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507 Perinatal Optimisation for Preterm Births Less than 34 Weeks at OLOL, Drogheda, Ireland
Authors: Stephane Maingard, Babu Paturi, Maura Daly, Finnola Armstrong
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Background: Perinatal optimization involves the implementation of twelve intervention bundles of care at Our Lady of Lourdes Hospital, reliably delivering evidence-based interventions in the antenatal, intrapartum, and neonatal period to improve preterm outcomes. These key interventions (e.g. Antenatal steroids, Antenatal counselling, Optimal cord management, Respiratory management etc.) are based on WHO (World Health Organization, BAPM (British Association of Perinatal Medicine), and the latest 2022 European Consensus guidelines recommendations. Methodology: In February 2023, a quality improvement project team (pediatricians, neonatologists, obstetricians, clinical skills managers) was established, and a project implementation plan was developed. The Program Study Act implemented the following: 1. Antenatal consultation pathway, 2. Creation and implementation of a perinatal checklist for preterm births less than 34 weeks of gestation, 3. Process changes to ensure the checklist is completed, 4. Completion of parent and staff surveys, 5. Ongoing training. We collected and compared a range of data before and after implementation. Results: Preliminary analysis so far at 1 month demonstrates improvement in the following areas: 50% increase in antenatal counselling. Right place of birth increased from 85% to 100%. Magnesium sulphate increased from 56% to 100%. No change was observed in buccal colostrum administration (28%), delayed cord clamping (75%), caffeine administration (100%), blood glucose level at one hour of life > 2,6mmol (85%). There was also no change noted in respiratory support at resuscitation, CPAP only (47%), IPPV with CPAP (45%), IPPV with intubation (20%), and surfactant administration (28%). A slight decrease in figures was noted in the following: steroid administration from 80% to 75% and thermal care obtaining optimal temperature on admission (65% to 50%). Discussion: Even though the findings are preliminary, the directional improvement shows promise. Improved communication has been achieved between all stakeholders, including our patients, who are key team members. Adherence to the bundles of care will help to improve survival and neurodevelopmental outcomes as well as reduce the length of stay, thereby overall reducing the financial cost, considering the lifetime cost of cerebral palsy is estimated at €800,000 and reducing the length of stay can result in savings of up to €206,000. Conclusion: Preliminary results demonstrate improvements across a range of patient, process, staff, and financial outcomes. Our future goal is a seamless pathway of patient centered care for babies and their families. This project is an interdisciplinary collaboration to implement best practices for a vulnerable patient cohort. Our two main challenges are changing our organization’s culture as well as ensuring the sustainability of the project.Keywords: perinatal, optimization, antenatal, counselling, IPPV
Procedia PDF Downloads 18506 A Case of Borderline Personality Disorder: An Explanatory Study of Unconscious Conflicts through Dream-Analysis
Authors: Mariam Anwaar, Kiran B. Ahmad
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Borderline Personality Disorder (BPD) is an invasive presence of affect instability, disturbance in self-concept and attachment in relationships. The profound indicator is the dichotomous approach of the world in which the ego categorizes individuals, especially their significant others, into secure or threatful beings, leaving little room for a complex combination of characteristics in one person. This defense mechanism of splitting their world has been described through the explanatory model of unconscious conflict theorized by Sigmund Freud’s Electra Complex in the Phallic Stage. The central role is of the father with whom the daughter experiences penis envy, thus identifying with the mother’s characteristics to receive the father’s attention. However, Margret Mahler, an object relation theorist, elucidates the central role of the mother and that the split occurs during the pre-Electra complex stage. Amid the 14 and 24 months of the infant, it acknowledges the world away from the mother as they have developed milestones such as crawling. In such novelty, the infant crawls away from the mother creating a sense of independence (individuation). On the other hand, being distant causes anxiety, making them return to their original object of security (separation). In BPD, the separation-individuation stage is disrupted, due to contradictory actions of the caregiver, which results in splitting the object into negative and positive aspects, repressing the former and adhering to the latter for survival. Thus, with time, the ego distorts the reality into dichotomous categories, using the splitting defenses, and the mental representation of the self is distorted due to the internalization of the negative objects. The explanatory model was recognized in the case study of Fizza, at 21-year-old Pakistani female, residing in Karachi. Her marital status is single with an occupation being a dental student. Fizza lives in a nuclear family but is surrounded by her extended family as they all are in close vicinity. She came with the complaints of depressive symptoms for two-years along with self-harm due to severe family conflicts. Through the intervention of Dialectical Behavior Therapy (DBT), the self-harming actions were reduced, however, this libidinal energy transformed into claustrophobic symptoms and, along with this, Fizza has always experienced vivid dreams. A retrospective method of Jungian dream-analysis was applied to locate the origins of the splitting in the unconscious. The result was the revelation of a sexual harassment trauma at the age of six-years which was displaced in the form of self-harm. In addition to this, the presence of a conflict at the separation-individuation stage was detected during the dream-analysis, and it was the underlying explanation of the claustrophobic symptoms. This qualitative case study implicates the use of a patient’s subjective experiences, such as dreams, to journey through the spiral of the unconscious in order to not only detect repressed memories but to use them in psychotherapy as a means of healing the patient.Keywords: borderline personality disorder, dream-analysis, Electra complex, separation-individuation, splitting, unconscious
Procedia PDF Downloads 153505 Globalisation and Diplomacy: How Can Small States Improve the Practice of Diplomacy to Secure Their Foreign Policy Objectives?
Authors: H. M. Ross-McAlpine
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Much of what is written on diplomacy, globalization and the global economy addresses the changing nature of relationships between major powers. While the most dramatic and influential changes have resulted from these developing relationships the world is not, on deeper inspection, governed neatly by major powers. Due to advances in technology, the shifting balance of power and a changing geopolitical order, small states have the ability to exercise a greater influence than ever before. Increasingly interdependent and ever complex, our world is too delicate to be handled by a mighty few. The pressure of global change requires small states to adapt their diplomatic practices and diversify their strategic alliances and relationships. The nature and practice of diplomacy must be re-evaluated in light of the pressures resulting from globalization. This research examines: how small states can best secure their foreign policy objectives? Small state theory is used as a foundation for exploring the case study of New Zealand. The research draws on secondary sources to evaluate the existing theory in relation to modern practices of diplomacy. As New Zealand lacks the required economic and military power to play an active, influential role in international affairs what strategies are used to exert influence? Furthermore, New Zealand lies in a remote corner of the Pacific and is geographically isolated from its nearest neighbors how does this affect security and trade priorities? The findings note a significant shift since the 1970’s in New Zealand’s diplomatic relations. This shift is arguably a direct result of globalization, regionalism and a growing independence from the traditional bi-lateral relationships. The need to source predictable trade, investment and technology are an essential driving force for New Zealand’s diplomatic relations. A lack of hard power aligns New Zealand’s prosperity with a secure, rules-based international system that increases the likelihood of a stable and secure global order. New Zealand’s diplomacy and prosperity has been intrinsically reliant on its reputation. A vital component of New Zealand’s diplomacy is preserving a reputation for integrity and global responsibility. It is the use of this soft power that facilitates the influence that New Zealand enjoys on the world stage. To weave a comprehensive network of successful diplomatic relationships, New Zealand must maintain a reputation of international credibility. Globalization has substantially influenced the practice of diplomacy for New Zealand. The current world order places economic and military might in the hands of a few, subsequently requiring smaller states to use other means for securing their interests. There are clear strategies evident in New Zealand’s diplomacy practice that draw attention to how other smaller states might best secure their foreign policy objectives. While these findings are limited, as with all case study research, there is value in applying the findings to other small states struggling to secure their interests in the wake of rapid globalization.Keywords: diplomacy, foreign policy, globalisation, small state
Procedia PDF Downloads 396504 Role of HIV-Support Groups in Mitigating Adverse Sexual Health Outcomes among HIV Positive Adolescents in Uganda
Authors: Lilian Nantume Wampande
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Group-based strategies in the delivery of HIV care have opened up new avenues not only for meaningful participation for HIV positive people but also platforms for deconstruction and reconstruction of knowledge about living with the virus. Yet the contributions of such strategies among patients who live in high risk areas are still not explored. This case study research assessed the impact of HIV support networks on sexual health outcomes of HIV positive out-of-school adolescents residing in fishing islands of Kalangala in Uganda. The study population was out-of-school adolescents living with HIV and their sexual partners (n=269), members of their households (n=80) and their health service providers (n=15). Data were collected via structured interviews, observations and focus group discussions between August 2016 and March 2017. Data was then analyzed inductively to extract key themes related to the approaches and outcomes of the groups’ activities. The study findings indicate that support groups unite HIV positive adolescents in a bid for social renegotiation to achieve change but individual constraints surpass the groups’ intentions. Some adolescents for example reported increased fear which led to failure to cope, sexual violence, self-harm and denial of status as a result of the high expectations placed on them as members of the support groups. Further investigations around this phenomenon show that HIV networks play a monotonous role as information sources for HIV positive out-of-school adolescents which limit their creativity to seek information elsewhere. Results still indicate that HIV adolescent groups recognize the complexity of long-term treatment and stay in care leading to improved immunity for the majority yet; there is still scattered evidence about how effective they are among adolescents at different phases in the disease trajectory. Nevertheless, the primary focus of developing adolescent self-efficacy and coping skills significantly address a range of disclosure difficulties and supports autonomy. Moreover, the peer techniques utilized in addition to the almost homogeneous group characteristics accelerates positive confidence, hope and belongingness. Adolescent HIV-support groups therefore have the capacity to both improve and/or worsen sexual health outcomes for a young adolescent who is out-of-school. Communication interventions that seek to increase awareness about ‘self’ should therefore be emphasized more than just fostering collective action. Such interventions should be sensitive to context and gender. In addition, facilitative support supervision done by close and trusted health care providers, most preferably Village Health Teams (who are often community elected volunteers) would help to follow-up, mentor, encourage and advise this young adolescent in matters involving sexuality and health outcomes. HIV/AIDS prevention programs have extended their efforts beyond individual focus to those that foster collective action, but programs should rekindle interpersonal level strategies to address the complexity of individual behavior.Keywords: adolescent, HIV, support groups, Uganda
