Search results for: infant mortality rate
7258 Poisoning Admission in Pediatrics Benghazi Hospital in Libya: Three Years Review of Medical Record
Authors: Mudafara Bengleil
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Estimation of the magnitude and causes of poisoning was the objective of the current study. A retrospective study of medical records of all poisoning children admitted to Benghazi Children Hospital in Libya from January 2008 up to December 2010. Number of children admitted was 244; the age ranged from less than one to 13 years old. Most of cases were admitted with mild symptom and the majority of them were boys. Only few cases admitted to intensive care unit and there was no mortality recorded through the period of study. Age group 1 to 3 years (50.8%) had the highest frequency of admission and the peak of admission was during summer. The most common cause of admission was due to ingestion of medication (53.69%), House hold product exposure (26.64%) was the second causes of admission while, 19.67% of admissions were due to Food poisoning. Almost all admitted cases were accidental and medicines were the most consumed substances in addition, improper storage of toxic agents were the first risk factor of poisoning. Present results indicated that, children poisoning seems to be a common pediatric care problem which need to control and prevent.Keywords: poisoning, children, hospital, medical
Procedia PDF Downloads 4237257 Predictive Models of Ruin Probability in Retirement Withdrawal Strategies
Authors: Yuanjin Liu
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Retirement withdrawal strategies are very important to minimize the probability of ruin in retirement. The ruin probability is modeled as a function of initial withdrawal age, gender, asset allocation, inflation rate, and initial withdrawal rate. The ruin probability is obtained based on the 2019 period life table for the Social Security, IRS Required Minimum Distribution (RMD) Worksheets, US historical bond and equity returns, and inflation rates using simulation. Several popular machine learning algorithms of the generalized additive model, random forest, support vector machine, extreme gradient boosting, and artificial neural network are built. The model validation and selection are based on the test errors using hyperparameter tuning and train-test split. The optimal model is recommended for retirees to monitor the ruin probability. The optimal withdrawal strategy can be obtained based on the optimal predictive model.Keywords: ruin probability, retirement withdrawal strategies, predictive models, optimal model
Procedia PDF Downloads 747256 A Double Differential Chaos Shift Keying Scheme for Ultra-Wideband Chaotic Communication Technology Applied in Low-Rate Wireless Personal Area Network
Authors: Ghobad Gorji, Hasan Golabi
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The goal of this paper is to describe the design of an ultra-wideband (UWB) system that is optimized for the low-rate wireless personal area network application. To this aim, we propose a system based on direct chaotic communication (DCC) technology. Based on this system, a 2-GHz wide chaotic signal is directly generated into the lower band of the UWB spectrum, i.e., 3.1–5.1 GHz. For this system, two simple modulation schemes, namely chaotic on-off keying (COOK) and differential chaos shift keying (DCSK), were studied before, and their performance was evaluated. We propose a modulation scheme, namely Double DCSK, to improve the performance of UWB DCC. Different characteristics of these systems, with Monte Carlo simulations based on the Additive White Gaussian Noise (AWGN) and the IEEE 802.15.4a standard channel models, are compared.Keywords: UWB, DCC, IEEE 802.15.4a, COOK, DCSK
Procedia PDF Downloads 747255 The Ratio of Second to Fourth Digit Length Correlates with Cardiorespiratory Fitness in Male College Students Men but Not in Female
Authors: Cheng-Chen Hsu
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Background: The ratio of the length of the second finger (index finger, 2D) to the fourth finger (ring finger, 4D) (2D:4D) is a putative marker of prenatal hormones. A low 2D:4D ratio is related to high prenatal testosterone (PT) levels. Physiological research has suggested that a low 2D:4D ratio is correlated with high sports ability. Aim: To examine the association between cardiorespiratory fitness and 2D:4D. Methods: Assessment of 2D:4D; Images of hands were collected from participants using a computer scanner. Hands were placed lightly on the surface of the plate. Image analysis was performed using Image-Pro Plus 5.0 software. Feature points were marked at the tip of the finger and at the center of the proximal crease on the second and fourth digits. Actual measurement was carried out automatically, 2D:4D was calculated by dividing 2nd by 4th digit length. YMCA 3-min Step Test; The test involves stepping up and down at a rate of 24 steps/min for 3 min; a tape recording of the correct cadence (96 beats/min) is played to assist the participant in keeping the correct pace. Following the step test, the participant immediately sits down and, within 5 s, the tester starts counting the pulse for 1 min. The score for the test, the total 1-min postexercise heart rate, reflects the heart’s ability to recover quickly. Statistical Analysis ; Pearson’s correlation (r) was used for assessing the relationship between age, physical measurements, one-minute heart rate after YMCA 3-minute step test (HR) and 2D:4D. An independent-sample t-test was used for determining possible differences in HR between subjects with low and high values of 2D:4D. All statistical analyses were carried out with SPSS 18 for Window. All P-values were two-tailed at P = 0.05, if not reported otherwise. Results: A median split by 2D:4D was applied, resulting in a high and a low group. One-minute heart rate after YMCA 3-minute step test was significantly difference between groups of male right-hand 2D:4D (p = 0.024). However, no difference in left-hand 2D:4D values between groups in male, and no digit ratio difference between groups in female. Conclusion: The results showed that cardiopulmonary fitness is related to right 2D:4D, only in men. We argue that prenatal testosterone may have an effect on cardiorespiratory fitness in male but not in female.Keywords: college students, digit ratio, finger, step test, fitness
Procedia PDF Downloads 2757254 Multi-Response Optimization of EDM for Ti-6Al-4V Using Taguchi-Grey Relational Analysis
Authors: Ritesh Joshi, Kishan Fuse, Gopal Zinzala, Nishit Nirmal
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Ti-6Al-4V is a titanium alloy having high strength, low weight and corrosion resistant which is a required characteristic for a material to be used in aerospace industry. Titanium, being a hard alloy is difficult to the machine via conventional methods, so it is a call to use non-conventional processes. In present work, the effects on Ti-6Al-4V by drilling a hole of Ø 6 mm using copper (99%) electrode in Electric Discharge Machining (EDM) process is analyzed. Effect of various input parameters like peak current, pulse-on time and pulse-off time on output parameters viz material removal rate (MRR) and electrode wear rate (EWR) is studied. Multi-objective optimization technique Grey relational analysis is used for process optimization. Experiments are designed using an L9 orthogonal array. ANOVA is used for finding most contributing parameter followed by confirmation tests for validating the results. Improvement of 7.45% in gray relational grade is observed.Keywords: ANOVA, electric discharge machining, grey relational analysis, Ti-6Al-4V
