arab student population and UK educational establishments are reviewed and future research pathways highlighted.

Keywords: motivation, Arab learners of English, language teaching, applied linguistics

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1313 English as a Medium of Instruction in Algerian Higher Business Degree Programmes

Authors: Sidi Ahmed Berrabah

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English as a Medium of Instruction (EMI) is expanding rapidly in the world. A growing volume of research has been dedicated to investigating its introduction, with findings that describe a complex picture and suggest that the practicality and effectiveness of EMI are still the subjects of debate. However, considerably less attention has been given to understanding EMI in a context where its introduction has been discussed but not yet put into practice. One such context is Algeria, where discourses about a potential introduction of EMI have been going on for some time. It is likely that the first courses where EMI is introduced are Business degree programmes. This study aims to examine the current discourses and attitudes towards the potential implementation of EMI and the language practices in Business degree programmes in three Algerian universities. The research is conducted in three different universities in three different regions in Algeria with the aim of including both ‘centre’ and ‘periphery’ Algerian universities. In order to achieve the previous aims, a mixed research paradigm is used. Questionnaires, semi structured interviews, and classroom observations are used to gather data from three participant cohorts: university students of Business, lecturers of Business, and lecturers of English for specific purposes. The findings showed that students and lecturers of Business are found in favour of the introduction of English instead of French or standard Arabic as a medium of instruction. The reason is that English is seen as having internationalisation and instrumental benefits, while French was too closely linked to the colonial history of the country. The favourable attitudes towards EMI, however, seem to contrast with the daily classroom practices at the departments of Business studies, where students and lecturers make practical choices of using their language repertoire based on their linguistic background and skills. Classrooms in the three Algerian universities featured fluid and translanguaging practices that cannot be reduced to a monolingual EMI policy.

Keywords: EMI, Algerian universities, business degree programmes, translanguaging

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1312 A Comparison of Caesarean Section Indications and Characteristics in 2009 and 2020 in a Saudi Tertiary Hospital

Authors: Sarah K. Basudan, Ragad I. Al Jazzar, Zeinah Sulaihim, Hanan M. Al-Kadri

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Background: Cesarean section has been increasing in recent years, with a wide range of etiologies contributing to this rise. This study aimed to assess the indications, outcomes, and complications in Riyadh, Saudi Arabia. Methods: A Retrospective Cohort study was conducted at King Abdulaziz medical city. The study includes two cohorts: G1 (2009) and G2 (2020) groups who met the inclusion criteria. The data was transferred to the SPSS (statistical package for social sciences) version 24 for analysis. The initial descriptive statistics were run for all variables, including numerical and categorical data. The numerical data were reported as median, and standard deviation and categorical data were reported as frequencies and percentages. Results: The data were collected from 399 women who were divided into two groups, G1(199) and G2(200). The mean age of all participants is 32+-6​; G1 and G2 had significant differences in age means with 30+-6 and 34+-5, respectively, with a p-value of <0.001, which indicates delayed fertility by four years. Moreover, a breech presentation was less likely to occur in G2 (OR 0.64, CI: 0.21-0.62. P<0.001). Nonetheless, maternal causes such as repeated C-sections and maternal medical conditions were more likely to happen in G2 (OR 1.5, CI: 1.04-2.38, p=0.03) and (OR 5.4, CI: 1.12-23.9, P=0.01), respectively. Furthermore, postpartum hemorrhage showed an increase of 12% in G2 (OR 5.4, CI: 2.2-13.4, p<0.001). G2 was more likely to be admitted to the neonatal intensive care unit (NICU) (OR 16, CI: 7.4-38.7) and to special care baby (SCB) (OR 7.2, CI: 3.9-13.1), both with a p-value<0.001 compared to regular nursery admission. Conclusion: There are multiple factors that are contributing to the increase in c section rate in a Saudi tertiary hospitals. The factors were suggested to be previous c-sections, abnormal fetal heart rate, malpresentation, and maternal or fetal medical conditions.

Keywords: cesarean sections, maternal indications, maternal complications, neonatal condition

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1311 Laparoscopic Curative Resection for Right-Sided Colonic Tumours: Initial Experience from a Cancer Hospital of a Developing Country

Authors: Awais Naeem, Osama Shakeel, Aamir Ali Syed, Shahid Khattak

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Introduction: Laparoscopic right hemicolectomy is an advanced cancer surgery in today's era. The aim of this study was to evaluate the surgical and initial oncological outcomes after curative, laparoscopic resection of right sided colonic tumors. Also to compare our results with those of previous randomized trials. Methods And Procedures: We retrospectively analyzed the medical record files of all the patients who presented to our hospital with the diagnosis of right sided colon carcinoma from January 2012 to December 2017 and underwent laparoscopic right hemicolectomy. Demographics, operative findings and histopathological reports were all recorded on a preformed data sheet. All the analysis was performed on SPSS 20. Results: Total of 48 patients were included. There were 37 male and 11 female patients with mean age of 49.7 (range from 25 – 82). Mean hospital stay was 8.25 ± 3.17 days. Blood loss was 80mls and operative mean time was 240 minutes. Eighteen patients had extended right hemicolectomy. Median length of the specimen retrieved was 31cm (range, 14-59cm). Mean size of tumor was 6.44cm + 2.53. Total number of lymph nodes removed was 20.5 + 8.3. All had R0 resection. Post-operatively 2 patients had pelvic collection and there was no 30 day mortality. In 33 patients there was T3 disease, 5 had T2 and 10 had T4 disease. There was distant recurrence in 4 patients with peritoneal metastasis in 3 and liver metastasis in 1 patient. Forty-six patients are still alive and 44 are disease free. The mean follow-up period was 25.31 (12 to 60) months. Conclusion: Our early experience with Laparascopic Right hemicolectomy as a safe and oncologically feasible surgical option. We attained comparable surgical results with curative intent.

