Search results for: biological and chemical treatment
11366 Sorption of Charged Organic Dyes from Anionic Hydrogels
Authors: Georgios Linardatos, Miltiadis Zamparas, Vlasoula Bekiari, Georgios Bokias, Georgios Hotos
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Hydrogels are three-dimensional, hydrophilic, polymeric networks composed of homopolymers or copolymers and are insoluble in water due to the presence of chemical or physical cross-links. When hydrogels come in contact with aqueous solutions, they can effectively sorb and retain the dissolved substances, depending on the nature of the monomeric units comprising the hydrogel. For this reason, hydrogels have been proposed in several studies as water purification agents. At the present work anionic hydrogels bearing negatively charged –COO- groups were prepared and investigated. These gels are based on sodium acrylate (ANa), either homopolymerized (poly(sodiumacrylate), PANa) or copolymerized (P(DMAM-co-ANa)) with N,N Dimethylacrylamide (DMAM). The hydrogels were used to extract some model organic dyes from water. It is found that cationic dyes are strongly sorbed and retained by the hydrogels, while sorption of anionic dyes was negligible. In all cases it was found that both maximum sorption capacity and equilibrium binding constant varied from one dye to the other depending on the chemical structure of the dye, the presence of functional chemical groups and the hydrophobic-hydrophilic balance. Finally, the nonionic hydrogel of the homopolymer poly(N,N-dimethylacrylamide), PDMAM, was also used for reasons of comparison.Keywords: anionic organic hydrogels, sorption, organic dyes, water purification agents
Procedia PDF Downloads 25911365 Use of Dual-Energy CT Post Endovascular Treatment of Cerebral Aneurysm
Authors: Mitchell Stanton
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Background: Endovascular management is well established as a mainstay treatment option for cerebral aneurysms. It is also well established that immediate post procedural imaging can be difficult to interpret due to the presence of contrast material. However, through the use of Dual-Energy computed tomography, it has become possible to differentiate contrast extravasation and intracranial haemorrhage. This case illustrates the importance of this technology following endovascular treatment of an unruptured cerebral aneurysm. Case Presentation: A 79-year-old female was found to have an unruptured large intracavernous ICA fusiform aneurysm on CT Brain Angiogram after presenting with acute ophthalmoplegia. This ophthalmoplegia was caused by mass effect from the aneurysm and subsequently the aneurysm was treated with an endovascular flow diverting stent. CT brain was performed post operatively due to a reduced level of consciousness and this showed diffuse subarachnoid hyperdensity of the left hemisphere. The use of Dual-Energy CT allowed accurate differentiation and illustrated diffuse contrast material extravasation, allowing patient to continue on dual-antiplatelets and therapeutic anticoagulation to reduce the risk of ischaemic injury post endovascular stent. Conclusion: Endovascular treatment options for management of intracranial aneurysms are constantly evolving. The use of Dual-Energy CT therefore has an integral role in accurately diagnosing any post-operative complications. Specifically, differentiating between subarachnoid haemorrhage and contrast extravasation is vital in these patients due to the significant consequences to their ongoing management in regards to continuation or cessation of antiplatelets or anticoagulation. With increasing access to this technology, its use should become standard practice in the post-operative investigation of these patients undergoing endovascular treatment.Keywords: aneurysm, computed tomography, contrast extravasation, dual-energy CT, endovascular, subarachnoid haemorrhage
Procedia PDF Downloads 7611364 Quality of Life and Self-Assessed Health of Buprenorphine–Maintained Opiate Addicts
Authors: Igna Brajević Gizdić, Gorka Vuletić
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Introduction: Addiction is a chronic brain relapsing disorder. Opioid Substitution Therapy (OST) using buprenorphine as a medical treatment option shows as a promising option for achieving and maintaining abstinence in opioid-addicted patients. This research aimed to determine and evaluate the quality of life (QoL) in opiate-addicted patients after five years of buprenorphine therapy. Method: The total sample included 44 buprenorphine-maintained opiate addicts in outpatient treatment. The participants were administered the QoL questionnaire (WHOQOL-BREF) at two-time points (T1 and T2) with an interval of at least five years. WHOQOL-BREF contains a total of 26 questions. The first two questions, related to overall QoL and general health status, and the remaining questions (3–26), which represented four domains—physical, psychological, social, and environmental health—were evaluated separately. Results: The results indicated no significant differences in overall self-assessed QoL nor in individual domains after five years (T2) of abstinence with OST buprenorphine- maintenance. Conclusion: These findings indicated no improvement in QoL of buprenorphine-maintenance opiate addicts in outpatient treatment. However, this might be due to the smaller sample size and participants' overall high scores in QoL at T1. This study suggests the importance of expectations when considering the QoL and general health of buprenorphine-maintenance opiate addicts in outpatient treatment.Keywords: abstinence, addicts, buprenorphine, opioid substitution therapy, quality of life
Procedia PDF Downloads 10311363 Health Education and Information: A Panacea to Tuberculosis Prevention and Eradication in Nigeria
Authors: Afolabi Joseph Fasoranti
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Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis. Tuberculosis is a major public health problem in Nigeria, being one of the ten leading causes of hospital admissions and a leading cause of death in adults, especially among the economically productive age group. This paper critically examined the importance of health education towards the eradication and prevention of tuberculosis in Nigeria. It was reviewed and discussed under the following subheadings; Global burden of tuberculosis in Nigeria, concept, definition and etiology of tuberculosis, Signs and symptoms of tuberculosis, diagnosis of tuberculosis, causative agent, modes of infection and incubation period, risk factors of pulmonary tuberculosis Dots and stop TB programmes in Nigeria Treatment and prevention of tuberculosis TB treatment strategies, Dealing with treatment problems in Nigeria Stigmatization against Tuberculosis Patients Health education as a tool for achieving free tuberculosis country. Emphasis for Tb control has been placed on the development of improved vaccines, diagnostic and treatment courses but less on health education and awareness. Although the need for these tools is indisputable, the obstacle facing the spread of TB go beyond technological. The findings of this study may stimulate health system policy makers, Government and non- governmental organizations, donor agencies and other stakeholders in planning and designing health education intervention programs on the control and eradication of tuberculosis. It therefore recommended that Government should implement health education as part of the DOTs, this will thus empower the tuberculosis patients on ways to live healthy, lifestyle, in doing this, they will recover fast and prevent them from spreading the disease.Keywords: tuberculosis, health education, panacea, Nigeria, prevention
Procedia PDF Downloads 33011362 Increased Seedling Vigor Through Phytohomeopathy
Authors: Jasper Jose Zanco
