Search results for: risk based inspection
30575 Evaluation of Associated Risk Factors and Determinants of near Miss Obstetric Cases at B.P. Koirala Institute of Health Sciences, Dharan
Authors: Madan Khadka, Dhruba Uprety, Rubina Rai
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Background and objective: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of the level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near-miss obstetric cases and maternal death. Material and Methods A Prospective Observational Study was done from August 1, 2014, to June 30, 2015, in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by the 5-factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, and a complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to June 2014. There were 6307 (71.5%) vaginal delivery and 2777(28.5%) caesarean section and 181 perinatal death with a total of 9,546 live birth. A total of 162 near miss was identified, and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions (WLTC) of 172, Severe maternal outcome ratio of 18.64 per 1000 live birth, Maternal near-miss mortality ratio (MNM: 1 MD) 10.1:1, Mortality index (MI) of 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9%. 19.75% were prim gravidae, with mean age 25.66 yrs, and cardiovascular and coagulation dysfunction as a major life threatening condition and sepsis (25%) was the major cause of mortality. Conclusion: Hemorrhage and hypertensive disorders are the leading causes of near miss event and sepsis as a leading cause of mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.Keywords: abortion, eclampsia, hemorrhage, maternal mortility, near miss
Procedia PDF Downloads 19530574 Enhancing the Implementation Strategy of Simultaneous Operations (SIMOPS) for the Major Turnaround at Pertamina Plaju Refinery
Authors: Fahrur Rozi, Daniswara Krisna Prabatha, Latief Zulfikar Chusaini
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Amidst the backdrop of Pertamina Plaju Refinery, which stands as the oldest and historically less technologically advanced among Pertamina's refineries, lies a unique challenge. Originally integrating facilities established by Shell in 1904 and Stanvac (originally Standard Oil) in 1926, the primary challenge at Plaju Refinery does not solely revolve around complexity; instead, it lies in ensuring reliability, considering its operational history of over a century. After centuries of existence, Plaju Refinery has never undergone a comprehensive major turnaround encompassing all its units. The usual practice involves partial turnarounds that are sequentially conducted across its primary, secondary, and tertiary units (utilities and offsite). However, a significant shift is on the horizon. In the Q-IV of 2023, the refinery embarks on its first-ever major turnaround since its establishment. This decision was driven by the alignment of maintenance timelines across various units. Plaju Refinery's major turnaround was scheduled for October-November 2023, spanning 45 calendar days, with the objective of enhancing the operational reliability of all refinery units. The extensive job list for this turnaround encompasses 1583 tasks across 18 units/areas, involving approximately 9000 contracted workers. In this context, the Strategy of Simultaneous Operations (SIMOPS) execution emerges as a pivotal tool to optimize time efficiency and ensure safety. A Hazard Effect Management Process (HEMP) has been employed to assess the risk ratings of each task within the turnaround. Out of the tasks assessed, 22 are deemed high-risk and necessitate mitigation. The SIMOPS approach serves as a preventive measure against potential incidents. It is noteworthy that every turnaround period at Pertamina Plaju Refinery involves SIMOPS-related tasks. In this context, enhancing the implementation strategy of "Simultaneous Operations (SIMOPS)" becomes imperative to minimize the occurrence of incidents. At least four improvements have been introduced in the enhancement process for the major turnaround at Refinery Plaju. The first improvement involves conducting systematic risk assessment and potential hazard mitigation studies for SIMOPS tasks before task execution, as opposed to the previous on-site approach. The second improvement includes the completion of SIMOPS Job Mitigation and Work Matrices Sheets, which was often neglected in the past. The third improvement emphasizes comprehensive awareness to workers/contractors regarding potential hazards and mitigation strategies for SIMOPS tasks before and during the major turnaround. The final improvement is the introduction of a daily program for inspecting and observing work in progress for SIMOPS tasks. Prior to these improvements, there was no established program for monitoring ongoing activities related to SIMOPS tasks during the turnaround. This study elucidates the steps taken to enhance SIMOPS within Pertamina, drawing from the experiences of Plaju Refinery as a guide. A real actual case study will be provided from our experience in the operational unit. In conclusion, these efforts are essential for the success of the first-ever major turnaround at Plaju Refinery, with the SIMOPS strategy serving as a central component. Based on these experiences, enhancements have been made to Pertamina's official Internal Guidelines for Executing SIMOPS Risk Mitigation, benefiting all Pertamina units.Keywords: process safety management, turn around, oil refinery, risk assessment
Procedia PDF Downloads 7230573 Investigation of Leptospira Infection in Stray Animals in Thailand: Leptospirosis Risk Reduction in Human
Authors: Ruttayaporn Ngasaman, Saowakon Indouang, Usa Chethanond
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Leptospirosis is a public health concern zoonosis in Thailand. Human and animals are often infected by contact with contaminated water. The infected animals play an important role in leptospira infection for both human and other hosts via urine. In humans, it can cause a wide range of symptoms, some of which may present mild flu-like symptoms including fever, vomiting, and jaundice. Without treatment, Leptospirosis can lead to kidney damage, meningitis, liver failure, respiratory distress, and even death. The prevalence of leptospirosis in stray animals in Thailand is unknown. The aim of this study was to investigate leptospira infection in stray animals including dogs and cats in Songkhla province, Thailand. Total of 434 blood samples were collected from 370 stray dogs and 64 stray cats during the population control program from 2014 to 2018. Screening test using latex agglutination for the detection of antibodies against Leptospira interrogans in serum samples shows 29.26% (127/434) positive. There were 120 positive samples of stray dogs and 7 positive samples of stray cats. Detection by polymerase chain reaction specific to LipL32 gene of Leptospira interrogans showed 1.61% (7/434) positive. Stray cats (5/64) show higher prevalence than stray dogs (2/370). Although active infection was low detected, but seroprevalence was high. This result indicated that stray animals were not active infection during sample collection but they use to get infected or in a latent period of infection. They may act as a reservoir for domestic animals and human in which stay in the same environment. In order to prevent and reduce the risk of leptospira infection in a human, stray animals should be done health checking, vaccination, and disease treatment.Keywords: leptospirosis, stray animals, risk reduction, Thailand
Procedia PDF Downloads 13230572 The Effect of the Epstein-Barr Virus on the Development of Multiple Sclerosis
Authors: Sina Mahdavi