Keywords: right hemicolectomy, right sided colonic tumors, laparoscopic, curative intent

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1310 Photocatalytic Hydrogen Production, Effect of Metal Particle Size and Their Electronic/Optical Properties on the Reaction

Authors: Hicham Idriss

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Hydrogen production from water is one of the most promising methods to secure renewable sources or vectors of energy for societies in general and for chemical industries in particular. At present over 90% of the total amount of hydrogen produced in the world is made from non-renewable fossil fuels (via methane reforming). There are many methods for producing hydrogen from water and these include reducible oxide materials (solar thermal production), combined PV/electrolysis, artificial photosynthesis and photocatalysis. The most promising of these processes is the one relying on photocatalysis; yet serious challenges are hindering its success so far. In order to make this process viable considerable improvement of the photon conversion is needed. Among the key studies that our group has been conducting in the last few years are those focusing on synergism between the semiconductor phases, photonic band gap materials, pn junctions, plasmonic resonance responses, charge transfer to metal cations, in addition to metal dispersion and band gap engineering. In this work results related to phase transformation of the anatase to rutile in the case of TiO2 (synergism), of Au and Ag dispersion (electron trapping and hydrogen-hydrogen recombination centers) as well as their plasmon resonance response (visible light conversion) are presented and discussed. It is found for example that synergism between the two common phases of TiO2 (anatase and rutile) is sensitive to the initial particle size. It is also found, in agreement with previous results, that the rate is very sensitive to the amount of metals (with similar particle size) on the surface unlike the case of thermal heterogeneous catalysis.

Keywords: photo-catalysis, hydrogen production, water splitting, plasmonic

Procedia PDF Downloads 246
1309 Using the Transtheoretical Model to Investigate Stages of Change in Regular Volunteer Service among Seniors in Community

Authors: Pei-Ti Hsu, I-Ju Chen, Jeu-Jung Chen, Cheng-Fen Chang, Shiu-Yan Yang

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Taiwan now is an aging society Research on the elderly should not be confined to caring for seniors, but should also be focused on ways to improve health and the quality of life. Senior citizens who participate in volunteer services could become less lonely, have new growth opportunities, and regain a sense of accomplishment. Thus, the question of how to get the elderly to participate in volunteer service is worth exploring. Apply the Transtheoretical Model to understand stages of change in regular volunteer service and voluntary service behaviour among the seniors. 1525 adults over the age of 65 from the Renai district of Keelung City were interviewed. The research tool was a self-constructed questionnaire and individual interviews were conducted to collect data. Then the data was processed and analyzed using the IBM SPSS Statistics 20 (Windows version) statistical software program. In the past six months, research subjects averaged 9.92 days of volunteer services. A majority of these elderly individuals had no intention to change their regular volunteer services. We discovered that during the maintenance stage, the self-efficacy for volunteer services was higher than during all other stages, but self-perceived barriers were less during the preparation stage and action stage. Self-perceived benefits were found to have an important predictive power for those with regular volunteer service behaviors in the previous stage, and self-efficacy was found to have an important predictive power for those with regular volunteer service behaviors in later stages. The research results support the conclusion that community nursing staff should group elders based on their regular volunteer services change stages and design appropriate behavioral change strategies.

Keywords: seniors, stages of change in regular volunteer services, volunteer service behavior, self-efficacy, self-perceived benefits

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1308 Consumer Behaviour and Experience When Purchasing Cage-Free Eggs in China

Authors: M. Chen, H. Lee, D. M. Weary

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China is the world’s largest egg producer, with more than 90% of production occurring in conventional cages. Cage-free housing systems offer the potential for improving hen welfare, but the growth of this system requires consumer demand, making it is important to understand consumers’ willingness to engage with cage-free eggs. Previous survey research indicates that the majority of Chinese consumers have a basic understanding of cage-free eggs and that some are willing to pay a price premium for these eggs. The aim of this research is to understand consumer behaviour, experience, and motivations when purchasing cage-free eggs in China. Purposive sampling will be used to select 20 participants from each of 2 groups: 1) consumers of cage-free eggs and 2) sales representatives who promote these eggs directly to consumers in supermarkets. This 4-month study will use methods of virtual ethnography to interact with participants repeatedly. Consumers will be asked to share their egg shopping, cooking, and eating experiences, and sales representatives will be asked to share their experiences promoting the eggs to consumers. Data collection will involve audio-recorded interviews, informal conversations (casual texts and calls), participant observation (video calling during shopping, cooking, and eating), and informant diaries (written reflections, photos, videos). All data (field notes, transcripts, diaries, photos, and videos) will be analyzed using Thematic Analysis. We expect that these will result in a nuanced understanding of consumer purchasing behaviour and motivation and will thus help identify strategies to promote higher animal welfare and cage-free egg products in China.

Keywords: animal welfare, cage-free eggs, China, consumer behaviour, ethnography

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1307 Motivating Factors of Mobile Device Applications toward Learning

Authors: Yen-Mei Lee

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Mobile learning (m-learning) has been applied in the education field not only because it is an alternative to web-based learning but also it possesses the ‘anytime, anywhere’ learning features. However, most studies focus on the technology-related issue, such as usability and functionality instead of addressing m-learning from the motivational perspective. Accordingly, the main purpose of the current paper is to integrate critical factors from different motivational theories and related findings to have a better understand the catalysts of an individual’s learning motivation toward m-learning. The main research question for this study is stated as follows: based on different motivational perspectives, what factors of applying mobile devices as medium can facilitate people’s learning motivations? Self-Determination Theory (SDT), Uses and Gratification Theory (UGT), Malone and Lepper’s taxonomy of intrinsic motivation theory, and different types of motivation concepts were discussed in the current paper. In line with the review of relevant studies, three motivating factors with five essential elements are proposed. The first key factor is autonomy. Learning on one’s own path and applying personalized format are two critical elements involved in the factor of autonomy. The second key factor is to apply a build-in instant feedback system during m-learning. The third factor is creating an interaction system, including communication and collaboration spaces. These three factors can enhance people’s learning motivations when applying mobile devices as medium toward learning. To sum up, in the currently proposed paper, with different motivational perspectives to discuss the m-learning is different from previous studies which are simply focused on the technical or functional design. Supported by different motivation theories, researchers can clearly understand how the mobile devices influence people’s leaning motivation. Moreover, instructional designers and educators can base on the proposed factors to build up their unique and efficient m-learning environments.