Procedia PDF Downloads 142503 The Effects of Bisphosphonates on Osteonecrosis of Jaw Bone: A Stem Cell Perspective
Authors: Huseyin Apdik, Aysegul Dogan, Selami Demirci, Ezgi Avsar Apdik, Fikrettin Sahin
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Mesenchymal stem cells (MSCs) are crucial cell types for bone maintenance and growth along with resident bone progenitor cells providing bone tissue integrity during osteogenesis and skeletal growth. Any deficiency in this regulation would result in vital bone diseases. Of those, osteoporosis, characterized by a reduction in bone mass and mineral density, is a critical skeletal disease for especially elderly people. The commonly used drugs for the osteoporosis treatment are bisphosphonates (BPs). The most prominent role of BPs is to prevent bone resorption arisen from high osteoclast activity. However, administrations of bisphosphonates may also cause bisphosphonate-induced osteonecrosis of the jaw (BIONJ). Up to the present, the researchers have proposed several circumstances for BIONJ. However, effects of long-term and/or high dose usage of BPs on stem cell’s proliferation, survival, differentiation or maintenance capacity have not been evaluated yet. The present study will be held to; figure out BPs’ effects on MSCs in vitro in the aspect of cell proliferation and toxicity, migration, angiogenic activity, lineage specific gene and protein expression levels, mesenchymal stem cell properties and potential signaling pathways affected by BP treatment. Firstly, mesenchymal stem cell characteristics of Dental Pulp Stem Cells (DPSCs) and Periodontal Ligament Stem Cells (PDLSCs) were proved using flow cytometry analysis. Cell viability analysis was completed to determine the cytotoxic effects of BPs (Zoledronate (Zol), Alendronate (Ale) and Risedronate (Ris)) on DPSCs and PDLSCs by the 3-(4,5-di-methyl-thiazol-2-yl)-5-(3-carboxymethoxy-phenyl)-2-(4-sulfo-phenyl)-2H-tetrazolium (MTS) assay. Non-toxic concentrations of BPs were determined at 24 h under growth condition, and at 21 days under osteogenic differentiation condition for both cells. The scratch assay was performed to evaluate their migration capacity under the usage of determined of BPs concentrations at 24 h. The results revealed that while the scratch closure is 70% in the control group for DPSCs, it was 57%, 66% and 66% in Zol, Ale and Ris groups, respectively. For PDLSs, while wound closure is 71% in control group, it was 65%, 66% and 66% in Zol, Ale and Ris groups, respectively. As future experiments, tube formation assay and aortic ring assay will be done to determinate angiogenesis abilities of DPSCs and PDLSCs treated with BPs. Expression levels of osteogenic differentiation marker genes involved in bone development will be determined using real time-polymerase change reaction (RT-PCR) assay and expression profiles of important proteins involved in osteogenesis will be evaluated using western blotting assay for osteogenically differentiated MSCs treated with or without BPs. In addition to these, von Kossa staining will be performed to measure calcium mineralization status of MSCs.Keywords: bisphosphonates, bisphosphonate-induced osteonecrosis of the jaw, mesenchymal stem cells, osteogenesis
Procedia PDF Downloads 263502 Courtyard Evolution in Contemporary Sustainable Living
Authors: Yiorgos Hadjichristou
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The paper will focus on the strategic development deriving from the evolution of the traditional courtyard spatial organization towards a new, contemporary sustainable way of living. New sustainable approaches that engulf the social issues, the notion of place, the understanding of weather architecture blended together with the bioclimatic behaviour will be seen through a series of experimental case studies in the island of Cyprus, inspired and originated from its traditional wisdom, ranging from small scale of living to urban interventions. Weather and nature will be seen as co-architectural authors with architects as intelligently claimed by Jonathan Hill in his Weather Architecture discourse. Furthermore, following Pallasmaa’s understanding, the building will be seen not as an end itself and the elements of an architectural experience as having a verb form rather than being nouns. This will further enhance the notion of merging the subject-human and the object-building as discussed by Julio Bermudez. This eventually will enable to generate the discussion of the understanding of the building constructed according to the specifics of place and inhabitants, shaped by its physical and human topography as referred by Adam Sharr in relation to Heidegger’s thinking. The specificities of the divided island and the dealing with sites that are in vicinity with the diving Green Line will further trigger explorations dealing with the regeneration issues and the social sustainability offering unprecedented opportunities for innovative sustainable ways of living. The above premises will lead us to develop innovative strategies for a profound, both technical and social sustainability, which fruitfully yields to innovative living built environments, responding to the ever changing environmental and social needs. As a starting point, a case study in Kaimakli in Nicosia a refurbishment with an extension of a traditional house, already engulfs all the traditional/ vernacular wisdom of the bioclimatic architecture. It aims at capturing not only its direct and quite obvious bioclimatic features, but rather to evolve them by adjusting the whole house in a contemporary living environment. In order to succeed this, evolutions of traditional architectural elements and spatial conditions are integrated in a way that does not only respond to some certain weather conditions, but they integrate and blend the weather within the built environment. A series of innovations aiming at maximum flexibility is proposed. The house can finally be transformed into a winter enclosure, while for the most part of the year it turns into a ‘camping’ living environment. Parallel to experimental interventions in existing traditional units, we will proceed examining the implementation of the same developed methodology in designing living units and complexes. Malleable courtyard organizations that attempt to blend the traditional wisdom with the contemporary needs for living, the weather and nature with the built environment will be seen tested in both horizontal and vertical developments. A new social identity of people, directly involved and interacting with the weather and climatic conditions will be seen as the result of balancing the social with the technological sustainability, the immaterial and the material aspects of the built environment.Keywords: building as a verb, contemporary living, traditional bioclimatic wisdom, weather architecture
Procedia PDF Downloads 418501 The Effect of Artificial Intelligence on Mobile Phones and Communication Systems
Authors: Ibram Khalafalla Roshdy Shokry
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This paper gives service feel multiple get entry to (CSMA) verbal exchange model based totally totally on SoC format method. Such model can be used to guide the modelling of the complex c084d04ddacadd4b971ae3d98fecfb2a communique systems, consequently use of such communication version is an crucial method in the creation of excessive general overall performance conversation. SystemC has been selected as it gives a homogeneous format drift for complicated designs (i.e. SoC and IP based format). We use a swarm device to validate CSMA designed version and to expose how advantages of incorporating communication early within the layout process. The wireless conversation created via the modeling of CSMA protocol that may be used to attain conversation among all of the retailers and to coordinate get proper of entry to to the shared medium (channel).The device of automobiles with wi-fiwireless communique abilities is expected to be the important thing to the evolution to next era intelligent transportation systems (ITS). The IEEE network has been continuously operating at the development of an wireless vehicular communication protocol for the enhancement of wi-fi get admission to in Vehicular surroundings (WAVE). Vehicular verbal exchange systems, known as V2X, help car to car (V2V) and automobile to infrastructure (V2I) communications. The wi-ficiencywireless of such communication systems relies upon on several elements, amongst which the encircling surroundings and mobility are prominent. as a result, this observe makes a speciality of the evaluation of the actual performance of vehicular verbal exchange with unique cognizance on the effects of the actual surroundings and mobility on V2X verbal exchange. It begins by wi-fi the actual most range that such conversation can guide and then evaluates V2I and V2V performances. The Arada LocoMate OBU transmission device changed into used to check and evaluate the effect of the transmission range in V2X verbal exchange. The evaluation of V2I and V2V communique takes the real effects of low and excessive mobility on transmission under consideration.Multiagent systems have received sizeable attention in numerous wi-fields, which include robotics, independent automobiles, and allotted computing, where a couple of retailers cooperate and speak to reap complicated duties. wi-figreen communication among retailers is a critical thing of these systems, because it directly influences their usual performance and scalability. This scholarly work gives an exploration of essential communication factors and conducts a comparative assessment of diverse protocols utilized in multiagent systems. The emphasis lies in scrutinizing the strengths, weaknesses, and applicability of those protocols across diverse situations. The studies additionally sheds light on rising tendencies within verbal exchange protocols for multiagent systems, together with the incorporation of device mastering strategies and the adoption of blockchain-based totally solutions to make sure comfy communique. those developments offer valuable insights into the evolving landscape of multiagent structures and their verbal exchange protocols.Keywords: communication, multi-agent systems, protocols, consensussystemC, modelling, simulation, CSMA
Procedia PDF Downloads 25500 Alkaloid Levels in Experimental Lines of Ryegrass in Southtern Chile
Authors: Leonardo Parra, Manuel Chacón-Fuentes, Andrés Quiroz
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One of the most important factors in beef and dairy production in the world as well as also in Chile, is related to the correct choice of cultivars or mixtures of forage grasses and legumes to ensure high yields and quality of grassland. However, a great problem is the persistence of the grasses as a result of the action of different hypogeous as epigean pests. The complex insect pests associated with grassland include white grubs (Hylamorpha elegans, Phytoloema herrmanni), blackworm (Dalaca pallens) and Argentine stem weevil (Listronotus bonariensis). In Chile, the principal strategy utilized for controlling this pest is chemical control, through the use of synthetic insecticides, however, underground feeding habits of larval and flight activity of adults makes this uneconomic method. Furthermore, due to problems including environmental degradation, development of resistance and chemical residues, there is a worldwide interest in the use of alternative environmentally friendly pest control methods. In this sense, in recent years there has been an increasing interest in determining the role of endophyte fungi in controlling epigean and hypogeous pest. Endophytes from ryegrass (Lolium perenne), establish a biotrophic relationship with the host, defined as mutualistic symbiosis. The plant-fungi association produces a “cocktail of alkaloids” where peramine is the main toxic substance present in endophyte of ryegrass and responsible for damage reduction of L. bonariensis. In the last decade, few studies have been developed on the effectiveness of new ryegrass cultivars carriers of endophyte in controlling insect pests. Therefore, the aim of this research is to provide knowledge concerning to evaluate the alkaloid content, such as peramine and Lolitrem B, present in new experimental lines of ryegrass and feasible to be used in grasslands of southern Chile. For this, during 2016, ryegrass plants of six experimental lines and two commercial cultivars sown at the Instituto de Investigaciones Agropecuarias Carrillanca (Vilcún, Chile) were collected and subjected to a process of chemical extraction to identify and quantify the presence of peramine and lolitrem B by the technique of liquid chromatography of high resolution (HPLC). The results indicated that the experimental lines EL-1 and EL-3 had high content of peramine (0.25 and 0.43 ppm, respectively) than with lolitrem B (0.061 and 0.19 ppm, respectively). Furthermore, the higher contents of lolitrem B were detected in the EL-4 and commercial cultivar Alto (positive control) with 0.08 and 0.17 ppm, respectively. Peramine and lolitrem B were not detected in the cultivar Jumbo (negative control). These results suggest that EL-3 would have potential as future cultivate because it has high content of peramine, alkaloid responsible for controlling insect pest. However, their current role on the complex insects attacking ryegrass grasslands should be evaluated. The information obtained in this research could be used to improve control strategies against hypogeous and epigean pests of grassland in southern Chile and also to reduce the use of synthetic pesticides.Keywords: HPLC, Lolitrem B, peramine, pest