Procedia PDF Downloads 3657253 A Comparative Approach for Modeling the Toxicity of Metal Mixtures in Two Ecologically Related Three-Spined (Gasterosteus aculeatus L.) And Nine-Spined (Pungitius pungitius L.) Sticklebacks
Authors: Tomas Makaras
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Sticklebacks (Gasterosteiformes) are increasingly used in ecological and evolutionary research and become well-established role as model species for biologists. However, ecotoxicology studies concerning behavioural effects in sticklebacks regarding stress responses, mainly induced by chemical mixtures, have hardly been addressed. Moreover, although many authors in their studies emphasised the similarity between three-spined and nine-spined stickleback in morphological, neuroanatomical and behavioural adaptations to environmental changes, several comparative studies have revealed considerable differences between these species in and their susceptibility and resistance to variousstressors in laboratory experiments. The hypothesis of this study was that three-spined and nine-spined stickleback species will demonstrate apparent differences in response patterns and sensitivity to metal-based chemicals stimuli. For this purpose, we investigated the swimming behaviour (including mortality rate based on 96-h LC50 values) of two ecologically similar three-spined (Gasterosteusaculeatus) and nine-spined sticklebacks (Pungitiuspungitius) to short-term (up to 24 h) metal mixture (MIX) exposure. We evaluated the relevance and efficacy of behavioural responses of test species in the early toxicity assessment of chemical mixtures. Fish exposed to six (Zn, Pb, Cd, Cu, Ni and Cr) metals in the mixture were either singled out by the Water Framework Directive as priority or as relevant substances in surface water, which was prepared according to the environmental quality standards (EQSs) of these metals set for inland waters in the European Union (EU) (Directive 2013/39/EU). Based on acute toxicity results, G. aculeatus found to be slightly (1.4-fold) more tolerant of MIX impact than those of P. pungitius specimens. The performed behavioural analysis showed the main effect on the interaction between time, species and treatment variables. Although both species exposed to MIX revealed a decreasing tendency in swimming activity, these species’ responsiveness to MIX was somewhat different. Substantial changes in the activity of G. aculeatus were established after 3-h exposure to MIX solutions, which was 1.43-fold lower, while in the case of P. pungitius, 1.96-fold higher than established 96-h LC50 values for each species. This study demonstrated species-specific differences in response sensitivity to metal-based water pollution, indicating behavioural insensitivity of P. pungitiuscompared to G. aculeatus. While many studies highlight the usefulness and suitability of nine-spined sticklebacks for evolutionary and ecological research, attested by their increasing popularity in these fields, great caution must be exercised when using them as model species in ecotoxicological research to probe metal contamination. Meanwhile, G. aculeatus showed to be a promising bioindicator species in the environmental ecotoxicology field.Keywords: acute toxicity, comparative behaviour, metal mixture, swimming activity
Procedia PDF Downloads 1627252 Basal Cell Carcinoma: Epidemiological Analysis of a 5-Year Period in a Brazilian City with a High Level of Solar Radiation
Authors: Maria E. V. Amarante, Carolina L. Cerdeira, Julia V. Cortes, Fiorita G. L. Mundim
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Basal cell carcinoma (BCC) is the most prevalent type of skin cancer in humans. It arises from the basal cells of the epidermis and cutaneous appendages. The role of sunlight exposure as a risk factor for BCC is very well defined due to its power to influence genetic mutations, in addition to having a suppressor effect on the skin immune system. Despite showing low metastasis and mortality rates, the tumor is locally infiltrative, aggressive, and destructive. Considering the high prevalence rate of this carcinoma and the importance of early detection, a retrospective study was carried out in order to correlate the clinical data available on BBC, characterize it epidemiologically, and thus enable effective prevention measures for the population. Data on the period from January 2015 to December 2019 were collected from the medical records of patients registered at one pathology service located in the southeast region of Brazil, known as SVO, which delivers skin biopsy results. The study was aimed at correlating the variables, sex, age, and subtypes found. Data analysis was performed using the chi-square test at a nominal significance level of 5% in order to verify the independence between the variables of interest. Fisher's exact test was applied in cases where the absolute frequency in the cells of the contingency table was less than or equal to five. The statistical analysis was performed using the R® software. Ninety-three basal cell carcinoma were analyzed, and its frequency in the 31-to 45-year-old age group was 5.8 times higher in men than in women, whereas, from 46 to 59 years, the frequency was found 2.4 times higher in women than in men. Between the ages of 46 to 59 years, it should be noted that the sclerodermiform subtype appears more than the solid one, with a difference of 7.26 percentage points. Reversely, the solid form appears more frequently in individuals aged 60 years or more, with a difference of 8.57 percentage points. Among women, the frequency of the solid subtype was 9.93 percentage points higher than the sclerodermiform frequency. In males, the same percentage difference is observed, but sclerodermiform is the most prevalent subtype. It is concluded in this study that, in general, there is a predominance of basal cell carcinoma in females and in individuals aged 60 years and over, which demonstrates the tendency of this tumor. However, when rarely found in younger individuals, the male gender prevailed. The most prevalent subtype was the solid one. It is worth mentioning that the sclerodermiform subtype, which is more aggressive, was seen more frequently in males and in the 46-to 59-year-old range.Keywords: basal cell carcinoma, epidemiology, sclerodermiform basal cell carcinoma, skin cancer, solar radiation, solid basal cell carcinoma
Procedia PDF Downloads 1407251 Effect of Pole Weight on Nordic Walking
Authors: Takeshi Sato, Mizuki Nakajima, Macky Kato, Shoji Igawa