Keywords: autonomy, learning motivation, mobile learning (m-learning), motivational perspective

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1306 Endometriosis-Associated Ovarian Cancer: Clinical and Pathological Pattern

Authors: I. Ramalho, S. Campos, M. Dias

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Introduction: Endometriosis may play a role in the pathogenesis of ovarian cancer (OC), however, the risk and prognosis have not been well established. The association between these two pathologies could have an important impact on prevention and early diagnosis of OC. Objective: To analyze the prevalence of endometriosis associated ovarian cancer and related clinical, epidemiological and histopathological issues. Design: We conducted a retrospective case series analysis of patients diagnosed with endometriosis and ovarian cancer in the Gynecology Department of Coimbra University Hospital Center since 2006 to 2015. Methods: We collected data from women diagnosed with ovarian cancer, with anatomopathology records reporting findings of endometriosis in ovarian cancer patients. Patients were retrieved from the pathological records and appropriate medical records were retrospectively reviewed. Statistical analysis was performed using SPSS 22.0. Results: Histological evidence of endometriosis was found in 17 out of 261 patients diagnosed with ovarian cancer (OC) (6.51%). The most usual symptoms were pelvic pain, abdominal distension, asthenia, ascites, weight loss and nausea. Mean age at diagnosis was 61.2 ± 15.1, 41-86 years old, 33.3% were pre-menopausal patients and cancer stage distribution was predominantly stage I (31.3%) and stage III (56.3%). OC occurred unilaterally in 14 patients and 2 patients were diagnosed with a synchronous ovarian and endometrial cancer. Regarding histological type, 10 OC were classified as clear cell carcinoma (CCC), 4 endometrioid carcinomas (EC) and 3 mixed type (clear cell and endometrioid). Four ovarian carcinomas presumably arose from endometriomas: 3 CCC and 1 EC. Conclusions: In accordance with previous studies, clear cell was the most common pathological type in endometriotic patients, followed by endometrioid carcinomas, and two rare synchronous ovarian and endometrial carcinomas were registered. Although endometriosis association to OC is uncommon, endometriosis should be managed with special care in order to early diagnosis.

Keywords: endometriosis, histology, observational study, ovarian cancer

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1305 The Security Trade-Offs in Resource Constrained Nodes for IoT Application

Authors: Sultan Alharby, Nick Harris, Alex Weddell, Jeff Reeve

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The concept of the Internet of Things (IoT) has received much attention over the last five years. It is predicted that the IoT will influence every aspect of our lifestyles in the near future. Wireless Sensor Networks are one of the key enablers of the operation of IoTs, allowing data to be collected from the surrounding environment. However, due to limited resources, nature of deployment and unattended operation, a WSN is vulnerable to various types of attack. Security is paramount for reliable and safe communication between IoT embedded devices, but it does, however, come at a cost to resources. Nodes are usually equipped with small batteries, which makes energy conservation crucial to IoT devices. Nevertheless, security cost in terms of energy consumption has not been studied sufficiently. Previous research has used a security specification of 802.15.4 for IoT applications, but the energy cost of each security level and the impact on quality of services (QoS) parameters remain unknown. This research focuses on the cost of security at the IoT media access control (MAC) layer. It begins by studying the energy consumption of IEEE 802.15.4 security levels, which is followed by an evaluation for the impact of security on data latency and throughput, and then presents the impact of transmission power on security overhead, and finally shows the effects of security on memory footprint. The results show that security overhead in terms of energy consumption with a payload of 24 bytes fluctuates between 31.5% at minimum level over non-secure packets and 60.4% at the top security level of 802.15.4 security specification. Also, it shows that security cost has less impact at longer packet lengths, and more with smaller packet size. In addition, the results depicts a significant impact on data latency and throughput. Overall, maximum authentication length decreases throughput by almost 53%, and encryption and authentication together by almost 62%.

Keywords: energy consumption, IEEE 802.15.4, IoT security, security cost evaluation

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1304 Prevalence and Risk Factors of Musculoskeletal Disorders among Physical Therapist's Seniors versus Internship Students

Authors: A. H. Bekhet, N. Helmy

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Background: Physical therapists are knowledgeable in treatment and prevention of musculoskeletal injuries; however, they have occupational musculoskeletal injuries because Physical therapy profession requires effort that may lead to work-related musculoskeletal disorders. No previous studies among physical therapists have been reported in Egypt. We aim to assess the prevalence and risk factors of musculoskeletal disorders among physical therapist’s seniors versus internship students. Method: We conducted a cross-sectional study in faculty of physical therapy Cairo university Prevalence and risk factors of musculoskeletal injuries were assessed using self-administered questionnaire with closed-ended questions. Seniors therapist was defined as a physical therapist with more than 5 years of work experience. Data were analyzed using SPSS 22.0 for Windows. Results: The study included 106 physical therapists (Junior = 72; senior = 34), the mean age of senior therapists was 30.1 (SD 6.3) years and junior therapists were 22.8 (SD 2.4). Female subjects constituted 83.9% of the studied sample. The mean hours of contact with patients was higher among junior therapists 6.4 (SD 2.6) vs. 5.7 (SD 2.1) among senior therapists. The prevalence of a musculoskeletal injury, once or more in their lifetime, was significantly higher among senior therapists (86% vs. 66.7%; p = 0.04). The highest risk factor in increasing the symptoms of the injury among junior therapists was maintaining a position for a prolonged period of time at 28% while performing manual therapy techniques was the highest risk factor among senior therapists at 32%. 53% of senior therapists have limited their patient contact time as a result of their injury in comparison to 25% of junior therapists (p = 0.09). Conclusion: the presented study shows that the prevalence of musculoskeletal injuries, once or more in their lifetime, is significantly higher among senior therapists.

Keywords: musculoskeletal injuries, occupational injuries, physical therapists, work related disorders

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1303 Sun-Driven Evaporation Enhanced Forward Osmosis Process for Application in Wastewater Treatment and Pure Water Regeneration

Authors: Dina Magdy Abdo, Ayat N. El-Shazly, Hamdy Maamoun Abdel-Ghafar, E. A. Abdel-Aal

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Forward osmosis (FO) is one of the important processes during the wastewater treatment system for environmental remediation and fresh water regeneration. Both Egypt and China are troubled by over millions of tons of wastewater every year, including domestic and industrial wastewater. However, traditional FO process in wastewater treatment usually suffers low efficiency and high energy consumption because of the continuously diluted draw solution. An additional concentration process is necessary to keep running of FO separation, causing energy waste. Based on the previous study on photothermal membrane, a sun-driven evaporation process is integrated into the draw solution side of FO system. During the sun-driven evaporation, not only the draw solution can be concentrated to maintain a stable and sustainable FO system, but fresh water can be directly separated for regeneration. Solar energy is the ultimate energy source of everything we have on Earth and is, without any doubt, the most renewable and sustainable energy source available to us. Additionally, the FO membrane process is rationally designed to limit the concentration polarization and fouling. The FO membrane’s structure and surface property will be further optimized by the adjustment of the doping ratio of controllable nano-materials, membrane formation conditions, and selection of functional groups. A novel kind of nano-composite functional separation membrane with bi-interception layers and high hydrophilicity will be developed for the application in wastewater treatment. So, herein we aim to design a new wastewater treatment system include forward osmosis with high-efficiency energy recovery via the integration of photothermal membrane.

