Search results for: clinical laboratory results
37696 Disseminated Tuberculosis: Experience from Tuberculosis Directly Observed Treatment Short Course Center at a Tertiary Care Teaching Hospital in the Philippines
Authors: Jamie R. Chua, Christina Irene D. Mejia, Regina P. Berba
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Disseminated tuberculosis is an infectious disease caused by Mycobacterium tuberculosis involving two or more non-contiguous sites identified through bacteriologic confirmation or clinical diagnosis. Over the five year period included in the study, the UP-PGH TB DOTS clinic had total of 3,967 referrals, and the prevalence of disseminated tuberculosis is 1% (68/3967). The mean age was 33.9 years (range 19-64 years) with a male: female ratio of 1:1. 67% (52 patients) had no predisposing comorbid illness or immune disorder. The most common presenting symptoms were abdominal pain (19%), back pain (13%), abdominal enlargement (11%) and mass (10.2%). Anemia, leukocytosis, hypoalbuminemia, and high-normal serum calcium were common biochemical and hematologic findings. Around 36% (25) of patients were diagnosed clinically with disseminated tuberculosis despite lacking bacteriologic evidence of multi-organ involvement. The lungs (86%) is still the most commonly involved site, followed by intestinal (22%), vertebral/Pott’s (27%), and pelvic/genital (19%). The mean time from presentation to initiation of therapy was 22 days (SD 32.7). Only 18 patients (29.3%) were properly recorded to have been referred to local TB DOTs facilities. Of the 68 patients, only 16% (11 patients) continued follow-up at PGH, and all had documented treatment completion. Treatment outcomes of the remaining were unknown. Due to the variety of involved sites, a high index of suspicion is required. Knowledge on clinical features, common radiographic findings, and histopathologic characteristics of disseminated TB is important as bacteriologic evidence of infection is not always apparent.Keywords: disseminated tuberculosis, Mycobacterium tuberculosis, miliary tuberculosis, tuberculosis
Procedia PDF Downloads 24037695 Investigating the Efficiency of Granular Sludge for Recovery of Phosphate from Wastewater
Authors: Sara Salehi, Ka Yu Cheng, Anna Heitz, Maneesha Ginige
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This study investigated the efficiency of granular sludge for phosphorous (P) recovery from wastewater. A laboratory scale sequencing batch reactor (SBR) was operated under alternating aerobic/anaerobic conditions to enrich a P accumulating granular biomass. This study showed that an overall 45-fold increase in P concentration could be achieved by reducing the volume of the P capturing liquor by 5-fold in the anaerobic P release phase. Moreover, different fractions of the granular biomass have different individual contributions towards generating a concentrated stream of P.Keywords: granular sludge, PAOs, P recovery, SBR
Procedia PDF Downloads 48237694 Influence of Temperature on the Development and Feeding Activity of Southern Green Stink Bug Nezara viridula (Heteroptera: Pentatomidae)
Authors: Pavitra Sharma, A. K. Singh
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The establishment of pest population in a habitat is greatly influenced by abiotic factors, such as temperature, photoperiod, and humidity. These factors influence the biology and behavior of insects and their pest status. Nezara viridula (Heteroptera: Pentatomidae), commonly known as southern green stink bug, is economically important pest of legumes. Both nymphs and adult suck the sap from different part of the plant and deteriorate the standing crop. Present study involves effects of temperature on incubation, hatching success and nymphal duration of N. viridula. The results indicated that the development of eggs requires optimal temperature range. Temperature conditions above and below the optimum range affect the incubation period as well as the percent hatchability of eggs. At 19°C, the egg incubation period was longest whereas it was shortest at 27°C. The change in temperature from the optimum condition also affected the hatchability of eggs in N. viridula. Decrease in the hatchability was observed with the decrease in temperature. However, the results were not statistically significant. Decrease in temperature from the optimum temperature to 19°C, also resulted in an increase in nymphal duration of N. viridula. However, no such effect of temperature within the studied range was observed on the morphology of nymphs or adults. Variation in temperature also had no adverse effects on the survival of laboratory bred population of Nezara nymphs. The feeding activity of the bug in relation to photoperiod was assessed by counting the number of punctures on the food surface. The results indicated that day-night regime did not affect the feeding activity of the bug significantly. The present study enhances our knowledge about the effect of environmental factors on the biology of insects and developing the strategy for ‘Integrated Pest Management’ of hemipteran insects by management of the physical factors.Keywords: development, feeding, hatchability, Nezara viridula
Procedia PDF Downloads 17837693 Clinical Features of Acute Aortic Dissection Patients Initially Diagnosed with ST-Segment Elevation Myocardial Infarction
Authors: Min Jee Lee, Young Sun Park, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Yoon Seon Lee, Kyung Soo Lim, Won Young Kim
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Background: Acute myocardial infarction (AMI) concomitant with acute aortic syndrome (AAS) is rare but prompt recognition of concomitant AAS is crucial, especially in patients with ST-segment elevation myocardial infarction (STEMI) because misdiagnosis with early thrombolytic or anticoagulant treatment may result in catastrophic consequences. Objectives: This study investigated the clinical features of patients of STEMI concomitant with AAS that may lead to the diagnostic clue. Method: Between 1 January 2010 and 31 December 2014, 22 patients who were the initial diagnosis of acute coronary syndrome (AMI and unstable angina) and AAS (aortic dissection, intramural hematoma and ruptured thoracic aneurysm) in our emergency department were reviewed. Among these, we excluded 10 patients who were transferred from other hospital and 4 patients with non-STEMI, leaving a total of 8 patients of STEMI concomitant with AAS for analysis. Result: The mean age of study patients was 57.5±16.31 years and five patients were Standford type A and three patients were type B aortic dissection. Six patients had ST-segment elevation in anterior leads and two patients had in inferior leads. Most of the patients had acute onset, severe chest pain but no patients had dissecting nature chest pain. Serum troponin I was elevated in three patients but all patients had D-dimer elevation. Aortic regurgitation or regional wall motion abnormality was founded in four patients. However, widened mediastinum was seen in all study patients. Conclusion: When patients with STEMI have elevated D-dimer and widened mediastinum, concomitant AAS may have to be suspected.Keywords: aortic dissection, myocardial infarction, ST-segment, d-dimer
Procedia PDF Downloads 39837692 The Influence of Coarse Aggregate Morphology on Concrete Workability: A Case Study with Algerian Crushed Limestone
Authors: Ahmed Boufedah Badissi, Ahmed Beroual, Farid Boursas
