Search results for: knowledge management best practice

Authors: P. V. Pramila , V. Mahesh

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Pulmonary Function Tests are important non-invasive diagnostic tests to assess respiratory impairments and provides quantifiable measures of lung function. Spirometry is the most frequently used measure of lung function and plays an essential role in the diagnosis and management of pulmonary diseases. However, the test requires considerable patient effort and cooperation, markedly related to the age of patients esulting in incomplete data sets. This paper presents, a nonlinear model built using Multivariate adaptive regression splines and Random forest regression model to predict the missing spirometric features. Random forest based feature selection is used to enhance both the generalization capability and the model interpretability. In the present study, flow-volume data are recorded for N= 198 subjects. The ranked order of feature importance index calculated by the random forests model shows that the spirometric features FVC, FEF 25, PEF,FEF 25-75, FEF50, and the demographic parameter height are the important descriptors. A comparison of performance assessment of both models prove that, the prediction ability of MARS with the `top two ranked features namely the FVC and FEF 25 is higher, yielding a model fit of R2= 0.96 and R2= 0.99 for normal and abnormal subjects. The Root Mean Square Error analysis of the RF model and the MARS model also shows that the latter is capable of predicting the missing values of FEV1 with a notably lower error value of 0.0191 (normal subjects) and 0.0106 (abnormal subjects). It is concluded that combining feature selection with a prediction model provides a minimum subset of predominant features to train the model, yielding better prediction performance. This analysis can assist clinicians with a intelligence support system in the medical diagnosis and improvement of clinical care.

Keywords: FEV, multivariate adaptive regression splines pulmonary function test, random forest

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Authors: Wisit Wichitkosoom

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Objective:The majority of the hisk-risk patients (ST-elevation myocardial infarction (STEMI), Acute cerebrovascular accident, Sepsis, Acute Traumatic patient ) are admitted to district or lacal hospitals (average 1-1.30 hr. from Udonthani general hospital, Northeastern province, Thailand) without proper facilities. The referral system was support to early care and early management at pre-hospital stage and prepare for the patient data to higher hospital. This study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to Udonthani General Hospital. Methods and results: Four district or local hospitals without proper facilities for treatment the very high-risk patient were serving the study region. Pre-hospital diagnoses were established with the simple technology such as LINE, SMS, telephone and Fax for concept of LEAN process and then the telemedicine, by ambulance monitoring (ECG, SpO2, BT, BP) in both real time and snapshot mode was administrated during the period of transfer for safety transfer concept (inter-hospital stage). The standard treatment for patients with STEMI, Intracranial injury and acute cerebrovascular accident were done. From 1 October 2012 to 30 September 2013, the 892 high-risk patients transported by ambulance and transferred to Udonthani general hospital were registered. Patients with STEMI diagnosed pre-hospitally and referred directly to the Udonthani general hospital with telemedicine closed monitor (n=248). The mortality rate decreased from 11.69% in 2011 to 6.92 in 2012. The 34 patients were arrested on the way and successful to CPR during transfer with the telemedicine consultation were 79.41%. Conclusion: The proper innovation could apply for health care system. The very high-risk patients must had the closed monitoring with two-way communication for the “safety transfer period”. It could modified to another high-risk group too.

Keywords: safety transfer, telemedicine, critical patients, medical and health sciences

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Authors: Umar Rehman, Holly Roy, K. T. Tsang, D. S. Jeyaretna, W Singleton, B. Fisher, P. A. Glew, J. Greig, Peter C. Whitfield

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Introduction: A brain abscess is a life-threatening condition, carrying significant mortality. It requires rapid identification and treatment. Management involves a combination of antibiotics and surgery. The aim of the current study was to identify common bacteria responsible for cerebral abscesses as well as the long term functional and neurological outcomes of patients following treatment in a retrospective series at a single UK neurosurgical centre. Methodology: We analysed patients that had received a diagnosis of 'cerebral abscess' or 'subdural empyema' between June 2002 and June 2018. This was done in the form of a retrospective review. The search resulted in a total of 180 patients; with 37 patients being excluded (spinal abscess, below 18 or non-abscess related admissions). Data were collected from medical case notes including information about demographics, comorbidities, immunosuppression, presentation, size/location of lesions, pathogens, treatment, and outcomes. Results: In total, we analysed 143 patients between the ages of 18-90. Focal neurological deficit and headaches were seen in 84% and 68% of patients respectively. 108 positive brain cultures were seen; with the largest proportion, 59.2% being gram-positive cocci, with strep intermedius being the most common pathogen identified in 13.9% of patients. Of the patients with positive blood cultures (n=11), 72.7% showed the same organism both in the blood and on the brain cultures. Long term outcomes (n=72) revealed that 48% of patients seizure-free without requiring anti-epileptics, 51.3% of patients had full recovery of their neurological symptoms. There was a mortality rate of 13.9% in the series. Conclusion: In conclusion, the largest bacterial cause of abscess within our population was due to gram-positive cocci. The majority of the patient demonstrated full neurological recovery with close to half of patients not requiring anti-epileptics following discharge.

Keywords: bacteria, cerebral abscess, long term outcome, neurological deficit

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Authors: Jared Cheves, Amanda DeChent, Joyce Pan

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Total knee replacements (TKAs) are one of the most common but painful surgical procedures performed in the United States. Currently, the gold standard for postoperative pain management is the utilization of opioids. However, in the wake of the opioid epidemic, the healthcare system is attempting to reduce opioid consumption by trialing innovative opioid sparing analgesic techniques such as continuous peripheral nerve blocks (CPNB) and continuous periarticular infiltration (CPAI). The alleviation of pain, particularly during the first 72 hours postoperatively, is of utmost importance due to its association with delayed recovery, impaired rehabilitation, immunosuppression, the development of chronic pain, the development of rebound pain, and decreased patient satisfaction. While both CPNB and CPAI are being used today, there is limited evidence comparing the two to the current standard of care or to each other. An extensive literature review was performed to explore the safety profiles and effectiveness of CPNB and CPAI in reducing reported pain scores and decreasing opioid consumption. The literature revealed the usage of CPNB contributed to lower pain scores and decreased opioid use when compared to opioid-only control groups. Additionally, CPAI did not improve pain scores or decrease opioid consumption when combined with a multimodal analgesic (MMA) regimen. When comparing CPNB and CPAI to each other, neither unanimously lowered pain scores to a greater degree, but the literature indicates that CPNB decreased opioid consumption more than CPAI. More research is needed to further cement the efficacy of CPNB and CPAI as standard components of MMA in TKA procedures. In addition, future research can also focus on novel catheter-free applications to reduce the complications of continuous catheter analgesics.