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The purpose of study was to investigate the effect of varying pole weights on energy expenditure, upper limb and lower limb muscle activity as Electromyogram during Nordic walking (NW). Four healthy men [age = 22.5 (±1.0) years, body mass = 61.4 (±3.6) kg, height = 170.3 (±4.3) cm] and three healthy women [age = 22.7 (±2.9) years, body mass = 53.0 (±1.7) kg, height = 156.7 (±4.5) cm] participated in the experiments after informed consent. Seven healthy subjects were tested on the treadmill, walking, walking (W) with Nordic Poles (NW) and walking with 1kg weight Nordic Poles (NW+1). Walking speed was 6 km per hours in all trials. Eight EMG activities were recorded by bipolar surface methods in biceps brachii, triceps brachii, trapezius, deltoideus, tibialis anterior, medial gastrocnemius, rectus femoris and biceps femoris muscles. And heart rate (HR), oxygen uptake (VO2), and rate of perceived exertion (RPE) were measured. The level of significance was set at a = 0.05, with p < 0.05 regarded as statistically significant. Our results confirmed that use of NW poles increased HR at a given upper arm muscle activity but decreased lower limb EMGs in comparison with W. Moreover NW was able to increase more step lengths with hip joint extension during NW rather than W. Also, EMG revealed higher activation of upper limb for almost all NW and 1kgNW tests plus added masses compared to W (p < 0.05). Therefore, it was thought either of NW and 1kgNW were to have benefit as a physical exercise for safe, feasible, and readily training for a wide range of aged people in the quality of daily life. However, there was no significant effected in leg muscles activity by using 1kgNW except for upper arm muscle activity during Nordic pole walking.Keywords: Nordic walking, electromyogram, heart rate, RPE
Procedia PDF Downloads 2397250 On the Estimation of Crime Rate in the Southwest of Nigeria: Principal Component Analysis Approach
Authors: Kayode Balogun, Femi Ayoola
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Crime is at alarming rate in this part of world and there are many factors that are contributing to this antisocietal behaviour both among the youths and old. In this work, principal component analysis (PCA) was used as a tool to reduce the dimensionality and to really know those variables that were crime prone in the study region. Data were collected on twenty-eight crime variables from National Bureau of Statistics (NBS) databank for a period of fifteen years, while retaining as much of the information as possible. We use PCA in this study to know the number of major variables and contributors to the crime in the Southwest Nigeria. The results of our analysis revealed that there were eight principal variables have been retained using the Scree plot and Loading plot which implies an eight-equation solution will be appropriate for the data. The eight components explained 93.81% of the total variation in the data set. We also found that the highest and commonly committed crimes in the Southwestern Nigeria were: Assault, Grievous Harm and Wounding, theft/stealing, burglary, house breaking, false pretence, unlawful arms possession and breach of public peace.Keywords: crime rates, data, Southwest Nigeria, principal component analysis, variables
Procedia PDF Downloads 4467249 Unsteady Simulation of Burning Off Carbon Deposition in a Coke Oven
Authors: Uzu-Kuei Hsu, Keh-Chin Chang, Joo-Guan Hang, Chang-Hsien Tai
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Carbon Deposits are often occurred inside the industrial coke oven during the coking process. Accumulation of carbon deposits may cause a big issue, which seriously influences the coking operation. The carbon is burning off by injecting fresh air through pipes into coke oven which is an efficient way practically operated in industries. The burning off carbon deposition in coke oven performed by Computational Fluid Dynamics (CFD) method has provided an evaluation of the feasibility study. A three-dimensional, transient, turbulent reacting flow simulation has performed with three different injecting air flow rate and another kind of injecting configuration. The result shows that injection higher air flow rate would effectively reduce the carbon deposits. In the meantime, the opened charging holes would suck extra oxygen from the atmosphere to participate in reactions. In term of coke oven operating limits, the wall temperatures are monitored to prevent over-heating of the adiabatic walls during the burn-off process.Keywords: coke oven, burning off, carbon deposits, carbon combustion, CFD
Procedia PDF Downloads 6947248 “Thou Shalt Surely Die”: A Game Theory Analysis of the Book of Genesis
Authors: Bo Kampmann Walther
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This essay examines the narratives of the Book of Genesis through the lens of game theory, a mathematical framework for analyzing strategic interactions among rational actors. By treating key figures in Genesis as players in a game, this analysis sheds light on their decisions and the resulting consequences. Focusing primarily on the story of Adam and Eve, the essay utilizes concepts such as game state, saddle point, optimal strategy, and Nash equilibrium to explore the dynamics at play and scrutinize the existence of two kinds of game rules in Genesis: one being global and post-Fall oriented, the other being local and relegated to life in the Garden. The serpent's intervention and the subsequent actions of Adam and Eve are modeled as strategic moves, revealing the complexities and shifts in the game state from harmony in Eden to a world marked by toil and mortality post-Fall.Keywords: game theory, Genesis, strategy, saddle point, nash equilibrium, New Game State
Procedia PDF Downloads 457247 Optical Properties of N-(Hydroxymethyl) Acrylamide Polymer Gel Dosimeters for Radiation Therapy
Authors: Khalid A. Rabaeh, Belal Moftah, Ahmed A. Basfar, Akram A. Almousa
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Polymer gel dosimeters are tissue equivalent martial that fabricated from radiation sensitive chemicals which, upon irradiation, polymerize as a function of absorbed radiation dose. Polymer gel dosimeters can uniquely record the radiation dose distribution in three-dimensions (3D). A novel composition of normoxic polymer gel dosimeters based on radiation-induced polymerization of N-(Hydroxymethyl)acrylamide (NHMA) is introduced in this study for radiotherapy treatment planning. The dosimeters were irradiated by 10 MV photon beam of a medical linear accelerator at a constant dose rate of 600 cGy/min with doses up to 30 Gy. The polymerization degree is directly proportional to absorbed dose received by the polymer gel. UV/Vis spectrophotometer was used to investigate the degree of white color of irradiated NHMA gel which is associated to the degree of polymerization of polymer gel dosimeters. The absorbance increases with absorbed dose for all gel dosimeters in the dose range between 0 and 30 Gy. Dose rate , energy of radiation and the stability of the polymerization after irradiation were investigated. No appreciable effects of these parameters on the performance of the novel gel dosimeters were observed.Keywords: dosimeter, gel, spectrophotometer, N-(Hydroxymethyl)acrylamide
Procedia PDF Downloads 4697246 Why is the Recurrence Rate of Residual or Recurrent Disease Following Endoscopic Mucosal Resection (EMR) of the Oesophageal Dysplasia’s and T1 Tumours Higher in the Greater Midlands Cancer Network?