Keywords: forword, membrane, solar, water treatment

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1302 Teachers of English for Accounting Purpose: Self-Identity and Self-Reflectivity

Authors: Nanis Setyorini

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This is an interpretive study that aims to explore English teachers’ self-identity and self-reflection on teaching of English for accounting purpose in Indonesian accounting schools. Pierre Bourdieu’s concepts of capitals, habitus, and field are applied to capture and analyze the outright feelings, dilemma, and efforts of how English teachers see their educational background and adjust their understanding of English teaching for specific purpose, how they deliver unrecognized materials about accountancy, how they build confidence in teaching accountancy experts, and how to develop their professional commitment as English teachers for accounting purpose. Therefore, semi-structured interviews and focus group discussions are conducted to 16 English teachers in accounting schools within five state and private universities in East Java, Indonesia. The appropriateness of English teachers for accounting students remains a debatable topic. Previous literatures assume that the best English teachers for accounting students should be those who can demonstrate good quality use of English as well as those who have sound accounting knowledge and experience; however, such teachers are rare to find. Most English teachers in Indonesian accounting schools generally graduate from English education or English literature that provide a very limited pedagogic theories and practices of English for specific purpose (ESP). As a result, ESP teachers often had misconception and loss of face when they deliver subject contents to their accounting students who sometimes have been employed as professional accountants. The teachers also face a dilemma in locating themselves as the insiders in English knowledge, but the outsiders in accounting field. These situations are generally problems in their early-stage of teaching due to the lack of ESP knowledge, the shortage of teaching preparation, the absence of ESP in-house trainings on English for accountancy, and the unconducive relations with accounting educators as well as other ESP teachers. Then, self-learning with various resources and strategies is said as their effort to develop their teaching competence so they are able to teach English for accounting students more effectively.

Keywords: ESP teacher, English for accounting, self-identity, self-reflectivity

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1301 Integrating Nursing Informatics to Improve Patient-Centered Care: A Project to Reduce Patient Waiting Time at the Blood Pressure Counter

Authors: Pi-Chi Wu, Tsui-Ping Chu, Hsiu-Hung Wang

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Background: The ability to provide immediate medical service in outpatient departments is one of the keys to patient satisfaction. Objectives: This project used electronic equipment to integrate nursing care information to patient care at a blood pressure diagnostic counter. Through process reengineering, the average patient waiting time decreased from 35 minutes to 5 minutes, while service satisfaction increased from a score of 2.7 to 4.6. Methods: Data was collected from a local hospital in Southern Taiwan from a daily average of 2,200 patients in the outpatient department. Previous waiting times were affected by (1) space limitations, (2) the need to help guide patient mobility, (3) the need for nurses to appease irate patients and give instructions, (4), the need for patients to replace lost counter tickets, (5) the need to re-enter information, (6) the replacement of missing patient information. An ad hoc group was established to enhance patient satisfaction and shorten waiting times for patients to see a doctor. A four step strategy consisting of (1) counter relocation, (2) queue reorganization, (3) electronic information integration, (4) process reengineering was implemented. Results: Implementation of the developed strategy decreased patient waiting time from 35 minutes to an average of 5 minutes, and increased patient satisfaction scores from 2.7 to 6.4. Conclusion: Through the integration of information technology and process transformation, waiting times were drastically reduced, patient satisfaction increased, and nurses were allowed more time to engage in more cost-effective services. This strategy was simultaneously enacted in separate hospitals throughout Taiwan.

Keywords: process reengineering, electronic information integration, patient satisfaction, patient waiting time

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1300 Assessing Sustainability Dimensions of Transportation as a Critical Infrastructure: Jordan as a Case Study

Authors: Malak M. Shatnawi

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Infrastructure is the fundamental facility that plays an important part in socio-economic development for modern societies, if such sector is well planned, managed by decision makers in a way that is compatible with the population growth, safety, and national security needs; it will enrich progress, prosperity, awareness, social and economic welfare for any country. Infrastructure is the most important aspect of life because it can provide materials, products, and services that will improve and facilitate living conditions and maintain sustainability at the same time, and in order to study critical infrastructure, in general, we must think sustainability. Otherwise there will be a significant gap. The planning processes for sustainability include urban infrastructure and public transportation are considered the most important sectors for economic development for both developed and developing countries as they are linked to the civilizational and urban development, meanwhile, choosing the appropriate transportation mode that will provide a good level of service, and increase the satisfaction of the potential users is a difficult task. This research paper tries to assess where is Jordan located vs. each transportation sustainability dimensions in aspects related to social, economic and environmental dimensions based on (Zietsman et al. 2006) adopted model for sustainability transportation infrastructure. Measures of performance indicators for each dimensional goal were traced and supported with needed data, figures and statistical findings. The study uses analytical, descriptive style and methodology based on different references and previous studies from secondary data sources to support the case. Recommendations for enhancing sustainability were concluded, and future reform directions were proposed which can be applied to Jordan and generalized for other developing countries with similar circumstances.

Keywords: infrastructure transportation sustainability, economic, social, environmental

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1299 Associations Between Psychological Distress and COVID-19 Disease Course: A Retrospective Cohort Study of 3084 Cases in Belgium

Authors: Gwendy Darras, Mattias Desmet

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Previous research showed that psychological distress has a negative impact on the disease course of viral infections. For COVID-19, the same association was observed in small samples of specific segments of the population (e.g. health care workers). The present study presents a more refined analysis of this association, measuring a broader spectrum of psychological distress in a large sample (n=3084) of the general Flemish population. Several types of psychological distress (state, trait and health anxiety, depression, intra-, and interpersonal stress) are registered throughout three periods: one year before the contamination, one week before the contamination, and during the contamination. In doing so, validated scales such as DASS-21, IIP-32, and FCV-19S are used. Furthermore, the course of COVID-19 is registered in several ways: number of symptoms, number of days sick leave due to COVID-19, and number of days the symptoms have lasted. Also, different control variables such as vaccination status, medical and psychological history are taken into account. Statistical analysis shows that all types of psychological distress are positively correlated with the severity of the COVID-19 disease course. Anxiety during the contamination shows the strongest correlation, but psychological distress one year before the onset of COVID-19 was still significantly associated with the worsening of the disease course. As the assessment of the latter type of distress happened before the onset of the COVID-19 disease course, retrospective bias resulting in artificial associations between self-reported stress and COVID-19 severity is unlikely to have impacted the observations. In view of possible future pandemics, it is important to focus on general stress and anxiety reduction in the general population as soon as possible. It is also advisable to minimize the use of stress-inducing messages to encourage the population to adhere to the measures issued during a pandemic.