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This research aims to elucidate the role of coarse aggregate in influencing the fresh properties of normal-strength concrete. Specifically, it is aimed to identify the optimal gradation of coarse aggregate to enhance workability. While existing literature discusses the impact of aggregate granularity on concrete workability, more numerical data or models need to quantify the relationship between workability, granularity, and coarse aggregate shape. The main objective is to create a model that describes how coarse aggregate morphology contributes to fresh concrete properties. To investigate the effect of coarse aggregate gradation on Normal Strength Concrete (NSC) workability, various combinations of coarse aggregates (4/22.4 mm) were produced in the laboratory, utilizing three elementary classes: finer coarse aggregate 4/8 mm (Fca), medium coarse aggregate 8/16 mm (Mca), and coarser coarse aggregate 16/22.4 mm (Cca). We introduced a factor, FCR (Finer to Coarser coarse aggregate Ratio), as a numerical parameter to provide a quantitative evaluation and more detailed results analysis. Quantitative characterization parameters for coarse aggregate morphology were established, exploring the influence of particle size distribution, specific surface, and aggregate shape on workability. The research findings are significant for establishing correlations between coarse aggregate morphology and concrete properties. FCR emerges as a valuable tool for predicting the impact of aggregate gradation variations on concrete. The results of this study create a valuable database for construction professionals and concrete producers, affirming that the fresh properties of NSC are intricately linked to coarse aggregate morphology, particularly gradation.Keywords: morphology, coarse aggregate, workability, fresh properties, gradation
Procedia PDF Downloads 6237691 Experimental Study of Solar Drying of Verbena in Three Types of Solar Dryers
Authors: Llham Lhoume, Rachid Tadili, Nora Arbaoui
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One of the most crucial ways to combat food insecurity is to minimize crop losses, food drying is one of the most organic, effective, low-cost and energy-efficient food preservation methods. In this regard, we undertake in this study an experimental evaluation and analysis of the thermal performance of different natural convection drying systems: a solar greenhouse dryer, an indirect solar dryer with a single compartment and a solar dryer with two compartments. These systems have been implemented at the Solar Energy and Environment Laboratory of Mohammed V University (Morocco). The objective of this work is to study the feasibility of converting a solar greenhouse into a solar dryer for use during the summer. On the other hand, to study the thermal performances of this greenhouse dryer by comparing it with other solar dryers. The experimental study showed that the drying of verbena leaves took 6 hours in the indirect dryer 1, 3 hours in the indirect dryer, 2 and 4 hours in the greenhouse dryer, but the amortization period of the solar greenhouse dryer is lower than the other two solar dryers. The results of this study provide key information on the implementation and performance of these systems for drying a food of great global interest.Keywords: solar energy, drying, agriculture, biotechnologie
Procedia PDF Downloads 8037690 The Dependence of the Liquid Application on the Coverage of the Sprayed Objects in Terms of the Characteristics of the Sprayed Object during Spraying
Authors: Beata Cieniawska, Deta Łuczycka, Katarzyna Dereń
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When assessing the quality of the spraying procedure, three indicators are used: uneven distribution of precipitation of liquid sprayed, degree of coverage of sprayed surfaces, and deposition of liquid spraying However, there is a lack of information on the relationship between the quality parameters of the procedure. Therefore, the research was carried out at the Institute of Agricultural Engineering of Wrocław University of Environmental and Life Sciences. The aim of the study was to determine the relationship between the degree of coverage of sprayed surfaces and the deposition of liquid in the aspect of the parametric characteristics of the protected plant using selected single and double stream nozzles. Experiments were conducted under laboratory conditions. The carrier of nozzles acted as an independent self-propelled sprayer used for spraying, whereas the parametric characteristics of plants were determined using artificial plants as the ratio of the vertical projection surface and the horizontal projection surface. The results and their analysis showed a strong and very strong correlation between the analyzed parameters in terms of the characteristics of the sprayed object.Keywords: degree of coverage, deposition of liquid, nozzle, spraying
Procedia PDF Downloads 33537689 Usage of “Flowchart of Diagnosis and Treatment” Software in Medical Education
Authors: Boy Subirosa Sabarguna, Aria Kekalih, Irzan Nurman
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Introduction: Software in the form of Clinical Decision Support System could help students in understanding the mind set of decision-making in diagnosis and treatment at the stage of general practitioners. This could accelerate and ease the learning process which previously took place by using books and experience. Method: Gather 1000 members of the National Medical Multimedia Digital Community (NM2DC) who use the “flowchart of diagnosis and treatment” software, and analyse factors related to: display, speed in learning, convenience in learning, helpfulness and usefulness in the learning process, by using the Likert Scale through online questionnaire which will further be processed using percentage. Results and Discussions: Out of the 1000 members of NM2DC, apparently: 97.0% of the members use the software and 87.5% of them are students. In terms of the analysed factors related to: display, speed in learning, convenience in learning, helpfulness and usefulness of the software’s usage, the results indicate a 90.7% of fairly good performance. Therefore, the “Flowchart of Diagnosis and Treatment” software has helped students in understanding the decision-making of diagnosis and treatment. Conclusion: the use of “Flowchart of Diagnosis and Treatment” software indicates a positive role in helping students understand decision-making of diagnosis and treatment.Keywords: usage, software, diagnosis and treatment, medical education
Procedia PDF Downloads 35937688 Transarterial Chemoembolization (TACE) in Hepatocellular Carcinoma (HCC)
Authors: Ilirian Laçi, Alketa Spahiu
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Modality of treatment in hepatocellular carcinoma (HCC) patients depends on the stage of the disease. The Barcelona Clinic Liver Cancer Classification (BCLC) is the preferred staging system. There are many patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. The differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Because of these differences, not all patients benefit equally from TACE. Several tools have been devised to aid the decision-making process, which have shown promising initial results but have failed external evaluation and have not been translated to the clinic aspects. Criteria for treatment decisions in daily clinical practice are needed in all stages of the disease.Keywords: hepatocellular carcinoma, transarterial chemoembolization, TACE, liver
Procedia PDF Downloads 9837687 Malaria Menace in Pregnancy; Hard to Ignore
Authors: Nautiyal Ruchira, Nautiyal Hemant, Chaudhury Devnanda, Bhargava Surbhi, Chauhan Nidhi