Procedia PDF Downloads 242499 Experimental Study of the Behavior of Elongated Non-spherical Particles in Wall-Bounded Turbulent Flows
Authors: Manuel Alejandro Taborda Ceballos, Martin Sommerfeld
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Transport phenomena and dispersion of non-spherical particle in turbulent flows are found everywhere in industrial application and processes. Powder handling, pollution control, pneumatic transport, particle separation are just some examples where the particle encountered are not only spherical. These types of multiphase flows are wall bounded and mostly highly turbulent. The particles found in these processes are rarely spherical but may have various shapes (e.g., fibers, and rods). Although research related to the behavior of regular non-spherical particles in turbulent flows has been carried out for many years, it is still necessary to refine models, especially near walls where the interaction fiber-wall changes completely its behavior. Imaging-based experimental studies on dispersed particle-laden flows have been applied for many decades for a detailed experimental analysis. These techniques have the advantages that they provide field information in two or three dimensions, but have a lower temporal resolution compared to point-wise techniques such as PDA (phase-Doppler anemometry) and derivations therefrom. The applied imaging techniques in dispersed two-phase flows are extensions from classical PIV (particle image velocimetry) and PTV (particle tracking velocimetry) and the main emphasis was simultaneous measurement of the velocity fields of both phases. In a similar way, such data should also provide adequate information for validating the proposed models. Available experimental studies on the behavior of non-spherical particles are uncommon and mostly based on planar light-sheet measurements. Especially for elongated non-spherical particles, however, three-dimensional measurements are needed to fully describe their motion and to provide sufficient information for validation of numerical computations. For further providing detailed experimental results allowing a validation of numerical calculations of non-spherical particle dispersion in turbulent flows, a water channel test facility was built around a horizontal closed water channel. Into this horizontal main flow, a small cross-jet laden with fiber-like particles was injected, which was also solely driven by gravity. The dispersion of the fibers was measured by applying imaging techniques based on a LED array for backlighting and high-speed cameras. For obtaining the fluid velocity fields, almost neutrally buoyant tracer was used. The discrimination between tracer and fibers was done based on image size which was also the basis to determine fiber orientation with respect to the inertial coordinate system. The synchronous measurement of fluid velocity and fiber properties also allow the collection of statistics of fiber orientation, velocity fields of tracer and fibers, the angular velocity of the fibers and the orientation between fiber and instantaneous relative velocity. Consequently, an experimental study the behavior of elongated non-spherical particles in wall bounded turbulent flows was achieved. The development of a comprehensive analysis was succeeded, especially near the wall region, where exists hydrodynamic wall interaction effects (e.g., collision or lubrication) and abrupt changes of particle rotational velocity. This allowed us to predict numerically afterwards the behavior of non-spherical particles within the frame of the Euler/Lagrange approach, where the particles are therein treated as “point-particles”.Keywords: crossflow, non-spherical particles, particle tracking velocimetry, PIV
Procedia PDF Downloads 86498 Kidney Supportive Care in Canada: A Constructivist Grounded Theory of Dialysis Nurses’ Practice Engagement
Authors: Jovina Concepcion Bachynski, Lenora Duhn, Idevania G. Costa, Pilar Camargo-Plazas
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Kidney failure is a life-limiting condition for which treatment, such as dialysis (hemodialysis and peritoneal dialysis), can exact a tremendously high physical and psychosocial symptom burden. Kidney failure can be severe enough to require a palliative approach to care. The term supportive care can be used in lieu of palliative care to avoid the misunderstanding that palliative care is synonymous with end-of-life or hospice care. Kidney supportive care, encompassing advance care planning, is an approach to care that improves the quality of life for people receiving dialysis through early identification and treatment of symptoms throughout the disease trajectory. Advanced care planning involves ongoing conversations about the values, goals, and preferences for future care between individuals and their healthcare teams. Kidney supportive care is underutilized and often initiated late in this population. There is evidence to indicate nurses are not providing the necessary elements of supportive kidney care. Dialysis nurses’ delay or lack of engagement in supportive care until close to the end of life may result in people dying without receiving optimal palliative care services. Using Charmaz’s constructivist grounded theory, the purpose of this doctoral study is to develop a substantive theory that explains the process of engagement in supportive care by nurses working in dialysis settings in Canada. Through initial purposeful and subsequent theoretical sampling, 23 nurses with current or recent work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings drawn from across Canada were recruited to participate in two intensive interviews using the Zoom© teleconferencing platform. Concurrent data collection and data analysis, constant comparative analysis of initial and focused codes until the attainment of theoretical saturation, and memo-writing, as well as researcher reflexivity, have been undertaken to aid the emergence of concepts, categories, and, ultimately, the constructed theory. At the time of abstract submission, data analysis is currently at the second level of coding (i.e., focused coding stage) of the research study. Preliminary categories include: (a) focusing on biomedical care; (b) multi-dimensional challenges to having the conversation; (c) connecting and setting boundaries with patients; (d) difficulty articulating kidney-supportive care; and (e) unwittingly practising kidney-supportive care. For the conference, the resulting theory will be presented. Nurses working in dialysis are well-positioned to ensure the delivery of quality kidney-supportive care. This study will help to determine the process and the factors enabling and impeding nurse engagement in supportive care in dialysis to effect change for normalizing advance care planning conversations in the clinical setting. This improved practice will have substantive beneficial implications for the many individuals living with kidney failure and their supporting loved ones.Keywords: dialysis, kidney failure, nursing, supportive care
Procedia PDF Downloads 102497 Thermoluminescence Investigations of Tl2Ga2Se3S Layered Single Crystals
Authors: Serdar Delice, Mehmet Isik, Nizami Hasanli, Kadir Goksen
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Researchers have donated great interest to ternary and quaternary semiconductor compounds especially with the improvement of the optoelectronic technology. The quaternary compound Tl2Ga2Se3S which was grown by Bridgman method carries the properties of ternary thallium chalcogenides group of semiconductors with layered structure. This compound can be formed from TlGaSe2 crystals replacing the one quarter of selenium atom by sulfur atom. Although Tl2Ga2Se3S crystals are not intentionally doped, some unintended defect types such as point defects, dislocations and stacking faults can occur during growth processes of crystals. These defects can cause undesirable problems in semiconductor materials especially produced for optoelectronic technology. Defects of various types in the semiconductor devices like LEDs and field effect transistor may act as a non-radiative or scattering center in electron transport. Also, quick recombination of holes with electrons without any energy transfer between charge carriers can occur due to the existence of defects. Therefore, the characterization of defects may help the researchers working in this field to produce high quality devices. Thermoluminescence (TL) is an effective experimental method to determine the kinetic parameters of trap centers due to defects in crystals. In this method, the sample is illuminated at low temperature by a light whose energy is bigger than the band gap of studied sample. Thus, charge carriers in the valence band are excited to delocalized band. Then, the charge carriers excited into conduction band are trapped. The trapped charge carriers are released by heating the sample gradually and these carriers then recombine with the opposite carriers at the recombination center. By this way, some luminescence is emitted from the samples. The emitted luminescence is converted to pulses by using an experimental setup controlled by computer program and TL spectrum is obtained. Defect characterization of Tl2Ga2Se3S single crystals has been performed by TL measurements at low temperatures between 10 and 300 K with various heating rate ranging from 0.6 to 1.0 K/s. The TL signal due to the luminescence from trap centers revealed one glow peak having maximum temperature of 36 K. Curve fitting and various heating rate methods were used for the analysis of the glow curve. The activation energy of 13 meV was found by the application of curve fitting method. This practical method established also that the trap center exhibits the characteristics of mixed (general) kinetic order. In addition, various heating rate analysis gave a compatible result (13 meV) with curve fitting as the temperature lag effect was taken into consideration. Since the studied crystals were not intentionally doped, these centers are thought to originate from stacking faults, which are quite possible in Tl2Ga2Se3S due to the weakness of the van der Waals forces between the layers. Distribution of traps was also investigated using an experimental method. A quasi-continuous distribution was attributed to the determined trap centers.Keywords: chalcogenides, defects, thermoluminescence, trap centers
Procedia PDF Downloads 282496 Simple Finite-Element Procedure for Modeling Crack Propagation in Reinforced Concrete Bridge Deck under Repetitive Moving Truck Wheel Loads
Authors: Rajwanlop Kumpoopong, Sukit Yindeesuk, Pornchai Silarom