Keywords: anxiety, COVID-19, depression, psychoneuroimmunology, psychological distress, stress

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1298 Influenza Vaccine Uptake Among Tunisian Physicians in the 2018-2019 Influenza Season

Authors: Ines Cherif, Ghassen Kharroubi, Leila Bouabid, Adel Gharbi, Aicha Boukthir, Margaret Mccarron, Nissaf Ben Alaya, Afif Ben Salah, Jihene Bettaieb

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Healthcare workers' flu vaccination prevents influenza disease among both patients and caregivers. We aimed in this study to assess influenza vaccine (IV) coverage in 2018-2019 among Tunisian physicians and to determine factors associated with IV receipt. A cross sectional study was carried out in Tunisian primary and secondary health care facilities in the 2018-2019 influenza season. Physicians with direct patient contact were recruited according to a self-weighted multistage sampling. Data were collected through a face to face questionnaire containing questions on knowledge, attitudes, and practices regarding IV. Bivariate analysis was used in order to determine factors associated with IV receipt. A total of 167 physicians were included in the study with a mean age of 48.2 ± 7.7 years and a sex-ratio (M: F) of 0.37. Among participants, 15.1% (95% CI: [9.7%-20.3%]) were vaccinated against influenza in the 2018-2019 influenza season. Bivariate analysis revealed that previous flu immunization in the four years preceding the 2018-2019 influenza season (OR=32.3; p < 10-3), belief that vaccinating healthcare workers may reduce work absenteeism (OR=4.7, p=0.028), belief that flu vaccine should be mandatory to healthcare workers (OR=3.3, p=0.01) and high confidence towards IV efficacy in preventing influenza among caregivers (OR= 4.5, p=0.01) were associated with a higher IV receipt in 2018-2019 among physicians. Less than one fifth of Tunisian physicians were vaccinated against influenza in 2018-2019. Higher vaccine uptake was related to a higher belief in vaccine efficacy in preventing influenza disease among both patients and caregivers. This underscores the need for periodic educational campaigns to raise physicians' awareness about IV efficacy. The switch to an IV mandatory policy should also be considered.

Keywords: influenza vaccine, physicians, Tunisia, vaccination uptake

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1297 Bilateral Hemodynamic Responses on Prefrontal Cortex during Voluntary Regulated Breathing (Pranayama) Practices: A Near Infrared Spectroscopy Study

Authors: Singh Deepeshwar, Suhas Vinchurkar

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Similar to neuroimaging findings through functional magnetic resonance imaging (fMRI) assessing regional cerebral blood oxygenation, the functional near infrared spectroscopy (fNIRS) has also been used to assess hemodynamic responses in the imaged region of the brain. The present study assessed hemodynamic responses in terms of changes in oxygenation (HbO), deoxygenation (HbR) and total hemoglobin (THb) on the prefrontal cortex (PFC), bilaterally, using fNIRS in 10 participants who performed three voluntary regulated breathing (pranayama) practices viz. (i) Left nostril breathing (LNB), (ii) Right nostril breathing (RNB); and (iii) Alternating nostril breathing (ANB) and compared with normal breathing as baseline (BS). For this, we used 64 channel NIRS system covering left and the right prefrontal cortex. The normal breathing kept as baseline (BS) measures as regressors in the investigation of hemodynamic responses when compared with LNB, RNB and ANB. In the results, we found greater oxygenation in contralateral side i.e., higher activation on the left prefrontal cortex (lPFC) during RNB, and right prefrontal cortex (rPFC) during LNB, whereas ANB showed greater deoxygenation responses on both sides of PFC. Interestingly, LNB showed increased oxygenation on ipsilateral side i.e., lPFC but not during RNB. This suggests that voluntary regulated breathing produced an immediate effect not only on contralateral but ipsilateral sides of the brain as well. In conclusion, breathing practices are tightly coupled to cerebral rhythms of alternating cerebral hemispheric activity during particular nostril breathing. These results of the specific nostril breathing do not support previous findings of contralateral hemispheric improvement while left or right nostril breathing only.

Keywords: hemodynamic responses, brain, pranayama, voluntary regulated breathing practices, prefrontal cortex

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1296 Lateral Torsional Buckling Resistance of Trapezoidally Corrugated Web Girders

Authors: Annamária Käferné Rácz, Bence Jáger, Balázs Kövesdi, László Dunai

Abstract:

Due to the numerous advantages of steel corrugated web girders, its application field is growing for bridges as well as for buildings. The global stability behavior of such girders is significantly larger than those of conventional I-girders with flat web, thus the application of the structural steel material can be significantly reduced. Design codes and specifications do not provide clear and complete rules or recommendations for the determination of the lateral torsional buckling (LTB) resistance of corrugated web girders. Therefore, the authors made a thorough investigation regarding the LTB resistance of the corrugated web girders. Finite element (FE) simulations have been performed to develop new design formulas for the determination of the LTB resistance of trapezoidally corrugated web girders. FE model is developed considering geometrical and material nonlinear analysis using equivalent geometric imperfections (GMNI analysis). The equivalent geometric imperfections involve the initial geometric imperfections and residual stresses coming from rolling, welding and flame cutting. Imperfection sensitivity analysis was performed to determine the necessary magnitudes regarding only the first eigenmodes shape imperfections. By the help of the validated FE model, an extended parametric study is carried out to investigate the LTB resistance for different trapezoidal corrugation profiles. First, the critical moment of a specific girder was calculated by FE model. The critical moments from the FE calculations are compared to the previous analytical calculation proposals. Then, nonlinear analysis was carried out to determine the ultimate resistance. Due to the numerical investigations, new proposals are developed for the determination of the LTB resistance of trapezoidally corrugated web girders through a modification factor on the design method related to the conventional flat web girders.