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Introduction: South East Asian region contributes 2.5 million cases of malaria each year to the global burden of 300 to 500 million of which 76% is reported from India. Government of India launched a national program almost half a century ago, still malaria remains a major public health challenge. Pregnant women are more susceptible to severe malaria and its fetomaternal complications. Inadequate surveillance and under-reporting underestimates the problem. Aim: Present study aimed to analyze the clinical course and pattern of malaria during pregnancy and to study the feto-maternal outcome. Methodology: This is a prospective observational study carried out at Himalayan Institute of Medical Sciences – a tertiary care center in the sub-Himalayan state of Uttarakhand, Northern India. All the pregnant women with malaria and its complications were recruited in the study during 2009 to 2014 which included referred cases from the state of western Uttar Pradesh. A thorough history and clinical examination were carried out to assess maternal and fetal condition. Relevant investigations including haemogram, platelet count, LFT, RFT, and USG was done. Blood slides and rapid diagnostic tests were done to diagnose the type of malaria.The primary outcomes measured were the type of malaria infection, maternal complications associated with malaria, outcome of pregnancy and effect on the fetus. Results: 67 antenatal cases with malaria infection were studied. 71% patients were diagnosed with plasmodium vivax infection, 25% cases were plasmodium falciparum positive and in 3% cases mixed infection was found. 38(56%) patients were primigravida and 29(43%) were multiparous. Most of the patients had already received some treatment from their local doctors and presented with severe malaria with the complications. Thrombocytopenia was the commonest manifestation seen in 35(52%) patients, jaundice in 28%, severe anemia in 18%, and severe oligohydramnios in 10% and renal failure in 6% cases. Regarding pregnancy outcome there were 44 % preterm deliveries, 22% had IUFD and abortions in 6% cases.20% of newborn were low birth weight and 6% were IUGR. There was only one maternal death which occurred due to ARDS in falciparum malaria. Although Plasmodium vivax was the main parasite considering the severity of clinical presentation, all the patients received intensive care. As most of the patients had received chloroquine therapy hence they were treated with IV artesunate followed by oral artemesinin combination therapy. Other therapies in the form of packed RBC’s and platelet transfusions, dialysis and ventilator support were provided when required. Conclusion: Even in areas with annual parasite index (API) less than 2 like ours, malaria in pregnancy could be an alarming problem. Vivax malaria cannot be considered benign in pregnancy because of high incidence of morbidity. Prompt diagnosis and aggressive treatment can reduce morbidity and mortality significantly. Increased community level research, integrating ANC checkups with the distribution of insecticide-treated nets in areas of high endemicity, imparting education and awareness will strengthen the existing control strategies.Keywords: severe malaria, pregnancy, plasmodium vivax, plasmodium falciparum
Procedia PDF Downloads 28037686 Evaluation of Collagen Synthesis in Macrophages/Fibroblasts Co-Culture Using Polylactic Acid Particles as Stimulants
Authors: Feng Ju Chuang, Yu Wen Wang, Tai Jung Hsieh, Shyh Ming Kuo
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Polylactic acid is a synthetic polymer with good biocompatibility and degradability, is widely used in clinical applications. In this study, we utilized Polylactic acid particles as stimulants for macrophages and the collagen synthesis of co-cultured fibroblasts was evaluated. The results indicated that Polylactic acid particles were nontoxic to cells from 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. No obvious inflammation effect was observed (under the PLLA concentration of 1 mg/mL) after 24-h co-culture of Raw264.7 and NIH3T3 cells (from TNF-α assay). The addition of PLLA particles to the Raw264.7 and NIH3T3 co-cultures increased the synthesis of collagen, the highest collagen synthesis from the fibroblast was the 0.2 mg/mL (approximately 60% increased as compared with without addition Polylactic acid particles). Moreover, a co-axial atomization delivery device was used to percutaneously introduce Polylactic acid particles into the dermis layer and stimulating macrophages to secrete growth factors promoting fibroblasts to produce collagen. The preliminary results demonstrated the synthesis of collagen was increased mildly after the introduction of Polylactic acid particles for 28-d post implantation. The Polylactic acid particles could be successfully introduced into the dermis layer from H&E staining examination, however, the optimum concentration of Polylactic acid particles and the time-period for collagen synthesis still need to be evaluated.Keywords: collagen synthesis, macrophage, NIH3T3 cells, polylactic acid particles
Procedia PDF Downloads 11337685 Operative Technique of Glenoid Anteversion Osteotomy and Soft Tissue Rebalancing for Brachial Plexus Birth Palsy
Authors: Michael Zaidman, Naum Simanovsky
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The most of brachial birth palsies are transient. Children with incomplete recovery almost always develop an internal rotation and adduction contracture. The muscle imbalance around the shoulder results in glenohumeral joint deformity and functional limitations. Natural history of glenohumeral deformity is it’s progression with worsening of function. Anteversion glenoid osteotomy with latissimus dorsi and teres major tendon transfers could be an alternative procedure of proximal humeral external rotation osteotomy for patients with severe glenohumeral dysplasia secondary to brachial plexus birth palsy. We will discuss pre-operative planning and stepped operative technique of the procedure on clinical example.Keywords: obstetric brachial plexus palsy, glenoid anteversion osteotomy, tendon transfer, operative technique
Procedia PDF Downloads 7437684 The Frequency of Q Fever Among Hospitalized Patients with Pyrexia
Authors: Hassan Ali Abood Nassrullah, Jabbar Fadeel Mahdi, Mohammed Salih Mahdi Alkurdi, Ali Al Mousawi, Saad Ibrahim Al-Ghabban, Abdul Amir H. Kadhum, Ahmed Al-Amiery
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Background: Q fever is a zoonotic disease characterized by its clinical polymorphism and can present acutely as fever, pneumonia, hepatitis, and chronically as infective endocarditis, arthritis, osteomyelitis, or hepatitis. Objective: The aim of this study is To estimate the prevalence of cases of Q fever in hospitalized febrile patients in Imam Al Hussain Teaching Medical City in Karbala. Methods: One hundred patients with pyrexia were admitted to the medical ward from 1st August to 31st December 2019. Serological procedures fortified by Enzyme-linked Immunosorbent Assay test. Patients were considered to have acute Q fever when the specific antibodies (IgM and IgG) of phase II of Coxiella burnetii were positive. Results: The mean age of the patients was 35.05±12.93 years; females constituted 60% of them. Eighteen patients (18%) showed positive results for IgM, a lower proportion (13% n=13) had positive IgG levels, and 9% showed equivocal results. Statistical analysis revealed a significant association between positive IgM levels of the female gender and in patients consuming unpasteurized milk. One patient (female aged 60 years) died in the hospital, while all other patients were discharged well. Two female patients were pregnant, and one of them had an abortion. Conclusions: Q fever is more common in febrile patients. The study indicates that this disease should not be overlooked in the differential diagnosis of acute fever. Serological testing should be performed in all patients with acute febrile illness with an unsettling diagnosis.Keywords: antibodies, frequency, immunoglobulin IgM, Q fever