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Modeling cracks in concrete is complicated by its strain-softening behavior which requires the use of sophisticated energy criteria of fracture mechanics to assure stable and convergent solutions in the finite-element (FE) analysis particularly for relatively large structures. However, for small-scale structures such as beams and slabs, a simpler approach relies on retaining some shear stiffness in the cracking plane has been adopted in literature to model the strain-softening behavior of concrete under monotonically increased loading. According to the shear retaining approach, each element is assumed to be an isotropic material prior to cracking of concrete. Once an element is cracked, the isotropic element is replaced with an orthotropic element in which the new orthotropic stiffness matrix is formulated with respect to the crack orientation. The shear transfer factor of 0.5 is used in parallel to the crack plane. The shear retaining approach is adopted in this research to model cracks in RC bridge deck with some modifications to take into account the effect of repetitive moving truck wheel loads as they cause fatigue cracking of concrete. First modification is the introduction of fatigue tests of concrete and reinforcing steel and the Palmgren-Miner linear criterion of cumulative damage in the conventional FE analysis. For a certain loading, the number of cycles to failure of each concrete or RC element can be calculated from the fatigue or S-N curves of concrete and reinforcing steel. The elements with the minimum number of cycles to failure are the failed elements. For the elements that do not fail, the damage is accumulated according to Palmgren-Miner linear criterion of cumulative damage. The stiffness of the failed element is modified and the procedure is repeated until the deck slab fails. The total number of load cycles to failure of the deck slab can then be obtained from which the S-N curve of the deck slab can be simulated. Second modification is the modification in shear transfer factor. Moving loading causes continuous rubbing of crack interfaces which greatly reduces shear transfer mechanism. It is therefore conservatively assumed in this study that the analysis is conducted with shear transfer factor of zero for the case of moving loading. A customized FE program has been developed using the MATLAB software to accomodate such modifications. The developed procedure has been validated with the fatigue test of the 1/6.6-scale AASHTO bridge deck under the applications of both fixed-point repetitive loading and moving loading presented in the literature. Results are in good agreement both experimental vs. simulated S-N curves and observed vs. simulated crack patterns. Significant contribution of the developed procedure is a series of S-N relations which can now be simulated at any desired levels of cracking in addition to the experimentally derived S-N relation at the failure of the deck slab. This permits the systematic investigation of crack propagation or deterioration of RC bridge deck which is appeared to be useful information for highway agencies to prolong the life of their bridge decks.Keywords: bridge deck, cracking, deterioration, fatigue, finite-element, moving truck, reinforced concrete
Procedia PDF Downloads 257495 A Case Report on Cognitive-Communication Intervention in Traumatic Brain Injury
Authors: Nikitha Francis, Anjana Hoode, Vinitha George, Jayashree S. Bhat
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The interaction between cognition and language, referred as cognitive-communication, is very intricate, involving several mental processes such as perception, memory, attention, lexical retrieval, decision making, motor planning, self-monitoring and knowledge. Cognitive-communication disorders are difficulties in communicative competencies that result from underlying cognitive impairments of attention, memory, organization, information processing, problem solving, and executive functions. Traumatic brain injury (TBI) is an acquired, non - progressive condition, resulting in distinct deficits of cognitive communication abilities such as naming, word-finding, self-monitoring, auditory recognition, attention, perception and memory. Cognitive-communication intervention in TBI is individualized, in order to enhance the person’s ability to process and interpret information for better functioning in their family and community life. The present case report illustrates the cognitive-communicative behaviors and the intervention outcomes of an adult with TBI, who was brought to the Department of Audiology and Speech Language Pathology, with cognitive and communicative disturbances, consequent to road traffic accident. On a detailed assessment, she showed naming deficits along with perseverations and had severe difficulty in recalling the details of the accident, her house address, places she had visited earlier, names of people known to her, as well as the activities she did each day, leading to severe breakdowns in her communicative abilities. She had difficulty in initiating, maintaining and following a conversation. She also lacked orientation to time and place. On administration of the Manipal Manual of Cognitive Linguistic Abilities (MMCLA), she exhibited poor performance on tasks related to visual and auditory perception, short term memory, working memory and executive functions. She attended 20 sessions of cognitive-communication intervention which followed a domain-general, adaptive training paradigm, with tasks relevant to everyday cognitive-communication skills. Compensatory strategies such as maintaining a dairy with reminders of her daily routine, names of people, date, time and place was also recommended. MMCLA was re-administered and her performance in the tasks showed significant improvements. Occurrence of perseverations and word retrieval difficulties reduced. She developed interests to initiate her day-to-day activities at home independently, as well as involve herself in conversations with her family members. Though she lacked awareness about her deficits, she actively involved herself in all the therapy activities. Rehabilitation of moderate to severe head injury patients can be done effectively through a holistic cognitive retraining with a focus on different cognitive-linguistic domains. Selection of goals and activities should have relevance to the functional needs of each individual with TBI, as highlighted in the present case report.Keywords: cognitive-communication, executive functions, memory, traumatic brain injury
Procedia PDF Downloads 347494 Possible Involvement of DNA-methyltransferase and Histone Deacetylase in the Regulation of Virulence Potential of Acanthamoeba castellanii
Authors: Yi H. Wong, Li L. Chan, Chee O. Leong, Stephen Ambu, Joon W. Mak, Priyadashi S. Sahu
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Background: Acanthamoeba is a free-living opportunistic protist which is ubiquitously distributed in the environment. Virulent Acanthamoeba can cause fatal encephalitis in immunocompromised patients and potential blinding keratitis in immunocompetent contact lens wearers. Approximately 24 species have been identified but only the A. castellanii, A. polyphaga and A. culbertsoni are commonly associated with human infections. Until to date, the precise molecular basis for Acanthamoeba pathogenesis remains unclear. Previous studies reported that Acanthamoeba virulence can be diminished through prolonged axenic culture but revived through serial mouse passages. As no clear explanation on this reversible pathogenesis is established, hereby, we postulate that the epigenetic regulators, DNA-methyltransferases (DNMT) and histone-deacetylases (HDAC), could possibly be involved in granting the virulence plasticity of Acanthamoeba spp. Methods: Four rounds of mouse passages were conducted to revive the virulence potential of the virulence-attenuated Acanthamoeba castellanii strain (ATCC 50492). Briefly, each mouse (n=6/group) was inoculated intraperitoneally with Acanthamoebae cells (2x 105 trophozoites/mouse) and incubated for 2 months. Acanthamoebae cells were isolated from infected mouse organs by culture method and subjected to subsequent mouse passage. In vitro cytopathic, encystment and gelatinolytic assays were conducted to evaluate the virulence characteristics of Acanthamoebae isolates for each passage. PCR primers which targeted on the 2 members (DNMT1 and DNMT2) and 5 members (HDAC1 to 5) of the DNMT and HDAC gene families respectively were custom designed. Quantitative real-time PCR (qPCR) was performed to detect and quantify the relative expression of the two gene families in each Acanthamoeba isolates. Beta-tubulin of A. castellanii (Genbank accession no: XP_004353728) was included as housekeeping gene for data normalisation. PCR mixtures were also analyzed by electrophoresis for amplicons detection. All statistical analyses were performed using the paired one-tailed Student’s t test. Results: Our pathogenicity tests showed that the virulence-reactivated Acanthamoeba had a higher degree of cytopathic effect on vero cells, a better resistance to encystment challenge and a higher gelatinolytic activity which was catalysed by serine protease. qPCR assay showed that DNMT1 expression was significantly higher in the virulence-reactivated compared to the virulence-attenuated Acanthamoeba strain (p ≤ 0.01). The specificity of primers which targeted on DNMT1 was confirmed by sequence analysis of PCR amplicons, which showed a 97% similarity to the published DNA-methyltransferase gene of A. castellanii (GenBank accession no: XM_004332804.1). Out of the five primer pairs which targeted on the HDAC family genes, only HDAC4 expression was significantly difference between the two variant strains. In contrast to DNMT1, HDAC4 expression was much higher in the virulence-attenuated Acanthamoeba strain. Conclusion: Our mouse passages had successfully restored the virulence of the attenuated strain. Our findings suggested that DNA-methyltransferase (DNMT1) and histone deacetylase (HDAC4) expressions are associated with virulence potential of Acanthamoeba spp.Keywords: acanthamoeba, DNA-methyltransferase, histone deacetylase, virulence-associated proteins
Procedia PDF Downloads 289493 Stress and Distress among Physician Trainees: A Wellbeing Workshop
Authors: Carmen Axisa, Louise Nash, Patrick Kelly, Simon Willcock
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Introduction: Doctors experience high levels of burnout, stress and psychiatric morbidity. This can affect the health of the doctor and impact patient care. Study Aims: To evaluate the effectiveness of a workshop intervention to promote wellbeing for Australian Physician Trainees. Methods: A workshop was developed in consultation with specialist clinicians to promote health and wellbeing for physician trainees. The workshop objectives were to improve participant understanding about factors affecting their health and wellbeing, to outline strategies on how to improve health and wellbeing and to encourage participants to apply these strategies in their own lives. There was a focus on building resilience and developing long term healthy behaviours as part of the physician trainee daily lifestyle. Trainees had the opportunity to learn practical strategies for stress management, gain insight into their behaviour and take steps to improve their health and wellbeing. The workshop also identified resources and support systems available to trainees. The workshop duration was four and a half hours including a thirty- minute meal break where a catered meal was provided for the trainees. Workshop evaluations were conducted at the end of the workshop. Sixty-seven physician trainees from Adult Medicine and Paediatric training programs in Sydney Australia were randomised into intervention and control groups. The intervention group attended a workshop facilitated by specialist clinicians and the control group did not. Baseline and post intervention measurements were taken for both groups to evaluate the impact and effectiveness of the workshop. Forty-six participants completed all three measurements (69%). Demographic, personal and self-reported data regarding work/life patterns was collected. Outcome measures include Depression Anxiety Stress Scale (DASS), Professional Quality of Life Scale (ProQOL) and Alcohol Use Disorders Identification Test (AUDIT). Results: The workshop was well received by the physician trainees and workshop evaluations showed that the majority of trainees strongly agree or agree that the training was relevant to their needs (96%) and met their expectations (92%). All trainees strongly agree or agree that they would recommend the workshop to their medical colleagues. In comparison to the control group we observed a reduction in alcohol use, depression and burnout but an increase in stress, anxiety and secondary traumatic stress in the intervention group, at the primary endpoint measured at 6 months. However, none of these differences reached statistical significance (p > 0.05). Discussion: Although the study did not reach statistical significance, the workshop may be beneficial to physician trainees. Trainees had the opportunity to share ideas, gain insight into their own behaviour, learn practical strategies for stress management and discuss approach to work, life and self-care. The workshop discussions enabled trainees to share their experiences in a supported environment where they learned that other trainees experienced stress and burnout and they were not alone in needing to acquire successful coping mechanisms and stress management strategies. Conclusion: These findings suggest that physician trainees are a vulnerable group who may benefit from initiatives that promote wellbeing and from a more supportive work environment.Keywords: doctors' health, physician burnout, physician resilience, wellbeing workshop
Procedia PDF Downloads 191492 Establishing Correlation between Urban Heat Island and Urban Greenery Distribution by Means of Remote Sensing and Statistics Data to Prioritize Revegetation in Yerevan
Authors: Linara Salikhova, Elmira Nizamova, Aleksandra Katasonova, Gleb Vitkov, Olga Sarapulova.
