Search results for: discrete events
879 Predictive Factors of Healthcare-Associated Infections and Antibiotic Use Patterns: A Cross-Sectional Survey at the Charles Nicolle Hospital of Tunis
Authors: Nouira Mariem, Ennigrou Samir
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Background and aims: Healthcare-associated infections (HAI) represent a major public health problem worldwide. They represent one of the most serious adverse events in health care. The objectives of our study were to estimate the prevalence of HAI at the Charles Nicolle Hospital (CNH) and to identify the main associated factors as well as to estimate the frequency of antibiotic use. Methods: It was a cross-sectional study at the CNH with a unique passage per department (October-December 2018). All patients present at the wards for more than 48 hours were included. All patients from outpatient consultations, emergency, and dialysis departments were not included. The site definitions of infections proposed by the Centers for Disease Control and Prevention (CDC) were used. Only clinically and/or microbiologically confirmed active HAIs were included. Results: A total of 318 patients were included, with a mean age of 52 years and a sex ratio (female/male) of 1.05. A total of 41 patients had one or more active HAIs, corresponding to a prevalence of 13.1% (95% CI: 9.3%-16.9%). The most frequent site infections were urinary tract infections and pneumonia. Multivariate analysis among adult patients (>=18 years) (n=261) revealed that infection on admission (p=0.01), alcoholism (p=0.01), high blood pressure (p=0.008), having at least one invasive device inserted (p=0.004), and history of recent surgery (p=0.03), increased the risk of HAIs significantly. More than 1 of 3 patients (35.4%) were under antibiotics on the day of the survey, of which more than half (57.4%) were under two or more types of antibiotics. Conclusion: The prevalence of HAIs and antibiotic prescriptions at the CNH were considerably high. An infection prevention and control committee, as well as the development of an antibiotic stewardship program with continuous monitoring using repeated prevalence surveys, must be implemented to limit the frequency of these infections effectively.Keywords: prevalence, healthcare associated infection, antibiotic, Tunisia
Procedia PDF Downloads 82878 An Analytical Study on the Impact of Cultural and Literary Heritage on the Contemporary Arabic Novel
Authors: Sharafat Karimi, Jamil Jafari
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The impact of Western Literature on other nations' pieces of literature (including Arabic) has caused critics to ignore the importance of Arabic cultural & literary heritage in the formation of contemporary Arabic fiction; but on the contrary, an important part of literary genres in any society, especially fiction has been formed in the past and depends on ancient literary events. The current paper, utilizing the descriptive-analytical method and by means of library studies, tries to challenge those critics who regard Western Literature as the only effective factor on the appearance of Arabic fiction. Furthermore, this research tries to find out effective Islamic-Arabic elements on the development of Arabic novel by the investigation of some fictional works. The results show that in addition to regarding Western literature as an important factor, Arab novelists have applied their heritage, culture, and ancient history, either written or orally transmitted to the current generation, in their innovations. Among great historical works containing moral stories, allegorical legends, myths, tales of heroes, and folklore, we can refer to Arabian Nights, Kalila & Dimna, romantic stories, historical puzzles, history of Islam, history of ancient Egypt, Maqama, and Quranic stories. Famous novels like 'Hadith Isa ibn-Hisham', 'Layali Alif Layla', 'Abas al-Aqdar', 'Radoubis', 'Ahlam Shahrzad, and 'Alam Bela Kharaet' were compiled on the basis of ancient literary heritage not only in the theme but also in the structure; so one can conclude that the ancient literary-cultural heritage and Islamic-Arabian history have been influential on Arabic novel appearance and development.Keywords: Arabic fictional literature, culture, heritage, history, language, novel
Procedia PDF Downloads 127877 Optimizing Glycemic Control with AI-Guided Dietary Supplements: A Randomized Trial in Type 2 Diabetes
Authors: Evgeny Pokushalov, Claire Garcia, Andrey Ponomarenko, John Smith, Michael Johnson, Inessa Pak, Evgenya Shrainer, Dmitry Kudlay, Leila Kasimova, Richard Miller
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This study evaluated the efficacy of an AI-guided dietary supplement regimen compared to a standard physician-guided regimen in managing Type 2 diabetes (T2D). A total of 160 patients were randomly assigned to either the AI-guided group (n=80) or the physician-guided group (n=80) and followed over 90 days. The AI-guided group received 5.3 ± 1.2 supplements per patient, while the physician-guided group received 2.7 ± 0.6 supplements per patient. The AI system personalized supplement types and dosages based on individual genetic and metabolic profiles. The AI-guided group showed a significant reduction in HbA1c levels from 7.5 ± 0.8% to 7.1 ± 0.7%, compared to a reduction from 7.6 ± 0.9% to 7.4 ± 0.8% in the physician-guided group (mean difference: -0.3%, 95% CI: -0.5% to -0.1%; p < 0.01). Secondary outcomes, including fasting plasma glucose, HOMA-IR, and insulin levels, also improved more in the AI-guided group. Subgroup analyses revealed that the AI-guided regimen was particularly effective in patients with specific genetic polymorphisms and elevated metabolic markers. Safety profiles were comparable between both groups, with no serious adverse events reported. In conclusion, the AI-guided dietary supplement regimen significantly improved glycemic control and metabolic health in T2D patients compared to the standard physician-guided approach, demonstrating the potential of personalized AI-driven interventions in diabetes management.Keywords: Type 2 diabetes, AI-guided supplementation, personalized medicine, glycemic control, metabolic health, genetic polymorphisms, dietary supplements, HbA1c, fasting plasma glucose, HOMA-IR, personalized nutrition
Procedia PDF Downloads 10876 Economic Recession and its Psychological Effects on Educated Youth: A Case Study of Pakistan
Authors: Aroona Hashmi
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An economic recession can lead people to feel more insecure about their financial situation. The series of events leading into a recession can be especially distressing for Educated Youth. One of the most salient factors linking economic recession to psychological distress is unemployment. It is proved that a large number of educated young people are facing higher unemployment rate in Pakistan. Young people are likely to get frustrated at the lack of opportunities made available to them. If the young population increases more rapidly than job opportunities, then number of unemployment is likely to increase. The aim of present study was to investigate the relationship between economic instability, growing rate of aggression and frustration among educated youth. The study aimed to find out the impact of increased economic instability on the learning abilities of the students. Data was gathered from six university students of Punjab, Pakistan. The sample of the study consisted of three hundred male and female university students. The data was analyzed by applying Chi -square test. The results of the research indicate that there is a significant relationship between low household income and growing rate of aggression among educated youth. The increasing trend of economic instability significantly influences the learning abilities of the students. The study concludes that feeling of deprivation produce frustration and could be expressed through aggression. Therefore, if factors that are responsible for youth unemployment in Pakistan are addressed, psychological effects will be reduced. The right way of tackling the youth bulge is to turn the youth into a productive workforce. There is a dire need to transform the education system to societal needs. At the same time creating demand for the young workforce is achieved through dynamic changes in the economic structure.Keywords: psychological effects, economic recession, educated youth, environmental factors