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Plants are affected by substances diluted below certain limits. In seeds subjected to ultra-high dilutions (UHD), according to phytohomeopathic methods, it is possible to reduce the concentrations to infinitesimal levels and the effects persist. This research aimed to test different potencies of UHD to modify the vigor of Eruca versicaria (L) Cav. seedlings. The research was carried out at the Plant Production Laboratory of UNISUL University in Santa Catarina, Brazil. Eight UHD treatments were tested, four drops for every 30 mL of distilled water: Control (70% alcohol - A70); Sulphur (S9), Acidum fluoridricum (A30), Calcarea carbonica (C200), Graphies naturalis (G200), Kali carbonicum (K100) Belladonna (B12), diluted and succussed in Hahnemannian centesimal standards. Succussion is a standard pharmaceutical method found in worldwide pharmaceuticals. The statistical design consisted of 50 seeds every 4 replicates per treatment, completely randomized, followed by ANOVA and Tukey's test. Succussion may integrate the high dilution of water treatments, even after successive dilutions, and the product of this process acts through physical-chemical and bioelectric stimuli, causing physiological responses at the cellular level, such as the activation of antioxidant systems, increased resistance to environmental stress or growth modulation. According to some researchers, these responses could be mediated by genetic expression changes or the plants' cellular signaling systems. The results showed significant differences between the control (A70) and the other treatments. Conductivity measurements were made in the seed germination water and impedance; the seedlings were measured for dry weight and total area. The highest conductivity occurred in the control treatment (27.8 μS/cm) and the lowest in K100 (21.3 μS/cm). After germination, on germitest paper, A70 was significantly different from G200 (<1%) and S9 (5%). Both homeopathies differed from the other treatments, with S9 obtaining the best germination (87.1%) and vigor index (IV=7.98) in relation to the other treatments. The control, A70, presented the lowest germination (63.9%) and vigor (IV=4.93).Keywords: ultra high dilution, impedance, condutivity, eruca versicaria
Procedia PDF Downloads 1811361 Conversion of Atmospheric Carbone Dioxide into Minerals at Room Conditions by Using the Sea Water Plus Various Additives
Authors: Muthana A. M. Jamel Al-Gburi
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Elimination of carbon dioxide (CO2) gas from the atmosphere is very important but complicated since there is increasing in the amounts of carbon dioxide and other greenhouse gases in the atmosphere, which mainly caused by some of the human activities and the burning of fossil fuels. So that will lead to global warming. The global warming affects the earth temperature causing an increase to a higher level and, at the same time, creates tornadoes and storms. In this project, we are going to do a new technique for extracting carbon dioxide directly from the air and change it to useful minerals and Nano scale fibers made of carbon by using several chemical processes through chemical reactions. So, that could lead to an economical and healthy way to make some valuable building materials. Also, it may even work as a weapon against environmental change. In our device (Carbone Dioxide Domestic Extractor), we are using Ocean-seawater to dissolve the CO₂ gas and then converted it into carbonate minerals by using a number of additives like Shampoo, clay, and MgO. Note that the atmospheric air includes CO₂ gas, has circulated within the seawater by the air pump. More, that we will use a number of chemicals agents to convert the water acid into useful minerals. After we constructed the system, we did intense experiments and investigations to find the optimum chemical agent, which must be work at the environmental condition. Further to that, we will measure the solubility of CO₂ and other salts in the seawater.Keywords: global warming, CO₂ gas, ocean-sea water, additives, solubility level
Procedia PDF Downloads 11111360 Fibroblast Compatibility of Core-Shell Coaxially Electrospun Hybrid Poly(ε-Caprolactone)/Chitosan Scaffolds
Authors: Hilal Turkoglu Sasmazel, Ozan Ozkan, Seda Surucu
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Tissue engineering is the field of treating defects caused by injuries, trauma or acute/chronic diseases by using artificial scaffolds that mimic the extracellular matrix (ECM), the natural biological support for the tissues and cells within the body. The main aspects of a successful artificial scaffold are (i) large surface area in order to provide multiple anchorage points for cells to attach, (ii) suitable porosity in order to achieve 3 dimensional growth of the cells within the scaffold as well as proper transport of nutrition, biosignals and waste and (iii) physical, chemical and biological compatibility of the material in order to obtain viability throughout the healing process. By hybrid scaffolds where two or more different materials were combined with advanced fabrication techniques into complex structures, it is possible to combine the advantages of individual materials into one single structure while eliminating the disadvantages of each. Adding this to the complex structure provided by advanced fabrication techniques enables obtaining the desired aspects of a successful artificial tissue scaffold. In this study, fibroblast compatibility of poly(ε-caprolactone) (PCL)/chitosan core-shell electrospun hybrid scaffolds with proper mechanical, chemical and physical properties successfully developed in our previous study was investigated. Standard 7-day cell culture was carried out with L929 fibroblast cell line. The viability of the cells cultured with the scaffolds was monitored with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) viability assay for every 48 h starting with 24 h after the initial seeding. In this assay, blank commercial tissue culture polystyrene (TCPS) Petri dishes, single electrospun PCL and single electrospun chitosan mats were used as control in order to compare and contrast the performance of the hybrid scaffolds. The adhesion, proliferation, spread and growth of the cells on/within the scaffolds were observed visually on the 3rd and the 7th days of the culture period with confocal laser scanning microscopy (CSLM) and scanning electron microscopy (SEM). The viability assay showed that the hybrid scaffolds caused no toxicity for fibroblast cells and provided a steady increase in cell viability, effectively doubling the cell density for every 48 h for the course of 7 days, as compared to TCPS, single electrospun PCL or chitosan mats. The cell viability on the hybrid scaffold was ~2 fold better compared to TCPS because of its 3D ECM-like structure compared to 2D flat surface of commercially cell compatible TCPS, and the performance was ~2 fold and ~10 fold better compared to single PCL and single chitosan mats, respectively, even though both fabricated similarly with electrospinning as non-woven fibrous structures, because single PCL and chitosan mats were either too hydrophobic or too hydrophilic to maintain cell attachment points. The viability results were verified with visual images obtained with CSLM and SEM, in which cells found to achieve characteristic spindle-like fibroblast shape and spread on the surface as well within the pores successfully at high densities.Keywords: chitosan, core-shell, fibroblast, electrospinning, PCL
Procedia PDF Downloads 17611359 From Sampling to Sustainable Phosphate Recovery from Mine Waste Rock Piles
Authors: Hicham Amar, Mustapha El Ghorfi, Yassine Taha, Abdellatif Elghali, Rachid Hakkou, Mostafa Benzaazoua
