Search results for: quality by design
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 20610

Search results for: quality by design

3750 Atom Probe Study of Early Stage of Precipitation on Binary Al-Li, Al-Cu Alloys and Ternary Al-Li-Cu Alloys

Authors: Muna Khushaim

Abstract:

Aluminum-based alloys play a key role in modern engineering, especially in the aerospace industry. Introduction of solute atoms such as Li and Cu is the main approach to improve the strength in age-hardenable Al alloys via the precipitation hardening phenomenon. Knowledge of the decomposition process of the microstructure during the precipitation reaction is particularly important for future technical developments. The objective of this study is to investigate the nano-scale chemical composition in the Al-Cu, Al-Li and Al-Li-Cu during the early stage of the precipitation sequence and to describe whether this compositional difference correlates with variations in the observed precipitation kinetics. Comparing the random binomial frequency distribution and the experimental frequency distribution of concentrations in atom probe tomography data was used to investigate the early stage of decomposition in the different binary and ternary alloys which were experienced different heat treatments. The results show that an Al-1.7 at.% Cu alloy requires a long ageing time of approximately 8 h at 160 °C to allow the diffusion of Cu atoms into Al matrix. For the Al-8.2 at.% Li alloy, a combination of both the natural ageing condition (48 h at room temperature) and a short artificial ageing condition (5 min at 160 °C) induces increasing on the number density of the Li clusters and hence increase number of precipitated δ' particles. Applying this combination of natural ageing and short artificial ageing conditions onto the ternary Al-4 at.% Li-1.7 at.% Cu alloy induces the formation of a Cu-rich phase. Increasing the Li content in the ternary alloy up to 8 at.% and increasing the ageing time to 30 min resulted in the precipitation processes ending with δ' particles. Thus, the results contribute to the understanding of Al-alloy design.

Keywords: aluminum alloy, atom probe tomography, early stage, decomposition

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3749 The Role of Autophagy Modulation in Angiotensin-II Induced Hypertrophy

Authors: Kitti Szoke, Laszlo Szoke, Attila Czompa, Arpad Tosaki, Istvan Lekli

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Autophagy plays an important role in cardiac hypertrophy, which is one of the most common causes of heart failure in the world. This self-degradative catabolic process, responsible for protein quality control, balancing sources of energy at critical times, and elimination of damaged organelles. The autophagic activity can be triggered by starvation, oxidative stress, or pharmacological agents, like rapamycin. This induced autophagy can promote cell survival during starvation or pathological stress. In this study, it is investigated the effect of the induced autophagic process on angiotensin induced hypertrophic H9c2 cells. In our study, it is used H9c2 cells as an in vitro model. To induce hypertrophy, cells were treated with 10000 nM angiotensin-II, and to activate autophagy, 100 nM rapamycin treatment was used. The following groups were formed: 1: control, 2: 10000 nM AT-II, 3: 100 nM rapamycin, 4: 100 nM rapamycin pretreatment then 10000 nM AT-II. The cell viability was examined via MTT (cell proliferation assay) assay. The cells were stained with rhodamine-conjugated phalloidin and DAPI to visualize F-actin filaments and cell nuclei then the cell size alteration was examined in a fluorescence microscope. Furthermore, the expression levels of autophagic and apoptotic proteins such as Beclin-1, p62, LC3B-II, Cleaved Caspase-3 were evaluated by Western blot. MTT assay result suggests that the used pharmaceutical agents in the tested concentrations did not have a toxic effect; however, at group 3, a slight decrement was detected in cell viability. In response to AT-II treatment, a significant increase was detected in the cell size; cells became hypertrophic. However, rapamycin pretreatment slightly reduced the cell size compared to group 2. Western blot results showed that AT-II treatment-induced autophagy, because the increased expression of Beclin-1, p62, LC3B-II were observed. However, due to the incomplete autophagy, the apoptotic Cleaved Caspase-3 expression also increased. Rapamycin pretreatment up-regulated Beclin-1 and LC3B-II, down-regulated p62 and Cleaved Caspase-3, indicating that rapamycin-induced autophagy can restore the normal autophagic flux. Taken together, our results suggest that rapamycin activated autophagy reduces angiotensin-II induced hypertrophy.

Keywords: angiotensin-II, autophagy, H9c2 cell line, hypertrophy, rapamycin

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3748 The Investigation of Work Stress and Burnout in Nurse Anesthetists: A Cross-Sectional Study

Authors: Yen Ling Liu, Shu-Fen Wu, Chen-Fuh Lam, I-Ling Tsai, Chia-Yu Chen

Abstract:

Purpose: Nurse anesthetists are confronting extraordinarily high job stress in their daily practice, deriving from the fast-track anesthesia care, risk of perioperative complications, routine rotating shifts, teaching programs and interactions with the surgical team in the operating room. This study investigated the influence of work stress on the burnout and turnover intention of nurse anesthetists in a regional general hospital in Southern Taiwan. Methods: This was a descriptive correlational study carried out in 66 full-time nurse anesthetists. Data was collected from March 2017 to June 2017 by in-person interview, and a self-administered structured questionnaire was completed by the interviewee. Outcome measurements included the Practice Environment Scale of the Nursing Work Index (PES-NWI), Maslach Burnout Inventory (MBI) and nursing staff turnover intention. Numerical data were analyzed by descriptive statistics, independent t test, or one-way ANOVA. Categorical data were compared using the chi-square test (x²). Datasets were computed with Pearson product-moment correlation and linear regression. Data were analyzed by using SPSS 20.0 software. Results: The average score for job burnout was 68.7916.67 (out of 100). The three major components of burnout, including emotional depletion (mean score of 26.32), depersonalization (mean score of 13.65), and personal(mean score of 24.48). These average scores suggested that these nurse anesthetists were at high risk of burnout and inversely correlated with turnover intention (t = -4.048, P < 0.05). Using linear regression model, emotional exhaustion and depersonalization were the two independent factors that predicted turnover intention in the nurse anesthetists (19.1% in total variance). Conclusion/Implications for Practice: The study identifies that the high risk of job burnout in the nurse anesthetists is not simply derived from physical overload, but most likely resulted from the additional emotional and psychological stress. The occurrence of job burnout may affect the quality of nursing work, and also influence family harmony, in turn, may increase the turnover rate. Multimodal approach is warranted to reduce work stress and job burnout in nurse anesthetists to enhance their willingness to contribute in anesthesia care.