Procedia PDF Downloads 388875 Neuron Point-of-Care Stem Cell Therapy: Intrathecal Transplant of Autologous Bone Marrow-Derived Stem Cells in Patients with Cerebral Palsy
Authors: F. Ruiz-Navarro, M. Matzner, G. Kobinia
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Background: Cerebral palsy (CP) encompasses the largest group of childhood movement disorders, the patterns and severity varies widely. Today, the management focuses only on a rehabilitation therapy that tries to secure the functions remained and prevents complications. However the treatments are not aimed to cure the disease. Stem cells (SCs) transplant via intrathecal is a new approach to the disease. Method: Our aim was to performed a pilot study under the condition of unproven treatment on clinical practice to assessed the safety and efficacy of Neuron Point-of-care Stem cell Therapy (N-POCST), an ambulatory procedure of autologous bone marrow derived SCs (BM-SCs) harvested from the posterior superior iliac crest undergo an on-site cell separation for intrathecal infusion via lumbar puncture. Results: 82 patients were treated in a period of 28 months, with a follow-up after 6 months. They had a mean age of 6,2 years old and male predominance (65,9%). Our preliminary results show that: A. No patient had any major side effects, B. Only 20% presented mild headache due to LP, C. 53% of the patients had an improvement in spasticity, D. 61% improved the coordination abilities, 23% improved the motor function, 15% improved the speech, 23% reduced the number of convulsive events with the same doses or less doses of anti-convulsive medication and 94% of the patients report a subjective general improvement. Conclusions: These results support previous worldwide publications that described the safety and effectiveness of autologous BM-SCs transplant for patients wit CP.Keywords: autologous transplant, cerebral palsy, point of care, childhood movement disorders
Procedia PDF Downloads 414874 Thiopental-Fentanyl versus Midazolam-Fentanyl for Emergency Department Procedural Sedation and Analgesia in Patients with Shoulder Dislocation and Distal Radial Fracture-Dislocation: A Randomized Double-Blind Controlled Trial
Authors: D. Farsi, G. Dokhtvasi, S. Abbasi, S. Shafiee Ardestani, E. Payani
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Background and aim:It has not been well studied whether fentanyl-thiopental (FT) is effective and safe for PSA in orthopedic procedures in Emergency Department (ED). The aim of this trial was to evaluate the effectiveness of intravenous FTversusfentanyl-midazolam (FM)in patients who suffered from shoulder dislocation or distal radial fracture-dislocation. Methods:In this randomized double-blinded study, Seventy-six eligible patients were entered the study and randomly received intravenous FT or FM. The success rate, onset of action and recovery time, pain score, physicians’ satisfaction and adverse events were assessed and recorded by treating emergency physicians. The statistical analysis was intention to treat. Results: The success rate after administrating loading dose in FT group was significantly higher than FM group (71.7% vs. 48.9%, p=0.04); however, the ultimate unsuccess rate after 3 doses of drugs in the FT group was higher than the FM group (3 to 1) but it did not reach to significant level (p=0.61). Despite near equal onset of action time in two study group (P=0.464), the recovery period in patients receiving FT was markedly shorter than FM group (P<0.001). The occurrence of adverse effects was low in both groups (p=0.31). Conclusion: PSA using FT is effective and appears to be safe for orthopedic procedures in the ED. Therefore, regarding the prompt onset of action, short recovery period of thiopental, it seems that this combination can be considered more for performing PSA in orthopedic procedures in ED.Keywords: procedural sedation and analgesia, thiopental, fentanyl, midazolam, orthopedic procedure, emergency department, pain
Procedia PDF Downloads 252873 Mitigation of Wind Loads on a Building Using Small Wind Turbines
Authors: Arindam Chowdhury, Andres Tremante, Mohammadtaghi Moravej, Bodhisatta Hajra, Ioannis Zisis, Peter Irwin
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Extreme wind events, such as hurricanes, have caused significant damage to buildings, resulting in losses worth millions of dollars. The roof of a building is most vulnerable to wind-induced damage due to the high suctions experienced by the roof in extreme wind conditions. Wind turbines fitted to buildings can help generate energy, but to our knowledge, their application to wind load mitigation is not well known. This paper presents results from an experimental study to assess the effect of small wind turbines (developed and patented by the first and second authors) on the wind loads on a low rise building roof. The tests were carried out for an open terrain at the Wall of Wind (WOW) experimental facility at Florida International University (FIU), Miami, Florida, USA, for three cases – bare roof, roof fitted with wind turbines placed closer to the roof edges, and roof with wind turbines placed away from the roof edges. Results clearly indicate that the presence of the wind turbines reduced the mean and peak pressure coefficients (less suction) on the roof when compared to the bare deck case. Furthermore, the peak pressure coefficients were found to be lower (less suction) when the wind turbines were placed closer to the roof, than away from the roof. Flow visualization studies using smoke and gravel clearly showed that the presence of the turbines disrupted the formation of vortices formed by cornering winds, thereby reducing roof suctions and preventing lift off of roof coverings. This study shows that the wind turbines besides generating wind energy, can be used for mitigating wind induced damage to the building roof. Future research must be directed towards understanding the effect of these wind turbines on other roof geometries (e.g. hip/gable) in different terrain conditions.Keywords: wall of wind, wind loads, wind turbine, building
Procedia PDF Downloads 249872 Entrepreneurship And Heritage Tourism: Identifying Opportunities Around Tsodilo Hills World Heritage Site
Authors: O. Nthoi-Molefe, V. Makwinja
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In the North West district of Botswana, Heritage tourism has the potential to offer tremendous economic and social opportunities for local communities in terms of supporting Tourism product development and entrepreneurship. This paper Identifies that Cultural Heritage Entrepreneur brings to the market goods and services, organizes and runs cultural heritage in a commercial or non-profit manner depending on characteristics of cultural resources identified. Data was collected through a series of focus group discussions that included sixteen village community members within the region. Data collected was transcribed and then further analyzed thematically to bring forward results to be analysed. Using Tsodilo Hills World Heritage Site as a case study, the researchers acknowledged that Cultural Heritage Entrepreneurs in that area should use a creative approach in order toidentify suitable solutions for financing different tourism activities starting with sponsored events, grant funds, donations, including the benefits of financial opportunities brough be foreign visitors and domestic tourists alike. The researchers also identified a need for specialized training for the identified entrepreneurs in order to maintain quality services of tourism products and sites (interpretation), information for tourists, visitation services, diversification, and upgrading of the heritage experience. The research reveals that the identified Cultural Heritage Entrepreneurs prefer economic motivation, exploitation over the cultural value of their resources, further calling for recommendations of the research that emphasize on the need for detailed training on how to valorize their cultural resources for the growth of Tourism in the area.Keywords: education, community development, entrepreneurship, cultural tourism