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Background and Objective: Multiple sclerosis (MS) is the most common inflammatory autoimmune disease of the central nervous system (CNS) that affects the myelination process in the CNS. Complex interactions of various "environmental or infectious" factors may act as triggers in autoimmunity and disease progression. The association between viral infections, especially Epstein-Barr virus (EBV) and MS, is one potential cause that is not well understood. In this study, we aim to summarize the available data on EBV infection in MS disease progression. Materials and Methods: For this study, the keywords "Multiple sclerosis," "Epstein-Barr virus," and "central nervous system" in the databases PubMed, Google Scholar, Sid, and MagIran between 2016 and 2022 were searched, and 14 articles were chosen, studied, and analyzed. Results: Demyelinated lesions isolated from MS patients contain EBNAs from EBV proteins. The EBNA1 domain contains a pentapeptide fragment identical to B-crystallin, a heat shock peptide, that is increased in peripheral B cells in response to B-crystallin infection, resulting in myelin-directed autoimmunity mediated by proinflammatory T cells. EBNA2, which is involved in the regulation of viral transcription, may enhance transcription from MS risk loci. A 7-fold increase in the risk of MS has been observed in EBV infection with HLA-DR15 synergy. Conclusion: EBV infection along with a variety of specific genetic risk alleles, cause inflammatory cascades in the CNS by infected B cells. There is a high expression of EBV during the course of MS, which indicates the relationship between EBV and MS, that this virus can play a role in the development of MS by creating an inflammatory state. Therefore, measures to modulate the expression of EBV may be effective in reducing inflammatory processes in demyelinated areas of MS patients.Keywords: multiple sclerosis, Epstein-Barr virus, central nervous system, EBNAs
Procedia PDF Downloads 9230571 Intelligent Tooling Embedded Sensors for Monitoring the Wear of Cutting Tools in Turning Applications
Authors: Hatim Laalej, Jon Stammers
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In machining, monitoring of tool wear is essential for achieving the desired dimensional accuracy and surface finish of a machined workpiece. Currently, the task of monitoring the wear on the cutting tool is carried out by the operator who performs manual inspections of the cutting tool, causing undesirable stoppages of machine tools and consequently resulting in costs incurred from loss of productivity. The cutting tool consumable costs may also be higher than necessary when tools are changed before the end of their useful life. Furthermore, damage can be caused to the workpiece when tools are not changed soon enough leading to a significant increase in the costs of manufacturing. The present study is concerned with the development of break sensor printed on the flank surface of poly-crystalline diamond (PCD) cutting to perform on-line condition monitoring of the cutting tool used to machine Titanium Ti-6al-4v bar. The results clearly show that there is a strong correlation between the break sensor measurements and the amount of wear in the cutting tool. These findings are significant in that they help the user/operator of the machine tool to determine the condition of the cutting tool without the need of performing manual inspection, thereby reducing the manufacturing costs such as the machine down time.Keywords: machining, manufacturing, tool wear, signal processing
Procedia PDF Downloads 24330570 An Audit of Restaging Transurethral Resection of Bladder Tumor (Re-TURBT) Quality in a District General Hospital
Authors: Rizwan Iqbal
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Introduction: Re-TURBT has been recommended by international guidelines for patients with non-muscle invasive bladder cancer (NMIBC) who are deemed high-risk. Indications for re-TURBTs remain controversial and studies show mixed outcomes. It should be performed when the initial TURBT specimen lacks detrusor muscle, has tumor stage pT1 or G3/high-grade, or where resection is deemed incomplete. This ensures complete resection of tumors that have a high risk of recurrence as well as accurately identifying any tumors which have been upstaged. The aim of this audit was to evaluate the quality of re-TURBTs in a district general hospital. Method: Data were retrospectively collected from 31 patients who had re-TURBTs between April 2021 and September 2022. Data included baseline demographics, time from initial to re-TURBT, quality of operation note, presence of residual tumor, complications, and administration of chemotherapy within 24 hours of the initial TURBT. Data collection remains ongoing at the time of writing. Results: The mean age was 76 years old and 71.0% of patients were male. 32.3% of patients had their re-TURBT within six weeks and 32.3% had intravesical chemotherapy administered within 24 hours of the initial TURBT. 74.2% of initial TURBTs had detrusor muscle present in the specimen. 48.4% of patients had residual disease following re-TURBT. Just one patient had their pathology upstaged at re-TURBT. The use of the TURBT proforma on the operation note was variable, with 51.6% and 38.7% of surgeons using the proforma after the initial and re-TURBT. Conclusion: Re-TURBT improves bladder cancer staging and is necessary in patients who are deemed high-risk in order to identify any upstaging or recurrence of the disease.Keywords: urology, bladder cancer, turbt, cancer
Procedia PDF Downloads 6230569 Modifying Cardiometabolic Disease Risk Factors in Urban Primary School Children: Three Different Exercise Interventions
Authors: Anneke Van Biljon
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Background: Exercise is a primary form of preventing and improving cardiometabolic disease risk factors; however specific exercise variables and their associated health benefits in children are inconclusive. A preliminary study revealed that different exercise variables may improve particular cardiometabolic health benefits. Objectives: This study further investigated the specific cardiometabolic health benefits associated with three isocaloric exercise interventions set at different intensities. Methods: Hundred-and-twenty (n = 120) participants between the ages of 10 – 14 years old were assigned to four different study groups 1. High intensity interval training (HIIT) at > 80% MHR 2. Moderate intensity continuous training (MICT) at 65% – 70% MHR 3. Alternative intensities (ALT) of HIIT and MICT 4. Control group. Exercise interventions were designed to generate isocaloric workloads of ~154.77 kcal per session, three times per week for five weeks. The one-way ANOVA test established comparisons between group means. Post hoc tests were calculated to determine specific group differences. Results: Although, all exercise groups improved cardiometabolic health, the MICT group showed greater improvements in fasting glucose (-9.30%), whereas cardiorespiratory fitness increased most by 31.33% (p = 0.000) within the HIIT group. Finally, ALT group recorded overall superior and additional cardiometabolic health benefits compared with both MICT and HIIT groups. Conclusion: The findings of this study indicate that superior benefits may be elicited when combining and alternating MICT and HIIT. These results provide specific exercise recommendations for achieving optimal and substantial cardiometabolic health benefits in children which will contribute towards achieving the health-related Sustainable Development Goals for 2030.Keywords: cardiometabolic disease risk factors, exercise, pediatrics, interventions
Procedia PDF Downloads 24730568 Study of Electro Magnetic Acoustic Transducer to Detect Flaw in Pipeline
Authors: Yu-Lin Shen, Ming-Kuen Chang
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In addition to a considerable amount of machinery and equipment, intricacies of the transmission pipeline exist in Petrochemical plants. Long term corrosion may lead to pipeline thinning and rupture, causing serious safety concerns. With the advances in non-destructive testing technology, more rapid and long-range ultrasonic detection techniques are often used for pipeline inspection, EMAT without coupling to detect, it is a non-contact ultrasonic, suitable for detecting elevated temperature or roughened e surface of line. In this study, we prepared artificial defects in pipeline for Electro Magnetic Acoustic Transducer Testing (EMAT) to survey the relationship between the defect location, sizing and the EMAT signal. It was found that the signal amplitude of EMAT exhibited greater signal attenuation with larger defect depth and length.. In addition, with bigger flat hole diameter, greater amplitude attenuation was obtained. In summary, signal amplitude attenuation of EMAT was affected by the defect depth, defect length and the hole diameter and size.Keywords: EMAT, NDT, artificial defect, ultrasonic testing