Keywords: anesthesia nurses, burnout, job, turnover intention

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3747 Elasticity Model for Easing Peak Hour Demand for Metrorail Transport System

Authors: P. K. Sarkar, Amit Kumar Jain

Abstract:

The demand for Urban transportation is characterised by a large scale temporal and spatial variations which causes heavy congestion inside metro trains in peak hours near Centre Business District (CBD) of the city. The conventional approach to address peak hour congestion, metro trains has been to increase the supply by way of introduction of more trains, increasing the length of the trains, optimising the time table to increase the capacity of the system. However, there is a limitation of supply side measures determined by the design capacity of the systems beyond which any addition in the capacity requires huge capital investments. The demand side interventions are essentially required to actually spread the demand across the time and space. In this study, an attempt has been made to identify the potential Transport Demand Management tools applicable to Urban Rail Transportation systems with a special focus on differential pricing. A conceptual price elasticity model has been developed to analyse the effect of various combinations of peak and nonpeak hoursfares on demands. The elasticity values for peak hour, nonpeak hour and cross elasticity have been assumed from the relevant literature available in the field. The conceptual price elasticity model so developed is based on assumptions which need to be validated with actual values of elasticities for different segments of passengers. Once validated, the model can be used to determine the peak and nonpeak hour fares with an objective to increase overall ridership, revenue, demand levelling and optimal utilisation of assets.

Keywords: urban transport, differential fares, congestion, transport demand management, elasticity

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3746 Advances in Machine Learning and Deep Learning Techniques for Image Classification and Clustering

Authors: R. Nandhini, Gaurab Mudbhari

Abstract:

Ranging from the field of health care to self-driving cars, machine learning and deep learning algorithms have revolutionized the field with the proper utilization of images and visual-oriented data. Segmentation, regression, classification, clustering, dimensionality reduction, etc., are some of the Machine Learning tasks that helped Machine Learning and Deep Learning models to become state-of-the-art models for the field where images are key datasets. Among these tasks, classification and clustering are essential but difficult because of the intricate and high-dimensional characteristics of image data. This finding examines and assesses advanced techniques in supervised classification and unsupervised clustering for image datasets, emphasizing the relative efficiency of Convolutional Neural Networks (CNNs), Vision Transformers (ViTs), Deep Embedded Clustering (DEC), and self-supervised learning approaches. Due to the distinctive structural attributes present in images, conventional methods often fail to effectively capture spatial patterns, resulting in the development of models that utilize more advanced architectures and attention mechanisms. In image classification, we investigated both CNNs and ViTs. One of the most promising models, which is very much known for its ability to detect spatial hierarchies, is CNN, and it serves as a core model in our study. On the other hand, ViT is another model that also serves as a core model, reflecting a modern classification method that uses a self-attention mechanism which makes them more robust as this self-attention mechanism allows them to lean global dependencies in images without relying on convolutional layers. This paper evaluates the performance of these two architectures based on accuracy, precision, recall, and F1-score across different image datasets, analyzing their appropriateness for various categories of images. In the domain of clustering, we assess DEC, Variational Autoencoders (VAEs), and conventional clustering techniques like k-means, which are used on embeddings derived from CNN models. DEC, a prominent model in the field of clustering, has gained the attention of many ML engineers because of its ability to combine feature learning and clustering into a single framework and its main goal is to improve clustering quality through better feature representation. VAEs, on the other hand, are pretty well known for using latent embeddings for grouping similar images without requiring for prior label by utilizing the probabilistic clustering method.

Keywords: machine learning, deep learning, image classification, image clustering

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3745 Facilitating Waste Management to Achieve Sustainable Residential Built Environments

Authors: Ingy Ibrahim El-Darwish, Neveen Youssef Azmy

Abstract:

The endowment of a healthy environment can be implemented by endorsing sustainable fundamentals. Design of sustainable buildings through recycling of waste, can reduce health problems, provide good environments and contribute to the aesthetically pleasing entourage. Such environments can help in providing energy-saving alternatives to consolidate the principles of sustainability. The poor community awareness and the absence of laws and legislation in Egypt for waste management specifically in residential areas have led to an inability to provide an integrated system for waste management in urban and rural areas. Many problems and environmental challenges face the Egyptian urban environments. From these problems, is the lack of a cohesive vision for waste collection and recycling for energy-saving. The second problem is the lack public awareness of the short term and long term vision of waste management. Bad practices have adversely affected the efficiency of environmental management systems due to lack of urban legislations that codify collection and recycling of residential communities in Egyptian urban environments. Hence, this research tries to address residents on waste management matters to facilitate legislative process on waste collection and classification within residential units and outside them in a preparation phase for recycling in the Egyptian urban environments. In order to achieve this goal, one of the Egyptian communities has been addressed, analyzed and studied. Waste collection, classification, separation and access to recycling places in the urban city are proposed in preparation for a legislation ruling and regulating the process. Hence, sustainable principles are to be achieved.

Keywords: recycling, residential buildings, sustainability, waste

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3744 Process Development of pVAX1/lacZ Plasmid DNA Purification Using Design of Experiment

Authors: Asavasereerat K., Teacharsripaitoon T., Tungyingyong P., Charupongrat S., Noppiboon S. Hochareon L., Kitsuban P.

Abstract:

Third generation of vaccines is based on gene therapy where DNA is introduced into patients. The antigenic or therapeutic proteins encoded from transgenes DNA triggers an immune-response to counteract various diseases. Moreover, DNA vaccine offers the customization of its ability on protection and treatment with high stability. The production of DNA vaccines become of interest. According to USFDA guidance for industry, the recommended limits for impurities from host cell are lower than 1%, and the active conformation homogeneity supercoiled DNA, is more than 80%. Thus, the purification strategy using two-steps chromatography has been established and verified for its robustness. Herein, pVax1/lacZ, a pre-approved USFDA DNA vaccine backbone, was used and transformed into E. coli strain DH5α. Three purification process parameters including sample-loading flow rate, the salt concentration in washing and eluting buffer, were studied and the experiment was designed using response surface method with central composite face-centered (CCF) as a model. The designed range of selected parameters was 10% variation from the optimized set point as a safety factor. The purity in the percentage of supercoiled conformation obtained from each chromatography step, AIEX and HIC, were analyzed by HPLC. The response data were used to establish regression model and statistically analyzed followed by Monte Carlo simulation using SAS JMP. The results on the purity of the product obtained from AIEX and HIC are between 89.4 to 92.5% and 88.3 to 100.0%, respectively. Monte Carlo simulation showed that the pVAX1/lacZ purification process is robust with confidence intervals of 0.90 in range of 90.18-91.00% and 95.88-100.00%, for AIEX and HIC respectively.