Procedia PDF Downloads 159871 Determination of the Runoff Coefficient in Urban Regions, an Example from Haifa, Israel
Authors: Ayal Siegel, Moshe Inbar, Amatzya Peled
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This study examined the characteristic runoff coefficient in different urban areas. The main area studied is located in the city of Haifa, northern Israel. Haifa spreads out eastward from the Mediterranean seacoast to the top of the Carmel Mountain range with an elevation of 300 m. above sea level. For this research project, four watersheds were chosen, each characterizing a different part of the city; 1) Upper Hadar, a spacious suburb on the upper mountain side; 2) Qiryat Eliezer, a crowded suburb on a level plane of the watershed; 3) Technion, a large technical research university which is located halfway between the top of the mountain range and the coast line. 4) Keret, a remote suburb, on the southwestern outskirts of Haifa. In all of the watersheds found suitable, instruments were installed to continuously measure the water level flowing in the channels. Three rainfall gauges scattered in the study area complete the hydrological requirements for this research project. The runoff coefficient C in peak discharge events was determined by the Rational Formula. The main research finding is the significant relationship between the intensity of rainfall, and the impervious area which is connected to the drainage system of the watershed. For less intense rainfall, the full potential of the connected impervious area will not be exploited. As a result, the runoff coefficient value decreases as do the peak discharge rate and the runoff yield from the storm event. The research results will enable application to other areas by means of hydrological model to be be set up on GIS software that will make it possible to estimate the runoff coefficient of any given city watershed.Keywords: runoff coefficient, rational method, time of concentration, connected impervious area.
Procedia PDF Downloads 350870 Numerical Investigation of Multiphase Flow Structure for the Flue Gas Desulfurization
Authors: Cheng-Jui Li, Chien-Chou Tseng
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This study adopts Computational Fluid Dynamics (CFD) technique to build the multiphase flow numerical model where the interface between the flue gas and desulfurization liquid can be traced by Eulerian-Eulerian model. Inside the tower, the contact of the desulfurization liquid flow from the spray nozzles and flue gas flow can trigger chemical reactions to remove the sulfur dioxide from the exhaust gas. From experimental observations of the industrial scale plant, the desulfurization mechanism depends on the mixing level between the flue gas and the desulfurization liquid. In order to significantly improve the desulfurization efficiency, the mixing efficiency and the residence time can be increased by perforated sieve trays. Hence, the purpose of this research is to investigate the flow structure of sieve trays for the flue gas desulfurization by numerical simulation. In this study, there is an outlet at the top of FGD tower to discharge the clean gas and the FGD tower has a deep tank at the bottom, which is used to collect the slurry liquid. In the major desulfurization zone, the desulfurization liquid and flue gas have a complex mixing flow. Because there are four perforated plates in the major desulfurization zone, which spaced 0.4m from each other, and the spray array is placed above the top sieve tray, which includes 33 nozzles. Each nozzle injects desulfurization liquid that consists of the Mg(OH)2 solution. On each sieve tray, the outside diameter, the hole diameter, and the porosity are 0.6m, 20 mm and 34.3%. The flue gas flows into the FGD tower from the space between the major desulfurization zone and the deep tank can finally become clean. The desulfurization liquid and the liquid slurry goes to the bottom tank and is discharged as waste. When the desulfurization solution flow impacts the sieve tray, the downward momentum will be converted to the upper surface of the sieve tray. As a result, a thin liquid layer can be developed above the sieve tray, which is the so-called the slurry layer. And the volume fraction value within the slurry layer is around 0.3~0.7. Therefore, the liquid phase can't be considered as a discrete phase under the Eulerian-Lagrangian framework. Besides, there is a liquid column through the sieve trays. The downward liquid column becomes narrow as it interacts with the upward gas flow. After the flue gas flows into the major desulfurization zone, the flow direction of the flue gas is upward (+y) in the tube between the liquid column and the solid boundary of the FGD tower. As a result, the flue gas near the liquid column may be rolled down to slurry layer, which developed a vortex or a circulation zone between any two sieve trays. The vortex structure between two sieve trays results in a sufficient large two-phase contact area. It also increases the number of times that the flue gas interacts with the desulfurization liquid. On the other hand, the sieve trays improve the two-phase mixing, which may improve the SO2 removal efficiency.Keywords: Computational Fluid Dynamics (CFD), Eulerian-Eulerian Model, Flue Gas Desulfurization (FGD), perforated sieve tray
Procedia PDF Downloads 284869 Analyzing the Untenable Corruption Intricate Patterns in Africa and Combating Strategies for the Efficiency of Public Sector Supply Chains
Authors: Charles Mazhazhate
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This study interrogates and analyses the intricate kin- and- kith network patterns of corruption and mismanagement of resources prevalent in public sector supply chains bedeviling the developing economies of Sub-Saharan Africa with particular reference to Zimbabwe. This is forcing governments to resort to harsh fiscal policies that see their citizens paying high taxes against a backdrop of incomes below the poverty datum line, and this negatively affects their quality of life. The corporate world is also affected by the various tax-regime instituted. Mismanagement of resources and corrupt practices are rampant in state-owned enterprises to the extent that institutional policies, procedures, and practices are often flouted for the benefit of a clique of individuals. This interwoven in kith and kin blood human relations in organizations where appointments to critical positions are based on ascribed status. People no longer place value in their systems to make them work thereby violating corporate governance principles. Greediness and ‘unholy friendship connections’ are instrumental in fueling the employment of people who know each other from their discrete backgrounds. Such employments or socio-metric unions are meant to protect those at the top by giving them intelligent information through spying on what other subordinates are doing inside and outside the organization. This practice has led to the underperforming of organizations as those employees with connections and their upper echelons favorites connive to abuse resources for their own benefit. Even if culprits are known, no draconian measures are employed as a deterrence measure. Public value along public sector supply chains is lost. The study used a descriptive case study research design on fifty organizations in Zimbabwe mainly state-owned enterprises. Both qualitative and quantitative instrumentations were used. Both Snowball and random sampling techniques were used. The study found out that in all the fifty SOEs, there were employees in key positions related to top management, with tentacles feeding into the law enforcement agents, judiciary, security systems, and the executive. Such employees in public seem not to know each other with but would be involved in dirty scams and then share the proceeds with top people behind the scenes. The study also established that the same employees do not have the necessary competencies, qualifications, abilities, and capabilities to be in those positions. This culture is now strong that it is difficult to bust. The study recommends recruitment of all employees through an independent employment bureau to ensure strategic fit.Keywords: corruption, state owned enterprises, strategic fit, public sector supply chains, efficiency