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While most European cities conduct research on heat-related risks, there is a research gap in the Caucasus region, particularly in Yerevan, Armenia. This study aims to test the method of establishing a correlation between urban heat islands (UHI) and urban greenery distribution for prioritization of heat-vulnerable areas for revegetation. Armenia has failed to consider measures to mitigate UHI in urban development strategies despite a 2.1°C increase in average annual temperature over the past 32 years. However, planting vegetation in the city is commonly used to deal with air pollution and can be effective in reducing UHI if it prioritizes heat-vulnerable areas. The research focuses on establishing such priorities while considering the distribution of urban greenery across the city. The lack of spatially explicit air temperature data necessitated the use of satellite images to achieve the following objectives: (1) identification of land surface temperatures (LST) and quantification of temperature variations across districts; (2) classification of massifs of land surface types using normalized difference vegetation index (NDVI); (3) correlation of land surface classes with LST. Examination of the heat-vulnerable city areas (in this study, the proportion of individuals aged 75 years and above) is based on demographic data (Census 2011). Based on satellite images (Sentinel-2) captured on June 5, 2021, NDVI calculations were conducted. The massifs of the land surface were divided into five surface classes. Due to capacity limitations, the average LST for each district was identified using one satellite image from Landsat-8 on August 15, 2021. In this research, local relief is not considered, as the study mainly focuses on the interconnection between temperatures and green massifs. The average temperature in the city is 3.8°C higher than in the surrounding non-urban areas. The temperature excess ranges from a low in Norq Marash to a high in Nubarashen. Norq Marash and Avan have the highest tree and grass coverage proportions, with 56.2% and 54.5%, respectively. In other districts, the balance of wastelands and buildings is three times higher than the grass and trees, ranging from 49.8% in Quanaqer-Zeytun to 76.6% in Nubarashen. Studies have shown that decreased tree and grass coverage within a district correlates with a higher temperature increase. The temperature excess is highest in Erebuni, Ajapnyak, and Nubarashen districts. These districts have less than 25% of their area covered with grass and trees. On the other hand, Avan and Norq Marash districts have a lower temperature difference, as more than 50% of their areas are covered with trees and grass. According to the findings, a significant proportion of the elderly population (35%) aged 75 years and above reside in the Erebuni, Ajapnyak, and Shengavit neighborhoods, which are more susceptible to heat stress with an LST higher than in other city districts. The findings suggest that the method of comparing the distribution of green massifs and LST can contribute to the prioritization of heat-vulnerable city areas for revegetation. The method can become a rationale for the formation of an urban greening program.Keywords: heat-vulnerability, land surface temperature, urban greenery, urban heat island, vegetation
Procedia PDF Downloads 72491 Reduction of Specific Energy Consumption in Microfiltration of Bacillus velezensis Broth by Air Sparging and Turbulence Promoter
Authors: Jovana Grahovac, Ivana Pajcin, Natasa Lukic, Jelena Dodic, Aleksandar Jokic
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To obtain purified biomass to be used in the plant pathogen biocontrol or as soil biofertilizer, it is necessary to eliminate residual broth components at the end of the fermentation process. The main drawback of membrane separation techniques is permeate flux decline due to the membrane fouling. Fouling mitigation measures increase the pressure drop along membrane channel due to the increased resistance to flow of the feed suspension, thus increasing the hydraulic power drop. At the same time, these measures lead to an increase in the permeate flux due to the reduced resistance of the filtration cake on the membrane surface. Because of these opposing effects, the energy efficiency of fouling mitigation measures is limited, and the justification of its application is provided by information on a reducing specific energy consumption compared to a case without any measures employed. In this study, the influence of static mixer (Kenics) and air-sparging (two-phase flow) on reduction of specific energy consumption (ER) was investigated. Cultivation Bacillus velezensis was carried out in the 3-L bioreactor (Biostat® Aplus) containing 2 L working volume with two parallel Rushton turbines and without internal baffles. Cultivation was carried out at 28 °C on at 150 rpm with an aeration rate of 0.75 vvm during 96 h. The experiments were carried out in a conventional cross-flow microfiltration unit. During experiments, permeate and retentate were recycled back to the broth vessel to simulate continuous process. The single channel ceramic membrane (TAMI Deutschland) used had a nominal pore size 200 nm with the length of 250 mm and an inner/external diameter of 6/10 mm. The useful membrane channel surface was 4.33×10⁻³ m². Air sparging was brought by the pressurized air connected by a three-way valve to the feed tube by a simple T-connector without diffusor. The different approaches to flux improvement are compared in terms of energy consumption. Reduction of specific energy consumption compared to microfiltration without fouling mitigation is around 49% and 63%, for use of two-phase flow and a static mixer, respectively. In the case of a combination of these two fouling mitigation methods, ER is 60%, i.e., slightly lower compared to the use of turbulence promoter alone. The reason for this result can be found in the fact that flux increase is more affected by the presence of a Kenics static mixer while sparging results in an increase of energy used during microfiltration. By comparing combined method with turbulence promoter flux enhancement method ER is negative (-7%) which can be explained by increased power consumption for air flow with moderate contribution to the flux increase. Another confirmation for this fact can be found by comparing energy consumption values for combined method with energy consumption in the case of two-phase flow. In this instance energy reduction (ER) is 22% that demonstrates that turbulence promoter is more efficient compared to two phase flow. Antimicrobial activity of Bacillus velezensis biomass against phytopathogenic isolates Xanthomonas campestris was preserved under different fouling reduction methods.Keywords: Bacillus velezensis, microfiltration, static mixer, two-phase flow
Procedia PDF Downloads 118490 Spinetoram10% WG+Sulfoxaflor 30% WG: A Promising Green Chemistry to Manage Pest Complex in Bt Cotton
Authors: Siddharudha B. Patil
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Cotton is a premier commercial fibre crop of India subjected to ravages of insect pests. Sucking pests viz thrips, Thrips tabaci,(lind) leaf hopper Amrsca devastance,(dist) miridbug, Poppiocapsidea beseratense (Dist) and bollworms continue to inflict damage Bt Cotton right from seeding stage. Their infestation impact cotton yield to an extent of 30-40 percent. Chemical control is still adoptable as one of the techniques for combating these pests. Presently, growers have many challenges in selecting effective chemicals which fit in with an integrated pest management. Spinetoram has broad spectrum with excellent insecticidal activity against both sucking pests and bollworms. Hence, it is expected to make a great contribution to stable production and quality improvement of agricultural products. Spinetoram is a derivative of biologically active substances (Spinosyns) produced by soil actinomycetes, Saccharopolypara spinosa which is semi synthetic active ingredient representing Spinosyn chemical class of insecticide and has demonstrated higher level of efficacy with reduced risk on beneficial arthropods. The efforts were made in the present study to test the efficacy of Spinetoram against sucking pests and bollworms in comparison with other insecticides in Bt Cotton under field condition. Field experiment was laid out during 2013-14 and 2014-15 at Agricultural Research station Dharwad (Karnataka-India) in a randomized block design comprising eight treatments and three replications. Bt cotton genotype, Bunny BG-II was sown in a plot size of 5.4 m x5.4 m. Recommend agronomical practices were followed. The Spinetoram 12% SC alone and incombination with sulfaxaflore with varied dosages against pest complex was tested. Performance was compared with Spinosad 45% SC and thiamethoxam 25% WG. The results of consecutive seasons revealed that nonsignificant difference in thrips and leafhopper population and varied significantly after 3 days of imposition. Among the treatments, combiproduct, Spinetoram 10%WG + Sulfoxaflor 30% WG@ 140 gai/ha registered lowest population of thrips (3.91/3 leaves) and leaf hoppers (1.08/3 leaves) followed by its lower dosages viz 120 gai/ha (4.86/3 leaves and 1.14/3 leaves of thrips and leaf hoppers, respectively) and 100 gai/ha (6.02 and 1.23./3 leaves of thrips and leaf hoppers respectively) being at par, significantly superior to rest of the treatments. On the contrary, the population of thrips, leaf hopper and miridbugs in untreated control was on higher side. Similarly the higher dosage of Spinetoram 10% WG+ Sulfoxaflor 30% WG (140 gai/ha) proved its bioefficacy by registering lowest miridbug incidence of 1.70/25 squares, followed by its lower dosage (1.78 and 1.83/25 squares respectively) Further observation made on bollworms incidence revealed that the higher dosage of Spinetoram 10% WG+Sulfoxaflor 30% WG (140 gai/ha) registered lowest percentage of boll damage (7.22%), more number of good opened bolls (36.89/plant) and higher seed cotton yield (19.45q/ha) followed by rest of its lower dosages, Spinetoram 12% SC alone and Spinosad 45% SC being at par significantly superior to rest of the treatments. However, significantly higher boll damage (15.13%) and lower seed cotton yield (14.45 q/ha) was registered in untreated control. Thus Spinetoram10% WG+Sulfoxaflor 30% WG can be a promising option for pest management in Bt Cotton.Keywords: Spinetoram10% WG+Sulfoxaflor 30% WG, sucking pests, bollworms, Bt cotton, management
Procedia PDF Downloads 250489 Implementation of Language Policy in a Swedish Multicultural Early Childhood School: A Development Project
Authors: Carina Hermansson
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This presentation focuses a development project aiming at developing and documenting the steps taken at a multilingual, multicultural K-5 school, with the aim to improve the achievement levels of the pupils by focusing language and literacy development across the schedule in a digital classroom, and in all units of the school. This pre-formulated aim, thus, may be said to adhere to neoliberal educational and accountability policies in terms of its focus on digital learning, learning results, and national curriculum standards. In particular the project aimed at improving the collaboration between the teachers, the leisure time unit, the librarians, the mother tongue teachers and bilingual study counselors. This is a school environment characterized by cultural, ethnic, linguistic, and professional pluralization. The overarching aims of the research project were to scrutinize and analyze the factors enabling and obstructing the implementation of the Language Policy in a digital classroom. Theoretical framework: We apply multi-level perspectives in the analyses inspired by Uljens’ ideas about interactive and interpersonal first order (teacher/students) and second order(principal/teachers and other staff) educational leadership as described within the framework of discursive institutionalism, when we try to relate the Language Policy, educational policy, and curriculum with the administrative processes. Methodology/research design: The development project is based on recurring research circles where teachers, leisure time assistants, mother tongue teachers and study counselors speaking the mother tongue of the pupils together with two researchers discuss their digital literacy practices in the classroom. The researchers have in collaboration with the principal developed guidelines for the work, expressed in a Language Policy document. In our understanding the document is, however, only a part of the concept, the actions of the personnel and their reflections on the practice constitute the major part of the development project. One and a half years out of three years have now passed and the project has met with a row of difficulties which shed light on factors of importance for the progress of the development project. Field notes and recordings from the research circles, a survey with the personnel, and recorded group interviews provide data on the progress of the project. Expected conclusions: The problems experienced deal with leadership, curriculum, interplay between aims, technology, contents and methods, the parents as customers taking their children to other schools, conflicting values, and interactional difficulties, that is, phenomena on different levels, ranging from school to a societal level, as for example teachers being substituted as a result of the marketization of schools. Also underlying assumptions from actors at different levels create obstacles. We find this study and the problems we are facing utterly important to share and discuss in an era with a steady flow of refugees arriving in the Nordic countries.Keywords: early childhood education, language policy, multicultural school, school development project