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Phosphate mine waste rock (PMWR) generated during ore extraction is continuously increasing, resulting in a significant environmental footprint. The main objectives of this study consist of i) elaboration of the sampling strategy of PMWR piles, ii) a mineralogical and chemical characterization of PMWR piles, and iii) 3D block model creation to evaluate the potential valorization of the existing PMWR. Destructive drilling using reverse circulation from 13 drills was used to collect samples for chemical (X-ray fluorescence analysis) and mineralogical assays. The 3D block model was created based on the data set, including chemical data of the realized drills using Datamine RM software. The optical microscopy observations showed that the sandy phosphate from drills in the PMWR piles is characterized by the abundance of carbonate fluorapatite with the presence of calcite, dolomite, and quartz. The mean grade of composite samples was around 19.5±2.7% for P₂O₅. The mean grade of P₂O₅ exhibited an increasing tendency by depth profile from bottom to top of PMWR piles. 3D block model generated with chemical data confirmed the tendency of the mean grades’ variation and may allow a potential selective extraction according to %P₂O₅. The 3D block model of P₂O₅ grade is an efficient sampling approach that confirmed the variation of P₂O₅ grade. This integrated approach for PMWR management will be a helpful tool for decision-making to recover the residual phosphate, adopting the circular economy and sustainability in the phosphate mining industry.Keywords: 3D modelling, reverse circulation drilling, circular economy, phosphate mine waste rock, sampling
Procedia PDF Downloads 7811358 Removal of Acetaminophen with Chitosan-Nano Activated Carbon Beads from Aqueous Sources
Authors: Parisa Amouzgar, Chan Eng Seng, Babak Salamatinia
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Pharmaceutical products are being increasingly detected in the environment. However, conventional treatment systems do not provide an adequate treatment for pharmaceutical drug elimination and still there is not a regulated standard for their limitation in water. Since decades before, pharmaceuticals have been in the water but only recently, their levels in the environment have been recognized and quantified as potentially hazardous to ecosystems. In this study chitosan with a bio-based NAC (Ct-NAC) were made as beads with extrusion dripping method and investigated for acetaminophen removal from water. The effects of beading parameters such as flow rate in dripping, the distance from dipping tip to the solution surface, concentration of chitosan and percentage of NAC were analyzed to find the optimum condition. Based on the results, the overall adsorption rate and removal efficiency increased during the time till the equilibrium rate which was 80% removal of acetaminophen. The maximum adsorption belonged to the beads with 1.75% chitosan, 60% NAC, flow-rate of 1.5 ml/min while the distance of dripping was 22.5 cm.Keywords: pharmaceuticals, water treatment, chitosan nano activated carbon beads, Acetaminophen
Procedia PDF Downloads 35711357 The Analysis of Acute Pancreatitis Patients in a University Hospital
Authors: Adnan Sahin, Ufuk Uylas, Ercument Pasaoglu, Tarik Caga, Enver Ihtiyar, Serdar Erkasap, Ersin Ates, Fatih Yasar
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Background: In this study, it was evaluated the demographic features, etiological factors and the management of acute pancreatitis. Methods: 106 patient hospitalized due to acute pancreatitis were retrospectively examined from 1 January 2015 to 31 December 2015 in Department of General Surgery of ESOGUMF. The data of gender, signs and symptoms, etiological factors, WBC, AST, ALT, Amilase, USG and CT findings treatment options ERCP, and complications, mortality rate were analysed. Results: The mean age of patients were 58.8 (53 men and 53 women). The causes of acute pancreatitis were as follows: gallbladder stone was 89, hyperlipidemia was 5 and idiopathic were 16 patients. Severe pancreatitis was developed in 16 patients in the biliary pancreatitis group and ERCP was performed. Cholecystectomy was performed to all biliary pancreatitis group patients after acute pancreatitis subside. The mean hospital stay period was 9.33 (2-37) day. Discussion and conclusion: Severe acute pancreatitis is a mortal disease. The most common etiological cause of acute pancreatitis is biliary origin. The first line treatment modality of acute pancreatitis is medical. Cholecystectomy should be planned to the all-biliary caused acute pancreatitis patients after the attack subside. ERCP is a useful treatment modality in the case of clinical worsening and suspicion of acute cholangitis. ERCP procedure used 16 patients in our series and these patients have a good morbidity and mean hospital period is lower than the others. We suppose that ERCP procedure should be planned selectively and conservatively.Keywords: acute pancreatitis, ERCP, morbidity, treatment
Procedia PDF Downloads 34511356 Impact Of Anthropogenic Pressures On The Water Quality Of Hammams In The Municipality Of Dar Bouazza, Morocco
Authors: Nihad Chakri, Btissam El Amrani, Faouzi Berrada, Halima Jounaid, Fouad Amraoui
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Public baths or hammams play an essential role in the Moroccan urban and peri-urban fabric, constituting part of the cultural heritage. Urbanization in Morocco has led to a significant increase in the number of these traditional hammams: between 6,000 and 15,000 units (to be updated) operate with a traditional heating system. Numerous studies on energy consumption indicate that a hammam consumes between 60 and 120m3 of water and one to two tons of wood per day. On average, one ton of wood costs 650 Moroccan dirhams (approximately 60 Euros), resulting in a daily fuel cost of around 1300 Moroccan dirhams (about 120 Euros). These high consumptions result in significant environmental nuisances generated by: Wastewater: in the case of hammams located on the outskirts of Casablanca, such as our study area, the Municipality of Dar Bouazza, most of these waters are directly discharged into the receiving environment without prior treatment because they are not connected to the sanitation network. Emissions of black smoke and ashes produced by the often incomplete combustion of wood. Reducing the liquid and gas emissions generated by these hammams thus poses an environmental and sustainable development challenge that needs to be addressed. In this context, we initiated the Eco-hammam project with the objective of implementing innovative and locally adapted solutions to limit the negative impacts of hammams on the environment and reduce water and wood energy consumption. This involves treating and reusing wastewater through a compact system with heat recovery and using alternative energy sources to increase and enhance the energy efficiency of these traditional hammams. To achieve this, on-site surveys of hammams in the Dar Bouazza Municipality and the application of statistical approaches to the results of the physico-chemical and bacteriological characterization of incoming and outgoing water from these units were conducted. This allowed us to establish an environmental diagnosis of these entities. In conclusion, the analysis of well water used by Dar Bouazza's hammams revealed the presence of certain parameters that could be hazardous to public health, such as total germs, total coliforms, sulfite-reducing spores, chromium, nickel, and nitrates. Therefore, this work primarily focuses on prospecting upstream of our study area to verify if other sources of pollution influence the quality of well water.Keywords: public baths, hammams, cultural heritage, urbanization, water consumption, wood consumption, environmental nuisances, wastewater, environmental challenge, sustainable development, Eco-hammam project, innovative solutions, local adaptation, negative impacts, water conservation, wastewater treatment, heat recovery, alternative energy sources, on-site surveys, Dar Bouazza Municipality, statistical approaches, physico-chemical characterization, bacteriological characterization, environmental diagnosis, well water analysis, public health, pollution sources, well water quality
