Search results for: cardiac output
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2500

Search results for: cardiac output

490 Category-Base Theory of the Optimum Signal Approximation Clarifying the Importance of Parallel Worlds in the Recognition of Human and Application to Secure Signal Communication with Feedback

Authors: Takuro Kida, Yuichi Kida

Abstract:

We show a base of the new trend of algorithm mathematically that treats a historical reason of continuous discrimination in the world as well as its solution by introducing new concepts of parallel world that includes an invisible set of errors as its companion. With respect to a matrix operator-filter bank that the matrix operator-analysis-filter bank H and the matrix operator-sampling-filter bank S are given, firstly, we introduce the detailed algorithm to derive the optimum matrix operator-synthesis-filter bank Z that minimizes all the worst-case measures of the matrix operator-error-signals E(ω) = F(ω) − Y(ω) between the matrix operator-input-signals F(ω) and the matrix operator-output signals Y(ω) of the matrix operator-filter bank at the same time. Further, feedback is introduced to the above approximation theory and it is indicated that introducing conversations with feedback does not superior automatically to the accumulation of existing knowledge of signal prediction. Secondly, the concept of category in the field of mathematics is applied to the above optimum signal approximation and is indicated that the category-based approximation theory is applied to the set-theoretic consideration of the recognition of humans. Based on this discussion, it is shown naturally why the narrow perception that tends to create isolation shows an apparent advantage in the short term and, often, why such narrow thinking becomes intimate with discriminatory action in a human group. Throughout these considerations, it is presented that, in order to abolish easy and intimate discriminatory behavior, it is important to create a parallel world of conception where we share the set of invisible error signals, including the words and the consciousness of both worlds.

Keywords: signal prediction, pseudo inverse matrix, artificial intelligence, conditional optimization

Procedia PDF Downloads 156
489 Queerness and Gender Representation Through the Lens of Five Ghanaian Artists

Authors: Sela Adjei

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This research delves into the nuanced representations of queerness in Ghana, presented through photographs, illustrations, film and music videos on social media and streaming platforms. The study focuses on the works of five Ghanaian artists (Va-Bene Elikem Fiatsi, Angel Maxine, Josephine Kuuire, Bright Ackwerh and Philip Nee Whang) within the context of Ghana's evolving media landscape. Of primary concern is a need to uncover the various aspects of queerness captured within the distinct artistic expressions of these five creatives. This study adopts a qualitative approach by analyzing artistic expressions of queerness in Ghana’s digital media spaces. Content analysis and visual semiotics served as the guiding tools to discuss and decipher the nuanced messages embedded in their works, considering both the visual and narrative aspects. This dual approach takes into account both the visual aesthetics and narrative elements, enhancing our understanding of the complex interplay between queerness and gender representation in the media. This study's contribution is twofold. First, it enriches the discourse surrounding queerness as portrayed by artists within Ghana's vibrant media landscape and situates their works within the broader discourse of global gender identities. Secondly, analyzing the creative output of these five Ghanaian artists broadens our understanding of gender minorities and the various challenges they face in Ghana (currently debating in parliament to pass an anti-LGBTQ+ bill that criminalizes activities related to gender minority groups). While focusing on the intersection of queerness, art, and gender identities, the reflections in this study challenge existing narratives and offer fresh insights into how these artists navigate and challenge societal norms through their creative expressions.

Keywords: queer, film, representation, streaming, media, gender

Procedia PDF Downloads 61
488 Laser Therapy in Patients with Rheumatoid Arthritis: A Clinical Trial