Keywords: total knee arthroplasty, continuous peripheral nerve blocks, continuous periarticular infiltration, opioid, multimodal analgesia

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Authors: Atikah Nurhayati, Asep A. Handaka

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Indonesia is a world’s major fish producer which can feed not only its citizens but also the people of the world. Currently, the total annual production is 11 tons and expected to double by the year of 2050. Given the potential, fishery has been an important part of the national food security system in Indonesia. Despite such a potential, a big challenge is facing the Indonesians in making fish the reliable source for their food, more specifically source of protein intake. The long geographic distance between the fish production centers and the consumer concentrations has prevented effective supply chain from producers to consumers and therefore demands a good logistic system. This paper is based on our research, which aimed at analyzing the fish supply chain and is to suggest relevant improvement to the chain. The research was conducted in the Year of 2016 in selected locations of Java Island, where intensive transaction on fishery commodities occur. Data used in this research comprises secondary data of time series reports on production and distribution and primary data regarding distribution aspects which were collected through interviews with purposively selected 100 respondents representing fishers, traders and processors. The data were analyzed following the supply chain management framework and processed following logistic regression and validity tests. The main findings of the research are as follows. Firstly, it was found that improperly managed connectivity and logistic chain is the main cause for insecurity of availability and affordability for the consumers. Secondly, lack of quality of most local processed products is a major obstacle for improving affordability and connectivity. The paper concluded with a number of recommended strategies to tackle the problem. These include rationalization of the length of the existing supply chain, intensification of processing activities, and improvement of distribution infrastructure and facilities.

Keywords: fishery, food security, logistic, supply chain

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Authors: Hilal Keklicek, Baris Cetin, Yeliz Salci, Ayla Fil, Umut Altinkaynak, Kadriye Armutlu

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Objectives and Goals: Spasticity is a common symptom characterized with a velocity dependent increase in tonic stretch reflexes (muscle tone) in patient with multiple sclerosis (MS). Hypertonic muscles affect the normal plantigrade contact by disturbing accommodation of foot to the ground while walking. It is important to know the differences between healthy and neurologic foot features for management of spasticity related deformities and/or determination of rehabilitation purposes and contents. This study was planned with the aim of investigating the dynamic plantar pressure distribution in individuals with MS and determining the differences between healthy individuals (HI). Methods: Fifty-five individuals with MS (108 foot with spasticity according to Modified Ashworth Scale) and 20 HI (40 foot) were the participants of the study. The dynamic pedobarograph was utilized for evaluation of dynamic loading parameters. Participants were informed to walk at their self-selected speed for seven times to eliminate learning effect. The parameters were divided into 2 categories including; maximum loading pressure (N/cm2) and time of maximum pressure (ms) were collected from heal medial, heal lateral, mid foot, heads of first, second, third, fourth and fifth metatarsal bones. Results: There were differences between the groups in maximum loading pressure of heal medial (p < .001), heal lateral (p < .001), midfoot (p=.041) and 5th metatarsal areas (p=.036). Also, there were differences between the groups the time of maximum pressure of all metatarsal areas, midfoot, heal medial and heal lateral (p < .001) in favor of HI. Conclusions: The study provided basic data about foot pressure distribution in individuals with MS. Results of the study primarily showed that spasticity of lower extremity muscle disrupted the posteromedial foot loading. Secondarily, according to the study result, spasticity lead to inappropriate timing during load transfer from hind foot to forefoot.

Keywords: multiple sclerosis, plantar pressure distribution, gait, norm values

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Authors: Y. Fandja, O. Colot, M. Croquet

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Small and medium-sized firms (SMEs) face difficulties in accessing bank credit. Bank credit is actually the main source of external financing for SMEs. In general, SMEs are risky businesses because of the potential opacity maintained by the leader in the management of affairs, the agency conflicts between business owners and third-party funders and the potential opportunism of the leader due to the incompleteness of the contracts. These elements accentuate the problems of information asymmetries between SMEs and bankers leading to capital rationing. Moreover, the last economic crisis reinforced this rationing of capital. However, a long-term relationship between SMEs and their bank would enable the latter to accumulate a set of relevant information allowing the reduction of information asymmetry and, consequently, the reduction of credit rationing. The objective of this research is to investigate the lived experience of SMEs loan officers in their relationships with their clients in order to understand how these relationships can affect the financing structure of these SMEs. To carry out this research, an Interpretative Phenomenological Analysis is implemented. This approach is part of the constructivist paradigm and refers to the subjective narratives of the individual rather than to an objective description of the facts. The role of the researcher is to explore the lived experience of the interviewees and to try to understand the meaning they give to this experience. Currently, several sixty-minute semi-structured interviews with loan officers for SMEs have been conducted. The analysis of the content of these interviews brought out three main themes. First, the relationship between the credit officer and the company manager is complex because the credit officer is not aware of establishing a personal relationship with his client. Second; the emotional involvement in the bank financing decision is present and third, the trust in the relationship between the credit officer and his client is very important. The originality of this research is to use the interpretative phenomenological analysis more specific to psychology and sociology in order to approach in a different way the problem of the financing of SMEs through their particular relations with the bankers.

Keywords: financing structure, interpretative phenomenological analysis, relationship financing, SME

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Authors: Xenia I. Loizidou, Anthi Gavriel, Demetra Petsa

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The tourism industry is a significant contributor to Cyprus's Gross Domestic Product. However, as the main tourism product is 'sun and sea', the industry is significantly unsustainable, with the majority of tourists (approx. 90%) concentrated in coastal areas over a short period of time, causing negative environmental, social, and economic impacts. The newly established Cypriot Deputy Ministry of Tourism aims to diversify the Cypriot tourism industry by focusing on the development of niche tourism products that will elongate the touristic season and divert visitors to inland mountainous and rural areas. In this respect, conference and event tourism is an ideal product for development. The current paper presents the results of fieldwork carried out between January and March 2020 in Cyprus, with key stakeholders within the conference and event tourism sector. The work consisted of a survey and semi-structured interviews to determine the current level of sustainability within the conference tourism sector, the main barriers to the sector's development, as well as key stakeholder insights and suggestions for measures to improve the sector's sustainability. The results suggest that there is a general lack of understanding of the negative economic, environmental and social impacts associated with the organization of conventional conferences and events, compared to the positive impacts of sustainable conferences/events. There also seems to be a lack of awareness of actions that can be taken to make the conference and event sector more sustainable. Incentives, marketing, branding, and training are identified as some of the effective means to improve the sustainability of the Cypriot conference and event sector, as is the development of country-wide sustainability policy and a review and enforcement of national waste management legislation. The research outputs will be utilized for the development of targeted toolkits, training, and awareness-raising activities that will drive Cyprus towards becoming an international sustainable tourism destination.

Keywords: conference, event, sustainability, tourism

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Authors: M. L. Seretlo-Rangata, T. Sodi, S. Govender

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Despite interventions by various governments to regulate water demand and address water scarcity, literature shows that billions of people across the world continue to struggle with access because not everyone contributes equally to conservation efforts. Behavioral factors such as individual and collective aspects of cognition and commitment have been found to play an important role in water conservation. The aim of the present study was to explore the perceptions of community members in the Lephalale area, Limpopo province, towards water conservation with a view to developing an explanatory psychological model on water conservation. Twenty (20) participants who relied on communal taps to access water in Lephalale Local Municipality, Limpopo province, were selected through purposeful sampling. In-depth, semi-structured, individual face-to-face interviews were used to gather data and were analyzed utilizing thematic content analysis (TCA). The research findings revealed that there are various psychological effects of water scarcity on communities, such as emotional distress, interpersonal conflicts and disruptions of daily activities of living. Additionally, the study results showed that the coping strategies developed by participants to deal with water scarcity included adopting alternative water use behaviors as well as adjusting current behaviors and lifestyles. Derived from the study findings, a psychological model of water conservation was developed. The model incorporates some ideas from the Value-Belief-Norm (VBN) theory and the Afrocentric theory. The model suggests that people’s worldviews, including their values, beliefs and culture, are significant determinants of their pro-environmental behaviors. The study concludes by recommending that authorities and policymakers should consider psychological factors when developing water management programs, strategies and interventions with the consultation of psychology experts.