Procedia PDF Downloads 12337683 Review for Mechanical Tests of Corner Joints on Wooden Windows and Effects to the Stiffness
Authors: Milan Podlena, Stepan Hysek, Jiri Prochazka, Martin Bohm, Jan Bomba
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Corner joints are the weakest part of windows, where the members are connected together. Since the dimensions of the windows started become bigger, the strength requirements for corner joints started to increase as well. Therefore, the aim of this study was to test the samples of corner joints of wooden windows. Moisture content of test specimens was stabilized in the climate chamber. After conditioning, test specimens were loaded in the laboratory conditions onto an universal testing machine and the failure load was measured. Data was recalculated by using goniometric, bending moment and stiffness equation to the stiffness coefficients and the bending moments were investigated. The results showed difference that was observed for the mortise with tenon joint and the dowel joint. This difference was explained by a varied adhesive bond area, which is related to the dimensions of dowels (diameter and length) as well. The bending moments and stiffness ware (except of type of corner joint) also affected by type of used adhesive, type of dowels and wood species.Keywords: corner joint, wooden window, bending moment, stiffness
Procedia PDF Downloads 21937682 Metformin Protects Cardiac Muscle against the Pro-Apoptotic Effects of Hyperglycaemia, Elevated Fatty Acid and Nicotine
Authors: Christopher R. Triggle, Hong Ding, Khaled Machaca, Gnanapragasam Arunachalam
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The antidiabetic drug, metformin, has been in clinical use for over 50 years and remains the first choice drug for the treatment of type two diabetes. In addition to its effectiveness as an oral anti-hyperglycaemic drug metformin also possesses vasculoprotective effects that are assumed to be secondary to its ability to reduce insulin resistance and control glycated hemoglobin levels; however, recent data from our laboratory indicate that metformin also has direct vasoprotective effects that are mediated, at least in part, via the anti-ageing gene, SIRT1. Diabetes is a major risk factor for the development of cardiovascular disease (CVD) and it is also well established that tobacco use further enhances the risk of CVD; however, it is not known whether treatment with metformin can offset the negative effects of diabetes and tobacco use on cardiac function. The current study was therefore designed to investigate 1: the effects of hyperglycaemia (HG) either alone or in the presence of elevated fatty acids (palmitate) and nicotine on the protein expression levels of the deacetylase sirtuin 1 (the protein product of SIRT1), anti-apoptotic Bcl-2, pro-apoptotic BIM and the pro-apoptotic, tumour suppressor protein, acetylated p53 in cardiomyocytes. 2: the ability of metformin to prevent the detrimental effects of HG, palmitate and nicotine on cardiomyocyte survival. Cell culture protocols were designed using a rat cardiomyocyte cell line, H9c2, either under normal glycaemic (NG) conditions of 5.5mM glucose, or hyperglycaemic conditions (HG) of 25mM glucose with, or without, added palmitate (250μM) or nicotine (1.0mM) for 24h. Immuno-blotting was used to detect the expression of sirtuin 1, Bcl-2, BIM, acetylated (Ac)-p53, p53 with β-actin used as the reference protein. Exposure to HG, palmitate, or nicotine alone significantly reduced expression of sirtuin1, Bcl-2 and raised the expression levels of acetylated p53 and BIM; however, the combination of HG, palmitate and nicotine had a synergistic effect to significantly suppress the expression levels of sirtuin 1 and Bcl-2, but further enhanced the expression of Ac-p53, and BIM. The inclusion of 1000μM, but not 50μM, metformin in the H9c2 cell culture protocol prevented the effects of HG, palmitate and nicotine on the pro-apoptotic pathways. Collectively these data indicate that metformin, in addition to its anti-hyperglycaemic and vasculoprotective properties, also has direct cardioprotective actions that offset the negative effects of hyerglycaemia, elevated free fatty acids and nicotine on cardiac cell survival. These data are of particular significance for the treatment of patients with diabetes who are also smokers as the inclusion of metformin in their therapeutic treatment plan should help reduce cardiac-related morbidity and mortality.Keywords: apoptosis, cardiac muscle, diabetes, metformin, nicotine
Procedia PDF Downloads 31737681 Calibrations and Effect of Different Operating Conditions on the Performance of a Fluid Power Control System with Servo Solenoid Valve
Authors: Tahany W. Sadak, Fouly, A. Anwer, M. Rizk
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The current investigation presents a study on the hydraulic performance of an electro-hydraulic servo solenoid valve controlled linear piston used in hydraulic systems. Advanced methods have been used to measure and record laboratory experiments, to ensure accurate analysis and evaluation. Experiments have been conducted under different values of temperature (28, 40 and 50 °C), supply pressure (10, 20, 30, 40 and 50 bar), system stiffness (32 N/mm), and load (0.0 & 5560 N). It is concluded that increasing temperature of hydraulic oil increases the quantity of flow rate, so it achieves an increase of the quantity of flow by 5.75 % up to 48.8 % depending on operating conditions. The values of pressure decay at low temperature are less than the values at high temperature. The frequency increases with the increase of the temperature. When we connect the springs to the system, it decreases system frequency. These results are very useful in the process of packing and manufacturing of fluid products, where the properties are not affected by 50 °C, so energy and time are saved.Keywords: electro-hydraulic servo valve, fluid power control system, system stiffness, static and dynamic performance
Procedia PDF Downloads 15637680 The Functional Rehabilitation of Peri-Implant Tissue Defects: A Case Report
Authors: Özgür Öztürk, Cumhur Sipahi, Hande Yeşil
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Implant retained restorations commonly consist of a metal-framework veneered with ceramic or composite facings. The increasing and expanding use of indirect resin composites in dentistry is a result of innovations in materials and processing techniques. Of special interest to the implant restorative field is the possibility that composites present significantly lower peak vertical and transverse forces transmitted at the peri-implant level compared to metal-ceramic supra structures in implant-supported restorations. A 43-year-old male patient referred to the department of prosthodontics for an implant retained fixed prosthesis. The clinical and radiographic examination of the patient demonstrated the presence of an implant in the right mandibular first molar tooth region. A considerable amount of marginal bone loss around the implant was detected in radiographic examinations combined with a remarkable peri-implant soft tissue deficiency. To minimize the chewing loads transmitted to the implant-bone interface it was decided to fabricate an indirect composite resin veneered single metal crown over a screw-retained abutment. At the end of the treatment, the functional and aesthetic deficiencies were fully compensated. After a 6 months clinical and radiographic follow-up period the not any additional pathologic invasion was detected in the implant-bone interface and implant retained restoration did not reveal any vehement complication.Keywords: dental implant, fixed partial dentures, indirect composite resin, peri-implant defects