Authors: Joao Paulo Matheus, Renan Fangel

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Rheumatoid arthritis is a chronic, inflammatory, systemic and progressive disease that affects the synovial joints bilaterally, causing definitive orthopedic damage. It has a higher prevalence in postmenopausal female patients. It is a disabling disease that causes joint deformities that may compromise the functionality of the affected segment. The aim of this study was to evaluate the influence of low-intensity therapeutic laser on the perception of pain and quality of life in patients with rheumatoid arthritis. This is a randomized clinical study involving 6 women with a mean age of 56.8+6.3 years. Exclusion criteria: patients with acute pain, chronic infectious disease, underlying acute or chronic underlying disease. An AsGaAl laser with 808nm wavelength, 100mW power, beam output area of 0.028cm2, power density of 3.57W/cm2 was used. The laser was applied at pre-defined points in the interphalangeal and metacarpophalangeal joints, totaling 24 points, 2 times a week, for 4 weeks, totaling 8 sessions. The Pain Inventory (IBD) and Visual Analogue Scale (VAS) were used for the analysis of pain and for the WHOQOL-bref quality of life assessment. There was no statistical difference between the onset (5.67±2.66) and the final (4.67±3.78) of treatments (p=0.70). There was also no statistical difference between the beginning (5.67±2.66) and the final (4.67±3.78) of the treatments in the VAS analysis (p=0.68). The overall mean quality of life obtained by the questionnaire at the start of treatment was 42.3±7.6, while at the end of treatment it was 58.5±7.6 (p=0.01) and the domains of the questionnaire with significant differences were: psychological domain 42.9±6.8 and 66.7±12.9 (p=0.004), social domain 39.9±5.7 and 68.1±6.3 (p=0,0005) and environmental domain 36.3±7.3 and 56.3±12.5 (p=0.003). It can be concluded that the low-intensity therapeutic laser did not produce significant changes in the painful period of rheumatoid arthritis patients. However, there was an improvement in patients' quality of life in the psychological, social and environmental aspects.

Keywords: laser therapy, pain, quality of life, rheumatoid arthritis

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487 Commercialization of Smallholder Rice Producers and Its Determinants in Ethiopia

Authors: Abebaw Assaye, Seiichi Sakurai, Marutama Atsush, Dawit Alemu

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Rice is considered as a strategic agricultural commodity targeting national food security and import substitution in Ethiopia and diverse measures are put in place a number of initiatives to ensure the growth and development of rice sector in the country. This study assessed factors that influence smallholder farmers' level of rice commercialization in Ethiopia. The required data were generated from 594 randomly sampled rice producers using multi-stage sampling techniques from four major rice-producing regional states. Both descriptive and econometric methods were used to analyze the data. We adopted the ordered probit model to analyze factors determining output commercialization in the rice market. The ordered probit model result showed that the sex of the household head, educational status of the household head, credit use, proportion of irrigated land cultivated, membership in social groups, and land dedicated to rice production were found to influence significantly and positively the probability of being commercial-oriented. Conversely, the age of the household, total cultivated land, and distance to the main market were found to influence negatively. These findings suggest that promoting productivity-increasing technologies, development of irrigation facilities, strengthening of social institutions, and facilitating access to credit are crucial for enhancing the commercialization of rice in the study area. Since agricultural lands are limited, intensified farming through promoting improved rice technologies and mechanized farming could be an option to enhance marketable surplus and increase level of rice market particicpation.

Keywords: rice, commercialization, Tobit, ordered probit, Ethiopia

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486 The English as a Foreign Language Teachers’ Perceptions and Practices of Infusing Critical Thinking Skills to Improve Students’ Reading Comprehension

Authors: Michael Amale Kirko, Abebe Gebretsadik

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In the 21st century, developing students’ critical thinking skills has become a prime concern in higher education institutions. Cognizant of this fact, the Ethiopian higher education policy document used critical thinking as one of the guiding principles. The study aims to explore how English as a foreign language (EFL) teachers perceive and practice critical thinking skills (CTS) in teaching reading to improve reading comprehension at Wolaita Sodo University, Ethiopia. A descriptive survey study used an exploratory mixed-methods approach. The study involved 20 EFL instructors and 40 2nd-year English majoring students. The numerical data were collected using teacher and student surveys and classroom observations; the qualitative data were obtained through content analysis and interviews. Teacher survey results indicated that teachers' perceptions are above average (mean = 3.41). And the result of classroom observations showed the practice CTS in class was below average (mean=2.61). The content analysis result revealed instructors utilized fewer higher-order thinking questions during class activities, quizzes, midterm, and final exams. The teachers perceived that teacher, student, and material-related challenges were hindering the practice of CT to improve students’ reading comprehension. Finally, spearman’s rho output showed r=0.97 and p<0.05. Therefore, the results showed that the EFL teachers’ practices of CTS to improve students’ reading comprehension were less frequent; there was a strong, positive, and statistically significant relationship between the teachers’ perceptions and practices of CTS in reading class.