Procedia PDF Downloads 145488 Complex Decision Rules in Quality Assurance Processes for Quick Service Restaurant Industry: Human Factors Determining Acceptability
Authors: Brandon Takahashi, Marielle Hanley, Gerry Hanley
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The large-scale quick-service restaurant industry is a complex business to manage optimally. With over 40 suppliers providing different ingredients for food preparation and thousands of restaurants serving over 50 unique food offerings across a wide range of regions, the company must implement a quality assurance process. Businesses want to deliver quality food efficiently, reliably, and successfully at a low cost that the public wants to buy. They also want to make sure that their food offerings are never unsafe to eat or of poor quality. A good reputation (and profitable business) developed over the years can be gone in an instant if customers fall ill eating your food. Poor quality also results in food waste, and the cost of corrective actions is compounded by the reduction in revenue. Product compliance evaluation assesses if the supplier’s ingredients are within compliance with the specifications of several attributes (physical, chemical, organoleptic) that a company will test to ensure that a quality, safe to eat food is given to the consumer and will deliver the same eating experience in all parts of the country. The technical component of the evaluation includes the chemical and physical tests that produce numerical results that relate to shelf-life, food safety, and organoleptic qualities. The psychological component of the evaluation includes organoleptic, which is acting on or involving the use of the sense organs. The rubric for product compliance evaluation has four levels: (1) Ideal: Meeting or exceeding all technical (physical and chemical), organoleptic, & psychological specifications. (2) Deviation from ideal but no impact on quality: Not meeting or exceeding some technical and organoleptic/psychological specifications without impact on consumer quality and meeting all food safety requirements (3) Acceptable: Not meeting or exceeding some technical and organoleptic/psychological specifications resulting in reduction of consumer quality but not enough to lessen demand and meeting all food safety requirements (4) Unacceptable: Not meeting food safety requirements, independent of meeting technical and organoleptic specifications or meeting all food safety requirements but product quality results in consumer rejection of food offering. Sampling of products and consumer tastings within the distribution network is a second critical element of the quality assurance process and are the data sources for the statistical analyses. Each finding is not independently assessed with the rubric. For example, the chemical data will be used to back up/support any inferences on the sensory profiles of the ingredients. Certain flavor profiles may not be as apparent when mixed with other ingredients, which leads to weighing specifications differentially in the acceptability decision. Quality assurance processes are essential to achieve that balance of quality and profitability by making sure the food is safe and tastes good but identifying and remediating product quality issues before they hit the stores. Comprehensive quality assurance procedures implement human factors methodologies, and this report provides recommendations for systemic application of quality assurance processes for quick service restaurant services. This case study will review the complex decision rubric and evaluate processes to ensure the right balance of cost, quality, and safety is achieved.Keywords: decision making, food safety, organoleptics, product compliance, quality assurance
Procedia PDF Downloads 188487 Strength Properties of Ca-Based Alkali Activated Fly Ash System
Authors: Jung-Il Suh, Hong-Gun Park, Jae-Eun Oh
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Recently, the use of long-span precast concrete (PC) construction has increased in modular construction such as storage buildings and parking facilities. When applying long span PC member, reducing weight of long span PC member should be conducted considering lifting capacity of crane and self-weight of PC member and use of structural lightweight concrete made by lightweight aggregate (LWA) can be considered. In the process of lightweight concrete production, segregation and bleeding could occur due to difference of specific gravity between cement (3.3) and lightweight aggregate (1.2~1.8) and reducing weight of binder is needed to prevent the segregation between binder and aggregate. Also, lightweight precast concrete made by cementitious materials such as fly ash and ground granulated blast furnace (GGBFS) which is lower than specific gravity of cement as a substitute for cement has been studied. When only using fly ash for cementless binder alkali-activation of fly ash is most important chemical process in which the original fly ash is dissolved by a strong alkaline medium in steam curing with high-temperature condition. Because curing condition is similar with environment of precast member production, additional process is not needed. Na-based chloride generally used as a strong alkali activator has a practical problem such as high pH toxicity and high manufacturing cost. Instead of Na-based alkali activator calcium hydroxide [Ca(OH)2] and sodium hydroxide [Na2CO3] might be used because it has a lower pH and less expensive than Na-based alkali activator. This study explored the influences on Ca(OH)2-Na2CO3-activated fly ash system in its microstructural aspects and strength and permeability using powder X-ray analysis (XRD), thermogravimetry (TGA), mercury intrusion porosimetry (MIP). On the basis of microstructural analysis, the conclusions are made as follows. Increase of Ca(OH)2/FA wt.% did not affect improvement of compressive strength. Also, Ca(OH)2/FA wt.% and Na2CO3/FA wt.% had little effect on specific gravity of saturated surface dry (SSD) and absolute dry (AD) condition to calculate water absorption. Especially, the binder is appropriate for structural lightweight concrete because specific gravity of the hardened paste has no difference with that of lightweight aggregate. The XRD and TGA/DTG results did not present considerable difference for the types and quantities of hydration products depending on w/b ratio, Ca(OH)2 wt.%, and Na2CO3 wt.%. In the case of higher molar quantity of Ca(OH)2 to Na2CO3, XRD peak indicated unreacted Ca(OH)2 while DTG peak was not presented because of small quantity. Thus, presence of unreacted Ca(OH)2 is too small quantity to effect on mechanical performance. As a result of MIP, the porosity volume related to capillary pore depends on the w/b ratio. In the same condition of w/b ratio, quantities of Ca(OH)2 and Na2CO3 have more influence on pore size distribution rather than total porosity. While average pore size decreased as Na2CO3/FA w.t% increased, the average pore size increased over 20 nm as Ca(OH)2/FA wt.% increased which has inverse proportional relationship between pore size and mechanical properties such as compressive strength and water permeability.Keywords: Ca(OH)2, compressive strength, microstructure, fly ash, Na2CO3, water absorption
Procedia PDF Downloads 225486 Application of Alumina-Aerogel in Post-Combustion CO₂ Capture: Optimization by Response Surface Methodology
Authors: S. Toufigh Bararpour, Davood Karami, Nader Mahinpey
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Dependence of global economics on fossil fuels has led to a large growth in the emission of greenhouse gases (GHGs). Among the various GHGs, carbon dioxide is the main contributor to the greenhouse effect due to its huge emission amount. To mitigate the threatening effect of CO₂, carbon capture and sequestration (CCS) technologies have been studied widely in recent years. For the combustion processes, three main CO₂ capture techniques have been proposed such as post-combustion, pre-combustion and oxyfuel combustion. Post-combustion is the most commonly used CO₂ capture process as it can be readily retrofit into the existing power plants. Multiple advantages have been reported for the post-combustion by solid sorbents such as high CO₂ selectivity, high adsorption capacity, and low required regeneration energy. Chemical adsorption of CO₂ over alkali-metal-based solid sorbents such as K₂CO₃ is a promising method for the selective capture of diluted CO₂ from the huge amount of nitrogen existing in the flue gas. To improve the CO₂ capture performance, K₂CO₃ is supported by a stable and porous material. Al₂O₃ has been employed commonly as the support and enhanced the cyclic CO₂ capture efficiency of K₂CO₃. Different phases of alumina can be obtained by setting the calcination temperature of boehmite at 300, 600 (γ-alumina), 950 (δ-alumina) and 1200 °C (α-alumina). By increasing the calcination temperature, the regeneration capacity of alumina increases, while the surface area reduces. However, sorbents with lower surface areas have lower CO₂ capture capacity as well (except for the sorbents prepared by hydrophilic support materials). To resolve this issue, a highly efficient alumina-aerogel support was synthesized with a BET surface area of over 2000 m²/g and then calcined at a high temperature. The synthesized alumina-aerogel was impregnated on K₂CO₃ based on 50 wt% support/K₂CO₃, which resulted in the preparation of a sorbent with remarkable CO₂ capture performance. The effect of synthesis conditions such as types of alcohols, solvent-to-co-solvent ratios, and aging times was investigated on the performance of the support. The best support was synthesized using methanol as the solvent, after five days of aging time, and at a solvent-to-co-solvent (methanol-to-toluene) ratio (v/v) of 1/5. Response surface methodology was used to investigate the effect of operating parameters such as carbonation temperature and H₂O-to-CO₂ flowrate ratio on the CO₂ capture capacity. The maximum CO₂ capture capacity, at the optimum amounts of operating parameters, was 7.2 mmol CO₂ per gram K₂CO₃. Cyclic behavior of the sorbent was examined over 20 carbonation and regenerations cycles. The alumina-aerogel-supported K₂CO₃ showed a great performance compared to unsupported K₂CO₃ and γ-alumina-supported K₂CO₃. Fundamental performance analyses and long-term thermal and chemical stability test will be performed on the sorbent in the future. The applicability of the sorbent for a bench-scale process will be evaluated, and a corresponding process model will be established. The fundamental material knowledge and respective process development will be delivered to industrial partners for the design of a pilot-scale testing unit, thereby facilitating the industrial application of alumina-aerogel.Keywords: alumina-aerogel, CO₂ capture, K₂CO₃, optimization
Procedia PDF Downloads 116485 Study of a Decentralized Electricity Market on Awaji Island
Authors: Arkadiusz P. Wójcik, Tetsuya Sato, Shin-Ichiro Shima, Mateusz Malanowski