Keywords: AIEX, DNA vaccine, HIC, puification, response surface method, robustness

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3743 Numerical Analysis Of Stainless Steel Beam To Column Joints With Bolted Flush End Plates

Authors: Takwiir Tahriim Khan, Tausif Khalid, Mohammad Redwan Ahamed, Md Soebur Rahman

Abstract:

The mutual connection in joints has a significant impact on the safe and cost-effective design of steel structures. Generally, the end plates are welded at the end of the beam and columns are bolted with the end plates. Thus, the moment will be transferred at the interface, which is a critical segment at the connection. 3-D Finite Element Models (FEM) has been developed using ABAQUS 2017 software to predict the yield capacity of the end plate connections. The parameters used in this study are the depth, width, and thickness of the end plate, dimensions of the bolt, sectional and material properties of beams and columns. The influence width, depth, and thicknesses of the end plate connection on yield capacity were investigated through parametric studies. The results showed that, for increasing plate thickness from 0.3 inch to 0.8 inch by an increment of 0.1 inch the yield capacity increased by 2.85% on average, for decreasing the end plate depth from 13 inch to 11 inch the yield capacity increased by 25.4 %, and for decreasing the end plate width from 6.5 inch to 5.75 inch the yield capacity increased by 35.4%. Variation in yield capacity was also found by changing the beam and column section. Besides, the numerical results showed a good agreement with published experimental literature with an average variation of less than 8.3 % in yield capacity. So the study allows for a more effective combination of beam, column, and end plate dimensions.

Keywords: steel beam-column joints, finite element analysis, yield moment capacity, parametric study, ABAQUS, bolted joints, flush end plates, moment vs rotation curves

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3742 Advancements in AI Training and Education for a Future-Ready Healthcare System

Authors: Shamie Kumar

Abstract:

Background: Radiologists and radiographers (RR) need to educate themselves and their colleagues to ensure that AI is integrated safely, useful, and in a meaningful way with the direction it always benefits the patients. AI education and training are fundamental to the way RR work and interact with it, such that they feel confident using it as part of their clinical practice in a way they understand it. Methodology: This exploratory research will outline the current educational and training gaps for radiographers and radiologists in AI radiology diagnostics. It will review the status, skills, challenges of educating and teaching. Understanding the use of artificial intelligence within daily clinical practice, why it is fundamental, and justification on why learning about AI is essential for wider adoption. Results: The current knowledge among RR is very sparse, country dependent, and with radiologists being the majority of the end-users for AI, their targeted training and learning AI opportunities surpass the ones available to radiographers. There are many papers that suggest there is a lack of knowledge, understanding, and training of AI in radiology amongst RR, and because of this, they are unable to comprehend exactly how AI works, integrates, benefits of using it, and its limitations. There is an indication they wish to receive specific training; however, both professions need to actively engage in learning about it and develop the skills that enable them to effectively use it. There is expected variability amongst the profession on their degree of commitment to AI as most don’t understand its value; this only adds to the need to train and educate RR. Currently, there is little AI teaching in either undergraduate or postgraduate study programs, and it is not readily available. In addition to this, there are other training programs, courses, workshops, and seminars available; most of these are short and one session rather than a continuation of learning which cover a basic understanding of AI and peripheral topics such as ethics, legal, and potential of AI. There appears to be an obvious gap between the content of what the training program offers and what the RR needs and wants to learn. Due to this, there is a risk of ineffective learning outcomes and attendees feeling a lack of clarity and depth of understanding of the practicality of using AI in a clinical environment. Conclusion: Education, training, and courses need to have defined learning outcomes with relevant concepts, ensuring theory and practice are taught as a continuation of the learning process based on use cases specific to a clinical working environment. Undergraduate and postgraduate courses should be developed robustly, ensuring the delivery of it is with expertise within that field; in addition, training and other programs should be delivered as a way of continued professional development and aligned with accredited institutions for a degree of quality assurance.

Keywords: artificial intelligence, training, radiology, education, learning

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3741 Influence of Loudness Compression on Hearing with Bone Anchored Hearing Implants

Authors: Anja Kurz, Marc Flynn, Tobias Good, Marco Caversaccio, Martin Kompis

Abstract:

Bone Anchored Hearing Implants (BAHI) are routinely used in patients with conductive or mixed hearing loss, e.g. if conventional air conduction hearing aids cannot be used. New sound processors and new fitting software now allow the adjustment of parameters such as loudness compression ratios or maximum power output separately. Today it is unclear, how the choice of these parameters influences aided speech understanding in BAHI users. In this prospective experimental study, the effect of varying the compression ratio and lowering the maximum power output in a BAHI were investigated. Twelve experienced adult subjects with a mixed hearing loss participated in this study. Four different compression ratios (1.0; 1.3; 1.6; 2.0) were tested along with two different maximum power output settings, resulting in a total of eight different programs. Each participant tested each program during two weeks. A blinded Latin square design was used to minimize bias. For each of the eight programs, speech understanding in quiet and in noise was assessed. For speech in quiet, the Freiburg number test and the Freiburg monosyllabic word test at 50, 65, and 80 dB SPL were used. For speech in noise, the Oldenburg sentence test was administered. Speech understanding in quiet and in noise was improved significantly in the aided condition in any program, when compared to the unaided condition. However, no significant differences were found between any of the eight programs. In contrast, on a subjective level there was a significant preference for medium compression ratios of 1.3 to 1.6 and higher maximum power output.

Keywords: Bone Anchored Hearing Implant, baha, compression, maximum power output, speech understanding

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3740 The Optimization of the Parameters for Eco-Friendly Leaching of Precious Metals from Waste Catalyst

Authors: Silindile Gumede, Amir Hossein Mohammadi, Mbuyu Germain Ntunka

Abstract:

Goal 12 of the 17 Sustainable Development Goals (SDGs) encourages sustainable consumption and production patterns. This necessitates achieving the environmentally safe management of chemicals and all wastes throughout their life cycle and the proper disposal of pollutants and toxic waste. Fluid catalytic cracking (FCC) catalysts are widely used in the refinery to convert heavy feedstocks to lighter ones. During the refining processes, the catalysts are deactivated and discarded as hazardous toxic solid waste. Spent catalysts (SC) contain high-cost metal, and the recovery of metals from SCs is a tactical plan for supplying part of the demand for these substances and minimizing the environmental impacts. Leaching followed by solvent extraction, has been found to be the most efficient method to recover valuable metals with high purity from spent catalysts. However, the use of inorganic acids during the leaching process causes a secondary environmental issue. Therefore, it is necessary to explore other alternative efficient leaching agents that are economical and environmentally friendly. In this study, the waste catalyst was collected from a domestic refinery and was characterised using XRD, ICP, XRF, and SEM. Response surface methodology (RSM) and Box Behnken design were used to model and optimize the influence of some parameters affecting the acidic leaching process. The parameters selected in this investigation were the acid concentration, temperature, and leaching time. From the characterisation results, it was found that the spent catalyst consists of high concentrations of Vanadium (V) and Nickel (Ni); hence this study focuses on the leaching of Ni and V using a biodegradable acid to eliminate the formation of the secondary pollution.