Keywords: perceptions, critical thinking skills, practices, infusing thinking skills, reading comprehension

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485 An Indispensable Parameter in Lipid Ratios to Discriminate between Morbid Obesity and Metabolic Syndrome in Children: High Density Lipoprotein Cholesterol

Authors: Orkide Donma, Mustafa M. Donma

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Obesity is a low-grade inflammatory disease and may lead to health problems such as hypertension, dyslipidemia, diabetes. It is also associated with important risk factors for cardiovascular diseases. This requires the detailed evaluation of obesity, particularly in children. The aim of this study is to enlighten the potential associations between lipid ratios and obesity indices and to introduce those with discriminating features among children with obesity and metabolic syndrome (MetS). A total of 408 children (aged between six and eighteen years) participated in the scope of the study. Informed consent forms were taken from the participants and their parents. Ethical Committee approval was obtained. Anthropometric measurements such as weight, height as well as waist, hip, head, neck circumferences and body fat mass were taken. Systolic and diastolic blood pressure values were recorded. Body mass index (BMI), diagnostic obesity notation model assessment index-II (D2 index), waist-to-hip, head-to-neck ratios were calculated. Total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDLChol), low-density lipoprotein cholesterol (LDLChol) analyses were performed in blood samples drawn from 110 children with normal body weight, 164 morbid obese (MO) children and 134 children with MetS. Age- and sex-adjusted BMI percentiles tabulated by World Health Organization were used to classify groups; normal body weight, MO and MetS. 15th-to-85th percentiles were used to define normal body weight children. Children, whose values were above the 99th percentile, were described as MO. MetS criteria were defined. Data were evaluated statistically by SPSS Version 20. The degree of statistical significance was accepted as p≤0.05. Mean±standard deviation values of BMI for normal body weight children, MO children and those with MetS were 15.7±1.1, 27.1±3.8 and 29.1±5.3 kg/m2, respectively. Corresponding values for the D2 index were calculated as 3.4±0.9, 14.3±4.9 and 16.4±6.7. Both BMI and D2 index were capable of discriminating the groups from one another (p≤0.01). As far as other obesity indices were considered, waist-to hip and head-to-neck ratios did not exhibit any statistically significant difference between MO and MetS groups (p≥0.05). Diagnostic obesity notation model assessment index-II was correlated with the triglycerides-to-HDL-C ratio in normal body weight and MO (r=0.413, p≤0.01 and r=0.261, (p≤0.05, respectively). Total cholesterol-to-HDL-C and LDL-C-to-HDL-C showed statistically significant differences between normal body weight and MO as well as MO and MetS (p≤0.05). The only group in which these two ratios were significantly correlated with waist-to-hip ratio was MetS group (r=0.332 and r=0.334, p≤0.01, respectively). Lack of correlation between the D2 index and the triglycerides-to-HDL-C ratio was another important finding in MetS group. In this study, parameters and ratios, whose associations were defined previously with increased cardiovascular risk or cardiac death have been evaluated along with obesity indices in children with morbid obesity and MetS. Their profiles during childhood have been investigated. Aside from the nature of the correlation between the D2 index and triglycerides-to-HDL-C ratio, total cholesterol-to-HDL-C as well as LDL-C-to- HDL-C ratios along with their correlations with waist-to-hip ratio showed that the combination of obesity-related parameters predicts better than one parameter and appears to be helpful for discriminating MO children from MetS group.