Procedia PDF Downloads 160868 The Identification of Environmentally Friendly People: A Case of South Sumatera Province, Indonesia
Authors: Marpaleni
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The intergovernmental Panel on Climate Change (IPCC) declared in 2007 that global warming and climate change are not just a series of events caused by nature, but rather caused by human behaviour. Thus, to reduce the impact of human activities on climate change it is required to have information about how people respond to the environmental issues and what constraints they face. However, information on these and other phenomena remains largely missing, or not fully integrated within the existing data systems. The proposed study is aimed at filling the gap in this knowledge by focusing on Environmentally Friendly Behaviour (EFB) of the people of Indonesia, by taking the province of South Sumatera as a case of study. EFB is defined as any activity in which people engage to improve the conditions of the natural resources and/or to diminish the impact of their behaviour on the environment. This activity is measured in terms of consumption in five areas at the household level, namely housing, energy, water usage, recycling and transportation. By adopting the Indonesia’s Environmentally Friendly Behaviour conducted by Statistics Indonesia in 2013, this study aims to precisely identify one’s orientation towards EFB based on socio demographic characteristics such as: age, income, occupation, location, education, gender and family size. The results of this research will be useful to precisely identify what support people require to strengthen their EFB, to help identify specific constraints that different actors and groups face and to uncover a more holistic understanding of EFB in relation to particular demographic and socio-economics contexts. As the empirical data are examined from the national data sample framework, which will continue to be collected, it can be used to forecast and monitor the future of EFB.Keywords: environmentally friendly behavior, demographic, South Sumatera, Indonesia
Procedia PDF Downloads 285867 Bayesian System and Copula for Event Detection and Summarization of Soccer Videos
Authors: Dhanuja S. Patil, Sanjay B. Waykar
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Event detection is a standout amongst the most key parts for distinctive sorts of area applications of video data framework. Recently, it has picked up an extensive interest of experts and in scholastics from different zones. While detecting video event has been the subject of broad study efforts recently, impressively less existing methodology has considered multi-model data and issues related efficiency. Start of soccer matches different doubtful circumstances rise that can't be effectively judged by the referee committee. A framework that checks objectively image arrangements would prevent not right interpretations because of some errors, or high velocity of the events. Bayesian networks give a structure for dealing with this vulnerability using an essential graphical structure likewise the probability analytics. We propose an efficient structure for analysing and summarization of soccer videos utilizing object-based features. The proposed work utilizes the t-cherry junction tree, an exceptionally recent advancement in probabilistic graphical models, to create a compact representation and great approximation intractable model for client’s relationships in an interpersonal organization. There are various advantages in this approach firstly; the t-cherry gives best approximation by means of junction trees class. Secondly, to construct a t-cherry junction tree can be to a great extent parallelized; and at last inference can be performed utilizing distributed computation. Examination results demonstrates the effectiveness, adequacy, and the strength of the proposed work which is shown over a far reaching information set, comprising more soccer feature, caught at better places.Keywords: summarization, detection, Bayesian network, t-cherry tree
Procedia PDF Downloads 326866 Producing of Amorphous-Nanocrystalline Composite Powders
Authors: K. Tomolya, D. Janovszky, A. Sycheva, M. Sveda, A. Roosz
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CuZrAl amorphous alloys have attracted high interest due to unique physical and mechanical properties, which can be enhanced by adding of Ni and Ti elements. It is known that this properties can be enhanced by crystallization of amorphous alloys creating nanocrystallines in the matrix. The present work intends to produce nanosized crystalline parti-cle reinforced amorphous matrix composite powders by crystallization of amorphous powders. As the first step the amorphous powders were synthe-tized by ball-milling of crystalline powders. (Cu49Zr45Al6) 80Ni10Ti10 and (Cu49Zr44Al7) 80Ni10Ti10 (at%) alloys were ball-milled for 12 hours in order to reach the fully amorphous structure. The impact en-ergy of the balls during milling causes the change of the structure in the powders. Scanning electron microscopical (SEM) images shows that the phases mixed first and then changed into a fully amorphous matrix. Furthermore, nanosized particles in the amorphous matrix were crystallized by heat treatment of the amorphous powders that was confirmed by TEM measurement. It was of importance to define the tem-perature when the amorphous phase starts to crystal-lize. Amorphous alloys have a special heating curve and characteristic temperatures, which can be meas-ured by differential scanning calorimetry (DSC). A typical DSC curve of an amorphous alloy exhibits an endothermic event characteristic of the equilibrium glass transition (Tg) and a distinct undercooled liquid region, followed by one or two exothermic events corresponding to crystallization processes (Tp). After measuring the DSC traces of the amorphous powders, the annealing temperatures should be determined between Tx and Tp. In our experiments several temperatures from the annealing temperature range were selected and de-pendency of crystallized nanoparticles fraction on their hardness was investigated.Keywords: amorphous structure, composite, mechanical milling, powder, scanning electron microscopy (SEM), differential scanning calorimetry (DSC), transmission electronmocroscopy (TEM)
Procedia PDF Downloads 450865 A Review of the Handling and Disposal of Botulinum Toxin in a Maxillofacial Unit
Authors: Ashana Gupta
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Aim: In the UK, Botulinum Toxin (botox) is authorised for treating chronic myofascial pain secondary to masseter muscle hypertrophy (Fedorowicz et al. 2013). This audit aimed to ensure the Maxillofacial Unit is meeting the trust guidelines for the safe storage and disposal of botox. Method: The trust upholds a strict policy for botox handling. The audit was designed to optimise several elements including Staff awareness of regulations around botox handling A questionnaire was designed to test knowledge of advised storage temperatures, reporting of adverse events, disposal procedures and regulatory authorities. Steps taken to safely delivertoxin and eliminate unused toxin. A checklist was completed. These include marks for storagetemperature, identification checks, disposal of sharps, deactivation of toxin, and disposal. Results: All staff correctly stated storage requirements for toxin. 75% staff (n=8) were unsure about reporting and regulations. Whilst all staff knew how to dispose of vials, 0% staff showed awareness for the crucial step of deactivating toxin. All checklists (n=20) scored 100% for adequate storage, ID checks, and toxin disposal. However, there were no steps taken to deactivate toxin in any cases. Staff training took place with revision to clinical protocols. In line with Trust guidelines, an additional clinical step has been introduced including use of 0.5% sodium hypochlorite to deactivate botox. Conclusion: Deactivation is crucial to ensure residual toxin is not misused. There are cases of stolen botox within South-Tees Hospital (Woodcock, 2014). This audit was successful in increasing compliance to safe handling and disposal of botox by 100% and ensured our hospitalmeets Trust guidance.Keywords: botulinum toxin, aesthetics, handling, disposal