Keywords: eco-friendly leaching, optimization, metal recovery, leaching

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3739 Low-Cost Monitoring System for Hydroponic Urban Vertical Farms

Authors: Francesco Ruscio, Paolo Paoletti, Jens Thomas, Paul Myers, Sebastiano Fichera

Abstract:

This paper presents the development of a low-cost monitoring system for a hydroponic urban vertical farm, enabling its automation and a quantitative assessment of the farm performance. Urban farming has seen increasing interest in the last decade thanks to the development of energy efficient and affordable LED lights; however, the optimal configuration of such systems (i.e. amount of nutrients, light-on time, ambient temperature etc.) is mostly based on the farmers’ experience and empirical guidelines. Moreover, even if simple, the maintenance of such systems is labor intensive as it requires water to be topped-up periodically, mixing of the nutrients etc. To unlock the full potential of urban farming, a quantitative understanding of the role that each variable plays in the growth of the plants is needed, together with a higher degree of automation. The low-cost monitoring system proposed in this paper is a step toward filling this knowledge and technological gap, as it enables collection of sensor data related to water and air temperature, water level, humidity, pressure, light intensity, pH and electric conductivity without requiring any human intervention. More sensors and actuators can also easily be added thanks to the modular design of the proposed platform. Data can be accessed remotely via a simple web interface. The proposed platform can be used both for quantitatively optimizing the setup of the farms and for automating some of the most labor-intensive maintenance activities. Moreover, such monitoring system can also potentially be used for high-level decision making, once enough data are collected.

Keywords: automation, hydroponics, internet of things, monitoring system, urban farming

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3738 Strategic Management Education: A Driver of Architectural Career Development in a Changing Environment

Authors: Rigved Chandrashekhar Nimkhedkar, Rajat Agrawal, Vinay Sharma

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Architects need help with a demand for an expanded skill set to effectively navigate a landscape of evolving opportunities and challenges in the dynamic realm of the architectural profession. This literature and survey-based study investigates the reasons behind architects’ choices of careers, as well as the effects of the evolving architectural scenario. The traditional role of architects in construction projects evolves as they explore diverse career motivations, face financial constraints due to an oversupply of professionals, and experience specialisation and upskilling trends. Architects inherently derive numerous value chains as more and more disciplines have been introduced into the design-construction-operation supply chain. This insight emphasizes the importance of integrating management and entrepreneurial education into architectural education rather than keeping them separate entities. The study reveals the complex nature of the entrepreneurially challenging architectural profession, including cash flow management, market competition, environmental sustainability, and innovation opportunities. Loyal to their professional identity, architects express dissatisfaction while envisioning a future in which they play a more significant role in shaping reputable brands and contributing to education. The study emphasizes the importance of dovetailing management and entrepreneurial education in architecture education in preparing graduates for the industry’s changing nature, emphasising the need for real-world skills. This research contributes insights into the architectural profession’s transformative trajectory, emphasising adaptability, upskilling, and educational enhancements as critical success factors.

Keywords: architects, career path, education, management, specialisation

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3737 How Technology Can Help Teachers in Reflective Practice

Authors: Ambika Perisamy, Asyriawati binte Mohd Hamzah

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The focus of this presentation is to discuss teacher professional development (TPD) through the use of technology. TPD is necessary to prepare teachers for future challenges they will face throughout their careers and to develop new skills and good teaching practices. We will also be discussing current issues in embracing technology in the field of early childhood education and the impact on the professional development of teachers. Participants will also learn to apply teaching and learning practices through the use of technology. One major objective of this presentation is to coherently fuse practical, technology and theoretical content. The process begins by concretizing a set of preconceived ideas which need to be joined with theoretical justifications found in the literature. Technology can make observations fairer and more reliable, easier to implement, and more preferable to teachers and principals. Technology will also help principals to improve classroom observations of teachers and ultimately improve teachers’ continuous professional development. Video technology allows the early childhood teachers to record and keep the recorded video for reflection at any time. This will also provide opportunities for her to share with her principals for professional dialogues and continuous professional development plans. A total of 10 early childhood teachers and 4 principals were involved in these efforts which identified and analyze the gaps in the quality of classroom observations and its co relation to developing teachers as reflective practitioners. The methodology used involves active exploration with video technology recordings, conversations, interviews and authentic teacher child interactions which forms the key thrust in improving teaching and learning practice. A qualitative analysis of photographs, videos, transcripts which illustrates teacher’s reflections and classroom observation checklists before and after the use of video technology were adopted. Arguably, although PD support can be magnanimously strong, if teachers could not connect or create meaning out of the opportunities made available to them, they may remain passive or uninvolved. Therefore, teachers must see the value of applying new ideas such as technology and approaches to practice while creating personal meaning out of professional development. These video recordings are transferable, can be shared and edited through social media, emails and common storage between teachers and principals. To conclude the importance of reflective practice among early childhood teachers and addressing the concerns raised before and after the use of video technology, teachers and principals shared the feasibility, practical and relevance use of video technology.

Keywords: early childhood education, reflective, improve teaching and learning, technology

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3736 Availability of TB Infection Control Plans at Rural Hospitals of South Africa

Authors: Takalani Tshitangano

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Background: In Limpopo province the rate of new tuberculosis (TB) cases increase daily. The Infection Control (IC) plan is one of the essential actions for TB IC. This study aimed to establish the availability of these plans at health care facilities. Objectives: The objectives were to explore and describe the awareness and knowledge of health care workers (HCWs) of the availability and content of TB IC plan; and to identity the role of infection control committees from the perspective of HCWs. Method: A qualitative approach using a cross-sectional descriptive design was adopted. The target population was all HCWs from the seven hospitals of Vhembe district. A purposive sampling approach was used to select 57 participants. The approval to conduct this study was obtained from the relevant authorities and participants. Data were collected through seven focus group discussions comprising five to 10 members. An unstructured discussion guide was used to collect data, and an open-coding method was used to analyse the data. Lincoln and Guba’s criteria ensured trustworthiness of the study findings. Results: Findings revealed that HCWs were not aware of the availability and the information contained in the TB IC plans. No person was designated as TB IC officer at hospital level. There was lack of a TB IC Committee and teams as well as ineffective utilisation of those that did exist. Conclusions: It was concluded that if the TB IC plans are not available at health care facilities, then the TB IC practices implemented by HCWs vary, resulting in TB nosocomial infection transmission. It was recommended that the World Health Organisation’s TB IC plans be adopted and implemented in Vhembe district.