Keywords: water conservation, psychological model, pro-environmental behaviour, conservation psychology, water-use behaviour

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Authors: Reza Tirsadi Librawan, Tara Vergita Rakhma

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The increasing demand for energy and concern of global warming are intertwined issues of critical importance. With the pressing needs of clean, efficient and cost-effective energy conversion processes, an alternative clean energy source is needed. Biomass is one of the preferable options because it is clean and renewable. The efficiency for biomass conversion is constrained by the relatively low energy density and high moisture content from biomass. This study based on bio-based resources presents the Biomass Direct Chemical Looping Combustion Process (BDCLC), an alternative process that has a potential to convert biomass in thermal cracking to produce electricity and CO2. The BDCLC process using iron-based oxygen carriers has been developed as a biomass conversion process with in-situ CO2 capture. The BDCLC system cycles oxygen carriers between two reactor, a reducer reactor and combustor reactor in order to convert coal for electric power generation. The reducer reactor features a unique design: a gas-solid counter-current moving bed configuration to achieve the reduction of Fe2O3 particles to a mixture of Fe and FeO while converting the coal into CO2 and steam. The combustor reactor is a fluidized bed that oxidizes the reduced particles back to Fe2O3 with air. The oxidation of iron is an exothermic reaction and the heat can be recovered for electricity generation. The plant design’s objective is to obtain 5 MW of electricity with the design of the reactor in 900 °C, 2 ATM for the reducer and 1200 °C, 16 ATM for the combustor. We conduct process simulation and analysis to illustrate the individual reactor performance and the overall mass and energy management scheme of BDCLC process that developed by Aspen Plus software. Process simulation is then performed based on the reactor performance data obtained in multistage model.

Keywords: biomass, CO2 capture, direct chemical looping combustion, power generation

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Authors: Monish Sengupta, Benjamin Heydecker, Daniel Woodland

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New train control systems rely mainly on Automatic Train Protection (ATP) and Automatic Train Operation (ATO) dynamically to control the speed and hence performance. The ATP and the ATO form the vital element within the CBTC (Communication Based Train Control) and within the ERTMS (European Rail Traffic Management System) system architectures. Reliable and accurate measurement of train location, speed and acceleration are vital to the operation of train control systems. In the past, all CBTC and ERTMS system have deployed a balise or equivalent to correct the uncertainty element of the train location. Typically a CBTC train is allowed to miss only one balise on the track, after which the Automatic Train Protection (ATP) system applies emergency brake to halt the service. This is because the location uncertainty, which grows within the train control system, cannot tolerate missing more than one balise. Balises contribute a significant amount towards wayside maintenance and studies have shown that balises on the track also forms a constraint for future track layout change and change in speed profile.This paper investigates the causes of the location uncertainty that is currently experienced and considers whether it is possible to identify an effective filter to ascertain, in conjunction with appropriate sensors, more accurate speed, distance and location for a CBTC driven train without the need of any external balises. An appropriate sensor fusion algorithm and intelligent sensor selection methodology will be deployed to ascertain the railway location and speed measurement at its highest precision. Similar techniques are already in use in aviation, satellite, submarine and other navigation systems. Developing a model for the speed control and the use of Kalman filter is a key element in this research. This paper will summarize the research undertaken and its significant findings, highlighting the potential for introducing alternative approaches to train positioning that would enable removal of all trackside location correction balises, leading to huge reduction in maintenances and more flexibility in future track design.

Keywords: ERTMS, CBTC, ATP, ATO

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Authors: Gholba Niranjan Dilip, Anil Kumar

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Conduct of accurate reliable mapping of oil palm plantations and census of individual palm trees is a huge challenge. This study addresses this challenge and developed an optimized solution implemented deep learning techniques on remote sensing data. The oil palm is a very important tropical crop. To improve its productivity and land management, it is imperative to have accurate census over large areas. Since, manual census is costly and prone to approximations, a methodology for automated census using panchromatic images from Cartosat-2, SkySat and World View-3 satellites is demonstrated. It is selected two different study sites in Indonesia. The customized set of training data and ground-truth data are created for this study from Cartosat-2 images. The pre-trained model of Single Shot MultiBox Detector (SSD) Lite MobileNet V2 Convolutional Neural Network (CNN) from the TensorFlow Object Detection API is subjected to transfer learning on this customized dataset. The SSD model is able to generate the bounding boxes for each oil palm and also do the counting of palms with good accuracy on the panchromatic images. The detection yielded an F-Score of 83.16 % on seven different images. The detections are buffered and dissolved to generate polygons demarcating the boundaries of the oil palm plantations. This provided the area under the plantations and also gave maps of their location, thereby completing the automated census, with a fairly high accuracy (≈100%). The trained CNN was found competent enough to detect oil palm crowns from images obtained from multiple satellite sensors and of varying temporal vintage. It helped to estimate the increase in oil palm plantations from 2014 to 2021 in the study area. The study proved that high-resolution panchromatic satellite image can successfully be used to undertake census of oil palm plantations using CNNs.

Keywords: object detection, oil palm tree census, panchromatic images, single shot multibox detector

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Authors: Aisling Gough, Ruth F. Hunter, Jianjun Tang, Sarah F. Brennan, Oliver Smith, Mark A. Tully, Chris Patterson, Alberto Longo, George Hutchinson, Lindsay Prior, David French, Jean Adams, Emma McIntosh, Frank Kee

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Background: As a large proportion of the UK workforce is employed in sedentary occupations, worksite interventions have the potential to contribute significantly to the health of the population. The UK Government is currently encouraging the use of financial incentives to promote healthier lifestyles but there is a dearth of evidence regarding the effectiveness and sustainability of incentive schemes to promote physical activity in the workplace. Methods: A large cluster RCT is currently underway, incorporating nested behavioural economic field experiments and process evaluation, to evaluate the effectiveness of a Physical Activity Loyalty Scheme. Office-based employees were recruited from large public sector organisations in Lisburn and Belfast (Northern Ireland) and randomised to an Intervention or Control group. Participants in the Intervention Group were encouraged to take part in 150 minutes of physical activity per week through provision of financial incentives (retailer vouchers) to those who met physical activity targets throughout the course of the 6 month intervention. Minutes of physical activity were monitored when participants passed by sensors (holding a keyfob) placed along main walking routes, parks and public transport stops nearby their workplace. Participants in the Control Group will complete the same outcome assessments (waiting-list control). The primary outcome is steps per day measured via pedometers (7 days). Secondary outcomes include health and wellbeing (Short Form-8, EuroQol-5D-5L, Warwick Edinburgh Mental Well Being Scale), and work absenteeism and presenteeism. Data will be collected at baseline, 6, 12 and 18 months. Information on PAL card & website usage, voucher downloads and redemption of vouchers will also be collected as part of a comprehensive process evaluation. Results: In total, 853 participants have been recruited from 9 workplaces in Lisburn, 12 buildings within the Stormont Estate, Queen’s University Belfast and Belfast City Hospital. Participants have been randomised to intervention and control groups. Baseline and 6-month data for the Physical Activity Loyalty Scheme has been collected. Findings regarding the effectiveness of the intervention from the 6-month follow-up data will be presented. Discussion: This study will address the gap in knowledge regarding the effectiveness and cost-effectiveness of a workplace-based financial incentive scheme to promote a healthier lifestyle. As the UK workforce is increasingly sedentary, workplace-based physical activity interventions have significant potential in terms of encouraging employees to partake in physical activity during the working day which could lead to substantial improvements in physical activity levels overall. Implications: If a workplace based physical activity intervention such as this proves to be both effective and cost-effective, there is great potential to contribute significantly to the health and wellbeing of the workforce in the future. Workplace-based physical activity interventions have the potential to improve the physical and mental health of employees which may in turn lead to economic benefits for the employer, such as reduction in rates of absenteeism and increased productivity.