Procedia PDF Downloads 209864 Solving a Micromouse Maze Using an Ant-Inspired Algorithm
Authors: Rolando Barradas, Salviano Soares, António Valente, José Alberto Lencastre, Paulo Oliveira
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This article reviews the Ant Colony Optimization, a nature-inspired algorithm, and its implementation in the Scratch/m-Block programming environment. The Ant Colony Optimization is a part of Swarm Intelligence-based algorithms and is a subset of biological-inspired algorithms. Starting with a problem in which one has a maze and needs to find its path to the center and return to the starting position. This is similar to an ant looking for a path to a food source and returning to its nest. Starting with the implementation of a simple wall follower simulator, the proposed solution uses a dynamic graphical interface that allows young students to observe the ants’ movement while the algorithm optimizes the routes to the maze’s center. Things like interface usability, Data structures, and the conversion of algorithmic language to Scratch syntax were some of the details addressed during this implementation. This gives young students an easier way to understand the computational concepts of sequences, loops, parallelism, data, events, and conditionals, as they are used through all the implemented algorithms. Future work includes the simulation results with real contest mazes and two different pheromone update methods and the comparison with the optimized results of the winners of each one of the editions of the contest. It will also include the creation of a Digital Twin relating the virtual simulator with a real micromouse in a full-size maze. The first test results show that the algorithm found the same optimized solutions that were found by the winners of each one of the editions of the Micromouse contest making this a good solution for maze pathfinding.Keywords: nature inspired algorithms, scratch, micromouse, problem-solving, computational thinking
Procedia PDF Downloads 126863 Influence of Reinforcement Stiffness on the Performance of Back-to-Back Reinforced Earth Wall upon Rainwater Infiltration
Authors: Gopika Rajagopal, Sudheesh Thiyyakkandi
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Back-to-back reinforced earth (RE) walls are extensively used in these days as bridge abutments and highway ramps, owing to their cost efficiency and ease of construction. High quality select fill is the most suitable backfill material due to its excellent engineering properties and constructability. However, industries are compelled to use low quality, locally available soil because of its ample availability on site. However, several failure cases of such walls are reported, especially subsequent to rainfall events. The stiffness of reinforcement is one of the major factors affecting the performance of RE walls. The present study focused on analyzing the effect of reinforcement stiffness on the performance of complete select fill, complete marginal fill, and hybrid-fill (i.e., combination of select and marginal fills) back-to-back RE walls, immediately after construction and upon rainwater infiltration through finite element modelling. A constant width to height (W/H) ratio of 3 and height (H) of 6 m was considered for the numerical analysis and the stiffness of reinforcement layers was varied from 500 kN/m to 10000 kN/m. Results showed that reinforcement stiffness had a noticeable influence on the response of RE wall, subsequent to construction as well as rainwater infiltration. Facing displacement was found to decrease and maximum reinforcement tension and factor of safety were observed to increase with increasing the stiffness of reinforcement. However, beyond a stiffness of 5000 kN/m, no significant reduction in facing displacement was observed. The behavior of fully marginal fill wall considered in this study was found to be reasonable even after rainwater infiltration when the high stiffness reinforcement layers are used.Keywords: back-to-back reinforced earth wall, finite element modelling, rainwater infiltration, reinforcement stiffness
Procedia PDF Downloads 155862 The Flashnews as a Commercial Session of Political Marketing: The Content Analysis of the Embedded Political Narratives in Non-Political Media Products
Authors: Zsolt Szabolcsi
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Political communication in Hungary has undergone a significant change in the 2010s. One element of the transformation is the Flashnews. This media product was launched in March 2015 and since then 40-50 blocks are broadcasted, daily, on 5 channels. Flashnews blocks are condensed news sessions, containing the summary of political narratives. It starts with the introduction of the narrator, then, usually four news topics are presented and, finally, the narrator concludes the block. The block lasts only one minute and, therefore, it provides a blink session into the main narratives of political communication at the time. Beyond its rapid pace, what makes its avoidance difficult is that these blocks are always in the first position in the commercial break of a non-political media product. Although it is only one minute long, its significance is high. The content of the Flashnews reflects the main governmental narratives and, therefore, the Flashnews is part of the agenda-setting capacity of political communication. It reaches media consumers who have limited knowledge and interest in politics, and their use of media products is not politically related. For this audience, the Flashnews pops up in the same way as commercials. Due to its structure and appearance, the impact of Flashnews seems to be similar to commercials, imbedded into the break of media products. It activates existing knowledge constructs, builds up associational links and maintains their presence in a way that the recipient is not aware of the phenomenon. The research aims to examine the extent to which the Flashnews and the main news narratives are identical in their content. This aim is realized with the content analysis of the two news products by examining the Flashnews and the evening news during main sport events from 2016 to 2018. The initial hypothesis of the research is that Flashnews is a contribution to the news management technique for an effective articulation of political narratives in public service media channels.Keywords: flashnews, political communication, political marketing, news management
Procedia PDF Downloads 135861 Expectation during Improvisation: The Way It Influences the Musical Dialogue
Authors: Elisa Negretto