Keywords: health care workers' awareness, health care workers' knowledge, availability of TB infection control plans, rural hospitals

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3735 Expression of Tissue Plasminogen Activator in Transgenic Tobacco Plants by Signal Peptides Targeting for Delivery to Apoplast, Endoplasmic Reticulum and Cytosol Spaces

Authors: Sadegh Lotfieblisofla, Arash Khodabakhshi

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Tissue plasminogen activator (tPA) as a serine protease plays an important role in the fibrinolytic system and the dissolution of fibrin clots in human body. The production of this drug in plants such as tobacco could reduce its production costs. In this study, expression of tPA gene and protein targeting to different plant cell compartments, using various signal peptides has been investigated. For high level of expression, Kozak sequence was used after CaMV35S in the beginning of the gene. In order to design the final construction, Extensin, KDEL (amino acid sequence including Lys-Asp-Glu-Leu) and SP (γ-zein signal peptide coding sequence) were used as leader signals to conduct this protein into apoplast, endoplasmic reticulum and cytosol spaces, respectively. Cloned human tPA gene under the CaMV (Cauliflower mosaic virus) 35S promoter and NOS (Nopaline Synthase) terminator into pBI121 plasmid was transferred into tobacco explants by Agrobacterium tumefaciens strain LBA4404. The presence and copy number of genes in transgenic tobacco was proved by Southern blotting. Enzymatic activity of the rt-PA protein in transgenic plants compared to non-transgenic plants was confirmed by Zymography assay. The presence and amount of rt-PA recombinant protein in plants was estimated by ELISA analysis on crude protein extract of transgenic tobacco using a specific antibody. The yield of recombinant tPA in transgenic tobacco for SP, KDEL, Extensin signals were counted 0.50, 0.68, 0.69 microgram per milligram of total soluble proteins.

Keywords: tPA, recombinant, transgenic, tobacco

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3734 Hand Movements and the Effect of Using Smart Teaching Aids: Quality of Writing Styles Outcomes of Pupils with Dysgraphia

Authors: Sadeq Al Yaari, Muhammad Alkhunayn, Sajedah Al Yaari, Adham Al Yaari, Ayman Al Yaari, Montaha Al Yaari, Ayah Al Yaari, Fatehi Eissa

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Dysgraphia is a neurological disorder of written expression that impairs writing ability and fine motor skills, resulting primarily in problems relating not only to handwriting but also to writing coherence and cohesion. We investigate the properties of smart writing technology to highlight some unique features of the effects they cause on the academic performance of pupils with dysgraphia. In Amis, dysgraphics undergo writing problems to express their ideas due to ordinary writing aids, as the default strategy. The Amis data suggests a possible connection between available writing aids and pupils’ writing improvement; therefore, texts’ expression and comprehension. A group of thirteen dysgraphic pupils were placed in a regular classroom of primary school, with twenty-one pupils being recruited in the study as a control group. To ensure validity, reliability and accountability to the research, both groups studied writing courses for two semesters, of which the first was equipped with smart writing aids while the second took place in an ordinary classroom. Two pre-tests were undertaken at the beginning of the first two semesters, and two post-tests were administered at the end of both semesters. Tests examined pupils’ ability to write coherent, cohesive and expressive texts. The dysgraphic group received the treatment of a writing course in the first semester in classes with smart technology and produced significantly greater increases in writing expression than in an ordinary classroom, and their performance was better than that of the control group in the second semester. The current study concludes that using smart teaching aids is a ‘MUST’, both for teaching and learning dysgraphia. Furthermore, it is demonstrated that for young dysgraphia, expressive tasks are more challenging than coherent and cohesive tasks. The study, therefore, supports the literature suggesting a role for smart educational aids in writing and that smart writing techniques may be an efficient addition to regular educational practices, notably in special educational institutions and speech-language therapeutic facilities. However, further research is needed to prompt the adults with dysgraphia more often than is done to the older adults without dysgraphia in order to get them to finish the other productive and/or written skills tasks.

Keywords: smart technology, writing aids, pupils with dysgraphia, hands’ movement

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3733 To Design an Architectural Model for On-Shore Oil Monitoring Using Wireless Sensor Network System

Authors: Saurabh Shukla, G. N. Pandey

Abstract:

In recent times, oil exploration and monitoring in on-shore areas have gained much importance considering the fact that in India the oil import is 62 percent of the total imports. Thus, architectural model like wireless sensor network to monitor on-shore deep sea oil well is being developed to get better estimate of the oil prospects. The problem we are facing nowadays that we have very few restricted areas of oil left today. Countries like India don’t have much large areas and resources for oil and this problem with most of the countries that’s why it has become a major problem when we are talking about oil exploration in on-shore areas also the increase of oil prices has further ignited the problem. For this the use of wireless network system having relative simplicity, smallness in size and affordable cost of wireless sensor nodes permit heavy deployment in on-shore places for monitoring oil wells. Deployment of wireless sensor network in large areas will surely reduce the cost it will be very much cost effective. The objective of this system is to send real time information of oil monitoring to the regulatory and welfare authorities so that suitable action could be taken. This system architecture is composed of sensor network, processing/transmission unit and a server. This wireless sensor network system could remotely monitor the real time data of oil exploration and monitoring condition in the identified areas. For wireless sensor networks, the systems are wireless, have scarce power, are real-time, utilize sensors and actuators as interfaces, have dynamically changing sets of resources, aggregate behaviour is important and location is critical. In this system a communication is done between the server and remotely placed sensors. The server gives the real time oil exploration and monitoring conditions to the welfare authorities.