Procedia PDF Downloads 7011355 Overview of Constructed Wetlands System for Greywater Treatment: Challenges, Advantages, and Sustainable Analysis
Authors: Iga Maliga
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As developing country, Indonesia, retreatment for greywater is an important factor that guaranteeing water sustainability? But, its still not familiar in Indonesian society. Because they still use their old habit for wasting the water without retreatment. Differently, with industry wastewater, effect of domestic wastewater is not directly looked with naked eyes. Domestic wastewater that not gets treatment directly can affect pollution in water body or river. Its affected by accumulation many pollutants that include on water. This paper is trying to analyze the challenges and advantages on greywater treatment system based on Constructed Wetlands (CWs) system in Bandung, one of the biggest cities in Indonesia. Aside that, this paper also is trying to analyze sustainability aspects. There is economic, social and of course environment with two methods. The first, study literature is used to see the advantages and challenges that faced by Indonesia when CWs are applied. Secondly, quantitative method is used to get the society perception about retreatment of greywater. Then, it will get a conclusion that this technique not only good in theoretically but also practically.Keywords: greywater, constructed wetlands, advantages, challenges, Bandung, sustainability analysis
Procedia PDF Downloads 27411354 Eco-Friendly Synthesis of Carbon Quantum Dots as an Effective Adsorbent
Authors: Hebat‑Allah S. Tohamy, Mohamed El‑Sakhawy, Samir Kamel
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Fluorescent carbon quantum dots (CQDs) were prepared by an economical, green, and single-step procedure based on microwave heating of urea with sugarcane bagasse (SCB), cellulose (C), or carboxymethyl cellulose (CMC). The prepared CQDs were characterized using a series of spectroscopic techniques, and they had small size, strong absorption in the UV, and excitation wavelength-dependent fluorescence. The prepared CQDs were used for Pb(II) adsorption from an aqueous solution. The removal efficiency percentages (R %) were 99.16, 96.36, and 98.48 for QCMC, QC, and QSCB. The findings validated the efficiency of CQDs synthesized from CMC, cellulose, and SCB as excellent materials for further utilization in the environmental fields of wastewater pollution detection, adsorption, and chemical sensing applications. The kinetics and isotherms studied found that all CQD isotherms fit well with the Langmuir model than Freundlich and Temkin models. According to R², the pseudo-second-order fits the adsorption of QCMC, while the first-order one fits with QC and QSCB.Keywords: carbon quantum dots, graphene quantum dots, fluorescence, quantum yield, water treatment, agricultural wastes
Procedia PDF Downloads 13211353 Characteristics of a Dye-Entrapped Polypyrrole Film Prepared in the Presence of a Different Dye
Authors: M. Mominul Haque, Danny KY. Wong
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In this paper, we will demonstrate the feasibility of selectively removing the azo dye, Acid Red 1, in the presence of a second dye, Indigo Carmine, at conducting polypyrrole films. A long-term goal of this work is to develop an efficient and effective electrochemical treatment of textile effluents that does not yield any toxic by-products. Specifically, pyrrole was initially electrochemically oxidised in the presence of Acid Red 1 to prepare an Acid Red 1-entrapped polypyrrole film. Next, the Acid Red 1 entrapped film was electrochemically reduced to expel the dye from the film. The film was then ready for use in removing the dye in an Acid Red 1 solution. The entrapment efficiency of the film was then studied by spectroscopically determining the change in the absorbance of the dye solution. These experiments were repeated using Indigo Carmine or a mixture of Acid Red 1 and Indigo Carmine, in place of Acid Red 1. Therefore, this has given rise to an environmentally friendly treatment method for textile effluents. In our work, we have also studied the characteristics of Acid Red 1- and Indigo Carmine-entrapped polypyrrole films by scanning electron microscopy, X-ray diffraction and Fourier transfer infrared spectroscopy.Keywords: azo dye, electrochemical treatment, polypyrrole, Acid Red 1
Procedia PDF Downloads 40711352 Reverse Twin Block with Expansion Screw for Treatment of Skeletal Class III Malocclusion in Growing Patient: Case Report
Authors: Alfrina Marwan, Erna Sulistyawati
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Class III malocclusion shows both skeletal and dentoalveolar component. Sketal Class III malocclusion can have variants in different region, maxilla or mandibular. Skeletal Class III malocclusion during growth period is considered to treat to prevent its severity in adulthood. Orthopedics treatment of skeletal Class III malocclusion in growing patient can be treated by using reverse twin block with expansion screw to modify the growth pattern. The objective of this case report was to describe the functional correction of skeletal Class III maloclussion using reverse twin block with expansion screw in growing patient. A patient with concave profile came with a chief complaint of aesthetic problems. The cephalometric analysis showed that patient had skeletal Class III malocclusion (ANB -50, SNA 75º, Wits appraisal -3 mm) with anterior cross bite and deep bite (overjet -3 mm, overbite 6 mm). In this case report, the patient was treated with reverse twin block appliance with expansion screw. After three months of treatment, the skeletal problems have been corrected (ANB -1°), overjet, overbite and aesthetic were improved. Reverse twin block appliance with expansion screw can be used as orthopedics treatment for skeletal Class III malocclusion in growing patient and can improve the aesthetic with great satisfaction which was the main complaint in this patient.Keywords: maxilla retrognatism, reverse twin block, skeletal class III malocclusion, growing patient
Procedia PDF Downloads 19711351 Effect of a Polyherbal Gut Therapy Protocol in Changes of Gut and Behavioral Symptoms of Antibiotic Induced Dysbiosis of Autistic Babies
Authors: Dinesh K. S., D. R. C. V. Jayadevan
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Autism is the most prevalent of a subset of the disorders organized under the umbrella of pervasive developmental disorders. After the publication of Andrew Wakefield's paper in lancet, many critiques deny this connection even without looking in to the matter. The British Medical Journal even put an editorial regarding this issue. BMJ 2010; 340:c1807. But ayurveda has ample of evidences to believe this connectivity. Dysbiosis, yeast growth of the gut, nutritional deficiencies, enzyme deficiencies, essential fatty acid deficiencies, Gastro esophageal reflux disease, indigestion, inflammatory bowel, chronic constipation & its cascade are few of them to note. The purpose of this paper is to present the observed changes in the behavioural symptoms of autistic babies after a gut management protocol which is a usual programme of our autism treatment plan especially after dysbiotic changes after antibiotic administration. Is there any correlation between changes (if significant) in gut symptoms and behavioral problems of autistic babies especially after a dysbiosis induced by antibiotics. Retrospective analysis of the case sheets of autistic patients admitted in Vaidyaratnam P.S.Varier Ayurveda College hospital, kottakkal,kerala, india from September 2010 are taken for the data processing. Autistic patients are used to come to this hospital as a part of their usual course of treatment. We investigated 40 cases diagnosed as autistic by clinical psychologists from different institutions who had dysbiosis induced by antibiotics. Significant change in gut symptoms before and after treatment p<0.05 in most of its components Significant change in behavioral symptoms before and after treatments p<0.05 in most of the components Correlation between gut symptoms change and behavioral symptoms changes after treatment is + 0.86. Conclusion : Selected Polyherbal Ayurveda treatment has significant role to play to make changes abnormal behaviors in autistic babies and has a positive correlation with changes in gut symptoms induced by dysbiosis of antibiotic intake.Keywords: ayurveda, autism, dysbiosis, antibiotic