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Over the last decades, new technologies have significantly changed the way information is transmitted and stored. Renewable energy sources have become prevalent and affordable. Cooperation of the Information and Communication Technology industry and Renewable Energy industry makes it possible to create a next generation, decentralized power grid. In this context, the study seeks to identify the wider benefits to the local Japanese economy as a result of the development of a decentralised electricity market. Our general approach aims to integrate an economic analysis (monetary appraisal of costs and benefits to society) with externalities that are not quantifiable in monetary terms (e.g. social impact, environmental impact). The study also highlights opportunities and sets out recommendations for the citizens of the island and the local government. The simulation is the scientific basis for economic impact analysis. Various types of sources of energy have been taken into account: residential wind farm, residential wind turbine, solar farm, residential solar panels and private solar farms. Analysis of local geographic and economic conditions allowed creating a customized business model. Very often farmers on Awaji Island are using crop cycle. During each cycle, one part of the field is resting and replenishing nutrients. In the next year another part of the field is resting. Portable solar panels could be freely set up in this part of the field. At the end of the crop cycle, portable solar panels would be moved to the next resting part. Because of spacious area, for a single household 500 square meters of portable solar panels has been proposed and simulated. The devised simulation shows that the Rate of Return on Investment for solar panels, which are on the island, could reach up to 37.21%. Supposing that about 20% of households install solar panels they could produce 49.11% of the electric energy consumed by households on the island. The analysis shows that rest of the energy supply can be produced by currently existing one huge solar farm and two wind farms to meet 97.59% of demand on electricity for households on the island. Although there are more than 7,000 agricultural fields on the island, young people tend to avoid agricultural work and prefer to move from the island to big cities, live there in little mansions and work until late night. The business model proposed in this study could increase farmer’s monthly income by ¥200,000 - ¥300,000 (1,600 euro – 2,400 euro). Young people could work less and have a higher standard of living than in a city. Creation of a decentralized electricity market can unlock significant benefits in other industries (e.g. electric vehicles), providing a welcome boost to economic growth, jobs and quality of life.Keywords: digital twin, Matlab, model-based systems engineering, simulink, smart grid, systems engineering
Procedia PDF Downloads 121484 A Brief Review on Doping in Sports and Performance-Enhancing Drugs
Authors: Zahra Mohajer, Afsaneh Soltani
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Doping is a major issue in competitive sports and is favored by vast groups of athletes. The feeling of being higher-ranking than others and gaining fame has caused many athletes to misuse drugs. The definition of doping is to use prohibited substances and/or methods that help physical or mental performances or both. Doping counts as the illegal use of chemical substances or drugs, excessive amounts of physiological substances to increase the performance at or out of competition or even the use of inappropriate medications to treat an injury to gain the ability to participate in a competition. The International Olympic Committee (IOC) and World Anti-Doping Agency (WADA) have forbidden these substances to ensure fair and equal competition and also the health of the competitors. As of 2004 WADA has published an international list of illegal substances used for doping, which is updated annually. In the process of the Genome Project scientists have gained the ability to treat numerous diseases by gene therapy, which may result in bodily performance increase and therefore a potential opportunity to misuse by some athletes. Gene doping is defined as the non-therapeutic direct and indirect genetic modifications using genetic materials that can improve the performances in sports events. Biosynthetic drugs are a form of indirect genetic engineering. The method can be performed in three ways such as injecting the DNA directly into the muscle, inserting the genetically engineered cells, or transferring the DNA using a virus as a vector. Erythropoietin is a hormone majorly released by the kidney and in small amounts by the liver. Its function is to stimulate the erythropoiesis and therefore the more production of red blood cells (RBC) which causes an increase in Hemoglobin (Hb). During this process, the oxygen delivery to muscles will increase, which will improve athletic performance and postpone exhaustion. There are ways to increase the oxygen transferred to muscles such as blood transfusion, stimulating the production of red blood cells by using Erythropoietin (EPO), and also using allosteric effectors of Hemoglobin. EPO can either be injected as a protein or can be inserted into the cells as the gene which encodes EPO. Adeno-associated viruses have been employed to deliver the EPO gene to the cells. Employing the genes that naturally exist in the human body such as the EPO gene can reduce the risk of detecting gene doping. The first research about blood doping was conducted in 1947. The study has shown that an increase in hematocrit (HCT) up to 55% following homologous transfusion makes it more unchallenging for the body to perform the exercise at the altitude. Thereafter athletes’ attraction to blood infusion escalated. Also, a study has demonstrated that by reinfusing their own blood 4 weeks after being drawn, three men have shown a rise in Hb level which improved the oxygen uptake, and a delay in exhaustion. The list of performance-enhancing drugs is published by WADA annually and includes the following drugs: anabolic agents, hormones, Beta-2 agonists, Beta-blockers, Diuretics, Stimulants, narcotics, cannabinoids, and corticosteroids.Keywords: doping, PEDs, sports, WADA
Procedia PDF Downloads 106483 The Association between Attachment Styles, Satisfaction of Life, Alexithymia, and Psychological Resilience: The Mediational Role of Self-Esteem
Authors: Zahide Tepeli Temiz, Itir Tari Comert
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Attachment patterns based on early emotional interactions between infant and primary caregiver continue to be influential in adult life, in terms of mental health and behaviors of individuals. Several studies reveal that infant-caregiver relationships have impressed the affect regulation, coping with stressful and negative situations, general satisfaction of life, and self image in adulthood, besides the attachment styles. The present study aims to examine the relationships between university students’ attachment style and their self-esteem, alexithymic features, satisfaction of life, and level of resilience. In line with this aim, the hypothesis of the prediction of attachment styles (anxious and avoidant) over life satisfaction, self-esteem, alexithymia, and psychological resilience was tested. Additionally, in this study Structural Equational Modeling was conducted to investigate the mediational role of self-esteem in the relationship between attachment styles and alexithymia, life satisfaction, and resilience. This model was examined with path analysis. The sample of the research consists of 425 university students who take education from several region of Turkey. The participants who sign the informed consent completed the Demographic Information Form, Experiences in Close Relationships-Revised, Rosenberg Self-Esteem Scale, The Satisfaction with Life Scale, Toronto Alexithymia Scale, and Resilience Scale for Adults. According to results, anxious, and avoidant dimensions of insecure attachment predicted the self-esteem score and alexithymia in positive direction. On the other hand, these dimensions of attachment predicted life satisfaction in negative direction. The results of linear regression analysis indicated that anxious and avoidant attachment styles didn’t predict the resilience. This result doesn’t support the theory and research indicating the relationship between attachment style and psychological resilience. The results of path analysis revealed the mediational role self esteem in the relation between anxious, and avoidant attachment styles and life satisfaction. In addition, SEM analysis indicated the indirect effect of attachment styles over alexithymia and resilience besides their direct effect. These findings support the hypothesis of this research relation to mediating role of self-esteem. Attachment theorists suggest that early attachment experiences, including supportive and responsive family interactions, have an effect on resilience to harmful situations in adult life, ability to identify, describe, and regulate emotions and also general satisfaction with life. Several studies examining the relationship between attachment styles and life satisfaction, alexithymia, and psychological resilience draw attention to mediational role of self-esteem. Results of this study support the theory of attachment patterns with the mediation of self-image influence the emotional, cognitive, and behavioral regulation of person throughout the adulthood. Therefore, it is thought that any intervention intended for recovery in attachment relationship will increase the self-esteem, life satisfaction, and resilience level, on the one side, decrease the alexithymic features, on the other side.Keywords: alexithymia, anxious attachment, avoidant attachment, life satisfaction, path analysis, resilience, self-esteem, structural equation
Procedia PDF Downloads 195482 Knowledge Based Software Model for the Management and Treatment of Malaria Patients: A Case of Kalisizo General Hospital
Authors: Mbonigaba Swale
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Malaria is an infection or disease caused by parasites (Plasmodium Falciparum — causes severe Malaria, plasmodium Vivax, Plasmodium Ovale, and Plasmodium Malariae), transmitted by bites of infected anopheles (female) mosquitoes to humans. These vectors comprise of two types in Africa, particularly in Uganda, i.e. anopheles fenestus and Anopheles gambaie (‘example Anopheles arabiensis,,); feeds on man inside the house mainly at dusk, mid-night and dawn and rests indoors and makes them effective transmitters (vectors) of the disease. People in both urban and rural areas have consistently become prone to repetitive attacks of malaria, causing a lot of deaths and significantly increasing the poverty levels of the rural poor. Malaria is a national problem; it causes a lot of maternal pre-natal and antenatal disorders, anemia in pregnant mothers, low birth weights for the newly born, convulsions and epilepsy among the infants. Cumulatively, it kills about one million children every year in sub-Saharan Africa. It has been estimated to account for 25-35% of all outpatient visits, 20-45% of acute hospital admissions and 15-35% of hospital deaths. Uganda is the leading victim country, for which Rakai and Masaka districts are the most affected. So, it is not clear whether these abhorrent situations and episodes of recurrences and failure to cure from the disease are a result of poor diagnosis, prescription and dosing, treatment habits and compliance of the patients to the drugs or the ethical domain of the stake holders in relation to the main stream methodology of malaria management. The research is aimed at offering an alternative approach to manage and deal absolutely with problem by using a knowledge based software model of Artificial Intelligence (Al) that is capable of performing common-sense and cognitive reasoning so as to take decisions like the human brain would do to provide instantaneous expert solutions so as to avoid speculative simulation of the problem during differential diagnosis in the most accurate and literal inferential aspect. This system will assist physicians in many kinds of medical diagnosis, prescribing treatments and doses, and in monitoring patient responses, basing on the body weight and age group of the patient, it will be able to provide instantaneous and timely information options, alternative ways and approaches to influence decision making during case analysis. The computerized system approach, a new model in Uganda termed as “Software Aided Treatment” (SAT) will try to change the moral and ethical approach and influence conduct so as to improve the skills, experience and values (social and ethical) in the administration and management of the disease and drugs (combination therapy and generics) by both the patient and the health worker.Keywords: knowledge based software, management, treatment, diagnosis
Procedia PDF Downloads 57481 Urban Security through Urban Transformation: Case of Saraycik District
Authors: Emir Sunguroglu, Merve Sunguroglu, Yesim Aliefendioglu, Harun Tanrivermis