Keywords: sensor, wireless sensor network, oil, sensor, on-shore level

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3732 The Non-Motor Symptoms of Filipino Patients with Parkinson’s Disease

Authors: Cherrie Mae S. Sia, Noel J. Belonguel, Jarungchai Anton S. Vatanagul

Abstract:

Background: Parkinson’s disease (PD) is a chronic progressive, neurodegenerative disorder known for its motor symptoms such as bradykinesia, resting tremor, muscle rigidity, and postural instability. Patients with PD also experience non-motor symptoms (NMS) such as depression, fatigue, and sleep disturbances that are most of the time unrecognized by clinicians. This may be due to the lack of spontaneous reports from the patients or partly because of the lack of systematic questioning from the healthcare professional. There is limited data with regards to these NMS especially that of Filipino patients with PD. Objectives: This study aims to determine the non-motor symptoms of Filipino patients with Parkinson’s disease. Materials and Methods: This is a prospective, cohort study involving thirty-four patients of Filipino-descent diagnosed with PD in three out-patient clinics in Cebu City from April to September 2014. Each patient was interviewed using the Non-Motor Symptom Scale (NMSS). A Cebuano version of the NMSS was also provided for the non-English speaking patients. Interview time was approximately ten to fifteen minutes for each respondent. Results: Of the thirty-four patients with Parkinson’s disease, majority was noted to be males (N=19) and the disease was noted to be more prevalent in patients with a mean age of 62 (SD±9) years old. Hypertension (59%) and diabetes mellitus (29%) were the common co-morbidities in the study population. All patients presented more than one NMS, with insomnia (41.2%), poor memory (23.5%) and depression (14.7%) being the first non-motor symptoms to occur. Symptoms involving mood/cognition (mean=2.21), and attention/memory (mean=2.05) were noted to be the most frequent and of moderate severity. Based on the NMSS, the symptoms that were noted to be mild and often to occur were those that involved the mood/cognition (score=3.84), attention/memory (score=3.50), and sleep/fatigue (score=3.00) domains. Levodopa-Carbidopa, Ropinirole, and Pramipexole were the most frequently used medications in the study population. Conclusion: Non-motor symptoms (NMS) are common in patients with Parkinson’s disease (PD). They appear at the time of diagnosis of PD or even before the motor symptoms manifest. The earliest non-motor symptoms to occur are insomnia, poor memory, and depression. Those pertaining to mood/cognition and attention/memory are the most frequent NMS and they are of moderate severity. Identifying these NMS by doing a questionnaire-guided interview such as the Non-Motor Symptom Scale (NMSS) before they can become more severe and affect the patient’s quality of life is a must for every clinician caring for a PD patient. Early treatment and control of these NMS can then be given, hence, improving the patient’s outcome and prognosis.

Keywords: non motor symptoms, Parkinson's Disease, insomnia, depression

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3731 Association of Calcium Intake Adequacy with Wealth Indices among Selected Female Adults Living in Depressed and Non-Depressed Area in Metro Manila, Philippines

Authors: Maria Viktoria Melgo

Abstract:

This study aimed to determine the possible association between calcium intake and wealth indices of selected female adults. Specifically, it aimed to: a) determine the calcium intake adequacy of the respondents. b) determine the relationship, if any, between calcium intake adequacy, area and wealth indices. The study used the survey design and employed convenience sampling in selecting participants. Two hundred females aged 20 – 64 years old were covered in the study from depressed and non-depressed areas. Data collected were calcium intake taken from two 24-hour food recall and Food Frequency Questionnaire (FFQ) and wealth indices using housing characteristics, household assets and access to utilities and infrastructure. Descriptive statistics and Chi-square test were used to determine the frequency distribution and association between the given variables, respectively, using Statistical Package for Social Sciences (SPSS) and OpenEpi software. The results showed that there were 86% of respondents in the depressed area with an inadequate calcium intake while there were 78% of respondents in the non-depressed area with an adequate calcium intake. No significant relationship was obtained in most wealth indices with calcium intake adequacy and area but appliance and ownership of main material of the house showed a significant relationship to calcium intake adequacy by area. The study recommends that the Local Government Unit (LGU) should provide seminars or nutrition education that will further enhance the knowledge of the people in the community. The study also recommends to conduct a similar study but with different, larger sample size, different location nonetheless if it is in urban or rural and include the anthropometry measurement of the respondents.

Keywords: association, calcium intake adequacy, metro Manila, Philippines, wealth indices

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3730 Evaluation of Forming Properties on AA 5052 Aluminium Alloy by Incremental Forming

Authors: A. Anbu Raj, V. Mugendiren

Abstract:

Sheet metal forming is a vital manufacturing process used in automobile, aerospace, agricultural industries, etc. Incremental forming is a promising process providing a short and inexpensive way of forming complex three-dimensional parts without using die. The aim of this research is to study the forming behaviour of AA 5052, Aluminium Alloy, using incremental forming and also to study the FLD of cone shape AA 5052 Aluminium Alloy at room temperature and various annealing temperature. Initially the surface roughness and wall thickness through incremental forming on AA 5052 Aluminium Alloy sheet at room temperature is optimized by controlling the effects of forming parameters. The central composite design (CCD) was utilized to plan the experiment. The step depth, feed rate, and spindle speed were considered as input parameters in this study. The surface roughness and wall thickness were used as output response. The process performances such as average thickness and surface roughness were evaluated. The optimized results are taken for minimum surface roughness and maximum wall thickness. The optimal results are determined based on response surface methodology and the analysis of variance. Formability Limit Diagram is constructed on AA 5052 Aluminium Alloy at room temperature and various annealing temperature by using optimized process parameters from the response surface methodology. The cone has higher formability than the square pyramid and higher wall thickness distribution. Finally the FLD on cone shape and square pyramid shape at room temperature and the various annealing temperature is compared experimentally and simulated with Abaqus software.

Keywords: incremental forming, response surface methodology, optimization, wall thickness, surface roughness

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3729 Intelligent Fault Diagnosis for the Connection Elements of Modular Offshore Platforms

Authors: Jixiang Lei, Alexander Fuchs, Franz Pernkopf, Katrin Ellermann

Abstract:

Within the Space@Sea project, funded by the Horizon 2020 program, an island consisting of multiple platforms was designed. The platforms are connected by ropes and fenders. The connection is critical with respect to the safety of the whole system. Therefore, fault detection systems are investigated, which could detect early warning signs for a possible failure in the connection elements. Previously, a model-based method called Extended Kalman Filter was developed to detect the reduction of rope stiffness. This method detected several types of faults reliably, but some types of faults were much more difficult to detect. Furthermore, the model-based method is sensitive to environmental noise. When the wave height is low, a long time is needed to detect a fault and the accuracy is not always satisfactory. In this sense, it is necessary to develop a more accurate and robust technique that can detect all rope faults under a wide range of operational conditions. Inspired by this work on the Space at Sea design, we introduce a fault diagnosis method based on deep neural networks. Our method cannot only detect rope degradation by using the acceleration data from each platform but also estimate the contributions of the specific acceleration sensors using methods from explainable AI. In order to adapt to different operational conditions, the domain adaptation technique DANN is applied. The proposed model can accurately estimate rope degradation under a wide range of environmental conditions and help users understand the relationship between the output and the contributions of each acceleration sensor.