Procedia PDF Downloads 62711350 Inference for Synthetic Control Methods with Multiple Treated Units
Authors: Ziyan Zhang
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Although the Synthetic Control Method (SCM) is now widely applied, its most commonly- used inference method, placebo test, is often problematic, especially when the treatment is not uniquely assigned. This paper discusses the problems with the placebo test under the multivariate treatment case. And, to improve the power of inferences, I further propose an Andrews-type procedure as it potentially solves some drawbacks of the placebo test. Simulations are conducted to show the Andrews’ test is often valid and powerful, compared with the placebo test.Keywords: Synthetic Control Method, Multiple treatments, Andrews' test, placebo test
Procedia PDF Downloads 16411349 Pre-Drying Effects on the Quality of Frying Oil
Authors: Hasan Yalcin, Tugba Dursun Capar
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Deep-fat frying causes desirable as well as undesirable changes in oil and potato, and changes the quality of the oil by hydrolysis, oxidation, and polymerization. The main objective of the present study was to investigate the pre-drying effects on the quality of both frying oil and potatoes. Prior to frying, potato slices (10 mm x10 mm x 30 mm) were air- dried at 60°C for 15, 30, 45, 60, 90, and 120 mins., respectively. Potato slices without the pre-drying treatment were considered as the control variable. Potato slices were fried in sunflower oil at 180°C for 5, 10, and 13 mins. The deep-frying experiments were repeated five times using the new potato slices in the same oil without oil replenishment. Samples of the fresh oil, together with those sampled at the end of successive frying operations (1th, 3th and 5th) were removed and analysed. Moisture content, colour and oil intake of the potato and colour, peroxide value (PV), free fatty acid (FFA), fatty acid composition and viscosity of the used oil were evaluated. The effect of frying time was also examined. Results show that pre-drying treatment had a significant effect on physicochemical properties and colour parameters of potato slices and frying oil. Pre-drying considerably decreased the oil absorption. The lowest oil absorption was found for the treatment that was pre-dried for 120, and fried for 5 min. The FFA levels decreased permanently for each pre-treatment throughout the frying period. All the pre-drying treatments had reached their maximum levels of FFA by the end of the frying procedures. The PV of the control and 60 min pre-dried sample decreased after the third frying. However, the PV of other samples increased constantly throughout the frying periods. Lastly, pre-drying did not affect the fatty acid composition of frying oil considerably when compared against previously unused oil.Keywords: air-drying, deep-fat frying, moisture content oil uptake, quality
Procedia PDF Downloads 30811348 Comparing the Effects of Systemic Family Intervention on End Stage Renal Disease: Families of Different Modalities
Authors: Fenni Sim
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Background: The application of systemic family therapy approaches to community health cases have not gathered traction. In National Kidney Foundation, Singapore, the belief is that community support has great potential in helping End Stage Renal Failure (ESRF) patients manage the demands of their treatment regime, whether Hemodialysis (HD) or Peritoneal Dialysis(PD) and sustain them on the treatment. However, the current community support does not include family interventions and is largely nursing based. Although nursing support is well provided to patients, and their family members in issues related to treatment and compliance, complex family issues and dynamics arising from caregiver strain or pre-dialysis relationship strain might deter efforts in managing the challenges of the treatment. Objective: The objective of the study is to understand the potential scope of work provided by a social worker who is trained in systemic family therapy and the effects of these interventions. Methodology: 3 families on HD and 3 families on PD who have been receiving family intervention for the past 6 months would be chosen for the study. A qualitative interview would be conducted to review the effectiveness for the family. Scales such as SCORE-15, PHQ-9, and Zarit Burden were used to measure family functioning, depression, and caregiver’s burden for the families. Results: The research is still in preliminary phase. Conclusion: The study highlights the importance of family intervention for families with multiple stressors on different treatment modalities who might have different needs and challenges. Nursing support needs to be complemented with family-based support to manage complex family issues in order to achieve better health outcomes and improved family coping.Keywords: complementing nursing support, end stage renal failure, healthcare, systemic approaches
Procedia PDF Downloads 20411347 Two Component Source Apportionment Based on Absorption and Size Distribution Measurement
Authors: Tibor Ajtai, Noémi Utry, Máté Pintér, Gábor Szabó, Zoltán Bozóki
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Beyond its climate and health related issues ambient light absorbing carbonaceous particulate matter (LAC) has also become a great scientific interest in terms of its regulations recently. It has been experimentally demonstrated in recent studies, that LAC is dominantly composed of traffic and wood burning aerosol particularly under wintertime urban conditions, when the photochemical and biological activities are negligible. Several methods have been introduced to quantitatively apportion aerosol fractions emitted by wood burning and traffic but most of them require costly and time consuming off-line chemical analysis. As opposed to chemical features, the microphysical properties of airborne particles such as optical absorption and size distribution can be easily measured on-line, with high accuracy and sensitivity, especially under highly polluted urban conditions. Recently a new method has been proposed for the apportionment of wood burning and traffic aerosols based on the spectral dependence of their absorption quantified by the Aerosol Angström Exponent (AAE). In this approach the absorption coefficient is deduced from transmission measurement on a filter accumulated aerosol sample and the conversion factor between the measured optical absorption and the corresponding mass concentration (the specific absorption cross section) are determined by on-site chemical analysis. The recently developed multi-wavelength photoacoustic instruments provide novel, in-situ approach towards the reliable and quantitative characterization of carbonaceous particulate matter. Therefore, it also opens up novel possibilities on the source apportionment through the measurement of light absorption. In this study, we demonstrate an in-situ spectral characterization method of the ambient carbon fraction based on light absorption and size distribution measurements using our state-of-the-art multi-wavelength photoacoustic instrument (4λ-PAS) and Single Mobility Particle Sizer (SMPS) The carbonaceous particulate