Keywords: corrugated web, lateral torsional buckling, critical moment, FE modeling

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1295 The Effect of Manual Acupuncture-induced Injury as a Mechanism Contributing to Muscle Regeneration

Authors: Kamal Ameis

Abstract:

This study aims to further improve our understanding of the underlying mechanism of local injury that occurs after manual acupuncture needle manipulation, and that initiates the muscle regeneration process, which is essential for muscle maintenance and adaptation. Skeletal muscle is maintained by resident stem cells called muscle satellite cells. These cells are normally in quiescent state, but following muscle injury, they re-enter the cell cycle and execute a myogenic program resulting in muscle fiber regeneration. Our previous work in young rats demonstrated that acupuncture treatment induced injury that activated resident satellite (stem) cells, which leads to muscle regeneration. Skeletal muscle regeneration is an adaptive response to injury that requires a tightly orchestrated event between signaling pathways activated by growth factor and intrinsic regulatory program controlled by myogenic transcription factor. We identified several gene expressions uniquely important for muscle regeneration in response to acupuncture treatment at different time course using different biological techniques, including Immunocytochemistry, western blotting, and Real Time PCR. This study uses a novel but non-invasive model of injury induced by manual acupuncture to further our current understanding of regenerative mechanism of muscle stem cells. From a clinical perspective, this model of injury induced by manual acupuncture may be easily translatable into a clinical tool that can be used as an alternative to physical exercise for patients challenged by bed rest or forced inactivity. Finally, the knowledge gained from this research could be useful for studies of the local effects of various modalities of induced injury, such as the traditional method of healing by cupping (hijamah), which may enhanced muscle stem cells and muscle fiber regeneration.

Keywords: acupuncture, injury, regeneration, muscle stem cells

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1294 Neuron Point-of-Care Stem Cell Therapy: Intrathecal Transplant of Autologous Bone Marrow-Derived Stem Cells in Patients with Cerebral Palsy

Authors: F. Ruiz-Navarro, M. Matzner, G. Kobinia

Abstract:

Background: Cerebral palsy (CP) encompasses the largest group of childhood movement disorders, the patterns and severity varies widely. Today, the management focuses only on a rehabilitation therapy that tries to secure the functions remained and prevents complications. However the treatments are not aimed to cure the disease. Stem cells (SCs) transplant via intrathecal is a new approach to the disease. Method: Our aim was to performed a pilot study under the condition of unproven treatment on clinical practice to assessed the safety and efficacy of Neuron Point-of-care Stem cell Therapy (N-POCST), an ambulatory procedure of autologous bone marrow derived SCs (BM-SCs) harvested from the posterior superior iliac crest undergo an on-site cell separation for intrathecal infusion via lumbar puncture. Results: 82 patients were treated in a period of 28 months, with a follow-up after 6 months. They had a mean age of 6,2 years old and male predominance (65,9%). Our preliminary results show that: A. No patient had any major side effects, B. Only 20% presented mild headache due to LP, C. 53% of the patients had an improvement in spasticity, D. 61% improved the coordination abilities, 23% improved the motor function, 15% improved the speech, 23% reduced the number of convulsive events with the same doses or less doses of anti-convulsive medication and 94% of the patients report a subjective general improvement. Conclusions: These results support previous worldwide publications that described the safety and effectiveness of autologous BM-SCs transplant for patients wit CP.

Keywords: autologous transplant, cerebral palsy, point of care, childhood movement disorders

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1293 The Effects of Cost-Sharing Contracts on the Costs and Operations of E-Commerce Supply Chains

Authors: Sahani Rathnasiri, Pritee Ray, Sardar M. N. Isalm, Carlos A. Vega-Mejia

Abstract:

This study develops a cooperative game theory-based cost-sharing contract model for a business to consumer (B2C) e-commerce supply chain to minimize the overall supply chain costs and the individual costs within an information asymmetry scenario. The objective of this study is to address the issues of strategic interactions among the key players of the e-commerce supply chain operation, which impedes the optimal operational outcomes. Game theory has been included in the field of supply chain management to resolve strategic decision-making issues; however, most of the studies are limited only to two-echelons of the supply chains. Multi-echelon supply chain optimizations based on game-theoretic models are less explored in the previous literature. This study adopts a cooperative game model to focus on the common payoff of operations and addresses the issues of information asymmetry and coordination of a three-echelon e-commerce supply chain. The cost-sharing contract model integrates operational features such as production, inventory management and distribution with the contract related constraints. The outcomes of the model highlight the importance of maintaining lower operational costs by all players to obtain benefits from the cost-sharing contract. Further, the cost-sharing contract ensures true cost revelation, and hence eliminates the information asymmetry issues among the players. Comparing the results of the contract model with the de-centralized e-commerce supply chain operation further emphasizes that the cost-sharing contract derives Pareto-improved outcomes and minimizes the costs of overall e-commerce supply chain operation.

Keywords: cooperative game theory, cost-sharing contract, e-commerce supply chain, information asymmetry

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1292 Examining Risk Based Approach to Financial Crime in the Charity Sector: The Challenges and Solutions, Evidence from the Regulation of Charities in England and Wales

Authors: Paschal Ohalehi

Abstract:

Purpose - The purpose of this paper, which is part of a PhD thesis is to examine the role of risk based approach in minimising financial crime in the charity sector as well as offer recommendations to improving the quality of charity regulation whilst still retaining risk based approach as a regulatory framework and also making a case for a new regulatory model. Increase in financial crimes in the charity sector has put the role of regulation in minimising financial crime up for debates amongst researchers and practitioners. Although previous research has addressed the regulation of charities, research on the role of risk based approach to minimising financial crime in the charity sector is limited. Financial crime is a concern for all organisation including charities. Design/methodology/approach - This research adopts a social constructionist’s epistemological position. This research is carried out using semi structured in-depth interviews amongst randomly selected 24 charity trustees divided into three classes: 10 small charities, 10 medium charities and 4 large charities. The researcher also interviewed 4 stakeholders (NFA, Charity Commission and two different police forces in terms of size and area of coverage) in the charity sector. Findings - The results of this research show that reliance on risk based approach to financial crime in the sector is weak and fragmented with the research pointing to a clear evidence of disconnect between the regulator and the regulated leading to little or lack of regulation of trustees’ activities, limited monitoring of charities and lack of training and awareness on financial crime in the sector. Originality – This paper shows how regulation of charities in general and risk based approach in particular can be improved in order to meet the expectations of the stakeholders, the public, the regulator and the regulated.