Keywords: fault diagnosis, deep learning, domain adaptation, explainable AI

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3728 Effect of Palatal Lift Prosthesis on Speech Clarity in Flaccid Dysarthria

Authors: Firas Alfwaress, Abdelraheem Bebers Abdelhadi Hamasha, Maha Abu Awaad

Abstract:

Objectives: The aim of the present study was to investigate the effect of Palatal Lift Prosthesis (PLP) on speech clarity in patients with Flaccid Dysarthria. Five speech measures were investigated including Nasalance Scores, Diadchokinetic (DDK), Vowel Duration, airflow, and Sound Intensity. Participants: Twelve (7 Males and 5 females) native speakers of Jordanian Arabic with Flaccid Dysarthria following stroke, traumatic brain injury, and amyotrophic lateral sclerosis were included. The age of the participants ranged from 8–65 years with an average of 31.75 years. Design: Nasalance Scores, Diadchokinetic rate, Vowel Duration, and Sound Intensity were obtained using the Nasometer II, Model 6450 in three conditions. The first condition included obtaining the five measures without wearing the customized Palatal Lift Prosthesis. The second and third conditions included obtaining the five measures immediately after wearing the Palatal Lift Prosthesis and three months later. Results: Palatal lift prosthesis was found to be effective in individuals with flaccid dysarthria. Results showed decrease in the Nasalance Scores for the syllable repetition tasks and vowel prolongation tasks when comparing the means in the pre PLP with the post PLP at p≤0.001 except for the /m/ prolongation task. Results showed increased DDK repetition task, airflow amount, and sound intensity, and a decrease in vowel length at p≤0.001. Conclusions: The use of palatal lift prosthesis is effective in improving the speech of patients with flaccid dysarthria.

Keywords: palatal lift prosthesis, flaccid dysarthria, hypernasality, speech clarity, diadchokinetic rate

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3727 Factors Affecting Access to Education: The Experiences of Parents of Children Who Are Deaf or Hard of Hearing

Authors: Hanh Thi My Nguyen

Abstract:

The purpose of this research is to examine the experiences of parents of children who are deaf or hard of hearing in supporting their children to access education in Vietnam. Parents play a crucial role in supporting their children to gain full access to education. It was widely reported that parents of those children confronted a range of problems to support their children to access education. To author’s best knowledge, there has been a lack of research exploring the experiences of those parents in literature. This research examines factors affecting those parents in supporting their children to access education. To conduct the study, qualitative approach using a phenomenological research design was chosen to explore the central phenomena. Ten parents of children who were diagnosed as deaf or hard of hearing and aged 6-9 years were recruited through the support of the Association of Parents of Children with Hearing Impairment. Participants were interviewed via telephone with a mix of open and closed questions; interviews were audio recorded, transcribed and thematically analysed. The research results show that there are nine main factors that affected the parents in this study in making decisions relating to education for their children including: lack of information resources, perspectives of those parents on communication approaches, the families’ financial capacity, the psychological impact on the participants after their children’ diagnosis, the attitude of family members, attitude of school administrators, lack of local schools and qualified teachers, and current education system for the deaf in Vietnam. Apart from those factors, the lack of knowledge of the participants’ partners about deaf education and the partners’ employment are barriers to educational access and successful communication with their child.

Keywords: access to education, deaf, hard of hearing, parents experience

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3726 Relation Between Marital Adjustment and Parenting: The Moderating Effect of Children´s Temperament

Authors: Ester Ato, Maria Angeles Fernández-Vilar, Maria Dolores Galián

Abstract:

The aim of this work was to analyze the relation between children´s effortful control, marital adjustment and parenting practices in a sample of 345 Spanish children aged between 6 and 8 years. Traditionally, the literature confirms that a higher level of marital conflict has been associated with less effective and less positive parenting, but there are few studies that include the effect that children´s effortful control exert to this relation. To measure marital adjustment, parenting practices and children’s temperament, parents were given the Marital Adjustment Test (MAT), the Spanish version of the PCRI (Parent-Child Relationship Inventory), and the TMCQ (Temperament in Middle Childhood Questionnaire). The results confirmed that higher marital satisfaction predicted more positive parenting practices, whereas lower marital adjustment scores predicted less parenting support and control. Using a statistical modeling approach, we tested a moderation model that revealed the moderating role of effortful control in the relation between marital adjustment and parenting. Concretely, higher marital satisfaction predicts higher parenting communication and involvement, but only in children with low levels of effortful control. Therefore, a difficult temperament interferes in a less negative way in the family system when parents are satisfied and united. And a better self-regulated child predicts more effective parenting practice regardless of the parents´ marital satisfaction. The clinical implications of the present findings should be considered. Specifically, difficult children must be detected and evaluated in community settings, such as school or community programs, in order to take into account the marital adjustment and parenting practices of their parents, and to be able to design adequate family interventions and prevent future pathologizing patterns.

Keywords: effortful control, marital adjustment, parenting, moderation

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3725 Sustainability of Heritage Management in Aksum: Focus on Heritage Conservation and Interpretation

Authors: Gebrekiros Welegebriel Asfaw

Abstract:

The management of the fragile, unique and irreplaceable cultural heritage from different perspectives is becoming a major challenge as important elements of culture are vanishing throughout the globe. The major purpose of this study is to assess how the cultural heritages of Aksum are managed for their future sustainability from heritage conservation and interpretation perspectives. Descriptive type of research design inculcating both quantitative and qualitative research methods is employed. Primary quantitative data was collected from 189 respondents (19 professionals, 88 tourism service providers and 82 tourists) and interview was conducted with 33 targeted informants from heritage and related professions, security employees, local community, service providers and church representatives by applying probability and non probability sampling methods. Findings of the study reveal that the overall sustainable management status of the cultural heritage of Aksum is below average. It is found that the sustainability of cultural heritage management in Aksum is facing a lot of unfavorable factors like lack of long term planning, incompatible system of heritage administration, limited capacity and number of professionals, scant attention to community based heritage and tourism development, dirtiness and drainage problems, problems with stakeholder involvement and cooperation, lack of organized interpretation and presentation systems and others. So, re-organization of the management system, creating platform for coordination among stakeholders and developing appropriate interpretation system can be good remedies. Introducing community based heritage and tourism development concept is also recommendable for a long term win-win success in Aksum.