Keywords: behaviour change, cluster randomised controlled trial, loyalty scheme, physical activity

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Authors: Soojin Kim, Yongjae Kim

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Continuous economic downturn and ongoing budget cuts poses higher education with profound challenges which has a direct impact on the collegiate athletic programs. In response to the ever-changing landscape of the fiscal environment, universities seek to boost revenues, resorting to alternative sources of funding. In particular, athletic programs have become increasingly dependent on financial support from their alumni and boosters, which is how athletic departments attempt to offset budget shortfalls and make capital improvements. Although there currently exists three major divisions within National Collegiate Athletic Association (NCAA), the majority of the sport management studies on college sport tend to focus on Division I level. Particularly within the donor motivation literature, a plethora of donor motivation studies exist, but mainly on NCAA Division I athletic programs. Since each athletic department functions differently in a number of different dimensions, while institutional difference can also have a huge impact on athletic donor motivations, the current study attempts to fill this gap that exists in the literature. As such, the purpose of this study was to (I) reexamine the factor structure of the Athletic Donor motivation scale; and (II) identify the prominent athletic donor motives in a NCAA Division II athletic program. For the purpose of this study, a total of 232 actual donors were used for analysis. A confirmatory factor analysis (CFA) was employed to test construct validity, and the reliability of the scale was assessed using Composite Reliability. To identify the prominent motivational factors, the means and standard deviations were examined. Results of this study indicated that Vicarious Achievement, Philanthropy, and Commitment are the three primary motivational factors, while Tangible Benefits, was consistently found as an important motive in prior studies was found low. Such findings highlight the key difference and suggest different salient motivations exist that are specific to the context.

Keywords: college athletics, donor, motivation, NCAA

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Authors: Konstantinos Tolidis

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The mountains are amongst the most fragile environments in the world. The world’s mountain areas cover 24% of the Earth’s land surface and are home to 12% of the global population. A further 14% of the global population is estimated to live in the vicinity of their surrounding areas. As urbanization continues to increase in the world, the mountains are also key centers for recreation and tourism; their attraction is often heightened by their remarkably high levels of biodiversity. Due to the fact that the features in mountain areas vary spatially (development degree, human geography, socio-economic reality, relations of dependency and interaction with other areas-regions), the spatial planning on these areas consists of a crucial process for preserving the natural, cultural and human environment and consists of one of the major processes of an integrated spatial policy. This research has been focused on the spatial decision problem of land use allocation optimization which is an ordinary planning problem on the mountain areas. It is a matter of fact that such decisions must be made not only on what to do, how much to do, but also on where to do, adding a whole extra class of decision variables to the problem when combined with the consideration of spatial optimization. The utility of optimization as a normative tool for spatial problem is widely recognized. However, it is very difficult for planners to quantify the weights of the objectives especially when these are related to mountain areas. Furthermore, the land use allocation optimization problems at mountain areas must be addressed not only by taking into account the general development objectives but also the spatial objectives (e.g. compactness, compatibility and accessibility, etc). Therefore, the main research’s objective was to approach the land use allocation problem by utilizing a hybrid meta-heuristic optimization technique tailored to the mountain areas’ spatial characteristics. The results indicates that the proposed methodological approach is very promising and useful for both generating land use alternatives for further consideration in land use allocation decision-making and supporting spatial management plans at mountain areas.

Keywords: multiobjective land use allocation, mountain areas, spatial planning, spatial decision making, meta-heuristic methods

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Authors: Syed Beenish Rufai, Sarman Singh

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Background: Performance of Genotype MTBDRsl (Hain Life science GmbH Germany) for detection of mutations associated with second-line drug resistance is well known. However, less evidence regarding the association of mutations and genetic background of strains is known which, in the future, is essential for clinical management of anti-tuberculosis drugs in those settings where the probability of particular genotype is predominant. Material and Methods: During this retrospective study, a total of 259 MDR-TB isolates obtained from pulmonary TB patients were tested for second-line drug susceptibility testing (DST) using Genotype MTBDRsl VER 1.0 and compared with BACTEC MGIT-960 as a reference standard. All isolates were further characterized using spoligotyping. The spoligo patterns obtained were compared and analyzed using SITVIT_WEB. Results: Of total 259 MDR-TB isolates which were screened for second-line DST by Genotype MTBDRsl, mutations were found to be associated with gyrA, rrs and emb genes in 82 (31.6%), 2 (0.8%) and 90 (34.7%) isolates respectively. 16 (6.1%) isolates detected mutations associated with both FQ as well as to AG/CP drugs (XDR-TB). No mutations were detected in 159 (61.4%) isolates for corresponding gyrA and rrs genes. Genotype MTBDRsl showed a concordance of 96.4% for detection of sensitive isolates in comparison with second-line DST by BACTEC MGIT-960 and 94.1%, 93.5%, 60.5% and 50% for detection of XDR-TB, FQ, EMB, and AMK/CAP respectively. D94G was the most prevalent mutation found among (38 (46.4%)) OFXR isolates (37 FQ mono-resistant and 1 XDR-TB) followed by A90V (23 (28.1%)) (17 FQ mono-resistant and 6 XDR-TB). Among AG/CP resistant isolates A1401G was the most frequent mutation observed among (11 (61.1%)) isolates (2 AG/CP mono-resistant isolates and 9 XDR-TB isolates) followed by WT+A1401G (6 (33.3%)) and G1484T (1 (5.5%)) respectively. On spoligotyping analysis, Beijing strain (46%) was found to be the most predominant strain among pre-XDR and XDR TB isolates followed by CAS (30%), X (6%), Unique (5%), EAI and T each of 4%, Manu (3%) and Ural (2%) respectively. Beijing strain was found to be strongly associated with D94G (47.3%) and A90V mutations by (47.3%) and 34.8% followed by CAS strain by (31.6%) and 30.4% respectively. However, among AG/CP resistant isolates, only Beijing strain was found to be strongly associated with A1401G and WT+A1401G mutations by 54.5% and 50% respectively. Conclusion: Beijing strain was found to be strongly associated with the most prevalent mutations among pre-XDR and XDR TB isolates. Acknowledgments: Study was supported with Grant by All India Institute of Medical Sciences, New Delhi reference No. P-2012/12452.