Procedia PDF Downloads 47330567 PD Test in Gas Insulated Substation Using UHF Method
Authors: T. Prabakaran
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Gas Insulated Substations (GIS) are widely used as important switchgear equipment because of its high reliability, low space requirement, low risk factor and easy maintenance, yet some failures have been reported. Some of the failures are due to presence of metallic particles inside the GIS compartment. The defect can be generated in GIS during production, maintenance, installation and can be due to ageing of the component. The Ultra-High Frequency (UHF) method is used to diagnose the insulation condition of GIS by detecting the PD signals in GIS. This paper identifies PD patterns for free moving particle defect and particle fixed on cone using UHF method. As insulation failure usually starts with PD activity, this paper investigates the differences in PD characteristics in SF6 gas with different types of defects. Experimental results show that correct identification of defects can be achieved based on considered PD characteristics. The method can be applied to prove the quality of assembly work at commissioning, also on a regular basis after many years in service to detect aged and conducting particles as a part of the condition based maintenance.Keywords: gas insulated substation, partial discharge, free moving particle defect, particle fixed on cone defect, ultra high frequency method
Procedia PDF Downloads 24530566 Characterization of Cement Mortar Based on Fine Quartz
Authors: K. Arroudj, M. Lanez, M. N. Oudjit
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The introduction of siliceous mineral additions in cement production allows, in addition to the ecological and economic gain, improvement of concrete performance. This improvement is mainly due to the fixing of Portlandite, released during the hydration of cement, by fine siliceous, forming denser calcium silicate hydrates and therefore a more compact cementitious matrix. This research is part of the valuation of the Dune Sand (DS) in the cement industry in Algeria. The high silica content of DS motivated us to study its effect, at ground state, on the properties of mortars in fresh and hardened state. For this purpose, cement pastes and mortars based on ground dune sand (fine quartz) has been analyzed with a replacement to cement of 15%, 20% and 25%. This substitution has reduced the amount of heat of hydration and avoids any risk of initial cracking. In addition, the grinding of the dune sand provides amorphous thin populations adsorbed at the surface of the crystal particles of quartz. Which gives to ground quartz pozzolanic character. This character results an improvement of mechanical strength of mortar (66 MPa in the presence of 25% of ground quartz).Keywords: mineralogical structure, pozzolanic reactivity, Quartz, mechanical strength
Procedia PDF Downloads 28330565 Adolescent Health Risk Behaviors and the Mediating Effects of Family Dynamics and Socio-Demographic Factors
Authors: Rufina C. Abul, Dylan Kyle D. Apostol, Darius Rex G. Binuya, Alyanah Mae F. Cauilan, Darren A. Diaz, Angelica Jones A. Gallang, Charisse G. Kiwang, Alyanna Nicole G. Mactal, Nadine Beatrize V. Nerona, Janella Nicole R. Posadas, Charisse Purie C. Toledo
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Background: Dramatic physical development, socioemotional adjustment, and cognitive changes highlight adolescent development. Adolescent brains are susceptible to emotional reactivity, making them likely to engage in risk-taking and impulsive behaviors. The family is crucial in laying the foundations of good health. Aims: This study determined the degree of family cohesion, quality of father-child and mother-child relationships, and degree of academic pressure across cultures, age groups, and sexual orientations. Further, it sought the prevalence of adolescent health concerns, including suicide risks, risk-taking behaviors, social media engagement, and self-care deviations. Finally, the correlations between health risk behaviors and the elements of family dynamics were unraveled. Methods: The descriptive-correlational design served as the blueprint for this study. Data were collected from 1095 adolescents aged 12-21 in two high schools and two universities in Baguio City using self-report questionnaires. Data was analyzed using Microsoft Excel Toolpak and IBM SPSS Statistics to identify significant differences and relationships among variables through descriptive statistics (frequency, %, means and figures) and inferential statistics (ANOVA and logistic regression). Results and Discussion: Adolescents generally have strong family cohesion (FC), high-quality father-child relationships (F-CR), very high-quality mother-child relationships(M-CR), and experience high academic pressure (AP). Cultural affiliation does not influence the 4 elements of family dynamics; the higher the age, the stronger the family cohesion; males score significantly higher on family cohesion and mother-child relationship while significantly lower in perceived academic pressure compared to their female and LGBT counterparts. Suicide risk is prevalent among 29-63% of the population, safety issues have the lowest prevalence for having an abusive relationship (8.22%) and the highest for encountering major family changes (53.52%). Substance use was highest for vaping (22.74%), sexual engagement occurs in 14.61% of the population, while 63% are engaged in social media for >5 hours/day. The self-care deviation is highest for weight concerns (63.39%), lack of visits to health care professionals (64.65%) and lack of exercise (49.94%). All 4 elements of family dynamic (FC, F-CR, M-CR and AP) are significantly associated with safety concerns, suicide risks and social media engagement, while M-CR significantly influences cigarette smoking, alcohol drinking, rugby use and engagement in sex. Conclusion and Recommendations: Strong family cohesion and quality parent-child interactions improve emotional and behavioral outcomes. Sexual orientation has a significant impact on academic pressure and social media use, demanding targeted treatments. The link between family dynamics and health-risk behaviors emphasizes the importance of promoting positive family relationships and encouraging safer behaviors, which are critical for increasing adolescents' well-being.Keywords: adolescent health, family cohesion, health risk behaviors, suicide risk
Procedia PDF Downloads 530564 Enhancing Disaster Resilience: Advanced Natural Hazard Assessment and Monitoring
Authors: Mariza Kaskara, Stella Girtsou, Maria Prodromou, Alexia Tsouni, Christodoulos Mettas, Stavroula Alatza, Kyriaki Fotiou, Marios Tzouvaras, Charalampos Kontoes, Diofantos Hadjimitsis
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Natural hazard assessment and monitoring are crucial in managing the risks associated with fires, floods, and geohazards, particularly in regions prone to these natural disasters, such as Greece and Cyprus. Recent advancements in technology, developed by the BEYOND Center of Excellence of the National Observatory of Athens, have been successfully applied in Greece and are now set to be transferred to Cyprus. The implementation of these advanced technologies in Greece has significantly improved the country's ability to respond to these natural hazards. For wildfire risk assessment, a scalar wildfire occurrence risk index is created based on the predictions of machine learning models. Predicting fire danger is crucial for the sustainable management of forest fires as it provides essential information for designing effective prevention measures and facilitating response planning for potential fire incidents. A reliable forecast of fire danger is a key component of integrated forest fire management and is heavily influenced by various factors that affect fire ignition and spread. The fire risk model is validated by the sensitivity and specificity metric. For flood risk assessment, a multi-faceted approach is employed, including the application