selective source apportionment study was performed for ambient particulate matter in the city center of Szeged, Hungary where the dominance of traffic and wood burning aerosol has been experimentally demonstrated earlier. The proposed model is based on the parallel, in-situ measurement of optical absorption and size distribution. AAEff and AAEwb were deduced from the measured data using the defined correlation between the AOC(1064nm)/AOC(266nm) and N100/N20 ratios. σff(λ) and σwb(λ) were determined with the help of the independently measured temporal mass concentrations in the PM1 mode. Furthermore, the proposed optical source apportionment is based on the assumption that the light absorbing fraction of PM is exclusively related to traffic and wood burning. This assumption is indirectly confirmed here by the fact that the measured size distribution is composed of two unimodal size distributions identified to correspond to traffic and wood burning aerosols. The method offers the possibility of replacing laborious chemical analysis with simple in-situ measurement of aerosol size distribution data. The results by the proposed novel optical absorption based source apportionment method prove its applicability whenever measurements are performed at an urban site where traffic and wood burning are the dominant carbonaceous sources of emission.Keywords: absorption, size distribution, source apportionment, wood burning, traffic aerosol
Procedia PDF Downloads 22811346 Study of Nanocrystalline Al Doped Zns Thin Films by Chemical Bath Deposition Method
Authors: Hamid Merzouk, Djahida Touati-Talantikite, Amina Zaabar
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New nanosized materials are in huge expansion worldwide. They play a fundamental role in various industrial applications thanks their unique and functional properties. Moreover, in recent years, a great effort has been made to the design and control fabrication of nanostructured semiconductors such zinc sulphide. In recent years, much attention has been accorded in doped and co-doped ZnS to improve the ZnS films quality. We present in this work the preparation and characterization of ZnS and Al doped ZnS thin films. Nanoparticles ZnS and Al doped ZnS films are prepared by chemical bath deposition method (CBD), for various dopant concentrations. Thin films are deposed onto commercial microscope glass slides substrates. Thiourea is used as sulfide ion source, zinc acetate as zinc ion source and manganese acetate as manganese ion source in alkaline bath at 90 °C. X-ray diffraction (XRD) analyses are carried out at room temperature on films and powders with a powder diffractometer, using CuKα radiation. The average grain size obtained from the Debye–Scherrer’s formula is around 10 nm. Films morphology is examined by scanning electron microscopy. IR spectra of representative sample are recorded with the FTIR between 400 and 4000 cm-1.The transmittance (70 %) is performed with the UV–VIS spectrometer in the wavelength range 200–800 nm. This value is enhanced by Al doping.Keywords: ZnS, nanostructured semiconductors, thin films, chemical bath deposition
Procedia PDF Downloads 52411345 Analysis of Cardiac Health Using Chaotic Theory
Authors: Chandra Mukherjee
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The prevalent knowledge of the biological systems is based on the standard scientific perception of natural equilibrium, determination and predictability. Recently, a rethinking of concepts was presented and a new scientific perspective emerged that involves complexity theory with deterministic chaos theory, nonlinear dynamics and theory of fractals. The unpredictability of the chaotic processes probably would change our understanding of diseases and their management. The mathematical definition of chaos is defined by deterministic behavior with irregular patterns that obey mathematical equations which are critically dependent on initial conditions. The chaos theory is the branch of sciences with an interest in nonlinear dynamics, fractals, bifurcations, periodic oscillations and complexity. Recently, the biomedical interest for this scientific field made these mathematical concepts available to medical researchers and practitioners. Any biological network system is considered to have a nominal state, which is recognized as a homeostatic state. In reality, the different physiological systems are not under normal conditions in a stable state of homeostatic balance, but they are in a dynamically stable state with a chaotic behavior and complexity. Biological systems like heart rhythm and brain electrical activity are dynamical systems that can be classified as chaotic systems with sensitive dependence on initial conditions. In biological systems, the state of a disease is characterized by a loss of the complexity and chaotic behavior, and by the presence of pathological periodicity and regulatory behavior. The failure or the collapse of nonlinear dynamics is an indication of disease rather than a characteristic of health.Keywords: HRV, HRVI, LF, HF, DII
Procedia PDF Downloads 42511344 Investigating the Effects of Density and Different Nitrogen Nutritional Systems on Yield, Yield Components and Essential Oil of Fennel (Foeniculum Vulgare Mill.)
Authors: Mohammadreza Delfieh, Seyed Ali Mohammad Modarres Sanavy, Rouzbeh Farhoudi
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Fennel is of most important medicinal plants which is widely used in food and pharmaceutical industries. In order to investigate the effect of different nitrogen nutritional systems including chemical, organic and biologic ones at different plant densities on yield, yield components and seed essential oil content and yield of this valuable medicinal plant, a field experiment was carried out in 2013-2014 agricultural season at Islamic Azad University of Shoushtar agricultural college in split plot design with 18 treatments and based on completely randomized blocks design. Different nitrogen system treatments consisting of: 1. N1 or control (Uniformly spreading urea fertilizer in the plot, 50% at planting time and 50% at stem elongation), 2. N2 (Uniformly spreading 50% of urea fertilizer in the plot at planting time and spraying the other 50% of urea fertilizer at stem elongation on fennel foliage), 3. N3 or cow manure, 4. N4 or biofertilizer (Inoculation of fennel seeds with Azotobacter and Azospirillum), 5. N5 or Integrated-1 (Cow manure + uniformly spreading urea fertilizer in the plot at stem elongation), 6. N6 or Integrated-2 (Cow manure + Inoculation of fennel seeds with Azotobacter and Azospirillum) were applied to the main plots. Three fennel densities consisting of: 1. FD1 (60 plant/m2), 2. FD2 (80 plant/m2) and 3. FD3 (100 plant/m2) were applied to subplots. Results showed that all of the traits were significantly affected by applied treatments (P 0.01). The interaction between treatments also were significant at 5 percent level for shoot dry weight and at 1 percent level for other traits. Based on the results, using the Integrated-1 treatment at 100 plant per m2 produced 94.575 g/m2 seed yield containing 3.375 percent of essential oil. Utilization of such combination not only could lead to a desirable fennel quantity and quality, but also is more consistent with environment.Keywords: fennel (foeniculum vulgare mill.), nutritional system, nitrogen, biofertilizer, organic fertilizer, chemical fertilizer, density
Procedia PDF Downloads 45911343 Improvement of Microstructure, Wear and Mechanical Properties of Modified G38NiCrMo8-4-4 Steel Used in Mining Industry
Authors: Mustafa Col, Funda Gul Koc, Merve Yangaz, Eylem Subasi, Can Akbasoglu