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Improvisation is a fundamental form of musical practice and an increasing amount of literature shows a particular interest on the consequences it might have in different kinds of social contexts. A relevant aspect of the musical experience is the ability to create expectations, which reflects a basic strategy of the human mind, an intentional movement toward the future which is based on previous experiences. Musical Expectation – an unconscious tendency to project forward in time, to predict future sound events and the ongoing of a musical experience – can be regarded as a process that strongly influences the listeners’ emotional and affective response to music, as well as their social and aesthetic experience. While improvising, composers, interpreters and listeners generate and exchange expectations, thus creating a dynamic dialogue and meaningful relationships. The aim of this paper is to investigate how expectation contributes to the creation of such a dialogue during the unfolding of the musical experience and to what extent it influences the meaning music acquires during the performance. The difference between the ability to create expectations and the anticipation of the future ongoing of music will be questioned. Does it influence in different ways the meaning of music and the kind of dialogical relationship established between musicians and between performers and audience? Such questions will be investigated with reference to recent research in music cognition and the analysis of a particular case: a free jazz performance during which musicians improvise and/or change the location of the sound source. The present paper is an attempt to provide new insights for investigating and understanding the cognitive mechanisms underlying improvisation as a musical and social practice. They contribute to the creation of a model that we can find in many others social practices in which people have to build meaningful relationships and responses to environmental stimuli.Keywords: anticipation, expectation, improvisation, meaning, musical dialogue
Procedia PDF Downloads 249860 Comparative Study of Free Vibrational Analysis and Modes Shapes of FSAE Car Frame Using Different FEM Modules
Authors: Rajat Jain, Himanshu Pandey, Somesh Mehta, Pravin P. Patil
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Formula SAE cars are the student designed and fabricated formula prototype cars, designed according to SAE INTERNATIONAL design rules which compete in the various national and international events. This paper shows a FEM based comparative study of free vibration analysis of different mode shapes of a formula prototype car chassis frame. Tubing sections of different diameters as per the design rules are designed in such a manner that the desired strength can be achieved. Natural frequency of first five mode was determined using finite element analysis method. SOLIDWORKS is used for designing the frame structure and SOLIDWORKS SIMULATION and ANSYS WORKBENCH 16.2 are used for the modal analysis. Mode shape results of ANSYS and SOLIDWORKS were compared. Fixed –fixed boundary conditions are used for fixing the A-arm wishbones. The simulation results were compared for the validation of the study. First five modes were compared and results were found within the permissible limits. The AISI4130 (CROMOLY- chromium molybdenum steel) material is used and the chassis frame is discretized with fine quality QUAD mesh followed by Fixed-fixed boundary conditions. The natural frequency of the chassis frame is 53.92-125.5 Hz as per the results of ANSYS which is found within the permissible limits. The study is concluded with the light weight and compact chassis frame without compensation with strength. This design allows to fabricate an extremely safe driver ergonomics, compact, dynamically stable, simple and light weight tubular chassis frame with higher strength.Keywords: FEM, modal analysis, formula SAE cars, chassis frame, Ansys
Procedia PDF Downloads 348859 EMS Providers' Ability and Willingness to Respond to Bioterrorism
Authors: Ryan Houser
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Introduction: Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the COVID-19 pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services, even in the accelerating environment of biothreats. Methods: This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS (Emergency Medical Services ) providers. The survey was available for one month in 2021, during which 190 EMS providers responded to the survey. Results: Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a CBRN agent. The provider Clinical Competency levels range from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution and community). Only 10% of the respondents are both willing and able to effectively function in a bioterror environment. Discussion: In order to effectively prepare for and respond to a bioterrorist attack, all levels of the healthcare system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.Keywords: bioterrorism, prehospital, EMS, disaster, emergency, medicine, preparedness, policy
Procedia PDF Downloads 156858 Linking Adaptation to Climate Change and Sustainable Development: The Case of ClimAdaPT.Local in Portugal
Authors: A. F. Alves, L. Schmidt, J. Ferrao
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Portugal is one of the more vulnerable European countries to the impacts of climate change. These include: temperature increase; coastal sea level rise; desertification and drought in the countryside; and frequent and intense extreme weather events. Hence, adaptation strategies to climate change are of great importance. This is what was addressed by ClimAdaPT.Local. This policy-oriented project had the main goal of developing 26 Municipal Adaptation Strategies for Climate Change, through the identification of local specific present and future vulnerabilities, the training of municipal officials, and the engagement of local communities. It is intended to be replicated throughout the whole territory and to stimulate the creation of a national network of local adaptation in Portugal. Supported by methodologies and tools specifically developed for this project, our paper is based on the surveys, training and stakeholder engagement workshops implemented at municipal level. In an 'adaptation-as-learning' process, these tools functioned as a social-learning platform and an exercise in knowledge and policy co-production. The results allowed us to explore the nature of local vulnerabilities and the exposure of gaps in the context of reappraisal of both future climate change adaptation opportunities and possible dysfunctionalities in the governance arrangements of municipal Portugal. Development issues are highlighted when we address the sectors and social groups that are both more sensitive and more vulnerable to the impacts of climate change. We argue that a pluralistic dialogue and a common framing can be established between them, with great potential for transformational adaptation. Observed climate change, present-day climate variability and future expectations of change are great societal challenges which should be understood in the context of the sustainable development agenda.Keywords: adaptation, ClimAdaPT.Local, climate change, Portugal, sustainable development
Procedia PDF Downloads 196857 Monitoring of Latent Tree Mortality after Forest Fires: A Biosensor Approach
Authors: Alessio Giovannelli, Claudia Cocozza, Enrico Marchi, Valerio Giorgio Muzzini, Eleftherios Touloupakis, Raffaella Margherita Zampieri
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In Mediterranean countries, forest fires are recurrent events that need to be considered as a central component of regional and global forest management strategies and biodiversity restoration programmes. The response of tree function to fire damage can vary widely, also taking into account species, season, age of the tree, etc. Trees that survive fire may have different levels of physiological functionality, which may result in reduced growth or increased susceptibility to delayed mortality. An approach to assessing irreversible physiological injury in trees could help to inform management decisions at burned sites for biodiversity restoration, environmental safety and understanding of ecosystem functional adaptations. Physiological proxies for latent tree mortality, such as cambial cell death, reduced or absent starch and soluble sugar content in C sinks, and ethanol accumulation in the phloem, are considered proxies for cell death. However, their determination requires time-consuming laboratory protocols, making the approach unfeasible as a practical option in the field, but recent findings have shown that biosensors could be usefully applied to overcome these limitations. The study will focus on the development of amperometric biosensors capable of detecting a few target molecules in the phloem and xylem (such as ethanol and glucose) that have recently been identified as proxies for latent tree mortality. The results of a specific experiment on a stand of Pinus pinaster subjected to prescribed fire are reported.Keywords: enzymes, glucose, ethanol, prescribed fires