Procedia PDF Downloads 26237679 Developing HRCT Criterion to Predict the Risk of Pulmonary Tuberculosis
Authors: Vandna Raghuvanshi, Vikrant Thakur, Anupam Jhobta
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Objective: To design HRCT criterion to forecast the threat of pulmonary tuberculosis. Material and methods: This was a prospective study of 69 patients with clinical suspicion of pulmonary tuberculosis. We studied their medical characteristics, numerous separate HRCT-results, and a combination of HRCT findings to foresee the danger for PTB by utilizing univariate and multivariate investigation. Temporary HRCT diagnostic criteria were planned in view of these outcomes to find out the risk of PTB and tested these criteria on our patients. Results: The results of HRCT chest were analyzed, and Rank was given from 1 to 4 according to the HRCT chest findings. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Rank 1: Highly suspected PTB. Rank 2: Probable PTB Rank 3: Nonspecific or difficult to differentiate from other diseases Rank 4: Other suspected diseases • Rank 1 (Highly suspected TB) was present in 22 (31.9%) patients, all of them finally diagnosed to have pulmonary tuberculosis. The sensitivity, specificity, and negative likelihood ratio for RANK 1 on HRCT chest was 53.6%, 100%, and 0.43, respectively. • Rank 2 (Probable TB) was present in 13 patients, out of which 12 were tubercular, and 1 was non-tubercular. • The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the combination of Rank 1 and Rank 2 was 82.9%, 96.4%, 23.22, and 0.18, respectively. • Rank 3 (Non-specific TB) was present in 25 patients, and out of these, 7 were tubercular, and 18 were non-tubercular. • When all these 3 ranks were considered together, the sensitivity approached 100% however, the specificity reduced to 35.7%. The positive likelihood ratio and negative likelihood ratio were 1.56 and 0, respectively. • Rank 4 (Other specific findings) was given to 9 patients, and all of these were non-tubercular. Conclusion: HRCT is useful in selecting individuals with greater chances of pulmonary tuberculosis.Keywords: pulmonary, tuberculosis, multivariate, HRCT
Procedia PDF Downloads 17237678 Electron Beam Processing of Ethylene-Propylene-Terpolymer-Based Rubber Mixtures
Authors: M. D. Stelescu, E. Manaila, G. Craciun, D. Ighigeanu
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The goal of the paper is to present the results regarding the influence of the irradiation dose and amount of multifunctional monomer trimethylol-propane trimethacrylate (TMPT) on ethylene-propylene-diene terpolymer rubber (EPDM) mixtures irradiated in electron beam. Blends, molded on an electrically heated laboratory roller mill and compressed in an electrically heated hydraulic press, were irradiated using the ALID 7 of 5.5 MeV linear accelerator in the dose range of 22.6 kGy to 56.5 kGy in atmospheric conditions and at room temperature of 25 °C. The share of cross-linking and degradation reactions was evaluated by means of sol-gel analysis, cross-linking density measurements, FTIR studies and Charlesby-Pinner parameter (p0/q0) calculations. The blends containing different concentrations of TMPT (3 phr and 9 phr) and irradiated with doses in the mentioned range have present the increasing of gel content and cross-linking density. Modified and new bands in FTIR spectra have appeared, because of both cross-linking and chain scission reactions.Keywords: electron beam irradiation, EPDM rubber, crosslinking density, gel fraction
Procedia PDF Downloads 15537677 Randomized Trial of Tian Jiu Therapy in San Fu Days for Patients with Chronic Asthma
Authors: Libing Zhu, Waichung Chen, Kwaicing Lo, Lei Li
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Background: Tian Jiu Therapy (a medicinal vesiculation therapy according to traditional Chinese medicine theory) in San Fu Days (the three hottest days in a year is calculated by the Chinese ancient calendar) is widely used by patients with chronic asthma in China although from modern medicine perspective there is insufficient evidence of its effectiveness and safety issues. We investigated the efficacy and safety of Tian Jiu Therapy compared with placebo in patients with chronic asthma. Methods: Patients with chronic asthma were randomly assigned to Tian Jiu treatment group (n=165), placebo control group (n=158). Registered Chinese Medicine practitioners, in Orthopedics-Traumatology, Acupuncture, and Tui-na Clinical Centre for Teaching and Research, School of Chinese Medicine, The University of Hong Kong, administered Tian Jiu Therapy and placebo treatment in 3 times over 2 months. Patients completed questionnaires and lung function test before treatment and after treatment, 3, 6, 9, and 11 months, respectively. The primary outcome was the no of asthma-related sub-healthy symptoms and the percentage of patients with twenty-three symptoms. Results: 451 patients were recruited totally, 111 patients refused or did not participate according the appointment time and 17 did not meet the inclusion criteria. Consequently, 323 of eligible patients were enrolled. There was nothing difference between Tian Jiu Therapy group and placebo control group at the end of all treatments neither primary nor secondary outcomes. While Tian Jiu Therapy as compared with placebo significantly reduced the percentage of participants who are susceptible waken up by asthma symptoms from 27% to 14% at 2nd follow-up (P < 0.05). Similarly, Tian Jiu Therapy significantly reduced the proportion of participants who had the symptom of running nose and sneezing before onset from 18% to 8% at 2nd follow-up (P < 0.05). Additionally, Tian Jiu Therapy significantly reduced the level of asthma, the proportion of participants who don’t need to processed during asthma attack increased from 6% to 15% at 1st follow-up and 0% to 7% at 3rd follow-up (P < 0.05). Improvements also occurred with Tian Jiu Therapy group, it reduced the proportion of participants who were spontaneously sweating at 3rd follow up and diarrhea after intake of oily food at 4th follow-up (P < 0.05). Conclusion: When added to a regimen of foundational therapy for chronic asthma participants, Tian Jiu Therapy further reduced the need for medications to control asthma, improved the quality of participants’ life, and significantly reduced the level of asthma. What is more, this benefit seems to have an accumulative effect over time was in accordance with the TCM theory of 'winter disease is being cured in summer'.Keywords: asthma, Tian Jiu Therapy, San Fu Days, triaditional Chinese medicine, clinical trial
Procedia PDF Downloads 31437676 Experimental Study of Solar Drying of Verbena in Different Dryers
Authors: Ilham Ihoume, Rachid Tadili, Nora Arbaoui