of remote sensing techniques, the collection and processing of data from the most recent population and building census, technical studies and field visits, as well as hydrological and hydraulic simulations. All input data are used to create precise flood hazard maps according to various flooding scenarios, detailed flood vulnerability and flood exposure maps, which will finally produce the flood risk map. Critical points are identified, and mitigation measures are proposed for the worst-case scenario, namely, refuge areas are defined, and escape routes are designed. Flood risk maps can assist in raising awareness and save lives. Validation is carried out through historical flood events using remote sensing data and records from the civil protection authorities. For geohazards monitoring (e.g., landslides, subsidence), Synthetic Aperture Radar (SAR) and optical satellite imagery are combined with geomorphological and meteorological data and other landslide/ground deformation contributing factors. To monitor critical infrastructures, including dams, advanced InSAR methodologies are used for identifying surface movements through time. Monitoring these hazards provides valuable information for understanding processes and could lead to early warning systems to protect people and infrastructure. Validation is carried out through both geotechnical expert evaluations and visual inspections. The success of these systems in Greece has paved the way for their transfer to Cyprus to enhance Cyprus's capabilities in natural hazard assessment and monitoring. This transfer is being made through capacity building activities, fostering continuous collaboration between Greek and Cypriot experts. Apart from the knowledge transfer, small demonstration actions are implemented to showcase the effectiveness of these technologies in real-world scenarios. In conclusion, the transfer of advanced natural hazard assessment technologies from Greece to Cyprus represents a significant step forward in enhancing the region's resilience to disasters. EXCELSIOR project funds knowledge exchange, demonstration actions and capacity-building activities and is committed to empower Cyprus with the tools and expertise to effectively manage and mitigate the risks associated with these natural hazards. Acknowledgement:Authors acknowledge the 'EXCELSIOR': ERATOSTHENES: Excellence Research Centre for Earth Surveillance and Space-Based Monitoring of the Environment H2020 Widespread Teaming project.Keywords: earth observation, monitoring, natural hazards, remote sensing
Procedia PDF Downloads 3730563 Examining the Investment Behavior of Arab Women in the Stock Market
Authors: Razan Salem
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Gender plays a vital role in the stock markets because men and women differ in their behavior when investing in stocks. Accordingly, the role of gender differences in investment behavior is an increasingly important strand in the field of behavioral finance research. The investment behaviors of women relative to men have been examined in the behavioral finance literature, mainly for comparison purposes. Women's roles in the stock market have not been examined in the behavioral finance literature, however, particularly with respect to the Arab region. This study aims to contribute towards a better understanding of the investment behavior of Arab women (in regards to their risk tolerance, investment confidence, and investment literacy levels) relative to Arab men; using a sample from Arab women and men investors living in Saudi Arabia and Jordan. In order to achieve the study's main aim, the researcher used non-parametric tests, as Mann-Whitney U test, along with frequency distribution analysis to analyze the study’s primary data. The researcher distributed close-ended online questionnaires to a sample of 550 Arab male and female individuals investing in stocks in both Saudi Arabia and Jordan. The results confirm that the sample Arab women invest less in stocks compared to Arab men due to their risk-averse behaviors and limited confidence levels. The results also reveal that due to Arab women’s very low investment literacy levels, they fear from taking the risk and invest often in stocks relative to Arab men. Overall, the study’s main variables (risk tolerance, investment confidence, and investment literacy levels) have a combined effect on the investment behavior of Arab women and their limited participation in the stock market. Hence, this study is one of the very first studies that indicate the combined effect of the three main variables (which are usually studied separately in the existing literature) on the investment behavior of women, particularly Arab women. This study makes three important contributions to the growing literature on gender differences in investment behavior. First, while the behavioral finance literature documents evidence on gender differences in investment behaviors in many developed countries, there are very limited studies that investigate such differences in Arab countries. Arab women investors, generally, are ignored from the behavioral finance literature due probably to cultural barriers and data collection difficulties. Thus, this study extends the literature to include Arab women and their investment behaviors when trading stock relative to Arab men. Moreover, the study associates women investment literacy and confidence levels with their financial risk behaviors and participation in the stock market. This study provides direct evidence on Arab women's investment behaviors when trading stocks. Overall, studying Arab women investors is important to investigate whether the investment behavior identified for Western women investors are also found in Arab women investors.Keywords: Arab women, gender differences, investment behavior, stock markets
Procedia PDF Downloads 17930562 Corporate Water Footprint Assessment: The Case of Tata Steel
Authors: Sujata Mukherjee, Arunavo Mukherjee
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Water covers 70 per cent of our planet; however, freshwater is incredibly rare, and scarce has been listed as the highest impact global risk. The problems related to freshwater scarcity multiplies with the human population having more than doubled coupled with climate change, changing water cycles leading to droughts and floods and a rise in water pollution. Businesses, governments, and local communities are constrained by water scarcity and are facing growing challenges to their growth and sustainability. Water foot printing as an indicator for water use was introduced in 2002. Business water footprint measures the total water consumed to produce the goods and services it provides. It is a combination of the water that goes into the production and manufacturing of a product or service and the water used throughout the supply chain, as well as during the use of the product. A case study approach was applied describing the efforts of Tata Steel. It is based on a series of semi-structured in-depth interviews with top executives of the company as well as observation and content analysis of internal and external documents about the company’s efforts in sustainable water management. Tata Steel draws water required for industrial use from surface water sources, primarily perennial rivers and streams, internal reservoirs and water from municipal sources. The focus of the present study was to explore Tata Steel’s engagement in sustainable water management focusing on water foot printing accounting as a tool to account for water use in the steel supply chain at its Jamshedpur plant. The findings enabled the researchers to conclude that no sources of water are adversely affected by the company’s production of steel at Jamshedpur.Keywords: sustainability, corporate responsibility water management, risk management, business engagement
Procedia PDF Downloads 27230561 Entrepreneurship in Pakistan: Opportunities and Challenges
Authors: Bushra Jamil, Nudrat Baqri, Muhammad Hassan Saeed