Keywords: risk, risk based approach, financial crime, fraud, self-regulation

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1291 The Relationship of Creativity and Innovation in Artistic Work and Their Importance in Improving the Artistic Organizational Performance

Authors: Houyem Kotti

Abstract:

The development in societies requires that these societies are continuously changing in various aspects, a change that requires continuous adaptation to the data of the technical age. In order for the individual to perform his/her duty or task in a perfect way, it is necessary to provide all the basic requirements and necessities to increase the efficiency and effectiveness of the personnel working to accomplish their tasks, requirements, and work successfully. The success of the industries and organizations are linked to the need to create individuals in the creative and innovative field. Formation process is considered an economic development and social prosperity, and to improve the quantity and quality of artistic work. Therefore, creativity and innovation play an important role in improving the performance of the artistic organization as it is one of the variables affecting the organization's ability to grow and invest. In order to provide better services to their customers, especially in the face of competition and traditional methods of work, and in an environment that discourages and hinders creativity and impairs any process of development, change or creative behavior. The research methodology that will be performed for this study is described as qualitative by conducting several interviews with artistic people, experts in the artistic field and reviewing the related literature to collect the necessary and required qualitative data from secondary sources such as statistical reports, previous research studies, etc. In this research, we will attempt to clarify the relationship between innovation and its importance in the artistic organization, the conditions of achieving innovation and its constraints, barriers, and challenges. The creativity and innovation and their impacts on the performance of artistic organizations, explaining this mechanism, so as to ensure continuity of these organizations and keeping pace with developments in the global economic environment.

Keywords: artistic work, creativity and innovation, artistic organization, performance

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1290 The Multiaxial Load Proportionality Effect on the Fracture Surface Topography of Forged Magnesium Alloys

Authors: Andrew Gryguć, Seyed Behzad Behravesh, Hamid Jahed, Mary Wells, Wojciech Macek, Bruce Williams

Abstract:

This extended abstract investigates the influence of the multiaxial loading on the fatigue behavior of forged magnesium through quantitative analysis of its fracture surface topography and mesoscopic cracking orientation. Fatigue tests were performed on hollow tubular sample geometries extracted from closed-die forged AZ80 Mg components, with three different multiaxial strain paths (axial/shear), proportional, 45° out of phase, and 90° out of phase. Regardless of the strain path, fatigue cracks are initiated at the outer surface of the specimen where the combined stress state is largest. Depending on the salient mode of deformation, distinctive features in the fracture surface manifested themselves with different topographic amplitudes, surface roughness, and mesoscopic cracking orientation in the vicinity of the initiation site. The dominant crack propagation path was in the circumferential direction of the hollow tubular specimen (i.e., cracking transverse to the sample axis, with little to no branching), which is congruent with previous findings of low to moderate shear strain energy density (SED) multiaxial loading. For proportional loading, the initiation zone surface morphology was largely flat and striated, whereas, at phase angles of 45° and 90°, the initiation surface became more faceted and inclined. Overall, both a qualitative and quantitative link was developed between the fracture surface morphology and the level of non-proportionality in the loading providing useful insight into the fracture mechanics of forged magnesium as a relevant focus for future study.

Keywords: fatigue, fracture, magnesium, forging, fractography, anisotropy, strain energy density, asymmetry, multiaxial fatigue

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1289 Phonology and Syntax of Article Incorporation in Mauritian Creole: Evidence from Bantou Languages

Authors: Emmanuel Nikiema

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This paper examines article incorporation in Mauritian Creole, a French Lexifier Creole which exhibits three forms of article incorporation as illustrated in (1-3). While various analyses of article incorporation have been proposed in the literature, fewer studies have explored the motivation of this widespread phenomenon in Mauritian Creole (MC) as opposed to other French Lexifier Creoles spoken in the Caribbean. For example, Mauritian Creole exhibits 4 times more CV incorporation than Haitian Creole, and 40 times more than Reunion Creole. (1) Consonantal type (C): loraz ‘thunder storm’, lete ‘summer’, zwazo ‘bird’, nide ‘idea’. (2) Syllabic type (CV): lapo ‘skin’, liku ‘neck’, ledo ‘back’, leker ‘heart’, diber ‘butter’. (3) Bi-consonantal (CVC): delo ‘water’, dizef ‘egg’, lizye ‘eye’, dilwil ‘oil’. The goal of this study is twofold: 1) uncover the rules governing the three types of article incorporation in MC, and 2) account for its remarkable occurrence in MC as opposed to its quasi-absence in Reunion Creole. We have collected a corpus of over 700 cases and organized it into three categories (C; CV and CVC). For example, there are 471 examples of CV incorporation in MC against 112 in Haitian Creole and only 12 in Reunion Creole. Two questions can be raised: 1) what is the motivation and distribution of the three types of incorporation in MC, and 2) how can one account for the high volume of incorporation in MC as opposed to its quasi-absence in Reunion Creole? We suggest that article incorporation in MC is related to the structure of nouns in Bantou languages. While previous authors have largely used population settlement data in the colonies during the Creole formation period to justify their analyses, we propose an account based on the syntactic structure of Bantou nouns. This analysis will shed light on the contribution of African languages to the formation of MC, and on to why MC has exhibited more article incorporation cases than any other French Lexifier Creole.

Keywords: article incorporation, creole languages, description, phonology

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1288 Unshackled Slaves: An Analysis of the Adjudication of Degrading Conditions of Work by Brazilian Labour Courts

Authors: Aline F. C. Pereira

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In recent years, modern slavery has increasingly gathered attention in scholarly discussions and policy debates. Whereas the mainstream studies focus on forced labour and trafficking, little attention is paid to other forms of exploitation, such as degrading conditions of work –criminalised in Brazil as an autonomous type of slavery since 2003. This paper aims to bridge this gap. It adopts a mixed method that comprises both qualitative and quantitative analysis, to investigate the adjudication of 164 cases of degrading conditions of work by Brazilian labour courts. The research discloses an ungrounded reluctance to apply the domestic legal framework, as in most of the cases degrading conditions of work are not recognised as contemporary slavery, despite the law. In some cases, not even situations described as subhuman and degrading of human dignity were framed as slavery. The analysis also suggests that, as in chattel times, lack of freedom and subjection remain relevant in the legal characterisation of slave labour. The examination has further unraveled a phenomenon absent in previous studies: normalisation of precarity. By depicting precarity as natural and inevitable in rural areas, labour courts ensure conformity to the status quo and reduce the likelihood of resistance by victims. Moreover, compensations afforded to urban workers are higher than granted to rural employees, which seems to place human beings in hierarchical categories -a trace of colonialism. In sum, the findings challenge the worldwide spread assumption that Brazil addresses slavery efficiently. Conversely, the Brazilian Labour Judiciary seems to remain subservient to a colonial perspective of slavery, legitimising, and sanctioning abusive practices.