Authors: Harshadkumar Rajgor, Jeff Butterworth
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Background: Barretts oesophagus increases the risk of developing oesophageal adenocarcinoma. Over the last 40 years, there has been a 6 fold increase in the incidence of oesophageal adenocarcinoma in the western world and the incidence rates are increasing at a greater rate than cancers of the colon, breast and lung. Endoscopic mucosal resection (EMR) is a relatively new technique being used by 2 centres in the greater midlands cancer network. EMR can be used for curative or staging purposes, for high-grade dysplasia’s and T1 tumours of the oesophagus. EMR is also suitable for those who are deemed high risk for oesophagectomy. EMR has a recurrence rate of 21% according to the Wiesbaden data. Method: A retrospective study of prospectively collected data was carried out involving 24 patients who had EMR for curative or staging purposes. Complications of residual or recurrent disease following EMR that required further treatment were investigated. Results: In 54% of cases residual or recurrent disease was suspected. 96% of patients were given clear and concise information regarding their diagnosis of high-grade dysplasia or T1 tumours. All 24 patients consulted the same specialist healthcare team. Conclusion: EMR is a safe and effective treatment for patients who have high-grade dysplasia and T1NO tumours. In 54% of cases residual or recurrent disease was suspected. Initially, only single resections were undertaken. Multiple resections are now being carried out to reduce the risk of recurrence. Complications from EMR remain low in this series and consisted of a single episode of post procedural bleeding.Keywords: endoscopic mucosal resection, oesophageal dysplasia, T1 tumours, cancer network
Procedia PDF Downloads 3177245 Linear Frequency Modulation-Frequency Shift Keying Radar with Compressive Sensing
Authors: Ho Jeong Jin, Chang Won Seo, Choon Sik Cho, Bong Yong Choi, Kwang Kyun Na, Sang Rok Lee
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In this paper, a radar signal processing technique using the LFM-FSK (Linear Frequency Modulation-Frequency Shift Keying) is proposed for reducing the false alarm rate based on the compressive sensing. The LFM-FSK method combines FMCW (Frequency Modulation Continuous Wave) signal with FSK (Frequency Shift Keying). This shows an advantage which can suppress the ghost phenomenon without the complicated CFAR (Constant False Alarm Rate) algorithm. Moreover, the parametric sparse algorithm applying the compressive sensing that restores signals efficiently with respect to the incomplete data samples is also integrated, leading to reducing the burden of ADC in the receiver of radars. 24 GHz FMCW signal is applied and tested in the real environment with FSK modulated data for verifying the proposed algorithm along with the compressive sensing.Keywords: compressive sensing, LFM-FSK radar, radar signal processing, sparse algorithm
Procedia PDF Downloads 4857244 Stagnation-Point Flow towards a Stretching/Shrinking Sheet in a Nanofluid: A Stability Analysis
Authors: Anuar Ishak
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The characteristics of stagnation point flow of a nanofluid towards a stretching/shrinking sheet are investigated. The governing partial differential equations are transformed into a set of ordinary differential equations, which are then solved numerically using MATLAB routine boundary value problem solver bvp4c. The numerical results show that dual (upper and lower branch) solutions exist for the shrinking case, while for the stretching case, the solution is unique. A stability analysis is performed to determine the stability of the dual solutions. It is found that the skin friction decreases when the sheet is stretched, but increases when the suction effect is increased. It is also found that increasing the thermophoresis parameter reduces the heat transfer rate at the surface, while increasing the Brownian motion parameter increases the mass transfer rate at the surface.Keywords: dual solutions, heat transfer, forced convection, nanofluid, stability analysis
Procedia PDF Downloads 4197243 Investigating the Influence of Solidification Rate on the Microstructural, Mechanical and Physical Properties of Directionally Solidified Al-Mg Based Multicomponent Eutectic Alloys Containing High Mg Alloys
Authors: Fatih Kılıç, Burak Birol, Necmettin Maraşlı
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The directional solidification process is generally used for homogeneous compound production, single crystal growth, and refining (zone refining), etc. processes. The most important two parameters that control eutectic structures are temperature gradient and grain growth rate which are called as solidification parameters The solidification behavior and microstructure characteristics is an interesting topic due to their effects on the properties and performance of the alloys containing eutectic compositions. The solidification behavior of multicomponent and multiphase systems is an important parameter for determining various properties of these materials. The researches have been conducted mostly on the solidification of pure materials or alloys containing two phases. However, there are very few studies on the literature about multiphase reactions and microstructure formation of multicomponent alloys during solidification. Because of this situation, it is important to study the microstructure formation and the thermodynamical, thermophysical and microstructural properties of these alloys. The production process is difficult due to easy oxidation of magnesium and therefore, there is not a comprehensive study concerning alloys containing high Mg (> 30 wt.% Mg). With the increasing amount of Mg inside Al alloys, the specific weight decreases, and the strength shows a slight increase, while due to formation of β-Al8Mg5 phase, ductility lowers. For this reason, production, examination and development of high Mg containing alloys will initiate the production of new advanced engineering materials. The original value of this research can be described as obtaining high Mg containing (> 30% Mg) Al based multicomponent alloys by melting under vacuum; controlled directional solidification with various growth rates at a constant temperature gradient; and establishing relationship between solidification rate and microstructural, mechanical, electrical and thermal properties. Therefore, within the scope of this research, some > 30% Mg containing ternary or quaternary Al alloy compositions were determined, and it was planned to investigate the effects of directional solidification rate on the mechanical, electrical and thermal properties of these alloys. Within the scope of the research, the influence of the growth rate on microstructure parameters, microhardness, tensile strength, electrical conductivity and thermal conductivity of directionally solidified high Mg containing Al-32,2Mg-0,37Si; Al-30Mg-12Zn; Al-32Mg-1,7Ni; Al-32,2Mg-0,37Fe; Al-32Mg-1,7Ni-0,4Si; Al-33,3Mg-0,35Si-0,11Fe (wt.%) alloys with wide range of growth rate (50-2500 µm/s) and fixed temperature gradient, will be investigated. The work can be planned as; (a) directional solidification of Al-Mg based Al-Mg-Si, Al-Mg-Zn, Al-Mg-Ni, Al-Mg-Fe, Al-Mg-Ni-Si, Al-Mg-Si-Fe within wide range of growth rates (50-2500 µm/s) at a constant temperature gradient by Bridgman type solidification system, (b) analysis of microstructure parameters of directionally solidified alloys by using an optical light microscopy and Scanning Electron Microscopy (SEM), (c) measurement of microhardness and tensile strength of directionally solidified alloys, (d) measurement of electrical conductivity by four point probe technique at room temperature (e) measurement of thermal conductivity by linear heat flow method at room temperature.Keywords: directional solidification, electrical conductivity, high Mg containing multicomponent Al alloys, microhardness, microstructure, tensile strength, thermal conductivity