Keywords: tuberculosis, line probe assay, XDR TB, drug susceptibility

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Authors: Anne Schattel, Mitja Echim, Christof Büskens

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Trajectory planning for deep space missions has become a recent topic of great interest. Flying to space objects like asteroids provides two main challenges. One is to find rare earth elements, the other to gain scientific knowledge of the origin of the world. Due to the enormous spatial distances such explorer missions have to be performed unmanned and autonomously. The mathematical field of optimization and optimal control can be used to realize autonomous missions while protecting recourses and making them safer. The resulting algorithms may be applied to other, earth-bound applications like e.g. deep sea navigation and autonomous driving as well. The project KaNaRiA ('Kognitionsbasierte, autonome Navigation am Beispiel des Ressourcenabbaus im All') investigates the possibilities of cognitive autonomous navigation on the example of an asteroid mining mission, including the cruise phase and approach as well as the asteroid rendezvous, landing and surface exploration. To verify and test all methods an interactive, real-time capable simulation using virtual reality is developed under KaNaRiA. This paper focuses on the specific challenge of the guidance during the cruise phase of the spacecraft, i.e. trajectory optimization and optimal control, including first solutions and results. In principle there exist two ways to solve optimal control problems (OCPs), the so called indirect and direct methods. The indirect methods are being studied since several decades and their usage needs advanced skills regarding optimal control theory. The main idea of direct approaches, also known as transcription techniques, is to transform the infinite-dimensional OCP into a finite-dimensional non-linear optimization problem (NLP) via discretization of states and controls. These direct methods are applied in this paper. The resulting high dimensional NLP with constraints can be solved efficiently by special NLP methods, e.g. sequential quadratic programming (SQP) or interior point methods (IP). The movement of the spacecraft due to gravitational influences of the sun and other planets, as well as the thrust commands, is described through ordinary differential equations (ODEs). The competitive mission aims like short flight times and low energy consumption are considered by using a multi-criteria objective function. The resulting non-linear high-dimensional optimization problems are solved by using the software package WORHP ('We Optimize Really Huge Problems'), a software routine combining SQP at an outer level and IP to solve underlying quadratic subproblems. An application-adapted model of impulsive thrusting, as well as a model of an electrically powered spacecraft propulsion system, is introduced. Different priorities and possibilities of a space mission regarding energy cost and flight time duration are investigated by choosing different weighting factors for the multi-criteria objective function. Varying mission trajectories are analyzed and compared, both aiming at different destination asteroids and using different propulsion systems. For the transcription, the robust method of full discretization is used. The results strengthen the need for trajectory optimization as a foundation for autonomous decision making during deep space missions. Simultaneously they show the enormous increase in possibilities for flight maneuvers by being able to consider different and opposite mission objectives.

Keywords: deep space navigation, guidance, multi-objective, non-linear optimization, optimal control, trajectory planning.

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Authors: Waqas Ahmed Khan Afridi, Subhas Chandra Mukhopadhyay, Bandita Mainali

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The research paper presents a unique approach to evapotranspiration (ET) prediction using a Support Vector Machine (SVM) learning algorithm. The study leverages real-time sensor node data to develop an accurate and adaptable prediction model, addressing the inherent challenges of traditional ET estimation methods. The integration of the SVM algorithm with real-time sensor node data offers great potential to improve spatial and temporal resolution in ET predictions. In the model development, key input features are measured and computed using mathematical equations such as Penman-Monteith (FAO56) and soil water balance (SWB), which include soil-environmental parameters such as; solar radiation (Rs), air temperature (T), atmospheric pressure (P), relative humidity (RH), wind speed (u2), rain (R), deep percolation (DP), soil temperature (ST), and change in soil moisture (∆SM). The one-year field data are split into combinations of three proportions i.e. train, test, and validation sets. While kernel functions with tuning hyperparameters have been used to train and improve the accuracy of the prediction model with multiple iterations. This paper also outlines the existing methods and the machine learning techniques to determine Evapotranspiration, data collection and preprocessing, model construction, and evaluation metrics, highlighting the significance of SVM in advancing the field of ET prediction. The results demonstrate the robustness and high predictability of the developed model on the basis of performance evaluation metrics (R2, RMSE, MAE). The effectiveness of the proposed model in capturing complex relationships within soil and environmental parameters provide insights into its potential applications for water resource management and hydrological ecosystem.

Keywords: evapotranspiration, FAO56, KNIME, machine learning, RStudio, SVM, sensors

Procedia PDF Downloads 69

Authors: Rusne Kregzdaite

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The value of the cultural sector stems from the symbolic exploration that differentiates cultural organisations from other product or service organisations. As a result, the cultural sector has a dual impact on the socio-economic system: the economic value (expressed in terms of market relations) created influences the dynamics of the country's financial indicators, while the cultural (non-market) value indirectly contributes to the welfare of the state through changes in societal values, creativity transformations and cultural needs of the country. Measurement of indirect (cultural value) impacts is difficult, but in the case of the cultural sector (especially when it comes to economically inefficient state-funded culture), it helps to reveal the essential characteristics of the sector. The study aims to analyze the value of cultural organisations that are invisible in market processes and to base it on quantified calculations. This was be done by analyzing the usefulness of the consumer, incorporating not only the price paid but also the social and cultural decision-making factors that determine the spectator's choice (time dedicated for a visit, additional costs, content, previous experiences, corporate image). This may reflect the consumer's real choice to consume (all the costs he incurs may be considered the financial equivalent of his experience with the cultural establishment). The research methodology was tested by analyzing the performing arts sector and applying methods to the Lithuanian national drama theatre case. The empirical research consisted of a survey (more than 800 participants) of Lithuanian national drama theatre visitors to different performances. The willingness to pay and travel costs methods were used. Analysis of different performances lets identifies the factor that increases willingness to pay for the performance and affects theatre attendance. The research stresses the importance of cultural value and social perspective of the cultural sector and relates it to the discussions of public funding of culture.

Keywords: cultural economics, performing arts, willingness to pay, travel cost analysis, performing arts management

Procedia PDF Downloads 89

Authors: Mitia Ramarosaona, Sylvie Castagnet, Damien Halm, Henri-Alexandre Cayzac, Nicolas Dufaure, Philippe Papin