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One of the most crucial ways to combat food insecurity is to minimize crop losses; food drying is one of the most organic, efficient, low-cost, and energy-saving food preservation methods. In this regard, we undertake in this study an experimental evaluation and analysis of the thermal performance of different natural convection drying systems: a solar greenhouse dryer, an indirect solar dryer with a single compartment, and a solar dryer with two compartments. These systems have been implemented at the Solar Energy and Environment Laboratory of Mohammed V University (Morocco). The objective of this work is to study the feasibility of converting a solar greenhouse into a solar dryer for use during the summer. On the other hand, to study the thermal performances of this greenhouse dryer by comparing it with other solar dryers. The experimental study showed that the drying of verbena leaves took 6 hours in the indirect dryer 1, 3 hours in the indirect dryer, and 2 and 4 hours in the greenhouse dryer, but the amortization period of the solar greenhouse dryer is lower than the other two solar dryers. The results of this study provide key information on the implementation and performance of these systems for drying food of great global interest.Keywords: indirect solar dryer, solar energy, agricultural greenhouse, green energy
Procedia PDF Downloads 9337675 Predicting Mixing Patterns of Overflows from a Square Manhole
Authors: Modupe O. Jimoh
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During manhole overflows, its contents pollute the immediate environment. Understanding the pollutant transfer characteristics between manhole’s incoming sewer and the overflow is therefore of great importance. A square manhole with sides 388 mm by 388 mm and height 700 mm with an overflow facility was used in the laboratory to carry out overflow concentration measurements. Two scenarios were investigated using three flow rates. The first scenario corresponded to when the exit of the pipe becomes blocked and the only exit for the flow is the manhole. The second scenario is when there is an overflow in combination with a pipe exit. The temporal concentration measurements showed that the peak concentration of pollutants in the flow was attenuated between the inlet and the overflow. A deconvolution software was used to predict the Residence time distribution (RTD) and consequently the Cumulative Residence time distribution (CRTD). The CRTDs suggest that complete mixing is occurring between the pipe inlet and the overflow, like what is obtained in a low surcharged manhole. The results also suggest that an instantaneous stirred tank reactor model can describe the mixing characteristics.Keywords: CRTDs, instantaneous stirred tank reactor model, overflow, square manholes, surcharge, temporal concentration profiles
Procedia PDF Downloads 14437674 A Mixed Integer Programming Model for Optimizing the Layout of an Emergency Department
Authors: Farhood Rismanchian, Seong Hyeon Park, Young Hoon Lee
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During the recent years, demand for healthcare services has dramatically increased. As the demand for healthcare services increases, so does the necessity of constructing new healthcare buildings and redesigning and renovating existing ones. Increasing demands necessitate the use of optimization techniques to improve the overall service efficiency in healthcare settings. However, high complexity of care processes remains the major challenge to accomplish this goal. This study proposes a method based on process mining results to address the high complexity of care processes and to find the optimal layout of the various medical centers in an emergency department. ProM framework is used to discover clinical pathway patterns and relationship between activities. Sequence clustering plug-in is used to remove infrequent events and to derive the process model in the form of Markov chain. The process mining results served as an input for the next phase which consists of the development of the optimization model. Comparison of the current ED design with the one obtained from the proposed method indicated that a carefully designed layout can significantly decrease the distances that patients must travel.Keywords: Mixed Integer programming, Facility layout problem, Process Mining, Healthcare Operation Management
Procedia PDF Downloads 33937673 Systematic Review of Dietary Fiber Characteristics Relevant to Appetite and Energy Intake Outcomes in Clinical Intervention Trials of Healthy Humans
Authors: K. S. Poutanen, P. Dussort, A. Erkner, S. Fiszman, K. Karnik, M. Kristensen, C. F. M. Marsaux, S. Miquel-Kergoat, S. Pentikäinen, P. Putz, R. E. Steinert, J. Slavin, D. J. Mela
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Dietary fiber (DF) intake has been associated with lower body weight or less weight gain. These effects are generally attributed to putative effects of DF on appetite. Many intervention studies have tested the effect of DFs on appetite-related measures, with inconsistent results. However, DF includes a wide category of different compounds with diverse chemical and physical characteristics, and correspondingly diverse effects in human digestion. Thus, inconsistent results between DF consumption and appetite are not surprising. The specific contribution of different compounds with varying physico-chemical properties to appetite control and the mediating mechanisms are not well characterized. This systematic review aimed to assess the influence of specific DF characteristics, including viscosity, gel forming capacity, fermentability, and molecular weight, on appetite-related outcomes in healthy humans. Medline and FSTA databases were searched for controlled human intervention trials, testing the effects of well-characterized DFs on subjective satiety/appetite or energy intake outcomes. Studies were included only if they reported: 1) fiber name and origin, and 2) data on viscosity, gelling properties, fermentability, or molecular weight of the DF materials tested. The search generated 3001 unique records, 322 of which were selected for further consideration from title and abstract screening. Of these, 149 were excluded due to insufficient fiber characterization and 124 for other reasons (not original article, not randomized controlled trial, or no appetite related outcome), leaving 49 papers meeting all the inclusion criteria, most of which reported results from acute testing (<1 day). The eligible 49 papers described 90 comparisons of DFs in foods, beverages or supplements. DF-containing material of interest was efficacious for at least one appetite-related outcome in 51/90 comparisons. Gel-forming DF sources were most consistently efficacious but there were no clear associations between viscosity, MW or fermentability and appetite-related outcomes. A considerable number of papers had to be excluded from the review due to shortcomings in fiber characterization. To build understanding about the impact of DF on satiety/appetite specifically there should be clear hypotheses about the mechanisms behind the proposed beneficial effect of DF material on appetite, and sufficient data about the DF properties relevant for the hypothesized mechanisms to justify clinical testing. The hypothesized mechanisms should also guide the decision about relevant duration of exposure in studies, i.e. are the effects expected to occur during acute time frame (related to stomach emptying, digestion rate, etc.) or develop from sustained exposure (gut fermentation mediated mechanisms). More consistent measurement methods and reporting of fiber specifications and characterization are needed to establish reliable structure-function relationships for DF and health outcomes.Keywords: appetite, dietary fiber, physico-chemical properties, satiety