Procedia PDF Downloads 18856 Unfolding the Affective Atmospheres during the COVID-19 Pandemic Crisis: The Constitution and Performance of Affective Governance in Taiwan
Authors: Sang-Ju Yu
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This paper examines the changing essences and effects of ‘affective atmosphere’ during the COVID-19 pandemic crisis, which have been facilitated and shaped the ‘affective governance’ in Taiwan. Due to long-term uncertainty and unpredictability, the COVID-19 pandemic not only caused unprecedented global crisis but triggered the public’s negative emotional responses. This paper unravels how the shortage of Personal Protective Equipment and the proliferating fake news heightened people’s fear and anxiety and how specific affective atmospheres can be provoked and manipulated to harness emotional appeals of citizens strategically in Taiwan. Through the in-depth interviews with diverse stakeholders involved, it unfolds the dynamics and strategies of affective governance, wherein public emotions and concerns are now given significant consideration in both policy measures and the affective expression of leadership, spatial arrangement, service delivery, and the interaction with citizens. Addressing psychosocial and emotional needs has become the core of crisis response mechanisms suited to dynamic affective atmospheres and pandemic situation. This paper also demonstrates that epidemic prevention and control is not merely the production of neutral or rational policy-making processes, as it is dominated by multiple emotions resulted from unexpected and salient events at different moments. It provides explicit insight into how different prevention scenarios operated effectively through political and affective mobilisation to strengthen emotional bonding and collective identity which energises collective action. Basically, successful affective governance calls for both negative and positive emotions, for both scientific and political decision-making, for both community and bureaucracy, and both quality and efficiency of private–public collaboration.Keywords: affective atmospheres, affective governance, COVID-19 pandemic, private-public collaboration
Procedia PDF Downloads 94855 The Politics of Disruption: Disrupting Polity to Influence Policy in Nigeria
Authors: Okechukwu B. C. Nwankwo
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The surge of social protests sweeping through the globe is a contemporary phenomenon. Yet the phenomenon in itself is not new. Thus, various scholars have over the years developed conceptual frameworks for evaluating it. Adopting and adapting some of these frameworks this paper begins from a purely theoretical perspective exploring the concept and content of social protest within the specific context of Nigeria. It proceeds to build a typology of the phenomenon in terms of form, actors, origin, character, organisation, goal, dynamics, outcome and a whole lot of other variables that are context relevant for evaluating it in an operationally useful manner. The centrality of the context in which protest evolves is demonstrated. Adopting Easton’s systems theory, the paper builds on the assumption that protests emerge whenever and wherever political institutions and structures prove unable or unwilling to transform inputs in form of basic demands into outputs in form of responsive policies. It argues that protests in Nigeria are simply the crystallisation of opposition in the streets. Protests are thus extra-institutional politics. This is usually the case, as elsewhere, where there is no functional institutionalised opposition. Noting that protest, disruptive or otherwise, is an influence strategy, it argues that every single protest is a new opportunity for reform, for reorganisation of state capacities, for modifying rights and obligation of citizens and government to each other. Each reform outcome is, however, only a temporal antecedent. Its extensity gives signal for the next similar protest event. Through providing evidence on how protests in Nigeria create opportunity for reform, for more accountable, more effective governance, the paper shows the positive impact of protests and its importance even in the consolidation effort for the nation’s nascent democracy. Data on protest events will be based on media reports, especially print media.Keywords: democracy, dialectics, social protest, reform
Procedia PDF Downloads 134854 Another Beautiful Sounds: Building the Memory of Sound of Peddling in Beijing with Digital Technology
Authors: Dan Wang, Qing Ma, Xiaodan Wang, Tianjiao Qi
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The sound of peddling in Beijing, also called “yo-heave-ho” or “cry of one's ware”, is a unique folk culture and usually found in Beijing hutong. For the civilians in Beijing, sound of peddling is part of their childhood. And for those who love the traditional culture of Beijing, it is an old song singing the local conditions and customs of the ancient city. For example, because of his great appreciation, the British poet Osbert Stewart once put sound of peddling which he had heard in Beijing as a street orchestra performance in the article named "Beijing's sound and color".This research aims to collect and integrate the voice/photo resources and historical materials of sound concerning peddling in Beijing by digital technology in order to protect the intangible cultural heritage and pass on the city memory. With the goal in mind, the next stage is to collect and record all the materials and resources based on the historical documents study and interviews with civilians or performers. Then set up a metadata scheme (which refers to the domestic and international standards such as "Audio Data Processing Standards in the National Library", DC, VRA, and CDWA, etc.) to describe, process and organize the sound of peddling into a database. In order to fully show the traditional culture of sound of peddling in Beijing, web design and GIS technology are utilized to establish a website and plan holding offline exhibitions and events for people to simulate and learn the sound of peddling by using VR/AR technology. All resources are opened to the public and civilians can share the digital memory through not only the offline experiential activities, but also the online interaction. With all the attempts, a multi-media narrative platform has been established to multi-dimensionally record the sound of peddling in old Beijing with text, images, audio, video and so on.Keywords: sound of peddling, GIS, metadata scheme, VR/AR technology
Procedia PDF Downloads 304853 Effect of Hypoxia on AOX2 Expression in Chlamydomonas reinhardtii
Authors: Maria Ostroukhova, Zhanneta Zalutskaya, Elena Ermilova