Keywords: children, lipid ratios, metabolic syndrome, obesity indices

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484 Stability Analysis of Green Coffee Export Markets of Ethiopia: Markov-Chain Analysis

Authors: Gabriel Woldu, Maria Sassi

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Coffee performs a pivotal role in Ethiopia's GDP, revenue, employment, domestic demand, and export earnings. Ethiopia's coffee production and exports show high variability in the amount of production and export earnings. Despite being the continent's fifth-largest coffee producer, Ethiopia has not developed its ability to shine as a major exporter in the globe's green coffee exports. Ethiopian coffee exports were not stable and had high volume and earnings fluctuations. The main aim of this study was to analyze the dynamics of the export of coffee variation to different importing nations using a first-order Markov Chain model. 14 years of time-series data has been used to examine the direction and structural change in the export of coffee. A compound annual growth rate (CAGR) was used to determine the annual growth rate in the coffee export quantity, value, and per-unit price over the study period. The major export markets for Ethiopian coffee were Germany, Japan, and the USA, which were more stable, while countries such as France, Italy, Belgium, and Saudi Arabia were less stable and had low retention rates for Ethiopian coffee. The study, therefore, recommends that Ethiopia should again revitalize its market to France, Italy, Belgium, and Saudi Arabia, as these countries are the major coffee-consuming countries in the world to boost its export stake to the global coffee markets in the future. In order to further enhance export stability, the Ethiopian Government and other stakeholders in the coffee sector should have to work on reducing the volatility of coffee output and exports in order to improve production and quality efficiency, so that stabilize markets as well as to make the product attractive and price competitive in the importing countries.

Keywords: coffee, CAGR, Markov chain, direction of trade, Ethiopia

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483 Evaluating the Water Balance of Sokoto Basement Complex to Address Water Security Challenges

Authors: Murtala Gada Abubakar, Aliyu T. Umar

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A substantial part of Nigeria is part of semi-arid areas of the world, underlain by basement complex (hard) rocks which are very poor in both transmission and storage of appreciable quantity of water. Recently, a growing attention is being paid on the need to develop water resources in these areas largely due to concerns about increasing droughts and the need to maintain water security challenges. While there is ample body of knowledge that captures the hydrological behaviours of the sedimentary part, reported research which unambiguously illustrates water distribution in the basement complex of the Sokoto basin remains sparse. Considering the growing need to meet the water requirements of those living in this region necessitated the call for accurate water balance estimations that can inform a sustainable planning and development to address water security challenges for the area. To meet this task, a one-dimensional soil water balance model was developed and utilised to assess the state of water distribution within the Sokoto basin basement complex using measured meteorological variables and information about different landscapes within the complex. The model simulated the soil water storage and rates of input and output of water in response to climate and irrigation where applicable using data from 2001 to 2010 inclusive. The results revealed areas within the Sokoto basin basement complex that are rich and deficient in groundwater resource. The high potential areas identified includes the fadama, the fractured rocks and the cultivated lands, while the low potential areas are the sealed surfaces and non-fractured rocks. This study concludes that the modelling approach is a useful tool for assessing the hydrological behaviour and for better understanding the water resource availability within a basement complex.

Keywords: basement complex, hydrological processes, Sokoto Basin, water security

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482 Optimal Sputtering Conditions for Nickel-Cermet Anodes in Intermediate Temperature Solid Oxide Fuel Cells

Authors: Waqas Hassan Tanveer, Yoon Ho Lee, Taehyun Park, Wonjong Yu, Yaegeun Lee, Yusung Kim, Suk Won Cha

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Nickel-Gadolinium Doped Ceria (Ni-GDC) cermet anodic thin films were prepared on Scandia Stabilized Zirconia (ScSZ) electrolyte supports by radio frequency (RF) sputtering, with a range of different sputtering powers (50 – 200W) and background Ar gas pressures (30 – 90mTorr). The effects of varying sputtering power and pressure on the properties of Ni-GDC films were studied using Focused Ion Beam (FIB), X-ray Photoelectron Spectroscopy (XPS), X-ray Diffraction (XRD), Energy Dispersive X-ray (EDX), and Atomic Force Microscopy (AFM) techniques. The Ni content was found to be always higher than the Ce content, at all sputtering conditions. This increased Ni content was attributed to significantly higher energy transfer efficiency of Ni ions as compared to Ce ions with Ar background sputtering gas. The solid oxide fuel cell configuration was completed by using lanthanum strontium manganite (LSM/YSZ) cathodes on the other side of ScSZ supports. Performance comparison of cells was done by Voltage-Current-Power (VIP) curves, while the resistances of various cell components were observed by nyquist plots. Initial results showed that anode films made by higher powered RF sputtering performed better than lower powered ones for a specific Ar pressure. Interestingly, however, anodes made at highest power and pressure, were not the ones that showed the maximum power output at an intermediate solid oxide fuel cell temperature of 800°C. Finally, an optimal sputtering condition was reported for high performance Ni-GDC anodes.