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Entrepreneurship is creating or setting up a business not only for the purpose of generating profit but also for providing job opportunities. Entrepreneurs are problem solvers and product developers. They use their financial asset for hiring a professional team and combine the innovation, knowledge, and leadership leads to a successful startup or a business. To be a successful entrepreneur, one should be people-oriented and have perseverance. One must have the ability to take risk, believe in his/her potential, and have the courage to move forward in all circumstances. Most importantly, have the ability to take risk and can assess the risk. For STEM students, entrepreneurship is of specific importance and relevance as it helps them not just to be able to solve real life existing complications but to be able to recognize and identify emerging needs and glitches. It is becoming increasingly apparent that in today’s world, there is a need as well as a desire for STEM and entrepreneurship to work together. In Pakistan, entrepreneurship is slowly emerging, yet we are far behind. It is high time that we should introduce modern teaching methods and inculcate entrepreneurial initiative in students. A course on entrepreneurship can be included in the syllabus, and we must invite businessmen and policy makers to motivate young minds for entrepreneurship. This must be pitching competitions, opportunities to win seed funding, and facilities of incubation centers. In Pakistan, there are many good public sector research institutes, yet there is a void gap in the private sector. Only few research institute are meant for research and development. BJ Micro Lab is one of them. It is SECP registered company and is working in academia to promote and facilitate research in STEM. BJ Micro Lab is a women led initiative, and we are trying to promote research as a passion, not as an arduous burden. For this, we are continuously arranging training workshops and sessions. More than 100 students have been trained in ten different workshops arranged at BJ Micro Lab.Keywords: entrepreneurship, STEM, challenges, oppurtunties
Procedia PDF Downloads 12930560 Promoting Non-Formal Learning Mobility in the Field of Youth
Authors: Juha Kettunen
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The purpose of this study is to develop a framework for the assessment of research and development projects. The assessment map is developed in this study based on the strategy map of the balanced scorecard approach. The assessment map is applied in a project that aims to reduce the inequality and risk of exclusion of young people from disadvantaged social groups. The assessment map denotes that not only funding but also necessary skills and qualifications should be carefully assessed in the implementation of the project plans so as to achieve the objectives of projects and the desired impact. The results of this study are useful for those who want to develop the implementation of the Erasmus+ Programme and the project teams of research and development projects.Keywords: non-formal learning, youth work, social inclusion, innovation
Procedia PDF Downloads 29430559 Prevalence of Sarcocystosis in Slaughtered Sheep and Goats
Authors: Shivan N. Hussein, Ihsan K. Zangana
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A total of 2358 sheep and 532 goats were examined for the presence of macrocystis of Sarcocystis. For microcysts, different muscle tissues were randomly taken from 118 sheep and 110 goats. Macrocystis were examined through naked eye inspection, while microcysts were examined microscopically by using histopathology, pepsin digestion, mincing & squeezing, and muscle squash method. Overall prevalence of macrocystis was 1.2% in sheep and 2.6% in goats. The intensity rate of the cysts was 4 cysts/ gram in sheep & 3 cysts/ gram in goats, respectively, while the overall prevalence of microcysts in sheep and goats was 96.5%. The infection rate in sheep was 96.6% and in goats was 96.4%. The total intensity rate of microcysts was 32.4 cysts/ field in sheep and 16.8 cysts/ field in goats, respectively. Histopathological examination found different shapes, size, wall thickness, and intensity rates of microcysts in muscle tissues of sheep & goats. The pathological reaction showed mild to moderate granulocytosis, and mononuclear cells infiltrated surrounding the microcysts with necrotizing and degeneration of myofibrils. The largest average size of spindle and round shaped cysts (290 ± 89.7 x 76.1 ± 10 µm and 88.8 ± 10.3 µm) in goats and (127.2 ± 18.9 x 53.3 ± 5.4 µm and 74.4 ± 7.5 µm) in sheep, was detected in the esophageal muscle. Statistically, there was a significant difference (p < 0.05) in the prevalence of macrocystis in sheep and goats, while no significant difference (p > 0.05) was observed in the prevalence of microcysts between both animal species.Keywords: macrocystis, microcysts, intensity rate, measurement size
Procedia PDF Downloads 14530558 Gender-Based Violence among Women and Girls with Disability in Nepal
Authors: Manita Pyakurel, Ram Chandra Silwal, Padam Simkhada, Edwin van Teijlingen, Bikesh Bajracharya, Sushila Sapkota, Tina Gorkhali, Salita Gurung
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Introduction: Gender-based violence (GBV) has been identified as a social and personal security concern for women with disabilities who are at increased risk for various types of abuse. This study aims to determine the prevalence rates of physical, psychological, and sexual violence among women and girls with disability in Nepal. Methods: This cross-sectional study was conducted in 28 municipalities, 14 districts, and 7 provinces representing all three ecological regions of Nepal from January to March 2021. Study respondents were girls and women with disabilities, aged between 15 and 59 years, at the study sites. Face-to-face semi-structured interviews were conducted among 1294 respondents using the KoBo toolbox application on a smartphone or tablet. Results: Among the total study population, 35.3% shared lifetime violence experience. Only 4.8% formally reported violence experienced. Among the violence experienced participants maximum (92.6%) of women and girls identified no change in violence before and after the COVID-19 pandemic. Women who were married had protective odds of 0.71 for violence experienced in their lifetime [aOR-0.71, CI (0.56-0.90)]. Conclusion: More than one-third experienced violence in their lifetime. Intimate partner violence was the most common violence experienced by women and girls with disability in Nepal. Sexual violence was the least type of violence experienced. The most common perpetrator of violence includes the mother or father-in-law. Most of the women and girls never reported violence.Keywords: gender-based violence, prevalence, girls, women
Procedia PDF Downloads 13430557 Analysis of Human Mental and Behavioral Models for Development of an Electroencephalography-Based Human Performance Management System
Authors: John Gaber, Youssef Ahmed, Hossam A. Gabbar, Jing Ren
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Accidents at Nuclear Power Plants (NPPs) occur due to various factors, notable among them being poor safety management and poor safety culture. During abnormal situations, the likelihood of human error is many-fold higher due to the higher cognitive workload. The most common cause of human error and high cognitive workload is mental fatigue. Electroencephalography (EEG) is a method of gathering the electromagnetic waves emitted by a human brain. We propose a safety system by monitoring brainwaves for signs of mental fatigue using an EEG system. This requires an analysis of the mental model of the NPP operator, changes in brain wave power in response to certain stimuli, and the risk factors on mental fatigue and attention that NPP operators face when performing their tasks. We analyzed these factors and developed an EEG-based monitoring system, which aims to alert NPP operators when levels of mental fatigue and attention hinders their ability to maintain safety.Keywords: brain imaging, EEG, power plant operator, psychology
Procedia PDF Downloads 10130556 The Effectiveness of an Educational Program on Awareness of Cancer Signs, Symptoms, and Risk Factors among School Students in Oman
Authors: Khadija Al-Hosni, Moon Fai Chan, Mohammed Al-Azri