Keywords: Aksum, conservation, interpretation, Sustainable Cultural Heritage Management

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3724 Development of a Multi-User Country Specific Food Composition Table for Malawi

Authors: Averalda van Graan, Joelaine Chetty, Malory Links, Agness Mwangwela, Sitilitha Masangwi, Dalitso Chimwala, Shiban Ghosh, Elizabeth Marino-Costello

Abstract:

Food composition data is becoming increasingly important as dealing with food insecurity and malnutrition in its persistent form of under-nutrition is now coupled with increasing over-nutrition and its related ailments in the developing world, of which Malawi is not spared. In the absence of a food composition database (FCDB) inherent to our dietary patterns, efforts were made to develop a country-specific FCDB for nutrition practice, research, and programming. The main objective was to develop a multi-user, country-specific food composition database, and table from existing published and unpublished scientific literature. A multi-phased approach guided by the project framework was employed. Phase 1 comprised a scoping mission to assess the nutrition landscape for compilation activities. Phase 2 involved training of a compiler and data collection from various sources, primarily; institutional libraries, online databases, and food industry nutrient data. Phase 3 subsumed evaluation and compilation of data using FAO and IN FOODS standards and guidelines. Phase 4 concluded the process with quality assurance. 316 Malawian food items categorized into eight food groups for 42 components were captured. The majority were from the baby food group (27%), followed by a staple (22%) and animal (22%) food group. Fats and oils consisted the least number of food items (2%), followed by fruits (6%). Proximate values are well represented; however, the percent missing data is huge for some components, including Se 68%, I 75%, Vitamin A 42%, and lipid profile; saturated fat 53%, mono-saturated fat 59%, poly-saturated fat 59% and cholesterol 56%. A multi-phased approach following the project framework led to the development of the first Malawian FCDB and table. The table reflects inherent Malawian dietary patterns and nutritional concerns. The FCDB can be used by various professionals in nutrition and health. Rising over-nutrition, NCD, and changing diets challenge us for nutrient profiles of processed foods and complete lipid profiles.

Keywords: analytical data, dietary pattern, food composition data, multi-phased approach

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3723 Cooperative Cross Layer Topology for Concurrent Transmission Scheduling Scheme in Broadband Wireless Networks

Authors: Gunasekaran Raja, Ramkumar Jayaraman

Abstract:

In this paper, we consider CCL-N (Cooperative Cross Layer Network) topology based on the cross layer (both centralized and distributed) environment to form network communities. Various performance metrics related to the IEEE 802.16 networks are discussed to design CCL-N Topology. In CCL-N topology, nodes are classified as master nodes (Master Base Station [MBS]) and serving nodes (Relay Station [RS]). Nodes communities are organized based on the networking terminologies. Based on CCL-N Topology, various simulation analyses for both transparent and non-transparent relays are tabulated and throughput efficiency is calculated. Weighted load balancing problem plays a challenging role in IEEE 802.16 network. CoTS (Concurrent Transmission Scheduling) Scheme is formulated in terms of three aspects – transmission mechanism based on identical communities, different communities and identical node communities. CoTS scheme helps in identifying the weighted load balancing problem. Based on the analytical results, modularity value is inversely proportional to that of the error value. The modularity value plays a key role in solving the CoTS problem based on hop count. The transmission mechanism for identical node community has no impact since modularity value is same for all the network groups. In this paper three aspects of communities based on the modularity value which helps in solving the problem of weighted load balancing and CoTS are discussed.

Keywords: cross layer network topology, concurrent scheduling, modularity value, network communities and weighted load balancing

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3722 A Three-Dimensional Assessment Approach on Sustainable Development Process of Sportswear Products

Authors: Y. N. Fung, R. Liu, T. M. Choi

Abstract:

The life cycle assessment (LCA) is widely applied in the study of the sustainable fashion industry. Through the LCA, the social, environmental, and economic performances of the fashion industry can be assessed, which helps sustainable product developers (designers, retailers, and manufacturers) to address problems in product development. In prior studies, environmental impact, economic performance, and social responsibility are commonly considered separately. Inter-relations between dimensions of sustainability and LCA are rarely reported. The development process of sustainable sportswear products is complicated. Changes in the product components (e.g., materials, manufacturing methods, and product design) of sportswear will correspondingly influence supply chain activities and meanwhile affect environmental, economic, and social performances. In this study, the interrelations between different LCAs and how the interrelated LCAs can help product developers to strike a balance among environmental, economic, and social performances are explored. Based on the findings, a three-dimensional assessment framework on the sustainability life cycle is introduced. To examine the applicability of the developed framework, proof-of-concept sportswear legging products were developed. The developed sportswear legging products were assessed in terms of the interrelated dimensions of environmental, economic, and social performances. The results demonstrate the effects of shifting in desig¬n details and product functions on the environmental, social, and economic performances of sportswear products. The outcome of this study provides insights on the approach to balance sustainability and the development of cost-effective and sustainable sportswear products for sportswear developers.

Keywords: sustainable development, sports fashion, life cycle assessment, indicators for sustainability, sustainability impacts

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3721 Microalgae Hydrothermal Liquefaction Process Optimization and Comprehension to Produce High Quality Biofuel

Authors: Lucie Matricon, Anne Roubaud, Geert Haarlemmer, Christophe Geantet

Abstract:

Introduction: This case discusses the management of two floor of mouth (FOM) Squamous Cell Carcinomas (SCC) not identified upon initial biopsy. Case Report: A 51 year-old male presented with right FOM erythroleukoplakia. Relevant medical history included alcoholic dependence syndrome and alcoholic liver disease. Relevant drug therapy encompassed acamprosate, folic acid, hydroxocobalamin and thiamine. The patient had a 55.5 pack-year smoking history and alcohol dependence from age 14, drinking 16 units/day. FOM incisional biopsy and histopathological analysis diagnosed Carcinoma in situ. Treatment involved wide local excision. Specimen analysis revealed two separate foci of pT1 moderately differentiated SCCs. Carcinoma staging scans revealed no pathological lymphadenopathy, no local invasion or metastasis. SCCs had been excised in completion with narrow margins. MDT discussion concluded that in view of the field changes it would be difficult to identify specific areas needing further excision, although techniques such as Lugol’s Iodine were considered. Further surgical resection, surgical neck management and sentinel lymph node biopsy was offered. The patient declined intervention, primary management involved close monitoring alongside alcohol and smoking cessation referral. Discussion: Narrow excisional margins can increase carcinoma recurrence risk. Biopsy failed to identify SCCs, despite sampling an area of clinical concern. For gross field change multiple incisional biopsies should be considered to increase chance of accurate diagnosis and appropriate treatment. Coupling of tobacco and alcohol has a synergistic effect, exponentially increasing the relative risk of oral carcinoma development. Tobacco and alcoholic control is fundamental in reducing treatment‑related side effects, recurrence risk, and second primary cancer development.

Keywords: microalgae, biofuels, hydrothermal liquefaction, biomass

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