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G38NiCrMo8-4-4 steel is widely used in mining industries, machine parts, gears due to its high strength and toughness properties. In this study, microstructure, wear and mechanical properties of G38NiCrMo8-4-4 steel modified with boron used in the mining industry were investigated. For this purpose, cast materials were alloyed by melting in an induction furnace to include boron with the rates of 0 ppm, 15 ppm, and 50 ppm (wt.) and were formed in the dimensions of 150x200x150 mm by casting into the sand mould. Homogenization heat treatment was applied to the specimens at 1150˚C for 7 hours. Then all specimens were austenitized at 930˚C for 1 hour, quenched in the polymer solution and tempered at 650˚C for 1 hour. Microstructures of the specimens were investigated by using light microscope and SEM to determine the effect of boron and heat treatment conditions. Changes in microstructure properties and material hardness were obtained due to increasing boron content and heat treatment conditions after microstructure investigations and hardness tests. Wear tests were carried out using a pin-on-disc tribometer under dry sliding conditions. Charpy V notch impact test was performed to determine the toughness properties of the specimens. Fracture and worn surfaces were investigated with scanning electron microscope (SEM). The results show that boron element has a positive effect on the hardness and wear properties of G38NiCrMo8-4-4 steel.Keywords: G38NiCrMo8-4-4 steel, boron, heat treatment, microstructure, wear, mechanical properties
Procedia PDF Downloads 19511342 Effects of Injection of eCG and Oxytocin on Semen Characteristics of Zel Rams in Nonbreeding Season
Authors: Khosro Ghazvinian, Reza Narenji Sani, Touba Khodaiean, Melika Moezifar
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Many previous studies have reported that eCG was effective for completing spermatogenesis. In mice, eCG increased testes weight. In addition, Oxytocin (OT) was important in sperm transition and sperm motility in domestic animals. Peripheral circulation of OT also, was increased during sex incitement and ejaculation The objective of this study was to investigate the effect of IM injection of eCG and OT on semen characteristics in Zel rams in out of breeding season. Eighteen 3-year-old Zel adult rams were randomly divided into five equal groups (control and four treatment groups). 0.9% NaCl (1 ml) was injected IM into each ram in the control group, whereas eCG was administered IM at a single dose of 400 IU and 600 IU to each ram in the two eCG treatment groups and OT was administered IM at a single dose of 5 IU and 10 IU to each ram in the other two OT treatment groups. Semen samples were taken by an electroejaculator from all rams 10 min after the IM injection of 0.9% NaCl, eCG, or OT. eCG did not alter semen volume, and OT did not alter sperm motility or abnormal sperm, in comparison to the control values. Mass activity, sperm motility and total sperm number increased significantly in eCG group compared to the control group; and semen volume, mass activity, total sperm number of the OT treatment groups increased significantly compared to the control group. Exogenous 600 IU eCG and 10 IU OT increase mass activity, total sperm number, lived sperm and sperm concentration in Zel rams.Keywords: eCG, oxytocine, semen characteristics, Zel Ram, nonbreeding season
Procedia PDF Downloads 40411341 Impact of Physiotherapy on COVID-19 and Post COVID-19 Patients, (Expert Physiotherapy and American Hospital, Case Study)
Authors: Jonida Hasanaj
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Abstract: Four years after the pandemic, numerous studies discuss the long-term effects of COVID-19 on patients, with chronic fatigue syndrome being a prominent concern. Understanding the mechanisms behind this syndrome is crucial for developing prevention, treatment, and rehabilitation strategies. The appropriateness of physiotherapeutic treatment in covid 19 and post-COVID-19 patients has remained uncertain due to inconsistent diagnostic criteria, highlighting the need for further research. This paper intends to offer guidelines and specific suggestions for hospital-based physical therapists managing COVID-19 hospitalized patients at ‘’Expert Physiotherapy’ and ’American Hospital’ in Albania using a national approach in accordance with worldwide initiatives. Several studies indicate that chronic tiredness syndrome and high intracranial pressure could result from failure of the post-Covid-19 lymphatic system. Enabling the patient to intensify their physical activity and enhance their ability to move, exercise, and even resume a regular life cycle is the aim of physiotherapy treatment.Keywords: mobility, physiotherapy, post-covid 19, rehabilitation, results
Procedia PDF Downloads 6311340 The Role of Dentists in the Management of Obstructive Sleep Apnoea
Authors: David Parmenter, Brian Millar
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Obstructive sleep apnoea is a common condition which is generally under-diagnosed. Poorly managed obstructive sleep apnoea carries serious health risks and can greatly impact on the sufferer's quality of life. This publication covers the aetiology, symptoms, and treatment of sleep apnoea. The treatment of Obstructive Sleep Apnoea is an emerging field, and the useful role of the Dental Team is relatively unknown, therefor this paper will highlight the role of the dental team in its treatment. The concept of mandibular advancement appliances, along with the clinical and laboratory stages for constructing them, are documented. It is the hope of the author that this publication will educate healthcare professionals on the role of dental practitioners in the multidisciplinary team for treating sleep apnoea. Objective: Individuals should be more aware of the demographic of patients at risk of sleep apnoea, how it is diagnosed and which group of sleep apnoea patients are suitable to refer for mandibular appliance therapy. Individuals should also be aware of what a mandibular advancement appliance is and how it helps treat obstructive sleep apnoea.Keywords: sleep apnoea, snoring, sleep appliances, mandibular advancement appliance
Procedia PDF Downloads 10811339 Characterization of a Three-Electrodes Bioelectrochemical System from Mangrove Water and Sediments for the Reduction of Chlordecone in Martinique
Authors: Malory Jonata
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Chlordecone (CLD) is an organochlorine pesticide used between 1971 and 1993 in both Guadeloupe and Martinique for the control of banana black weevil. The bishomocubane structure which characterizes this chemical compound led to high stability in organic matter and high persistence in the environment. Recently, researchers found that CLD can be degraded by isolated bacteria consortiums and, particularly, by bacteria such as Citrobacter sp 86 and Delsulfovibrio sp 86. Actually, six transformation product families of CLD are known. Moreover, the latest discovery showed that CLD was disappearing faster than first predicted in highly contaminated soil in Guadeloupe. However, the toxicity of transformation products is still unknown, and knowledge has to be deepened on the degradation ways and chemical characteristics of chlordecone and its transformation products. Microbial fuel cells (MFC) are electrochemical systems that can convert organic matter into electricity thanks to electroactive bacteria. These bacteria can exchange electrons through their membranes to solid surfaces or molecules. MFC have proven their efficiency as bioremediation systems in water and soils. They are already used for the bioremediation of several organochlorine compounds such as perchlorate, trichlorophenol or hexachlorobenzene. In this study, a three-electrodes system, inspired by MFC, is used to try to degrade chlordecone using bacteria from a mangrove swamp in Martinique. As we know, some mangrove bacteria are electroactive. Furthermore, the CLD rate seems to decline in mangrove swamp sediments. This study aims to prove that electroactive bacteria from a mangrove swamp in Martinique can degrade CLD thanks to a three-electrodes bioelectrochemical system. To