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Background: Several studies suggest that most school-age adolescents are poorly informed on cancer warning signs and risk factors. Providing adolescents with sufficient knowledge would increase their awareness in adulthood and improve seeking behaviors later. Significant: The results will provide a clear vision in assisting key decision-makers in formulating policies on the students' awareness programs towards cancer. So, the likelihood of avoiding cancer in the future will be increased or even promote early diagnosis. Objectives: to evaluate the effectiveness of an education program designed to increase awareness of cancer signs and symptoms risk factors, improve the behavior of seeking help among school students in Oman, and address the barriers to obtaining medical help. Methods: A randomized controlled trial with two groups was conducted in Oman. A total of 1716 students (n=886/control, n= 830/education), aged 15-17 years, at 10th and 11th grade from 12 governmental schools 3 in governorates from 20-February-2022 to 12-May-2022. Basic demographic data were collected, and the Cancer Awareness Measure (CAM) was used as the primary outcome. Data were collected at baseline (T0) and 4 weeks after (T1). The intervention group received an education program about cancer's cause and its signs and symptoms. In contrast, the control group did not receive any education related to this issue during the study period. Non-parametric tests were used to compare the outcomes between groups. Results: At T0, the lamp was the most recognized cancer warning sign in control (55.0%) and intervention (55.2%) groups. However, there were no significant changes at T1 for all signs in the control group. In contrast, all sign outcomes were improved significantly (p<0.001) in the intervention group, the highest response was unexplained pain (93.3%). Smoking was the most recognized risk factor in both groups: (82.8% for control; 84.1% for intervention) at T0. However, there was no significant change in T1 for the control group, but there was for the intervention group (p<0.001), the highest identification was smoking cigarettes (96.5%). Too scared was the largest barrier to seeking medical help by students in the control group at T0 (63.0%) and T1 (62.8%). However, there were no significant changes in all barriers in this group. Otherwise, being too embarrassed (60.2%) was the largest barrier to seeking medical help for students in the intervention group at T0 and too scared (58.6%) at T1. Although there were reductions in all barriers, significant differences were found in six of ten only (p<0.001). Conclusion: The intervention was effective in improving students' awareness of cancer symptoms, warning signs (p<0.001), and risk factors (p<0.001 reduced the most addressed barriers to seeking medical help (p<0.001) in comparison to the control group. The Ministry of Education in Oman could integrate awareness of cancer within the curriculum, and more interventions are needed on the sociological part to overcome the barriers that interfere with seeking medical help.Keywords: adolescents, awareness, cancer, education, intervention, student
Procedia PDF Downloads 8530555 The Use of Metformin in Treatment of Polycystic Ovary Syndrome (PCOS) and Glucose Control in Pregnant Women with Gestational Diabetes Mellitus (GDM) at Tripoli Medical Center
Authors: Ebtisam A. Benomran, Abdurrauf M. Gusbi, Malak S. Elazarg, M. Sultan, Layla M. Kafu, Arwa M. Matoug, Esra E. Benamara
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Normal pregnancy is associated with metabolic changes leading to decreased insulin sensitivity and reduced glucose tolerance, however, 3-5% of pregnant women proceed to develop gestational diabetes mellitus (GDM). Researcher studied the use of metformin in many fields and the benefit to risk balance of using metformin during pregnancy and the risk of fetotoxic. In this study we examined the use of Metformin to control Glucose in pregnant Women with gestational diabetes mellitus (GDM) and evaluate its safety use during the first trimester of pregnancy.A group of pregnant patients with gestational diabetes mellitus from the first trimester of pregnancy, non smoking with no family history of congenital malformation disease, aged between (20-45 years) and have no liver diseases and who had indicating good compliance at more than one visit over several month until delivery put on Metformin were participated in this trial. Our study shown that all the studied group of pregnant women using metformin 500 mg daily delivered a healthy babies. Meta-analysis by mother risk program showed no increase in incidence of malformations by use Metformin during the first trimester of pregnancy. A hundred outpatients were participated in the survey on the general knowledge and awareness of diabetic patients to their illness and medication used their aged between 20-40 years old. In this survey we realize that 90% of the doctors are not giving the patient full information about their illness and the use of metformin during pregnancy, also about 65% of the patients did not know about the nutritionist in the hospital and the right control diet for diabetes. Courses on first aid, rapid diagnosis of poisoning and follow the written procedures to dealing with such cases.Keywords: gestational diabetes, malformations, metformin, pregnancy
Procedia PDF Downloads 48930554 Exploration of Influential Factors on First Year Architecture Students’ Productivity
Authors: Shima Nikanjam, Badiossadat Hassanpour, Adi Irfan Che Ani
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The design process in architecture education is based upon the Learning-by-Doing method, which leads students to understand how to design by practicing rather than studying. First-year design studios, as starting educational stage, provide integrated knowledge and skills of design for newly jointed architecture students. Within the basic design studio environment, students are guided to transfer their abstract thoughts into visual concrete decisions under the supervision of design educators for the first time. Therefore, introductory design studios have predominant impacts on students’ operational thinking and designing. Architectural design thinking is quite different from students’ educational backgrounds and learning habits. This educational challenge at basic design studios creates a severe need to study the reality of design education at foundation year and define appropriate educational methods with convenient project types with the intention of enhancing architecture education quality. Material for this study has been gathered through long-term direct observation at a first year second semester design studio at the faculty of architecture at EMU (known as FARC 102), fall and spring academic semester 2014-15. Distribution of a questionnaire among case study students and interviews with third and fourth design studio students who passed through the same methods of education in the past 2 years and conducting interviews with instructors are other methodologies used in this research. The results of this study reveal a risk of a mismatch between the implemented teaching method, project type and scale in this particular level and students’ learning styles. Although the existence of such risk due to varieties in students’ profiles could be expected to some extent, recommendations can support educators to reach maximum compatibility.Keywords: architecture education, basic design studio, educational method, forms creation skill
Procedia PDF Downloads 37230553 Factors Associated with Risky Sexual Behaviour in Adolescent Girls and Young Women in Cambodia: A Systematic Review
Authors: Farwa Rizvi, Joanne Williams, Humaira Maheen, Elizabeth Hoban