Procedia PDF Downloads 23537672 Observation of the Orthodontic Tooth's Long-Term Movement Using Stereovision System
Authors: Hao-Yuan Tseng, Chuan-Yang Chang, Ying-Hui Chen, Sheng-Che Chen, Chih-Han Chang
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Orthodontic tooth treatment has demonstrated a high success rate in clinical studies. It has been agreed upon that orthodontic tooth movement is based on the ability of surrounding bone and periodontal ligament (PDL) to react to a mechanical stimulus with remodeling processes. However, the mechanism of the tooth movement is still unclear. Recent studies focus on the simple principle compression-tension theory while rare studies directly measure tooth movement. Therefore, tracking tooth movement information during orthodontic treatment is very important in clinical practice. The aim of this study is to investigate the mechanism responses of the tooth movement during the orthodontic treatments. A stereovision system applied to track the tooth movement of the patient with the stamp brackets. The system was established by two cameras with their relative position calibrate. And the orthodontic force measured by 3D printing model with the six-axis load cell to determine the initial force application. The result shows that the stereovision system accuracy revealed the measurement presents a maximum error less than 2%. For the study on patient tracking, the incisor moved about 0.9 mm during 60 days tracking, and half of movement occurred in the first few hours. After removing the orthodontic force in 100 hours, the distance between before and after position incisor tooth decrease 0.5 mm consisted with the release of the phenomenon. Using the stereovision system can accurately locate the three-dimensional position of the teeth and superposition of 3D coordinate system for all the data to integrate the complex tooth movement.Keywords: orthodontic treatment, tooth movement, stereovision system, long-term tracking
Procedia PDF Downloads 42237671 Soil Salinity from Wastewater Irrigation in Urban Greenery
Authors: H. Nouri, S. Chavoshi Borujeni, S. Anderson, S. Beecham, P. Sutton
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The potential risk of salt leaching through wastewater irrigation is of concern for most local governments and city councils. Despite the necessity of salinity monitoring and management in urban greenery, most attention has been on agricultural fields. This study was defined to investigate the capability and feasibility of monitoring and predicting soil salinity using near sensing and remote sensing approaches using EM38 surveys, and high-resolution multispectral image of WorldView3. Veale Gardens within the Adelaide Parklands was selected as the experimental site. The results of the near sensing investigation were validated by testing soil salinity samples in the laboratory. Over 30 band combinations forming salinity indices were tested using image processing techniques. The outcomes of the remote sensing and near sensing approaches were compared to examine whether remotely sensed salinity indicators could map and predict the spatial variation of soil salinity through a potential statistical model. Statistical analysis was undertaken using the Stata 13 statistical package on over 52,000 points. Several regression models were fitted to the data, and the mixed effect modelling was selected the most appropriate one as it takes to account the systematic observation-specific unobserved heterogeneity. Results showed that SAVI (Soil Adjusted Vegetation Index) was the only salinity index that could be considered as a predictor for soil salinity but further investigation is needed. However, near sensing was found as a rapid, practical and realistically accurate approach for salinity mapping of heterogeneous urban vegetation.Keywords: WorldView3, remote sensing, EM38, near sensing, urban green spaces, green smart cities
Procedia PDF Downloads 16237670 The Effect of Additive Acid on the Phytoremediation Efficiency
Authors: G. Hosseini, A. Sadighzadeh, M. Rahimnejad, N. Hosseini, Z. Jamalzadeh
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Metal pollutants, especially heavy metals from anthropogenic sources such as metallurgical industries’ waste including mining, smelting, casting or production of nuclear fuel, including mining, concentrate production and uranium processing ends in the environment contamination (water and soil) and risk to human health around the facilities of this type of industrial activity. There are different methods that can be used to remove these contaminants from water and soil. These are very expensive and time-consuming. In this case, the people have been forced to leave the area and the decontamination is not done. For example, in the case of Chernobyl accident, an area of 30 km around the plant was emptied of human life. A very efficient and cost-effective method for decontamination of the soil and the water is phytoremediation. In this method, the plants preferentially native plants which are more adaptive to the regional climate are well used. In this study, three types of plants including Alfalfa, Sunflower and wheat were used to Barium decontamination. Alfalfa and Sunflower were not grown good enough in Saghand mine’s soil sample. This can be due to non-native origin of these plants. But, Wheat rise in Saghand Uranium Mine soil sample was satisfactory. In this study, we have investigated the effect of 4 types of acids inclusive nitric acid, oxalic acid, acetic acid and citric acid on the removal efficiency of Barium by Wheat. Our results indicate the increase of Barium absorption in the presence of citric acid in the soil. In this paper, we will present our research and laboratory results.Keywords: phytoremediation, heavy metal, wheat, soil
Procedia PDF Downloads 33837669 Challenges and Recommendations for Medical Device Tracking and Traceability in Singapore: A Focus on Nursing Practices
Authors: Zhuang Yiwen
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The paper examines the challenges facing the Singapore healthcare system related to the tracking and traceability of medical devices. One of the major challenges identified is the lack of a standard coding system for medical devices, which makes it difficult to track them effectively. The paper suggests the use of the Unique Device Identifier (UDI) as a single standard for medical devices to improve tracking and reduce errors. The paper also explores the use of barcoding and image recognition to identify and document medical devices in nursing practices. In nursing practices, the use of barcodes for identifying medical devices is common. However, the information contained in these barcodes is often inconsistent, making it challenging to identify which segment contains the model identifier. Moreover, the use of barcodes may be improved with the use of UDI, but many subsidized accessories may still lack barcodes. The paper suggests that the readiness for UDI and barcode standardization requires standardized information, fields, and logic in electronic medical record (EMR), operating theatre (OT), and billing systems, as well as barcode scanners that can read various formats and selectively parse barcode segments. Nursing workflow and data flow also need to be taken into account. The paper also