Procedia PDF Downloads 2617242 Evaluation of Zr/NH₄ClO₄ and Zr/KClO₄ Compositions for Development of Igniter for Ammonium Perchlorate and Hydroxyl-Terminated Polybutadiene Based Base Bleed System
Authors: Amir Mukhtar, Habib Nasir
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To achieve an enhanced range of large calibre artillery a base bleed unit equipped with ammonium perchlorate and hydroxyl-terminated polybutadiene (AP/HTPB) based composite propellant grain is installed at the bottom of a projectile which produces jet of hot gasses and reduces base drag during flight of the projectile. Upon leaving the muzzle at very high muzzle velocity, due to sudden pressure drop, the propellant grain gets quenched. Therefore, base-bleed unit is equipped with an igniter to ensure ignition as well as reignition of the propellant grain. Pyrotechnic compositions based on Zr/NH₄ClO₄ and Zr/KClO₄ mixtures have been studied for the effect of fuel/oxidizer ratio and oxidizer type on ballistic properties. Calorific values of mixtures were investigated by bomb calorimeter, the average burning rate was measured by fuse wire technique at ambient conditions, and high-pressure closed vessel was used to record pressure-time profile, maximum pressure achieved (Pmax), time to achieve Pmax and differential pressure (dP/dt). It was observed that the 30, 40, 50 and 60 wt.% of Zr has a very significant effect on ballistic properties of mixtures. Compositions with NH₄ClO₄ produced higher values of Pmax, dP/dt and Calorific value as compared to Zr/KClO₄ based mixtures. Composition containing KClO₄ comparatively produced higher burning rate and maximum burning rate was recorded at 8.30 mm/s with 60 wt.% Zr in Zr/KClO₄ pyrotechnic mixture. Zr/KClO₄ with 50 wt. % of Zr was tests fired in igniter assembly by electric initiation method. Igniter assembly was test fired several times and average burning time of 3.5 sec with igniter mass burning rate of 6.85 g/sec was recorded. Igniter was finally fired on static and dynamic level with base bleed unit which gave successful ignition to the base bleed grain and extended range was achieved with 155 mm artillery projectile.Keywords: base bleed, closed vessel, igniter, zirconium
Procedia PDF Downloads 1687241 Wear Behavior of Intermetallic (Ni3Al) Coating at High Temperature
Authors: K. Mehmood, Muhammad Asif Rafiq, A. Nasir Khan, M. Mudassar Rauf
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Air plasma spraying system was utilized to deposit Ni3Al coatings on AISI 321 steel samples. After thermal spraying, the nickel aluminide intermetallic coatings were isothermal heat treated at various temperatures. In this regard, temperatures from 500 °C to 800 °C with 100 °C increments were selected. The coatings were soaked for 10, 30, 60 and 100 hours at the mentioned temperatures. These coatings were then tested by a pin on disk method. It was observed that the coatings exposed at comparatively higher temperature experienced lower wear rate. The decrease in wear rate is due to the formation of NiO phase. Further, the as sprayed and heat treated coatings were characterized by other tools such as Microhardness testing, optical and scanning electron microscopy (SEM) and X-Ray diffraction analysis. After isothermal heat treatment, NiO was observed the main phase by X-Ray diffraction technique. Moreover, the surface hardness was also determined higher than cross sectional hardness.Keywords: air plasma spraying, Ni -20Al, tribometer, intermetallic coating, nickel aluminide
Procedia PDF Downloads 3327240 Effect of Preconception Picture-Based Nutrition Education on Knowledge and Adherence to Iron-Folic Acid Supplementation Among Women Planning to Be Pregnant in Ethiopia
Authors: Anteneh Berhane Yeyi, Tefera Belachew
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Any woman who could become pregnant is at risk of having a baby with neural tube defects (NTDs). A spontaneous aborted women with immediately preceding pregnancy may have an increased risk of develop NTDs. Ethiopia has one of the highest rates of micronutrient deficiencies, including folate and iron deficiency. Currently, in Ethiopia, NTDs is emerged as a public health concern. Even if Ethiopia, has implement different strategies for reducing maternal and neonatal mortality and morbidity, there is no room in the health care system and lack of integration for preventing the risk of NTDs for those women who aborted spontaneously and women who discontinue long acting contraception to become pregnant. The purpose of this study was to evaluate the effect of preconception picture-based nutrition education on knowledge and adherence to iron-folic acid supplement (IFAS) intake to reduce the risk of developing neural tube defects (NTDs) and iron deficiency anemia (IDA) among women who had a planned to pregnancy in Ethiopia, a country with a high burden of NTDs. Methodology: This study was conducted in Eastern Ethiopia. A double blinded parallel randomized controlled trial design was employed among women in the age group of 18-45 years who requested to interrupt modern contraceptive who have an intention to be pregnant and women with spontaneous abortion who refused to take a contraceptive. The interventional arm (n=122) received a preconception picture-based nutrition education with iron-folic acid supplement, and the control arm (n=122) received only preconception IFAS. In this study male partners were participated. Result: After three months of intervention the proportion of adherence to IFAS was 23% (n=56). With regard to adherence within the groups, 42.6% (n=52) in the intervention group and 3.3% (n=4) in the control group and the intervention group were significantly higher than in control group. In the intervention group the proportion of adherence to IFAS intake among participants increased by 40.1% and there were statistically difference (P<0.0001). The difference in difference between the two groups of adherence to IFAS intake was 37.6% and there were a statistical significance (P<0.0001). Level of knowledge between the groups did differ before and after intervention (P= 0.87 Vs P<0.0001). The overall the mean change in knowledge Mean (+SE) between group was 0.9 (+3.04 SE) and there were significant differences between two groups (P<0.001). Conclusion: In general this intervention is effective toward adherence to IFAS and a critical milestone to improve maternal health and reduce the neonate mortality due to NTDs and other advert effect of pregnancy and birth outcomes. This intervention is very short, simple, and cost effective and has potential for adaptation, feasible development to large-scale implementation in the existing health care system. Furthermore, this type of interventional approach has the potential to reduce the country's ANC program dropout rates and increase male partner’s participation on reproductive health.Keywords: NTDs, IFAS, WRA, Ethiopia
Procedia PDF Downloads 377239 Frequency of Tube Feeding in Aboriginal and Non-aboriginal Head and Neck Cancer Patients and the Impact on Relapse and Survival Outcomes
Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern
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Introduction: Head and neck cancer and treatments are known for their profound effect on nutrition and tube feeding is a common requirement to maintain nutrition. Aim: We aimed to evaluate the frequency of tube feeding in Aboriginal and non-Aboriginal patients, and to examine the relapse and survival outcomes in patients who require enteral tube feeding. Methods: We performed a retrospective cohort analysis of 320 head and neck cancer patients from a single centre in Western Australia, identifying 80 Aboriginal patients and 240 non-Aboriginal patients matched on a 1:3 ratio by site, histology, rurality, and age. Data collected included patient demographics, tumour features, treatment details, and cancer and survival outcomes. Results: Aboriginal and non-Aboriginal patients required feeding tubes at similar rates (42.5% vs 46.2% respectively), however Aboriginal patients were far more likely to fail to return to oral nutrition, with 26.3% requiring long-term tube feeding versus only 15% of non-Aboriginal patients. In the overall study population, 27.5% required short-term tube feeding, 17.8% required long-term enteral tube nutrition, and 45.3% of patients did not have a feeding tube at any point. Relapse was more common in patients who required tube feeding, with relapses in 42.1% of the patients requiring long-term tube feeding, 31.8% in those requiring a short-term tube, versus 18.9% in the ‘no tube’ group. Survival outcomes for patients who required a long-term tube were also significantly poorer when compared to patients who only required a short-term tube, or not at all. Long-term tube-requiring patients were half as likely to survive (29.8%) compared to patients requiring a short-term tube (62.5%) or no tube at all (63.5%). Patients requiring a long-term tube were twice as likely to die with active disease (59.6%) as patients with no tube (28%), or a short term tube (33%). This may suggest an increased relapse risk in patients who require long-term feeding, due to consequences of malnutrition on cancer and treatment outcomes, although may simply reflect that patients with recurrent disease were more likely to have longer-term swallowing dysfunction due to recurrent disease and salvage treatments. Interestingly long-term tube patients were also more likely to die with no active disease (10.5%) (compared with short-term tube requiring patients (4.6%), or patients with no tube (8%)), which is likely reflective of the increased mortality associated with long-term aspiration and malnutrition issues. Conclusions: Requirement for tube feeding was associated with a higher rate of cancer relapse, and in particular, long-term tube feeding was associated with a higher likelihood of dying from head and neck cancer, but also a higher risk of dying from other causes without cancer relapse. This data reflects the complex effect of head and neck cancer and its treatments on swallowing and nutrition, and ultimately, the effects of malnutrition, swallowing dysfunction, and aspiration on overall cancer and survival outcomes. Tube feeding was seen at similar rates in Aboriginal and non-Aboriginal patient, however failure to return to oral intake with a requirement for a long-term feeding tube was seen far more commonly in the Aboriginal population.Keywords: head and neck cancer, enteral tube feeding, malnutrition, survival, relapse, aboriginal patients
Procedia PDF Downloads 1037238 Driving Forces of Bank Liquidity: Evidence from Selected Ethiopian Private Commercial Banks
Authors: Tadele Tesfay Teame, Tsegaye Abrehame, Hágen István Zsombor
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Liquidity is one of the main concerns for banks, and thus achieving the optimum level of liquidity is critical. The main objective of this study is to discover the driving force of selected private commercial banks’ liquidity. In order to achieve the objective explanatory research design and quantitative research approach were used. Data has been collected from a secondary source of the sampled Ethiopian private commercial banks’ financial statements, the National Bank of Ethiopia, and the Minister of Finance, the sample covering the period from 2011 to 2022. Bank-specific and macroeconomic variables were analyzed by using the balanced panel fixed effect regression model. Bank’s liquidity ratio is measured by the total liquid asset to total deposits. The findings of the study revealed that bank size, capital adequacy, loan growth rate, and non-performing loan had a statistically significant impact on private commercial banks’ liquidity, and annual inflation rate and interest rate margin had a statistically significant impact on the liquidity of Ethiopian private commercial banks measured by L1 (bank liquidity). Thus, banks in Ethiopia should not only be concerned about internal structures and policies/procedures, but they must consider both the internal environment and the macroeconomic environment together in developing their strategies to efficiently manage their liquidity position and private commercial banks to maintain their financial proficiency shall have bank liquidity management policy by assimilating both bank-specific and macro-economic variables.Keywords: liquidity, Ethiopian private commercial banks, liquidity ratio, panel data regression analysis
Procedia PDF Downloads 1007237 Modelling and Analysis of Shear Banding in Flow of Complex Fluids
Authors: T. Chinyoka
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We present the Johnson-Segalman constitutive model to capture certain fluid flow phenomena that has been experimentally observed in the flow of complex polymeric fluids. In particular, experimentally observed phenomena such as shear banding, spurt and slip are explored and/or explained in terms of the non-monotonic shear-stress versus shear-rate relationships. We also explore the effects of the inclusion of physical flow aspects such as wall porosity on shear banding. We similarly also explore the effects of the inclusion of mathematical modelling aspects such as stress diffusion into the stress constitutive models in order to predict shear-stress (or shear-rate) paths. We employ semi-implicit finite difference methods for all the computational solution procedures.Keywords: Johnson-Segalman model, diffusive Johnson-Segalman model, shear banding, finite difference methods, complex fluid flow
Procedia PDF Downloads 3677236 The Redistributive Effects of Debtor Protection Laws
Authors: Hamid Boustanifar, Geraldo Cerqueiro, María Fabiana Penas
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We exploit state-level changes in the amount of personal wealth individuals can protect under Chapter 7 to analyze the causal effect of debtor protection on income inequality. We find that an increase in state exemptions significantly increases inequality by reducing income for low-income individuals and by increasing income for high-income individuals. The increase in inequality is four times larger among the self-employed than among wage earners, and it is due mainly to a growing income gap between skilled (i.e., individuals with a college degree) and unskilled entrepreneurs. We also find that the employment rate of skilled entrepreneurs significantly increases, while the employment rate of unskilled wage earners falls. Our results are consistent with a recent literature that shows that higher exemptions redistribute credit from low-wealth to high-wealth entrepreneurs, affecting the performance of their businesses.Keywords: debtor protection, credit markets, income inequality, debtor protection laws