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In light of the ongoing energy transition, 'Infrastructure developments' for hydrogen transportation and storage raise studies on the materials employed for hyperbaric vessels. Type IV tanks represent the most mature choice for gaseous hydrogen storage at high pressure – 70MPa. These tanks are made of a composite shell and an internal hydrogen-exposed polymer liner. High pressure conditions lead to severe mechanical loading requiring high resistance. Liner is in contact with hydrogen and undergoes compression – decompression cycles during system filling and emptying. Stresses induced by this loading, coupled with hydrogen diffusion, were found to cause microstructural changes and degradation of mechanical behaviour after decompression phase in some studies on HDPE. These phenomena are similar to those observed in elastomeric components like sealing rings, which can affect permeability and lead to their failure. They may lead to a hydrogen leak, compromising security and tightness of the tank. While these phenomena have been identified in elastomers, they remain less addressed in thermoplastics and consequences post-decompression damages on mechanical behaviour and to the best of author's knowledge was not studied either. Different additives are also included in liner formulation to improve its behaviour. This study aimed to better understand damage micro-mechanisms in PA11s exposed to hydrogen compression-decompression cycles and understand if additives influence their resistance. Samples of pure, plasticized and impact-modified PA11s are exposed to 1, 3 and 8 pressure cycles including hydrogen saturation at 70MPa followed by severe 15-second decompression. After hydrogen exposure and significantly later than full desorption, the residual mechanical behaviour is characterized through impact and monotonic tensile tests, on plain and notched samples. Several techniques of microstructure and micro-nano damage characterization are carried out to assess whether changes in macroscopic properties are driven by microstructural changes in the crystalline structure (SAXS-WAXS acquisitions and SEM micrographs). Thanks to WAXS acquisition and microscopic observation, the effects due to additives and pressure consequences can be decorrelated. Pure PA11 and PA11 with a low percentage of additives show an increase in stress level at the first yielding point after hydrogen cycles. The amplitude of the stress increase is more important in formulation with additives because of changes in PA11 matrix behavior and environment created by additives actions. Plasticizer modifies chain mobility leading to microstructure changes while other additives, more ductile than PA11, is able to cavitate inside PA11 matrix when undergoing decompression. On plasticized formulation, plasticizer migration are suspected to enhance impact of hydrogen cycling on mechanical behaviour. Compared to the literature on HDPE and elastomers, no damages like cavitation or cracking could be evidenced from SAXS experiments on every PA11 formulation tested. In perspectives, on all formulation, experimental work is underway to confirm influence of residual pressure level after decompression on post-decompression damages level, the aim is to better understand the factors affecting the mechanical behavior of thermoplastics subject to mechanical solicitation from decompression in hydrogen tank liners, not mechanical behaviour of liner in hydrogen tanks directly.

Keywords: additives, hydrogen tank liner, microstructural analysis, PA11

Procedia PDF Downloads 45

Authors: Isiaka Oladele Oladipo, Olusegun Adewale Ajayi

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The blood pressure fitness of female college students has been implicated in sedentary lifestyles. This study was designed to determine the effects of the Aerobic Dance Circuit Training Programme (ADCT) on blood pressure variables (Diastolic Blood Pressure (DBP) and Systolic Blood Pressure (SBP). Participants’ Pretest-Posttest control group quasi-experimental design using a 2x2x4 factorial matrix was adopted, while one (1) research question and two (2) research hypotheses were formulated. Seventy (70) untrained obese students-volunteers age 21.10±2.46 years were purposively selected from Oyo town, Nigeria; Emmanuel Alayande College of Education (experimental group and Federal College of Education (special) control group. The participants’ BMI, weight (kg), height (m), systolic bp(mmHg), and diastolic bp (mmHg) were measured before and completion of ADCT. Data collected were analysed using a pie chart, graph, percentage, mean, frequency, and standard deviation, while a t-test was used to analyse the stated hypotheses set at the critical level of 0.05. There were significant mean differences in baseline and post-treatment values of blood pressure variables in terms of SBP among the experimental group 136.49mmHg and 131.66mmHg; control group 130.82mmHg and 130.56mmHg (crit-t=2.00, cal.t=3.02, df=69, p<.0, the hypothesis was rejected; while DBP experimental group 88.65mmHg and 82.21mmHg; control group 69.91mmHg and 72.66mmHg (crit-t=2.00, cal.t=1.437, df=69, p>.05) in which the hypothesis was accepted). It was revealed from the findings that participants’ SBP decrease from week 4 to week 12 of ADCT indicated an effective reduction in blood pressure variables of obese female students. Therefore, the study confirmed that the use of ADCT is safe and effective in the management of blood pressure for the healthy benefit of obesity.

Keywords: aerobic dance circuit training, fitness lifestyles, obese college female students, systolic blood pressure, diastolic blood pressure

Procedia PDF Downloads 76

Authors: Amin Masoumiganjgah, Luke Salmon, Julianne Burnton, Fahimeh Bagheri, Gavin Lenton, S. L. Ezekial Tan

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Introduction: The incidence of proximal biceps tenodesis and acute distal biceps repair is increasing, and rehabilitation protocols following both are variable. Golf is a popular sport within Australia, and the Gold Coast has become a Mecca for golfers, with more courses per capita than anywhere else in the world. Currently, there are no clear guidelines regarding return to golf play following biceps procedures. The aim of this study was to determine biceps brachii activation during the golf swing through electromyographic analysis, and subsequently, aid in rehabilitation guidelines and return to golf following tenodesis and repair. Methods: Subjects were amateur golfers with no previous upper limb surgery. Surface electromyography (EMG) and high-speed video recording were used to analyse activation of the left and right biceps brachii and the anterior deltoid during the golf swing. Each participant’s maximum voluntary contraction (MVC) was recorded, and they were then required to hit a golf ball aiming for specific distances of 2, 50, 100 and 150 metres at a driving range. Noraxon myoResearch and Matlab were used for data analysis. Mean % MVC was calculated for leading and trailing arms during the full swing and its’ 4 phases: back-swing, acceleration, early follow-through and late follow-through. Results: 12 golfers (2 female and 10 male), participated in the study. Median age was 27 (25 – 38), with all being right handed. Over all distances, the mean activation of the short and long head of biceps brachii was < 10% through the full swing. When breaking down the 50, 100 and 150m swing into phases, mean MVC activation was lowest in backswing (5.1%), followed by acceleration (9.7%), early follow-through (9.2%), and late follow-through (21.4%). There was more variation and slightly higher activation in the right biceps (trailing arm) in backswing, acceleration, and early follow-through; with higher activation in the leading arm in late follow-through (25.4% leading, 17.3% trailing). 2m putts resulted in low MVC values (3.1% ) with little variation across swing phases. There was considerable individual variation in results – one tense subject averaged 11.0% biceps MVC through the 2m putting stroke and others recorded peak mean MVC biceps activations of 68.9% at 50m, 101.3% at 100m, and 111.3% at 150m. Discussion: Previous studies have investigated the role of rotator cuff, spine, and hip muscles during the golf swing however, to our knowledge, this is the first study that investigates the activation of biceps brachii. Many rehabilitation programs following a biceps tenodesis or repair allow active range against gravity and restrict strengthening exercises until 6 weeks, and this does not appear to be associated with any adverse outcome. Previous studies demonstrate a range of < 10% MVC is similar to the unloaded biceps brachii during walking(1), active elbow flexion with the hand positioned either in pronation or supination will produce MVC < 20% throughout range(2) and elbow flexion with a 4kg dumbbell can produce mean MVC’s of around 40%(3). Our study demonstrates that increasing activation is associated with the leading arm, increasing shot distance and the late follow-through phase. Although the cohort mean MVC of the biceps brachii is <10% through the full swing, variability is high and biceps activation reach peak mean MVC’s of over 100% in different swing phases for some individuals. Given these EMG values, caution is advised when advising patients post biceps procedures to return to long distance golf shots, particularly when the leading arm is involved. Even though it would appear that putting would be as safe as having an unloaded hand out of a sling following biceps procedures, the variability of activation patterns across different golfers would lead us to caution against accelerated golf rehabilitation in those who may be particularly tense golfers. The 50m short iron shot was too long to consider as a chip shot and more work can be done in this area to determine the safety of chipping.