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There is an increase in risky sexual behavior and unsafe sex in adolescent girls and young women aged 15 to 24 years in Cambodia, which negatively affects their reproductive health by increasing the risk of contracting sexually transmitted infections and unintended pregnancies. Risky sexual behavior includes ‘having sex at an early age, having multiple sexual partners, having sex while under the influence of alcohol or drugs, and unprotected sexual behaviors’. A systematic review of quantitative research conducted in Cambodia was undertaken, using the theoretical framework of the Social Ecological Model to identify the personal, social and cultural factors associated with risky sexual behavior and unsafe sex in young Cambodian women. PRISMA guidelines were used to search databases including Medline Complete, PsycINFO, CINAHL Complete, Academic Search Complete, Global Health, and Social Work Abstracts. Additional searches were conducted in Science Direct, Google Scholar and in the grey literature sources. A risk-of-bias tool developed explicitly for the systematic review of cross-sectional studies was used. Summary item on the overall risk of study bias after the inter-rater response showed that the risk-of-bias was high in two studies, moderate in one study and low in one study. The search strategy included a combination of subject terms and free text terms. The medical subject headings (MeSH) terms included were; contracept* or ‘birth control’ or ‘family planning’ or pregnan* or ‘safe sex’ or ‘protected intercourse’ or ‘unprotected intercourse’ or ‘protected sex’ or ‘unprotected sex’ or ‘risky sexual behaviour*’ or ‘abort*’ or ‘planned parenthood’ or ‘unplanned pregnancy’ AND ( barrier* or obstacle* or challenge* or knowledge or attitude* or factor* or determinant* or choic* or uptake or discontinu* or acceptance or satisfaction or ‘needs assessment’ or ‘non-use’ or ‘unmet need’ or ‘decision making’ ) AND Cambodia*. Initially, 300 studies were identified by using key words and finally, four quantitative studies were selected based on the inclusion criteria. The four studies were published between 2010 and 2016. The study participants ranged in age from 10-24 years, single or married, with 3 to 10 completed years of education. The mean age at sexual debut was reported to be 18 years. Using the perspective of the Social Ecological Model, risky sexual behavior was associated with individual-level factors including young age at sexual debut, low education, unsafe sex under the influence of alcohol and substance abuse, multiple sexual partners or transactional sex. Family level factors included living away from parents, orphan status and low levels of family support. Peer and partner level factors included peer delinquency and lack of condom use. Low socioeconomic status at the society level was also associated with risky sexual behaviour. There is scant research on sexual and reproductive health of adolescent girls and young women in Cambodia. Individual, family and social factors were significantly associated with risky sexual behaviour. More research is required to inform potential preventive strategies and policies that address young women’s sexual and reproductive health.Keywords: adolescents, high-risk sex, sexual activity, unplanned pregnancies
Procedia PDF Downloads 24430552 CFD Analysis of the Blood Flow in Left Coronary Bifurcation with Variable Angulation
Authors: Midiya Khademi, Ali Nikoo, Shabnam Rahimnezhad Baghche Jooghi
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Cardiovascular diseases (CVDs) are the main cause of death globally. Most CVDs can be prevented by avoiding habitual risk factors. Separate from the habitual risk factors, there are some inherent factors in each individual that can increase the risk potential of CVDs. Vessel shapes and geometry are influential factors, having great impact on the blood flow and the hemodynamic behavior of the vessels. In the present study, the influence of bifurcation angle on blood flow characteristics is studied. In order to approach this topic, by simplifying the details of the bifurcation, three models with angles 30°, 45°, and 60° were created, then by using CFD analysis, the response of these models for stable flow and pulsatile flow was studied. In the conducted simulation in order to eliminate the influence of other geometrical factors, only the angle of the bifurcation was changed and other parameters remained constant during the research. Simulations are conducted under dynamic and stable condition. In the stable flow simulation, a steady velocity of 0.17 m/s at the inlet plug was maintained and in dynamic simulations, a typical LAD flow waveform is implemented. The results show that the bifurcation angle has an influence on the maximum speed of the flow. In the stable flow condition, increasing the angle lead to decrease the maximum flow velocity. In the dynamic flow simulations, increasing the bifurcation angle lead to an increase in the maximum velocity. Since blood flow has pulsatile characteristics, using a uniform velocity during the simulations can lead to a discrepancy between the actual results and the calculated results.Keywords: coronary artery, cardiovascular disease, bifurcation, atherosclerosis, CFD, artery wall shear stress
Procedia PDF Downloads 16330551 Suggestions to the Legislation about Medical Ethics and Ethics Review in the Age of Medical Artificial Intelligence
Authors: Xiaoyu Sun
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In recent years, the rapid development of Artificial Intelligence (AI) has extensively promoted medicine, pharmaceutical, and other related fields. The medical research and development of artificial intelligence by scientific and commercial organizations are on the fast track. The ethics review is one of the critical procedures of registration to get the products approved and launched. However, the SOPs for ethics review is not enough to guide the healthy and rapid development of artificial intelligence in healthcare in China. Ethical Review Measures for Biomedical Research Involving Human Beings was enacted by the National Health Commission of the People's Republic of China (NHC) on December 1st, 2016. However, from a legislative design perspective, it was neither updated timely nor in line with the trends of AI international development. Therefore, it was great that NHC published a consultation paper on the updated version on March 16th, 2021. Based on the most updated laws and regulations in the States and EU, and in-depth-interviewed 11 subject matter experts in China, including lawmakers, regulators, and key members of ethics review committees, heads of Regulatory Affairs in SaMD industry, and data scientists, several suggestions were proposed on top of the updated version. Although the new version indicated that the Ethics Review Committees need to be created by National, Provincial and individual institute levels, the review authorities of different levels were not clarified. The suggestion is that the precise scope of review authorities for each level should be identified based on Risk Analysis and Management Model, such as the complicated leading technology, gene editing, should be reviewed by National Ethics Review Committees, it will be the job of individual institute Ethics Review Committees to review and approve the clinical study with less risk such as an innovative cream to treat acne. Furthermore, to standardize the research and development of artificial intelligence in healthcare in the age of AI, more clear guidance should be given to data security in the layers of data, algorithm, and application in the process of ethics review. In addition, transparency and responsibility, as two of six principles in the Rome Call for AI Ethics, could be further strengthened in the updated version. It is the shared goal among all countries to manage well and develop AI to benefit human beings. Learned from the other countries who have more learning and experience, China could be one of the most advanced countries in artificial intelligence in healthcare.Keywords: biomedical research involving human beings, data security, ethics committees, ethical review, medical artificial intelligence
Procedia PDF Downloads 16630550 ACL Tear Prevention Program
Authors: Ervin Meqikukiqi