Procedia PDF Downloads 4327235 Impact of Serum Estrogen and Progesterone Levels in the Outcome Pregnancy Rate in Frozen Embryo Transfer Cycles. A Prospective Cohort Study
Authors: Sayantika Biswas, Dipanshu Sur, Amitoj Athwal, Ratnabali Chakravorty
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Title: Impact of serum estrogen and progesterone levels in the outcome pregnancy rate in frozen embryo transfer cycles. A prospective cohort study Objective: The aim of the current study was to evaluate the effect of serum estradiol (E2) and progesterone (P4) levels at different time points on pregnancy outcomes in frozen embryo transfer (FET) cycles. Materials & Method: A prospective cohort study was performed in patients undergoing frozen embryo transfer. Patients under age 37 years of age with at least one good blastocyst or three good day 3 embryos were included in the study. For endometrial preparation, 14 days of oral estradiol use (2X2 mg for 5 days. 3X2 mg for 4 days, and 4X2 mg for 5 days) was followed by vaginal progesterone twice a day and 50 mg intramuscular progesterone twice a day. Embryo transfer was scheduled 72-76 hrs or 116-120hrs after the initiation of progesterone. Serum E2 and P4 levels were examined at 4 times a) at the start of the menstrual cycle prior to the hormone supplementation. b) on the day of P4 start. c) on the day of ET. d) on the third day after ET. Result: A total 41 women were included in this study (mean age 31.8; SD 2.8). Clinical pregnancy rate was 65.55%. Serum E2 levels on at the start of the menstrual cycle prior to the hormone supplementation and on the day of P4 start were high in patients who achieved pregnancy compared to who did not (P=0.005 and P=0.019 respectively). P4 levels on on the day of ET were also high in patients with clinical pregnancy. On the day of P4 start, a serum E2 threshold of 186.4 pg/ml had a sensitivity of 82%, and P4 had a sensitivity of 71% for the prediction of clinical pregnancy at the threshold value 16.00 ng/ml. Conclusion: In women undergoing FET with hormone replacement, serum E2 level >186.4 pg/ml on the day of the start of progesterone and serum P4 levels >16.00 ng/ml on embryo transfer day are associated with clinical pregnancy.Keywords: serum estradiol, serum progesterone, clinical pregnancy, frozen embryo transfer
Procedia PDF Downloads 827234 Comparative Analysis of the Expansion Rate and Soil Erodibility Factor (K) of Some Gullies in Nnewi and Nnobi, Anambra State Southeastern Nigeria
Authors: Nzereogu Stella Kosi, Igwe Ogbonnaya, Emeh Chukwuebuka Odinaka
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A comparative analysis of the expansion rate and soil erodibility of some gullies in Nnewi and Nnobi both of Nanka Formation were studied. The study involved an integration of field observations, geotechnical analysis, slope stability analysis, multivariate statistical analysis, gully expansion rate analysis, and determination of the soil erodibility factor (K) from Revised Universal Soil Loss Equation (RUSLE). Fifteen representative gullies were studied extensively, and results reveal that the geotechnical properties of the soil, topography, vegetation cover, rainfall intensity, and the anthropogenic activities in the study area were major factors propagating and influencing the erodibility of the soils. The specific gravity of the soils ranged from 2.45-2.66 and 2.54-2.78 for Nnewi and Nnobi, respectively. Grain size distribution analysis revealed that the soils are composed of gravel (5.77-17.67%), sand (79.90-91.01%), and fines (2.36-4.05%) for Nnewi and gravel (7.01-13.65%), sand (82.47-88.67%), and fines (3.78-5.02%) for Nnobi. The soils are moderately permeable with values ranging from 2.92 x 10-5 - 6.80 x 10-4 m/sec and 2.35 x 10-6 - 3.84 x 10⁻⁴m/sec for Nnewi and Nnobi respectively. All have low cohesion values ranging from 1–5kPa and 2-5kPa and internal friction angle ranging from 29-38° and 30-34° for Nnewi and Nnobi, respectively, which suggests that the soils have low shear strength and are susceptible to shear failure. Furthermore, the compaction test revealed that the soils were loose and easily erodible with values of maximum dry density (MDD) and optimum moisture content (OMC) ranging from 1.82-2.11g/cm³ and 8.20-17.81% for Nnewi and 1.98-2.13g/cm³ and 6.00-17.80% respectively. The plasticity index (PI) of the fines showed that they are nonplastic to low plastic soils and highly liquefiable with values ranging from 0-10% and 0-9% for Nnewi and Nnobi, respectively. Multivariate statistical analyses were used to establish relationship among the determined parameters. Slope stability analysis gave factor of safety (FoS) values in the range of 0.50-0.76 and 0.82-0.95 for saturated condition and 0.73-0.98 and 0.87-1.04 for unsaturated condition for both Nnewi and Nnobi, respectively indicating that the slopes are generally unstable to critically stable. The erosion expansion rate analysis for a fifteen-year period (2005-2020) revealed an average longitudinal expansion rate of 36.05m/yr, 10.76m/yr, and 183m/yr for Nnewi, Nnobi, and Nanka type gullies, respectively. The soil erodibility factor (K) are 8.57x10⁻² and 1.62x10-4 for Nnewi and Nnobi, respectively, indicating that the soils in Nnewi have higher erodibility potentials than those of Nnobi. From the study, both the Nnewi and Nnobi areas are highly prone to erosion. However, based on the relatively lower fine content of the soil, relatively lower topography, steeper slope angle, and sparsely vegetated terrain in Nnewi, soil erodibility and gully intensity are more profound in Nnewi than Nnobi.Keywords: soil erodibility, gully expansion, nnewi-nnobi, slope stability, factor of safety
Procedia PDF Downloads 1317233 Rotor Radial Vent Pumping in Large Synchronous Electrical Machines
Authors: Darren Camilleri, Robert Rolston
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Rotor radial vents make use of the pumping effect to increase airflow through the active material thus reduce hotspot temperatures. The effect of rotor radial pumping in synchronous machines has been studied previously. This paper presents the findings of previous studies and builds upon their theories using a parametric numerical approach to investigate the rotor radial pumping effect. The pressure head generated by the poles and radial vent flow-rate were identified as important factors in maximizing the benefits of the pumping effect. The use of Minitab and ANSYS Workbench to investigate the key performance characteristics of radial pumping through a Design of Experiments (DOE) was described. CFD results were compared with theoretical calculations. A correlation for each response variable was derived through a statistical analysis. Findings confirmed the strong dependence of radial vent length on vent pressure head, and radial vent cross-sectional area was proved to be significant in maximising radial vent flow rate.Keywords: CFD, cooling, electrical machines, regression analysis
Procedia PDF Downloads 3137232 Fabrication of Cesium Iodide Columns by Rapid Heating Method
Authors: Chien-Wan Hun, Shao-Fu Chang, Chien-Chon Chen, Ker-Jer Huang
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This study presents how to use a high-efficiency process for producing cesium iodide (CsI) crystal columns by rapid heating method. In the past, the heating rate of the resistance wire heating furnace was relatively slow and excessive iodine and CsI vapors were therefore generated during heating. Because much iodine and CsI vapors are produced during heating process, the composition of CsI crystal columns is not correct. In order to enhance the heating rate, making CsI material in the heating process can quickly reach the melting point temperature. This study replaced the traditional type of external resistance heating furnace with halogen-type quartz heater, and then, CsI material can quickly reach the melting point. Eventually, CsI melt can solidify in the anodic aluminum template forming CsI crystal columns.Keywords: cesium iodide, high efficiency, vapor, rapid heating, crystal column