Keywords: electromyographic analysis, biceps brachii rupture, golf swing, tendon surgery

Procedia PDF Downloads 81

Authors: Yung-Chung Chuang

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The cultural layers of archaeological sites are mainly affected by surface land use, land cover, and root system of surface vegetation. For this reason, continuous monitoring of land use and land cover change is important for archaeological sites protection and management. However, in actual operation, on-site investigation and orthogonal photograph interpretation require a lot of time and manpower. For this reason, it is necessary to perform a good alternative for surface vegetation survey in an automated or semi-automated manner. In this study, we applied semi-automatic digital aerial survey technology and canopy characters classification with very high-resolution aerial photographs for surface vegetation interpretation of archaeological sites. The main idea is based on different landscape or forest type can easily be distinguished with canopy characters (e.g., specific texture distribution, shadow effects and gap characters) extracted by semi-automatic image classification. A novel methodology to classify the shape of canopy characters using landscape indices and multivariate statistics was also proposed. Non-hierarchical cluster analysis was used to assess the optimal number of canopy character clusters and canonical discriminant analysis was used to generate the discriminant functions for canopy character classification (seven categories). Therefore, people could easily predict the forest type and vegetation land cover by corresponding to the specific canopy character category. The results showed that the semi-automatic classification could effectively extract the canopy characters of forest and vegetation land cover. As for forest type and vegetation type prediction, the average prediction accuracy reached 80.3%~91.7% with different sizes of test frame. It represented this technology is useful for archaeological site survey, and can improve the classification efficiency and data update rate.

Keywords: digital aerial survey, canopy characters classification, archaeological sites, multivariate statistics

Procedia PDF Downloads 142

Authors: Chamtouri I., Kechida M.

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Background: Evaluation has a prominent role in medical education and graduation. This evaluation has usually done in face-to-face, by written or oral questions. Simulation is increasingly taking a part as a method of evaluation. Due to the Covid-19 pandemic, which disrupted face-to-face evaluation, simulation using serious games (SG) is emerging in the field of training and assessment of medical students. The aim of our study is to compare the results of the evaluation of medical students by virtual simulation by online serious games versus clinical case-multiple choice questions (MCQ) and to assess the degree of satisfaction from these two evaluation methods. Methods: Medical students from the same study level were voluntarily participated in this study. Groupe 1 had an evaluation by SG dealing with “diagnosis and management of ST-segment elevationmyocardialinfarction (STEMI)alreadyprepared on the website www.Mediactiv.com. Groupe 2 were evaluated by clinical case-MCQ having thes same topic as SG. Results of the two groups were compared. Satisfaction questionnaire was filled by the two groups. Satisfaction degree was compared between the two groups. Results. In this study, 64 medical students (G1:31 and G2: 33) were enrolled. Obtaining complete notes in the "questioning" and "clinical examination" parts is significantly more important in-group 1 compared to group 2. No significant difference detected between the two groups in terms of “ECG interpretation” and “diagnosis of STEMI” parts. A greater number of students of group 1 obtained the full note compared to group 2 in “the initial treatment part” (54.8% vs. 39.4%; p = 0.04). Thirty learners (96.8%) in-group 1 obtained a total score ≥ 50% versus 69.7% in-group 2 (p = 0.004). The full score of 100% was obtained in three learners in-group1, while no student scored 100% in-group2 (p = 0.027). Medical evaluation using SG was reported as more innovative, fun, and realistic compared to evaluation by clinical case-MCQ. No significant difference detected between the two methods in terms of stress. Conclusion: Simulation by SG can be considered as an innovative and effective method in evaluating medical students with a higher degree of satisfaction.

Keywords: evaluation, serious games, medical students, satisfaction

Procedia PDF Downloads 142

Authors: Eman. K. Ramadan, Abdelgawad. S. El-Tahawy

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The objective of this study was to evaluate the effects of calving season on the production and economic efficiency of dairy farms in Egypt. Our study was performed at dairy production farms in the Alexandria, Behera, and Kafr El-Sheikh provinces of Egypt from summer 2010 to winter 2013. The randomly selected dairy farms had herds consisting of Baladi, Holstein-Friesian, or cross-bred (Baladi × Holstein-Friesian) cows. The data were collected from production records and responses to a structured questionnaire. The average total return differed significantly (P < 0.05) between the different cattle breeds and calving seasons. The average total return was highest for the Holstein-Friesian cows that calved in the winter (29106.42 EGP/cow/year), and it was lowest for Baladi cows that calved in the summer (12489.79 EGP/cow/year). Differences in total returns between the cows that calved in the winter or summer or between the foreign and native breeds, as well as variations in calf prices, might have contributed to the differences in milk yield. The average net profit per cow differed significantly (P < 0.05) between the cattle breeds and calving seasons. The average net profit values for the Baladi cows that calved in the winter or summer were 2413 and 2994.96 EGP/cow/year, respectively, and those for the Holstein-Friesian cows were 10744.17 and 7860.56 EGP/cow/year, respectively, whereas those for the cross-bred cows were 10174.86 and 7571.33 EGP/cow/year, respectively. The variations in net profit might have resulted from variation in the availability or price of feed materials, milk prices, or sales volumes. Our results show that the breed and calving season of dairy cows significantly affected the economic efficiency of dairy farms in Egypt. The cows that calved in the winter produced more milk than those that calved in the summer, which may have been the result of seasonal influences, such as temperature, humidity, management practices, and the type of feed or green fodder available.

Keywords: calving season, economic, production, efficiency, dairy

Procedia PDF Downloads 430

Authors: Sunho Seo, Younghwan Shin, Jong-Hong Park, Sooeun Song, Junsung Kim, Jusik Yun, Yongkyun Kim, Jong-Moon Chung

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In order to effectively cope with large and complex disasters, disaster response training is needed. Recently, disaster response training led by the ROK (Republic of Korea) government is being implemented through a 4 year R&D project, which has several similar functions as the HSEEP (Homeland Security Exercise and Evaluation Program) of the United States, but also has several different features as well. Due to the unpredictiveness and diversity of disasters, existing training methods have many limitations in providing experience in the efficient use of disaster incident response and recovery resources. Always, the challenge is to be as efficient and effective as possible using the limited human and material/physical resources available based on the given time and environmental circumstances. To enable repeated training under diverse scenarios, an AR (Augmented Reality) and VR (Virtual Reality) combined simulator is under development. Unlike existing disaster response training, simulator based training (that allows remote login simultaneous multi-user training) enables freedom from limitations in time and space constraints, and can be repeatedly trained with different combinations of functions and disaster situations. There are related systems such as ADMS (Advanced Disaster Management Simulator) developed by ETC simulation and HLS2 (Homeland Security Simulation System) developed by ELBIT system. However, the ROK government needs a simulator custom made to the country's environment and disaster types, and also combines the latest information and communication technologies, which include AR, VR, and MPEG-DASH (Moving Picture Experts Group - Dynamic Adaptive Streaming over HTTP) technology. In this paper, a new disaster response training simulator is proposed to overcome the limitation of existing training systems, and adapted to actual disaster situations in the ROK, where several technical features are described.