Keywords: intermediate temperature solid oxide fuel cells, nickel-cermet anodic thin films, nyquist plots, radio frequency sputtering

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481 Evaluating the Dosimetric Performance for 3D Treatment Planning System for Wedged and Off-Axis Fields

Authors: Nashaat A. Deiab, Aida Radwan, Mohamed S. Yahiya, Mohamed Elnagdy, Rasha Moustafa

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This study is to evaluate the dosimetric performance of our institution's 3D treatment planning system for wedged and off-axis 6MV photon beams, guided by the recommended QA tests documented in the AAPM TG53; NCS report 15 test packages, IAEA TRS 430 and ESTRO booklet no.7. The study was performed for Elekta Precise linear accelerator designed for clinical range of 4, 6 and 15 MV photon beams with asymmetric jaws and fully integrated multileaf collimator that enables high conformance to target with sharp field edges. Ten tests were applied on solid water equivalent phantom along with 2D array dose detection system. The calculated doses using 3D treatment planning system PrecisePLAN were compared with measured doses to make sure that the dose calculations are accurate for simple situations such as square and elongated fields, different SSD, beam modifiers e.g. wedges, blocks, MLC-shaped fields and asymmetric collimator settings. The QA results showed dosimetric accuracy of the TPS within the specified tolerance limits. Except for large elongated wedged field, the central axis and outside central axis have errors of 0.2% and 0.5%, respectively, and off- planned and off-axis elongated fields the region outside the central axis of the beam errors are 0.2% and 1.1%, respectively. The dosimetric investigated results yielded differences within the accepted tolerance level as recommended. Differences between dose values predicted by the TPS and measured values at the same point are the result from limitations of the dose calculation, uncertainties in the measurement procedure, or fluctuations in the output of the accelerator.

Keywords: quality assurance, dose calculation, wedged fields, off-axis fields, 3D treatment planning system, photon beam

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480 Subsurface Exploration for Soil Geotechnical Properties and its Implications for Infrastructure Design and Construction in Victoria Island, Lagos, Nigeria

Authors: Sunday Oladele, Joseph Oluwagbeja Simeon

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Subsurface exploration, integrating methods of geotechnics and geophysics, of a planned construction site in the coastal city of Lagos, Nigeria has been carried out with the aim of characterizing the soil properties and their implication for the proposed infrastructural development. Six Standard Penetration Tests (SPT), fourteen Dutch Cone Penetrometer Tests (DCPT) and 2D Electrical Resistivity Imaging employing Dipole-dipole and Pole-dipole arrays were implemented on the site. The topsoil (0 - 4m) consists of highly compacted sandy lateritic clay(10 to 5595Ωm) to 1.25m in some parts and dense sand in other parts to 5.50m depth. This topsoil was characterized as a material of very high shear strength (≤ 150kg/m2) and allowable bearing pressure value of 54kN/m2 to 85kN/m2 and a safety factor of 2.5. Soft amorphous peat/peaty clay (0.1 to 11.4Ωm), 3-6m thick, underlays the lateritic clay to about 18m depth. Grey, medium dense to very dense sand (0.37 to 2387Ωm) with occasional gravels underlies the peaty clay down to 30m depth. Within this layer, the freshwater bearing zones are characterized by high resistivity response (83 to 2387Ωm), while the clayey sand/saline water intruded sand produced subdued resistivity output (0.37 to 40Ωm). The overall ground-bearing pressure for the proposed structure would be 225kN/m2. Bored/cast-in-place pile at 18.00m depth with any of these diameters and respective safe working loads 600mm/1,140KN, 800mm/2,010KN and 1000mm/3,150KN is recommended for the proposed multi-story structure.