Keywords: adjudication, contemporary slavery, degrading conditions of work, normalisation of precarity

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1287 Inhibitory Attributes of Saudi Honey Against Hospital Acquired Methicillin Resistant Staph. aureus (MRSA) and Acinetobacter baumannii

Authors: Al-Hindi Rashad, Alotibi Ibrahim

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The aim of this study was to examine the antibacterial activity of the peroxide components of some locally produced honeys: Toran, Zaitoon (Olive), Shaflah, Saha, Jizan, Rabea Aja, Fakhira, Sedr Aljanoob, Tenhat, Karath and Bareq against two of the drug resistant bacteria; i.e., methicillin resistant Staph. aureus (MRSA, ATCC 43330) and Acinetobacter baumannii. Measurement of the antibacterial activity of honey samples by using the agar well diffusion method was adopted as follows: by using turbidity standard McFaraland 0.5, suspensions of bacterial strains MRSA ATCC 43330 and Acinetobacter baumannii were prepared. By the spreading plate method, 100 µl of the suspension was inoculated onto Muller-Hinton agar medium. On the inoculated agar medium, five wells were made using a sterile cork borer (diameter 5 mm).100 µl of honey dilutions (10%, 30%, 50%, 70% and 100%) were used. The study indicated that the highly effective activity was in some local honey samples such as Toran honey against MRSA, and Shafalah honey against MRSA and Acinetobacter baumannii which showed bactericidal effects at concentrations 70 % to 100 % as well. The majority of local honey samples recorded bacteriostatic effects on MRSA and Acinetobacter baumannii at consternations 50 % and above. In conclusion this investigation indicated that in regard to the majority inhibitory effect on microorganisms, the existing of H2O2 in honey samples together with phenolic content greatly provide a strong antibacterial activities among different types of honey, because in some previous studies the H2O2 content of honey interacts with phenolic content and showed better inhibitory effect than in absent of H2O2.

Keywords: antibacterial activity, honey, hospital acquired, Saudi Arabia

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1286 Groundwater Recharge Pattern in East and West Coast of India: Evidence of Dissimilar Moisture Sources

Authors: Ajit Kumar Behera, Saranya P., Sudhir Kumar, Krishnakumar A

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The stable isotope (δ¹⁸ O and δ²H) composition of groundwater of the coastal areas of Periyar and Mahanadi basins falling along East and West coast of India during North-East (NE) monsoon season have been studied. The east and west coast regions are surrounded by the Bay of Bengal and the Arabian Sea respectively, which are considered to be the primary sources for precipitation over India. The major difference between the Bay of Bengal and the Arabian Sea is that a number of large rivers feed the Bay of Bengal, whereas the Arabian Sea is fed by very few small rivers, resulting in enriched stable isotopic composition of the Arabian Sea than the Bay of Bengal. Previous studies have reported depleted ratios of stable isotopes during Northeast monsoon along East and West coasts due to the influence of the Bay of Bengal moisture source. The isotopic composition of groundwater of the Mahanadi delta in the east coast region varies from -6.87 ‰ to -3.40 ‰ for δ¹⁸ O and -45.42 ‰ to -22.43‰ for δ²H. However, the groundwater of the Periyar basin in the west coast has enriched stable isotope value varying from -4.3‰ to -2.5 ‰ for δ¹⁸ O and for δ²H from -23.7 to -6.4 ‰ which is a characteristic of South-West monsoon season. This suggests the groundwater system of the Mahanadi delta and the Periyar basins are influenced by dissimilar moisture sources. The δ¹⁸ O and δ² H relationship (δ²H= 6.513 δ¹⁸ O - 1.39) and d-excess value (< 10) in the east coast region indicates the influence of NE monsoon implying the quick groundwater recharge after precipitation with significant amount of evaporation. In contrast, the δ¹⁸ O and δ²H regression line (δ²H= 8.408 δ¹⁸ O + 11.71) with high d-excess value (>10) in the west coast region implies delayed recharge due to SW monsoon. The observed isotopic enrichment in west coast suggests that NE winter monsoon rainfall does not replenish groundwater quick enough to produce isotopic depletion during the season.

Keywords: Arabian sea, bay of Bengal, groundwater, monsoon, stable isotope

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1285 The Impact of the New Head Injury Pathway on the Number of CTs Performed in a Paediatric Population

Authors: Amel M. A. Osman, Roy Mahony, Lisa Dann, McKenna S.

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Background: Computed Tomography (CT) is a significant source of radiation in the pediatric population. A new head injury (HI) pathway was introduced in 2021, which altered the previous process of HI being jointly admitted with general pediatrics and surgery to admit these patients under the Emergency Medicine Team. Admitted patients included those with positive CT findings not requiring immediate neurosurgical intervention and those who did not meet current criteria for urgent CT brain as per NICE guidelines but were still symptomatic for prolonged observations. This approach aims to decrease the number of CT scans performed. The main aim is to assess the variation in CT scanning rates since the change in the admitting process. A retrospective review of patients presenting to CHI PECU with HI over 6-month period (01/01/19-31/05/19) compared to a 6-month period post introduction of the new pathway (01/06/2022-31/12/2022). Data was collected from the electronic record databases, symphony, and PACS. Results: In 2019, there were 869 presentations of HI, among which 32 (3.68%) had CT scans performed. 2 (6.25%) of those scanned had positive findings. In 2022, there were 1122 HI presentations, with 47 (4.19%) CT scans performed and positive findings in 5 (10.6%) cases. 57 patients were admitted under the new pathway for observation, with 1 having a CT scan following admission. Conclusion: Quantitative lifetime radiation risks for children are not negligible. While there was no statistically significant reduction in CTs performed amongst HIs presenting to our department, a significant group met the criteria for admission under the PECU consultant for prolonged monitoring. There was also a greater proportion of abnormalities on CT scans performed in 2022, demonstrating improved patient selection for imaging. Further data analysis is ongoing to determine if those who were admitted would have previously been scanned under the old pathway.

Keywords: head injury, CT, admission, guidline

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