explores the use of image recognition, specifically the Tesseract OCR engine, to identify and document implants in public hospitals due to limitations in barcode scanning. The study found that the solution requires an implant information database and checking output against the database. The solution also requires customization of the algorithm, cropping out objects affecting text recognition, and applying adjustments. The solution requires additional resources and costs for a mobile/hardware device, which may pose space constraints and require maintenance of sterile criteria. The integration with EMR is also necessary, and the solution require changes in the user's workflow. The paper suggests that the long-term use of Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) as a supporting terminology to improve clinical documentation and data exchange in healthcare. SNOMED CT provides a standardized way of documenting and sharing clinical information with respect to procedure, patient and device documentation, which can facilitate interoperability and data exchange. In conclusion, the paper highlights the challenges facing the Singapore healthcare system related to the tracking and traceability of medical devices. The paper suggests the use of UDI and barcode standardization to improve tracking and reduce errors. It also explores the use of image recognition to identify and document medical devices in nursing practices. The paper emphasizes the importance of standardized information, fields, and logic in EMR, OT, and billing systems, as well as barcode scanners that can read various formats and selectively parse barcode segments. These recommendations could help the Singapore healthcare system to improve tracking and traceability of medical devices and ultimately enhance patient safety.Keywords: medical device tracking, unique device identifier, barcoding and image recognition, systematized nomenclature of medicine clinical terms
Procedia PDF Downloads 7837668 Learning Recomposition after the Remote Period with Finalist Students of the Technical Course in the Environment of the Ifpa, Paragominas Campus, Pará State, Brazilian Amazon
Authors: Liz Carmem Silva-Pereira, Raffael Alencar Mesquita Rodrigues, Francisco Helton Mendes Barbosa, Emerson de Freitas Ferreira
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Due to the Covid-19 pandemic declared in March 2020 by the World Health Organization, the way of social coexistence across the planet was affected, especially in educational processes, from the implementation of the remote modality as a teaching strategy. This teaching-learning modality caused a change in the routine and learning of basic education students, which resulted in serious consequences for the return to face-to-face teaching in 2021. 2022, at the Federal Institute of Education, Science and Technology of Pará (IFPA) – Campus Paragominas had their training process severely affected, having studied the initial half of their training in the remote modality, which compromised the carrying out of practical classes, technical visits and field classes, essential for the student formation on the environmental technician. With the objective of promoting the recomposition of these students' learning after returning to the face-to-face modality, an educational strategy was developed in the last period of the course. As teaching methodologies were used for research as an educational principle, the integrative project and the parallel recovery action applied jointly, aiming at recomposing the basic knowledge of the natural sciences, together with the technical knowledge of the environmental area applied to the course. The project assisted 58 finalist students of the environmental technical course. A research instrument was elaborated with parameters of evaluation of the environmental quality for study in 19 collection points, in the Uraim River urban hydrographic basin, in the Paragominas City – Pará – Brazilian Amazon. Students were separated into groups under the professors' and laboratory assistants’ orientation, and in the field, they observed and evaluated the places' environmental conditions and collected physical data and water samples, which were taken to the chemistry and biology laboratories at Campus Paragominas for further analysis. With the results obtained, each group prepared a technical report on the environmental conditions of each evaluated point. This work methodology enabled the practical application of theoretical knowledge received in various disciplines during the remote teaching modality, contemplating the integration of knowledge, people, skills, and abilities for the best technical training of finalist students. At the activity end, the satisfaction of the involved students in the project was evaluated, through a form, with the signing of the informed consent term, using the Likert scale as an evaluation parameter. The results obtained in the satisfaction survey were: on the use of research projects within the disciplines attended, 82% of satisfaction was obtained; regarding the revision of contents in the execution of the project, 84% of satisfaction was obtained; regarding the acquired field experience, 76.9% of satisfaction was obtained, regarding the laboratory experience, 86.2% of satisfaction was obtained, and regarding the use of this methodology as parallel recovery, 71.8% was obtained of satisfaction. In addition to the excellent performance of students in acquiring knowledge, it was possible to remedy the deficiencies caused by the absence of practical classes, technical visits, and field classes, which occurred during the execution of the remote teaching modality, fulfilling the desired educational recomposition.Keywords: integrative project, parallel recovery, research as an educational principle, teaching-learning
Procedia PDF Downloads 6637667 Monitoring Blood Pressure Using Regression Techniques
Authors: Qasem Qananwah, Ahmad Dagamseh, Hiam AlQuran, Khalid Shaker Ibrahim
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Blood pressure helps the physicians greatly to have a deep insight into the cardiovascular system. The determination of individual blood pressure is a standard clinical procedure considered for cardiovascular system problems. The conventional techniques to measure blood pressure (e.g. cuff method) allows a limited number of readings for a certain period (e.g. every 5-10 minutes). Additionally, these systems cause turbulence to blood flow; impeding continuous blood pressure monitoring, especially in emergency cases or critically ill persons. In this paper, the most important statistical features in the photoplethysmogram (PPG) signals were extracted to estimate the blood pressure noninvasively. PPG signals from more than 40 subjects were measured and analyzed and 12 features were extracted. The features were fed to principal component analysis (PCA) to find the most important independent features that have the highest correlation with blood pressure. The results show that the stiffness index means and standard deviation for the beat-to-beat heart rate were the most important features. A model representing both features for Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) was obtained using a statistical regression technique. Surface fitting is used to best fit the series of data and the results show that the error value in estimating the SBP is 4.95% and in estimating the DBP is 3.99%.Keywords: blood pressure, noninvasive optical system, principal component analysis, PCA, continuous monitoring
Procedia PDF Downloads 161