Procedia PDF Downloads 3737231 Forgeability Study of Medium Carbon Micro-Alloyed Forging Steel
Authors: M. I. Equbal, R. K. Ohdar, B. Singh, P. Talukdar
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Micro-alloyed steel components are used in automotive industry for the necessity to make the manufacturing process cycles shorter when compared to conventional steel by eliminating heat treatment cycles, so an important saving of costs and energy can be reached by reducing the number of operations. Micro-alloying elements like vanadium, niobium or titanium have been added to medium carbon steels to achieve grain refinement with or without precipitation strengthening along with uniform microstructure throughout the matrix. Present study reports the applicability of medium carbon vanadium micro-alloyed steel in hot forging. Forgeability has been determined with respect to different cooling rates, after forging in a hydraulic press at 50% diameter reduction in temperature range of 900-11000C. Final microstructures, hardness, tensile strength, and impact strength have been evaluated. The friction coefficients of different lubricating conditions, viz., graphite in hydraulic oil, graphite in furnace oil, DF 150 (Graphite, Water-Based) die lubricant and dry or without any lubrication were obtained from the ring compression test for the above micro-alloyed steel. Results of ring compression tests indicate that graphite in hydraulic oil lubricant is preferred for free forging and dry lubricant is preferred for die forging operation. Exceptionally good forgeability and high resistance to fracture, especially for faster cooling rate has been observed for fine equiaxed ferrite-pearlite grains, some amount of bainite and fine precipitates of vanadium carbides and carbonitrides. The results indicated that the cooling rate has a remarkable effect on the microstructure and mechanical properties at room temperature.Keywords: cooling rate, hot forging, micro-alloyed, ring compression
Procedia PDF Downloads 3617230 Wear Characteristics of Al Based Composites Fabricated with Nano Silicon Carbide Particles
Authors: Mohammad Reza Koushki Ardestani, Saeed Daneshmand, Mohammad Heydari Vini
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In the present study, AA7075/SiO2 composites have been fabricated via liquid metallurgy process. Using the degassing process, the wet ability of the molten aluminum alloys increased which improved the bonding between aluminum matrix and reinforcement (SiO2) particles. AA7075 alloy and SiO2 particles were taken as the base matrix and reinforcements, respectively. Then, contents of 2.5 and 5 wt. % of SiO2 subdivisions were added into the AA7075 matrix. To improve wettability and distribution, reinforcement particles were pre-heated to a temperature of 550°C for each composite sample. A uniform distribution of SiO2 particles was observed through the matrix alloy in the microstructural study. A hardened EN32 steel disc as the counter face was used to evaluate the wear rate pin-on-disc, a wear testing machine containing. The results showed that the wear rate of the AA/SiO2 composites was lesser than that of the monolithic AA7075 samples. Finally, The SEM worn surfaces of samples were investigated.Keywords: Al7075, SiO₂, wear, composites, stir casting
Procedia PDF Downloads 1057229 Simulation-based Decision Making on Intra-hospital Patient Referral in a Collaborative Medical Alliance
Authors: Yuguang Gao, Mingtao Deng
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The integration of independently operating hospitals into a unified healthcare service system has become a strategic imperative in the pursuit of hospitals’ high-quality development. Central to the concept of group governance over such transformation, exemplified by a collaborative medical alliance, is the delineation of shared value, vision, and goals. Given the inherent disparity in capabilities among hospitals within the alliance, particularly in the treatment of different diseases characterized by Disease Related Groups (DRG) in terms of effectiveness, efficiency and resource utilization, this study aims to address the centralized decision-making of intra-hospital patient referral within the medical alliance to enhance the overall production and quality of service provided. We first introduce the notion of production utility, where a higher production utility for a hospital implies better performance in treating patients diagnosed with that specific DRG group of diseases. Then, a Discrete-Event Simulation (DES) framework is established for patient referral among hospitals, where patient flow modeling incorporates a queueing system with fixed capacities for each hospital. The simulation study begins with a two-member alliance. The pivotal strategy examined is a "whether-to-refer" decision triggered when the bed usage rate surpasses a predefined threshold for either hospital. Then, the decision encompasses referring patients to the other hospital based on DRG groups’ production utility differentials as well as bed availability. The objective is to maximize the total production utility of the alliance while minimizing patients’ average length of stay and turnover rate. Thus the parameter under scrutiny is the bed usage rate threshold, influencing the efficacy of the referral strategy. Extending the study to a three-member alliance, which could readily be generalized to multi-member alliances, we maintain the core setup while introducing an additional “which-to-refer" decision that involves referring patients with specific DRG groups to the member hospital according to their respective production utility rankings. The overarching goal remains consistent, for which the bed usage rate threshold is once again a focal point for analysis. For the two-member alliance scenario, our simulation results indicate that the optimal bed usage rate threshold hinges on the discrepancy in the number of beds between member hospitals, the distribution of DRG groups among incoming patients, and variations in production utilities across hospitals. Transitioning to the three-member alliance, we observe similar dependencies on these parameters. Additionally, it becomes evident that an imbalanced distribution of DRG diagnoses and further disparity in production utilities among member hospitals may lead to an increase in the turnover rate. In general, it was found that the intra-hospital referral mechanism enhances the overall production utility of the medical alliance compared to individual hospitals without partnership. Patients’ average length of stay is also reduced, showcasing the positive impact of the collaborative approach. However, the turnover rate exhibits variability based on parameter setups, particularly when patients are redirected within the alliance. In conclusion, the re-structuring of diagnostic disease groups within the medical alliance proves instrumental in improving overall healthcare service outcomes, providing a compelling rationale for the government's promotion of patient referrals within collaborative medical alliances.Keywords: collaborative medical alliance, disease related group, patient referral, simulation
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