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Basic human needs range from physiological needs such as food, water and shelter to safety needs such as security, protection from natural disasters and even urban terrorism which are extant and not fulfilled even in urban areas where people live civilly in large communities. These basic needs when arose in urban life lead to a different kind of crime set defined as urban crimes. Urban crimes mostly result from differences between socioeconomic conditions in society. Income inequality increases tendency towards urban crimes. Especially in slum areas and suburbs, urban crimes not only threaten public security but they also affect deliverance of public services. It is highlighted that, construction of urban security against problems caused by urban crimes is not only achieved by involvement of urban security in security of the community but also comprises juridical development and staying above a level of legal standards concurrently. The idea of urban transformation emerged as interventions to demolishment and rebuilding of built environment to solve the unhealthy urban environment, inadequate infrastructure and socioeconomic problems came up during the industrialization process. Considering the probability of urbanization process driving citizens to commit crimes, The United Nations Commission on Human Security’s focus on this theme is conferred to be a proper approach. In this study, the analysis and change in security before, through and after urban transformation, which is one of the tools related to urbanization process, is strived to be discussed through the case of Sincan County Saraycik District. The study also aims to suggest improvements to current legislation on public safety, urban resilience, and urban transformation. In spite of Saraycik District residing in a developing County in Ankara, Turkey, from urbanization perspective as well as socioeconomic and demographic indicators the District exhibits a negative view throughout the County and the country. When related to the county, rates of intentional harm reports, burglary reports, the offense of libel and threat reports and narcotic crime reports are higher. The District is defined as ‘crime hotspot’. Interviews with residents of Saraycik claim that the greatest issue of the neighborhood is Public Order and Security (82.44 %). The District becomes prominent with negative aspects, especially with the presence of unlicensed constructions, occurrence of important social issues such as crime and insecurity and complicated lives of inhabitants from poverty and low standard conditions of living. Additionally, the social structure and demographic properties and crime and insecurity of the field have been addressed in this study. Consequently, it is claimed that urban crime rates were related to level of education, employment and household income, poverty trap, physical condition of housing and structuration, accessibility of public services, security, migration, safety in terms of disasters and emphasized that urban transformation is one of the most important tools in order to provide urban security.Keywords: urban security, urban crimes, urban transformation, Saraycik district
Procedia PDF Downloads 304480 Speech and Swallowing Function after Tonsillo-Lingual Sulcus Resection with PMMC Flap Reconstruction: A Case Study
Authors: K. Rhea Devaiah, B. S. Premalatha
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Background: Tonsillar Lingual sulcus is the area between the tonsils and the base of the tongue. The surgical resection of the lesions in the head and neck results in changes in speech and swallowing functions. The severity of the speech and swallowing problem depends upon the site and extent of the lesion, types and extent of surgery and also the flexibility of the remaining structures. Need of the study: This paper focuses on the importance of speech and swallowing rehabilitation in an individual with the lesion in the Tonsillar Lingual Sulcus and post-operative functions. Aim: Evaluating the speech and swallow functions post-intensive speech and swallowing rehabilitation. The objectives are to evaluate the speech intelligibility and swallowing functions after intensive therapy and assess the quality of life. Method: The present study describes a report of an individual aged 47years male, with the diagnosis of basaloid squamous cell carcinoma, left tonsillar lingual sulcus (pT2n2M0) and underwent wide local excision with left radical neck dissection with PMMC flap reconstruction. Post-surgery the patient came with a complaint of reduced speech intelligibility, and difficulty in opening the mouth and swallowing. Detailed evaluation of the speech and swallowing functions were carried out such as OPME, articulation test, speech intelligibility, different phases of swallowing and trismus evaluation. Self-reported questionnaires such as SHI-E(Speech handicap Index- Indian English), DHI (Dysphagia handicap Index) and SESEQ -K (Self Evaluation of Swallowing Efficiency in Kannada) were also administered to know what the patient feels about his problem. Based on the evaluation, the patient was diagnosed with pharyngeal phase dysphagia associated with trismus and reduced speech intelligibility. Intensive speech and swallowing therapy was advised weekly twice for the duration of 1 hour. Results: Totally the patient attended 10 intensive speech and swallowing therapy sessions. Results indicated misarticulation of speech sounds such as lingua-palatal sounds. Mouth opening was restricted to one finger width with difficulty chewing, masticating, and swallowing the bolus. Intervention strategies included Oro motor exercise, Indirect swallowing therapy, usage of a trismus device to facilitate mouth opening, and change in the food consistency to help to swallow. A practice session was held with articulation drills to improve the production of speech sounds and also improve speech intelligibility. Significant changes in articulatory production and speech intelligibility and swallowing abilities were observed. The self-rated quality of life measures such as DHI, SHI and SESE Q-K revealed no speech handicap and near-normal swallowing ability indicating the improved QOL after the intensive speech and swallowing therapy. Conclusion: Speech and swallowing therapy post carcinoma in the tonsillar lingual sulcus is crucial as the tongue plays an important role in both speech and swallowing. The role of Speech-language and swallowing therapists in oral cancer should be highlighted in treating these patients and improving the overall quality of life. With intensive speech-language and swallowing therapy post-surgery for oral cancer, there can be a significant change in the speech outcome and swallowing functions depending on the site and extent of lesions which will thereby improve the individual’s QOL.Keywords: oral cancer, speech and swallowing therapy, speech intelligibility, trismus, quality of life
Procedia PDF Downloads 112479 Early Initiation of Breastfeeding and Its Determinants among Non-Caesarean Deliveries at Primary and Secondary Health Facilities: A Case Observational Study
Authors: Farhana Karim, Abdullah N. S. Khan, Mohiuddin A. K. Chowdhury, Nabila Zaka, Alexander Manu, Shams El Arifeen, Sk Masum Billah
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Breastfeeding, an integral part of newborn care, can reduce 55-87% of all-cause neonatal mortality and morbidity. Early initiation of breastfeeding within 1 hour of birth can avert 22% of newborn mortality. Only 45% of world’s newborns and 42% of newborns in South-Asia are put to the breast within one hour of birth. In Bangladesh, only a half of the mothers practice early initiation of breastfeeding which is less likely to be practiced if the baby is born in a health facility. This study aims to generate strong evidence for early initiation of breastfeeding practices in the government health facilities and to explore the associated factors influencing the practice. The study was conducted in selected health facilities in three neighbouring districts of Northern Bangladesh. Total 249 normal vaginal delivery cases were observed for 24 hours since the time of birth. The outcome variable was initiation of breastfeeding within 1 hour while the explanatory variables included type of health facility, privacy, presence of support person, stage of labour at admission, need for augmentation of labour, complications during delivery, need for episiotomy, spontaneous cry of the newborn, skin-to-skin contact with mother, post-natal contact with the service provider, receiving a post-natal examination and counselling on breastfeeding during postnatal contact. The simple descriptive statistics were employed to see the distribution of samples according to socio-demographic characteristics. Kruskal-Wallis test was carried out for testing the equality of medians among two or more categories of each variable and P-value is reported. A series of simple logistic regressions were conducted with all the potential explanatory variables to identify the determining factors for breastfeeding within 1 hour in a health facility. Finally, multiple logistic regression was conducted including the variables found significant at bi-variate analyses. Almost 90% participants initiated breastfeeding at the health facility and median time to initiate breastfeeding was 38 minutes. However, delivering in a sub-district hospital significantly delayed the breastfeeding initiation in comparison to delivering in a district hospital. Maintenance of adequate privacy and presence of separate staff for taking care of newborn significantly reduced the time in early breastfeeding initiation. Initiation time was found longer if the mother had an augmented labour, obstetric complications, and the newborn needed resuscitation. However, the initiation time was significantly early if the baby was put skin-to-skin on mother’s abdomen and received a postnatal examination by a provider. After controlling for the potential confounders, the odds of initiating breastfeeding within one hour of birth is higher if mother gives birth in a district hospital (AOR 3.0: 95% CI 1.5, 6.2), privacy is well-maintained (AOR 2.3: 95% CI 1.1, 4.5), babies cry spontaneously (AOR 7.7: 95% CI 3.3, 17.8), babies are put to skin-to-skin contact with mother (AOR 4.6: 95% CI 1.9, 11.2) and if the baby is examined by a provider in the facility (AOR 4.4: 95% CI 1.4, 14.2). The evidence generated by this study will hopefully direct the policymakers to identify and prioritize the scopes for creating and supporting early initiation of breastfeeding in the health facilities.Keywords: Bangladesh, early initiation of breastfeeding, health facility, normal vaginal delivery, skin to skin contact
Procedia PDF Downloads 153478 Study of Nucleation and Growth Processes of Ettringite in Supersaturated Diluted Solutions
Authors: E. Poupelloz, S. Gauffinet
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Ettringite Ca₆Al₂(SO₄)₃(OH)₁₂26H₂O is one of the major hydrates formed during cement hydration. Ettringite forms in Portland cement from the reaction between tricalcium aluminate Ca₃Al₂O₆ and calcium sulfate. Ettringite is also present in calcium sulfoaluminate cement in which it is the major hydrate, formed by the reaction between yeelimite Ca₄(AlO₂)₆SO₄ and calcium sulfate. About the formation of ettringite, numerous results are available in the literature even if some issues are still under discussion. However, almost all published work about ettringite was done on cementitious systems. Yet in cement, hydration reactions are very complex, the result of dissolution-precipitation processes and are submitted to various interactions. Understanding the formation process of a phase alone, here ettringite, is the first step to later understand the much more complex reactions happening in cement. This study is crucial for the comprehension of early cement hydration and physical behavior. Indeed formation of hydrates, in particular, ettringite, will have an influence on the rheological properties of the cement paste and on the need for admixtures. To make progress toward the understanding of existing phenomena, a specific study of nucleation and growth processes of ettringite was conducted. First ettringite nucleation was studied in ionic aqueous solutions, with controlled but different experimental conditions, as different supersaturation degrees (β), different pH or presence of exogenous ions. Through induction time measurements, interfacial ettringite crystals solution energies (γ) were determined. Growth of ettringite in supersaturated solutions was also studied through chain crystallization reactions. Specific BET surface area measurements and Scanning Electron Microscopy observations seemed to prove that growth process is favored over the nucleation process when ettringite crystals are initially present in a solution with a low supersaturation degree. The influence of stirring on ettringite formation was also investigated. Observation was made that intensity and nature of stirring have a high influence on the size of ettringite needles formed. Needle sizes vary from less than 10µm long depending on the stirring to almost 100µm long without any stirring. During all previously mentioned experiments, initially present ions are consumed to form ettringite in such a way that the supersaturation degree with regard to ettringite is decreasing over time. To avoid this phenomenon a device compensating the drop of ion concentrations by adding some more solutions, and therefore always have constant ionic concentrations, was used. This constant β recreates the conditions of the beginning of cement paste hydration, when the dissolution of solid reagents compensates the consumption of ions to form hydrates. This device allowed the determination of the ettringite precipitation rate as a function of the supersaturation degree β. Taking samples at different time during ettringite precipitation and doing BET measurements allowed the determination of the interfacial growth rate of ettringite in m²/s. This work will lead to a better understanding and control of ettringite formation alone and thus during cements hydration. This study will also ultimately define the impact of ettringite formation process on the rheology of cement pastes at early age, which is a crucial parameter from a practical point of view.Keywords: cement hydration, ettringite, morphology of crystals, nucleation-growth process
Procedia PDF Downloads 128