achieve this goal, the tree-electrodes assembly has been connected to a potentiostat. The substrate used is mangrove water and sediments sampled in the mangrove swamp of La Trinité, a coastal city in Martinique, where CLD contamination has already been studied. Electroactive biofilms are formed by imposing a potential relative to Saturated Calomel Electrode using chronoamperometry. Moreover, their comportment has been studied by using cyclic voltametry. Biofilms have been studied under different imposed potentials, several conditions of the substrate and with or without CLD. In order to quantify the evolution of CLD rates in the substrate’s system, gas chromatography coupled with mass spectrometry (GC-MS) was performed on pre-treated samples of water and sediments after short, medium and long-term contact with the electroactive biofilms. Results showed that between -0,8V and -0,2V, the three-electrodes system was able to reduce the chemical in the substrate solution. The first GC-MS analysis result of samples spiked with CLD seems to reveal decreased CLD concentration over time. In conclusion, the designed bioelectrochemical system can provide the necessary conditions for chlordecone degradation. However, it is necessary to improve three-electrodes control settings in order to increase degradation rates. The biological pathways are yet to enlighten by biologicals analysis of electroactive biofilms formed in this system. Moreover, the electrochemical study of mangrove substrate gives new informations on the potential use of this substrate for bioremediation. But further studies are needed to a better understanding of the electrochemical potential of this environment.Keywords: bioelectrochemistry, bioremediation, chlordecone, mangrove swamp
Procedia PDF Downloads 8211338 Plasma Treatment in Conjunction with EGM-2 Medium Can Enhance Endothelial and Osteogenic Marker Expressions of Bone Marrow MSCs
Authors: Chih-Hsin Lin, Shyh-Yuan Lee, Yuan-Min Lin
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For many tissue engineering applications, an important goal is to create functional tissues in-vitro, and such tissues to be viable, they have to be vascularized. Endothelial cells (EC) and endothelial progenitor cells (EPC) are promising candidates for vascularization. However, both of them have limited expansion capacity and autologous cells currently do not exist for either ECs or EPCs. Therefore, we use bone marrow mesenchymal stem cells (MSC) as a source material for ECs. Growth supplements are commonly used to induce MSC differentiation, and further improvements in differentiation conditions can be made by modifying the cell's growth environment. An example is pre-treatment of the growth dish with gas plasma, in order to modify the surface functional groups of the material that the cells are seeded on. In this work, we compare the effects of different gas plasmas on the growth and differentiation of MSCs. We treat the dish with different plasmas (CO2, N2, and O2) and then induce MSC differentiation with endothelial growth medium-2 (EGM-2). We find that EGM-2 by itself upregulates EC marker CD31 mRNA expression, but not VEGFR2, CD34, or vWF. However, these additional EC marker expressions were increased for cells seeded on plasma treated substrates. Specifically, for EC markers, we found that N2 plasma treatment upregulated CD31 and VEGFR-2 mRNA expressions; CO2 plasma treatment upregulated CD34 and vWF mRNA expressions. The osteogenic markers ALP and osteopontin mRNA expressions were markedly enhanced on all plasma-treated dishes. We also found that plasma treatment in conjunction with EGM-2 growth medium can enhance MSCs differentiation into endothelial-like cells and osteogenic-like cells. Our work shows that the effect of the growth medium (EGM-2) on MSCs differentiation is influenced by the plasma modified surface chemistry of the substrate. In conclusion, plasma surface modification can enhance EGM-2 effectiveness and induced both endothelial and osteogenic differentiation. Our findings provide a method to enhance EGM-2 based cell differentiation, with consequences for tissue engineering and stem cell biology applications.Keywords: endothelial differentiation, EGM-2, osteogenesis, plasma treatment, surface modification
Procedia PDF Downloads 33111337 Covariate-Adjusted Response-Adaptive Designs for Semi-Parametric Survival Responses
Authors: Ayon Mukherjee
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Covariate-adjusted response-adaptive (CARA) designs use the available responses to skew the treatment allocation in a clinical trial in towards treatment found at an interim stage to be best for a given patient's covariate profile. Extensive research has been done on various aspects of CARA designs with the patient responses assumed to follow a parametric model. However, ranges of application for such designs are limited in real-life clinical trials where the responses infrequently fit a certain parametric form. On the other hand, robust estimates for the covariate-adjusted treatment effects are obtained from the parametric assumption. To balance these two requirements, designs are developed which are free from distributional assumptions about the survival responses, relying only on the assumption of proportional hazards for the two treatment arms. The proposed designs are developed by deriving two types of optimum allocation designs, and also by using a distribution function to link the past allocation, covariate and response histories to the present allocation. The optimal designs are based on biased coin procedures, with a bias towards the better treatment arm. These are the doubly-adaptive biased coin design (DBCD) and the efficient randomized adaptive design (ERADE). The treatment allocation proportions for these designs converge to the expected target values, which are functions of the Cox regression coefficients that are estimated sequentially. These expected target values are derived based on constrained optimization problems and are updated as information accrues with sequential arrival of patients. The design based on the link function is derived using the distribution function of a probit model whose parameters are adjusted based on the covariate profile of the incoming patient. To apply such designs, the treatment allocation probabilities are sequentially modified based on the treatment allocation history, response history, previous patients’ covariates and also the covariates of the incoming patient. Given these information, an expression is obtained for the conditional probability of a patient allocation to a treatment arm. Based on simulation studies, it is found that the ERADE is preferable to the DBCD when the main aim is to minimize the variance of the observed allocation proportion and to maximize the power of the Wald test for a treatment difference. However, the former procedure being discrete tends to be slower in converging towards the expected target allocation proportion. The link function based design achieves the highest skewness of patient allocation to the best treatment arm and thus ethically is the best design. Other comparative merits of the proposed designs have been highlighted and their preferred areas of application are discussed. It is concluded that the proposed CARA designs can be considered as suitable alternatives to the traditional balanced randomization designs in survival trials in terms of the power of the Wald test, provided that response data are available during the recruitment phase of the trial to enable adaptations to the designs. Moreover, the proposed designs enable more patients to get treated with the better treatment during the trial thus making the designs more ethically attractive to the patients. An existing clinical trial has been redesigned using these methods.Keywords: censored response, Cox regression, efficiency, ethics, optimal allocation, power, variability
Procedia PDF Downloads 165