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The alternative oxidase (AOX) mediates cyanide-resistant respiration, which bypasses proton-pumping complexes III and IV of the cytochrome pathway to directly transfer electrons from reduced ubiquinone to molecular oxygen. In Chlamydomonas reinhardtii, AOX is a monomeric protein that is encoded by two genes of discrete subfamilies, AOX1 and AOX2. Although AOX has been proposed to play essential roles in stress tolerance of organisms, the role of subfamily AOX2 is largely unknown. In C. reinhardtii, AOX2 was initially identified as one of constitutively low expressed genes. Like other photosynthetic organisms C. reinhardtii cells frequently experience periods of hypoxia. To examine AOX2 transcriptional regulation and role of AOX2 in hypoxia adaptation, real-time PCR analysis and artificial microRNA method were employed. Two experimental approaches have been used to induce the anoxic conditions: dark-anaerobic and light-anaerobic conditions. C. reinhardtii cells exposed to the oxygen deprivation have shown increased AOX2 mRNA levels. By contrast, AOX1 was not an anoxia-responsive gene. In C. reinhardtii, a subset of genes is regulated by transcription factor CRR1 in anaerobic conditions. Notable, the AOX2 promoter region contains the potential motif for CRR1 binding. Therefore, the role of CRR1 in the control of AOX2 transcription was tested. The CRR1-underexpressing strains, that were generated and characterized in this work, exhibited low levels of AOX2 transcripts under anoxic conditions. However, the transformants still slightly induced AOX2 gene expression in the darkness. These confirmed our suggestions that darkness is a regulatory stimulus for AOX genes in C. reinhardtii. Thus, other factors must contribute to AOX2 promoter activity under dark-anoxic conditions. Moreover, knock-down of CRR1 caused a complete reduction of AOX2 expression under light-anoxic conditions. These results indicate that (1) CRR1 is required for AOX2 expression during hypoxia, and (2) AOX2 gene is regulated by CRR1 together with yet-unknown regulatory factor(s). In addition, the AOX2-underexpressing strains were generated. The analysis of amiRNA-AOX2 strains suggested a role of this alternative oxidase in hypoxia adaptation of the alga. In conclusion, the results reported here show that C. reinhardtii AOX2 gene is stress inducible. CRR1 transcriptional factor is involved in the regulation of the AOX2 gene expression in the absence of oxygen. Moreover, AOX2 but not AOX1 functions under oxygen deprivation. This work was supported by Russian Science Foundation (research grant № 16-14-10004).Keywords: alternative oxidase 2, artificial microRNA approach, chlamydomonas reinhardtii, hypoxia
Procedia PDF Downloads 241852 The Impact of Temporal Impairment on Quality of Experience (QoE) in Video Streaming: A No Reference (NR) Subjective and Objective Study
Authors: Muhammad Arslan Usman, Muhammad Rehan Usman, Soo Young Shin
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Live video streaming is one of the most widely used service among end users, yet it is a big challenge for the network operators in terms of quality. The only way to provide excellent Quality of Experience (QoE) to the end users is continuous monitoring of live video streaming. For this purpose, there are several objective algorithms available that monitor the quality of the video in a live stream. Subjective tests play a very important role in fine tuning the results of objective algorithms. As human perception is considered to be the most reliable source for assessing the quality of a video stream, subjective tests are conducted in order to develop more reliable objective algorithms. Temporal impairments in a live video stream can have a negative impact on the end users. In this paper we have conducted subjective evaluation tests on a set of video sequences containing temporal impairment known as frame freezing. Frame Freezing is considered as a transmission error as well as a hardware error which can result in loss of video frames on the reception side of a transmission system. In our subjective tests, we have performed tests on videos that contain a single freezing event and also for videos that contain multiple freezing events. We have recorded our subjective test results for all the videos in order to give a comparison on the available No Reference (NR) objective algorithms. Finally, we have shown the performance of no reference algorithms used for objective evaluation of videos and suggested the algorithm that works better. The outcome of this study shows the importance of QoE and its effect on human perception. The results for the subjective evaluation can serve the purpose for validating objective algorithms.Keywords: objective evaluation, subjective evaluation, quality of experience (QoE), video quality assessment (VQA)
Procedia PDF Downloads 602851 Risks in the Islamic Banking Model and Methods Adopted to Manage Them
Authors: K. P. Fasalu Rahman
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The financial services industry of Islam include large number of institutions, such as investment banks and commercial banks, investment companies and mutual insurance companies. All types of these financial institutions should have to deal with many issues and risks in their field of work. Islamic banks should expect to face two types of risks: risks that are similar to those faced by conventional financial intermediaries and risks that are unique to the Islamic Banks due to their compliance with the Shariah. The use of financial services and products that comply with the Shariah principles cause special issues for supervision and risk management. Risks are uncertain future events that could influence the achievement of the bank’s objectives, including strategic, operational, financial and compliance objectives. In Islamic banks, effective risk management deserves special attention. As an operational problem, risk management is the classification and identification of methods, processes, and risks in banks to supervise, monitor and measure them. In comparison to conventional banks, Islamic banks face big difficulties in identifying and managing risks due to bigger complexities emerging from the profit loss sharing (PLS) concept and nature of particular risks of Islamic financing. As the developing of managing risks tool becomes very essential, especially in Islamic banking as most of the products are depending on PLS principle, identifying and measuring each type of risk is highly important and critical in any Islamic finance based systems. This paper highlights the special and general risks surrounding Islamic banking. And it investigates in detail the need for risk management in Islamic banks. In addition to analyzing the effectiveness of risk management strategies adopted by Islamic financial institutions at present, this research is also suggesting strategies for improving risk management process of Islamic banks in future.Keywords: Islamic banking, management, risk, risk management
Procedia PDF Downloads 140850 Value of Unilateral Spinal Anaesthesia For Hip Fracture Surgery In The Elderly (75 Cases)
Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir
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Background and aims: While in Western countries, unilateral spinal anesthesia has been widely practiced for a long time, it remains little known in the local anesthesia community, and has not been the object of many studies. However, it is a simple, practical and effective technique. Our objective was to evaluate this practice in emergency anesthesia management in frail patients and to compare it with conventional spinal anesthesia. Methods: This is a prospective, observational, comparative study between hypobaric unilateral and conventional spinal anaesthesia for hip fracture surgery carried out in the operating room of the university military hospital of Staoueli. The work was spread over of 12-month period from 2019 to 2020. The parameters analyzed were hemodynamic variations, vasopressor use, block efficiency, postoperative adverse events, and postoperative morphine consumption. Results: -75 cases (mean age 72±14 years) -Group1= 41 patients (54.6%) divided into (ASA1=14.6% ASA2=60.98% ASA3=24.39%) single shoot spinal anaesthesia -Group2= 34 patients (45.3%) divided into (ASA1=2.9%, ASA2=26.4% ASA3=61.7%, ASA4=8.8%) unilateral hypobaric spinal anesthesia. -Hemodynamic variations were more severe in group 1 (51% hypotension) compared to 30% in group 2 RR=1.69 and odds ratio=2.4 -these variations were more marked in the ASA3 subgroup (group 1=70% hypotension versus group 2=30%) with an RR=2.33 and an odds ratio=5.44 -39% of group 1 required vasoactive drugs (15mg +/- 11) versus 32% of group 2 (8mg+/- 6.49) - no difference in the use of morphine in post-op. Conclusions: Within the limits of the population studied, this work demonstrates the clinical value of unilateral spinal anesthesia in ortho-trauma surgery in the frail patient.Keywords: spinal anaesthesia, vasopressor, morphine, hypobaric unilateral spinal anesthesia, ropivacaine, hip surgery, eldery, hemodynamic
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