Keywords: augmented reality, emergency response training simulator, MPEG-DASH, virtual reality

Procedia PDF Downloads 301

Authors: Shanza Akram, Samir Salah, Imran Saleem, Jassim Abdou, Ashraf Al Zaabi

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Estimated prevalence of asthma in UAE is around 10% (900,000 people). Patients with persistent symptoms despite using high dose ICS plus a second controller +/- Oral steroids are considered to have severe asthma. Omalizumab (Xolair) is an anti-IgE monoclonal antibody approved as add-on therapy for severe allergic asthma. The objective of our study was to obtain baseline characteristics of our local cohort, to determine the efficacy of omalizumab based on clinical outcomes pre and post 52 weeks of treatment and to assess safety and tolerability. Medical records of patients receiving omalizumab therapy for asthma at Zayed Military Hospital, Abu Dhabi were retrospectively reviewed. Patients fulfilling the criteria for severe allergic asthma as per GINA guidelines were included. Asthma control over 12 months pre and post omalizumab were analyzed by taking into account the number of exacerbations, hospitalizations, maintenance of medication dosages, the need for reliever therapy and PFT’s. 21 patients (5 females) with mean age 41 years were included. The mean duration of therapy was 22 months. 19 (91%) patients had Allergic Rhinitis/Sinusitis. Mean serum total IgE level was 648 IU/ml (65-1859). 11 (52%) patients were on oral maintenance steroids pre-treatment. 7 patients managed to stop steroids on treatment while 4 were able to decrease the dosage. Mean exacerbation rate decreased from 5 per year pre-treatment to 1.36 while on treatment. The number of hospitalizations decreased from a mean of 2 per year to 0.9 per year. Reliever inhaler usage decreased from mean of 40 to 15 puffs per week.2 patients discontinued therapy, 1 due to lack of benefit (2 doses) and 2nd due to severe persistent side effects. Patient compliance was poor in some cases. Treatment with omalizumab reduced the number of exacerbations, hospitalizations, maintenance and reliever medications, and is generally well tolerated. Our results show that there is room for improved documentation in terms of symptom recording and use of rescue medication at our institution. There is also need for better patient education and counseling in order to improve compliance.

Keywords: asthma, exacerbations, omalizumab, IgE

Procedia PDF Downloads 371

Authors: Ryan Adams

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Introduction: Major trauma is the leading cause of death in 15-45 year olds and a significant human, social and economic costs. Resuscitation is a stalwart of trauma management, especially in the pre-hospital environment and packed red blood cells (pRBC) are being increasingly used with the advent of permissive hypotension. The evidence in this area is lacking and further research is required to determine its efficacy. Aim: The aim of this retrospective, matched cohort study was to determine if major trauma patients, who received pre-hospital pRBC, have a difference in their initial emergency department cardiovascular status; when compared with injury-profile matched controls. Methods: The trauma databases of the Royal Brisbane and Women's Hospital, Royal Children's Hospital (Herston) and Queensland Ambulance Service were accessed and major trauma patient (ISS>12) data, who received pre-hospital pRBC, from January 2011 to August 2014 was collected. Patients were then matched against control patients that had not received pRBC, by their injury profile. The primary outcomes was cardiovascular status; defined as shock index and Revised Trauma Score. Results: Data for 25 patients who received pre-hospital pRBC was accessed and the injury profiles matched against suitable controls. On admittance to the emergency department, a statistically significant difference was seen in the blood group (Blood = 1.42 and Control = 0.97, p-value = 0.0449). However, the same was not seen with the RTS (Blood = 4.15 and Control 5.56, p-value = 0.291). Discussion: A worsening shock index and revised trauma score was associated with pre-hospital administration of pRBC. However, due to the small sample size, limited matching protocol and associated confounding factors it is difficult to draw any solid conclusions. Further studies, with larger patient numbers, are required to enable adequate conclusions to be drawn on the efficacy of pre-hospital packed red blood cell transfusion.

Keywords: pre-hospital, packed red blood cells, severe trauma, emergency medicine

Procedia PDF Downloads 394

Authors: Gul Jan

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It is the first quantitative ethno-botanical analysis and conservation issues of medicinal flora of Alpine and Sub-alpine, Hindikush region of Pakistan. The objective of the study aims to report, compare the uses and highlight the ethno-Botanical significance of medicinal plants for treatment of various diseases. A total of 250 (242 males and 8 females) local informants including 10 Local Traditional Healers were interviewed. Information was collected through semi-structured interviews, analyzed and compared by quantitative ethno-botanical indices such as Jaccard index (JI), Informant Consensus Factor (ICF), use value (UV) and Relative frequency of citation (RFC).Thorough survey indicated that 57 medicinal plants belongs to 43 families were investigated to treat various illnesses. The highest ICF is recorded for digestive system (0.69%), Circolatory system (0.61%), urinary tract system, (0.53%) and respiratory system (0.52%). Used value indicated that, Achillea mellefolium (UV = 0.68), Aconitum violaceum (UV = 0.69), Valeriana jatamansi (UV = 0.63), Berberis lyceum (UV = 0.65) and are exceedingly medicinal plant species used in the region. In comparison, highest similarity index is recorded in these studies with JI 17.72 followed by 16.41. According to DMR output, Pinus williciana ranked first due to multipurpose uses among all species and was found most threatened with higher market value. Unwise used of natural assets pooled with unsuitable harvesting practices have exaggerated pressure on plant species of the research region. The main issues causative to natural variety loss found were over grazing of animals, forest violation, wild animal hunting, fodder, plant collection as medicine, fuel wood, forest fire, and invasive species negatively affect the natural resources. For viable utilization, in situ and ex situ conservation, skillful collecting, and reforestation project may be the resolution. Further wide field management research is required.

Keywords: quantitative analysis, conservations issues, medicinal flora, alpine and sub-alpine, Hindukush region

Procedia PDF Downloads 307

Authors: Awais Ahmed, Javed Iqbal

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Pakistan has been for many years facing extreme challenges in energy deficit due to the shortage of power generation compared to increasing demand. A part of this energy deficit is also contributed by the power lost in transmission and distribution network. Unfortunately, distribution companies are not equipped with modern technologies and methods to identify and eliminate these losses. According to estimate, total energy lost in early 2000 was between 20 to 26 percent. To address this issue the present research study was designed with the objectives of developing a standalone GIS application for distribution companies having the capability of loss calculation as well as identification of overloaded transformers. For this purpose, Hilal Road feeder in Faisalabad Electric Supply Company (FESCO) was selected as study area. An extensive GPS survey was conducted to identify each consumer, linking it to the secondary pole of the transformer, geo-referencing equipment and documenting conductor sizes. To identify overloaded transformer, accumulative kWH reading of consumer on transformer was compared with threshold kWH. Technical losses of 11kV and 220V lines were calculated using the data from substation and resistance of the network calculated from the geo-database. To automate the process a standalone GIS application was developed using ArcObjects with engineering analysis capabilities. The application uses GIS database developed for 11kV and 220V lines to display and query spatial data and present results in the form of graphs. The result shows that about 14% of the technical loss on both high tension (HT) and low tension (LT) network while about 4 out of 15 general duty transformers were found overloaded. The study shows that GIS can be a very effective tool for distribution companies in management and planning of their distribution network.

Keywords: geographical information system, GIS, power distribution, distribution transformers, technical losses, GPS, SDSS, spatial decision support system

Procedia PDF Downloads 376