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It is difficult to assess how athletes can best modify their movements to prevent non contact ACL injuries. Speaking with an athletic trainer, physical therapist, or sports medicine specialist is a good place to start. Recent research has allowed therapists and clinicians to easily identify and target weak muscle areas (e.g., weak hips, which leads to knock-kneed landing positions) and identify ways to improve strength and thus help prevent injury. In addition, other risk factors such as reduced hamstring strength and increased joint range of motion can be further assessed by a physical therapist or athletic trainer to improve performance-or rehabilitation efforts after an injury has occurred. Current studies also demonstrate that specific types of training, such as jump routines and learning to pivot properly, help athletes prevent ACL injuries. These types of exercises and training programs are more beneficial if athletes start when they are young. It may be optimal to integrate prevention programs during early adolescence, prior to when young athletes develop certain habits that increase the risk of an ACL injury. This is a 20 minute program designed to reduce the risk of tears of the Anterior Cruciate Ligament. It should be started at least four and preferably six weeks prior to start of competition.Ideally it is done five times per week preseason and three times per week in season.The coach or trainer must constantly observe athletes during these exercises to correct and maintain proper technique. Once the athletes understand the principles, they can monitor and coach each other. Four phases: Warm-up, Strengthening, Plyometrics, Agility and Balance.Keywords: athletes, acl, prevention, injuries, plyoemtric, proprioception, agillity
Procedia PDF Downloads 42130549 Considerations When Using the Beach Chair Position for Surgery
Authors: Aniko Babits, Ahmad Daoud
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Introduction: The beach chair position (BCP) is a good approach to almost all types of shoulder procedures. However, moving an anaesthetized patient from the supine to sitting position may pose a risk of cerebral hypoperfusion and potential cerebral ischaemia as a result of significant reductions in blood pressure and cardiac output. Hypocapnia in ventilated patients and impaired blood flow to the vertebral artery due to hyperextension, rotation, or tilt of the head may have an impact too. Co-morbidities that may increase the risk of cerebral ischaemia in the BCP include diabetes with autonomic neuropathy, cerebrovascular disease, cardiac disease, severe hypertension, generalized vascular disease, history of fainting, and febrile conditions. Beach chair surgery requires a careful anaesthetic and surgical management to optimize patient safety and minimize the risk of adverse outcomes. Methods: We describe the necessary steps for optimal patient positioning and the aims of intraoperative management, including anaesthetic techniques to ensure patient safety in the BCP. Results: Regardless of the anaesthetic technique, adequate patient positioning is paramount in the BCP. The key steps to BCP are aimed at optimizing surgical success and minimizing the risk of severe neurovascular complications. The primary aim of anaesthetic management is to maintain cardiac output and mean arterial pressure (MAP) to protect cerebral perfusion. Blood pressure management includes treating a fall in MAP of more than 25% from baseline or a MAP less than 70 mmHg. This can be achieved by using intravenous fluids or vasopressors. A number of anaesthetic techniques could also improve cerebral oxygenation, including avoidance of intermittent positive pressure ventilation (IPPV) with general anaesthesia (GA), using regional anaesthesia, maintaining normocapnia and normothermia, and the application of compression stockings. Conclusions: In summary, BCP is a reliable and effective position to perform shoulder procedures. Simple steps to patient positioning and careful anaesthetic management could maximize patient safety and avoid unwanted adverse outcomes in patients undergoing surgery in BCP.Keywords: beach chair position, cerebral oxygenation, cerebral perfusion, sitting position
Procedia PDF Downloads 8930548 Sickle Cell Disease: Review of Managements in Pregnancy and the Outcome in Ampang Hospital, Selangor
Authors: Z. Nurzaireena, K. Azalea, T. Azirawaty, S. Jameela, G. Muralitharan
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The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.Keywords: anaemia, haemoglobinopathies, pregnancy, sickle cell disease
Procedia PDF Downloads 25730547 Anthropometric Indices of Obesity and Coronary Artery Atherosclerosis: An Autopsy Study in South Indian population
Authors: Francis Nanda Prakash Monteiro, Shyna Quadras, Tanush Shetty
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The association between human physique and morbidity and mortality resulting from coronary artery disease has been studied extensively over several decades. Multiple studies have also been done on the correlation between grade of atherosclerosis, coronary artery diseases and anthropometrical measurements. However, the number of autopsy-based studies drastically reduces this number. It has been suggested that while in living subjects, it would be expensive, difficult, and even harmful to subject them to imaging modalities like CT scans and procedures involving contrast media to study mild atherosclerosis, no such harm is encountered in study of autopsy cases. This autopsy-based study was aimed to correlate the anthropometric measurements and indices of obesity, such as waist circumference (WC), hip circumference (HC), body mass index (BMI) and waist hip ratio (WHR) with the degree of atherosclerosis in the right coronary artery (RCA), main branch of the left coronary artery (LCA) and the left anterior descending artery (LADA) in 95 South Indian origin victims of both the genders between the age of 18 years and 75 years. The grading of atherosclerosis was done according to criteria suggested by the American Heart Association. The study also analysed the correlation of the anthropometric measurements and indices of obesity with the number of coronaries affected with atherosclerosis in an individual. All the anthropometric measurements and the derived indices were found to be significantly correlated to each other in both the genders except for the age, which is found to have a significant correlation only with the WHR. In both the genders severe degree of atherosclerosis was commonly observed in LADA, followed by LCA and RCA. Grade of atherosclerosis in RCA is significantly related to the WHR in males. Grade of atherosclerosis in LCA and LADA is significantly related to the WHR in females. Significant relation was observed between grade of atherosclerosis in RCA and WC, and WHR, and between grade of atherosclerosis in LADA and HC in males. Significant relation was observed between grade of atherosclerosis in RCA and WC, and WHR, and between grade of atherosclerosis in LADA and HC in females. Anthropometric measurements/indices of obesity can be an effective means to identify high risk cases of atherosclerosis at an early stage that can be effective in reducing the associated cardiac morbidity and mortality. A person with anthropometric measurements suggestive of mild atherosclerosis can be advised to modify his lifestyle, along with decreasing his exposure to the other risk factors. Those with measurements suggestive of higher degree of atherosclerosis can be subjected to confirmatory procedures to start effective treatment.Keywords: atherosclerosis, coronary artery disease, indices, obesity
Procedia PDF Downloads 6530546 Investigating the Relationship between Growth, Beta and Liquidity
Authors: Zahra Amirhosseini, Mahtab Nameni
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The aim of this study was to investigate the relationship between growth, beta, and Company's cash. We calculate cash as dependent variable and growth opportunity and beta as independent variables. This study was based on an analysis of panel data. Population of the study is the companies which listed in Tehran Stock exchange and a financial data of 215 companies during the period 2010 to 2015 have been selected as the sample through systematic sampling. The results of the first hypothesis showed there is a significant relationship between growth opportunities cash holdings. Also according to the analysis done in the second hypothesis, we determined that there is an inverse relation between company risk and cash holdings.Keywords: growth, beta, liquidity, company
Procedia PDF Downloads 393