Keywords: subsurface exploration, Geotechnical properties, resistivity imaging, pile

Procedia PDF Downloads 93
479 Design, Development and Analysis of Combined Darrieus and Savonius Wind Turbine

Authors: Ashish Bhattarai, Bishnu Bhatta, Hem Raj Joshi, Nabin Neupane, Pankaj Yadav

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This report concerns the design, development, and analysis of the combined Darrieus and Savonius wind turbine. Vertical Axis Wind Turbines (VAWT's) are of two type's viz. Darrieus (lift type) and Savonius (drag type). The problem associated with Darrieus is the lack of self-starting while Savonius has low efficiency. There are 3 straight Darrieus blades having the cross-section of NACA(National Advisory Committee of Aeronautics) 0018 placed circumferentially and a helically twisted Savonius blade to get even torque distribution. This unique design allows the use of Savonius as a method of self-starting the wind turbine, which the Darrieus cannot achieve on its own. All the parts of the wind turbine are designed in CAD software, and simulation data were obtained via CFD(Computational Fluid Dynamics) approach. Also, the design was imported to FlashForge Finder to 3D print the wind turbine profile and finally, testing was carried out. The plastic material used for Savonius was ABS(Acrylonitrile Butadiene Styrene) and that for Darrieus was PLA(Polylactic Acid). From the data obtained experimentally, the hybrid VAWT so fabricated has been found to operate at the low cut-in speed of 3 m/s and maximum power output has been found to be 7.5537 watts at the wind speed of 6 m/s. The maximum rpm of the rotor blade is recorded to be 431 rpm(rotation per minute) at the wind velocity of 6 m/s, signifying its potentiality of wind power production. Besides, the data so obtained from both the process when analyzed through graph plots has shown the similar nature slope wise. Also, the difference between the experimental and theoretical data obtained has shown mechanical losses. The objective is to eliminate the need for external motors for self-starting purposes and study the performance of the model. The testing of the model was carried out for different wind velocities.

Keywords: VAWT, Darrieus, Savonius, helical blades, CFD, flash forge finder, ABS, PLA

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478 High-Resolution Flood Hazard Mapping Using Two-Dimensional Hydrodynamic Model Anuga: Case Study of Jakarta, Indonesia

Authors: Hengki Eko Putra, Dennish Ari Putro, Tri Wahyu Hadi, Edi Riawan, Junnaedhi Dewa Gede, Aditia Rojali, Fariza Dian Prasetyo, Yudhistira Satya Pribadi, Dita Fatria Andarini, Mila Khaerunisa, Raditya Hanung Prakoswa

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Catastrophe risk management can only be done if we are able to calculate the exposed risks. Jakarta is an important city economically, socially, and politically and in the same time exposed to severe floods. On the other hand, flood risk calculation is still very limited in the area. This study has calculated the risk of flooding for Jakarta using 2-Dimensional Model ANUGA. 2-Dimensional model ANUGA and 1-Dimensional Model HEC-RAS are used to calculate the risk of flooding from 13 major rivers in Jakarta. ANUGA can simulate physical and dynamical processes between the streamflow against river geometry and land cover to produce a 1-meter resolution inundation map. The value of streamflow as an input for the model obtained from hydrological analysis on rainfall data using hydrologic model HEC-HMS. The probabilistic streamflow derived from probabilistic rainfall using statistical distribution Log-Pearson III, Normal and Gumbel, through compatibility test using Chi Square and Smirnov-Kolmogorov. Flood event on 2007 is used as a comparison to evaluate the accuracy of model output. Property damage estimations were calculated based on flood depth for 1, 5, 10, 25, 50, and 100 years return period against housing value data from the BPS-Statistics Indonesia, Centre for Research and Development of Housing and Settlements, Ministry of Public Work Indonesia. The vulnerability factor was derived from flood insurance claim. Jakarta's flood loss estimation for the return period of 1, 5, 10, 25, 50, and 100 years, respectively are Rp 1.30 t; Rp 16.18 t; Rp 16.85 t; Rp 21.21 t; Rp 24.32 t; and Rp 24.67 t of the total value of building Rp 434.43 t.

Keywords: 2D hydrodynamic model, ANUGA, flood, flood modeling

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477 Modified Weibull Approach for Bridge Deterioration Modelling

Authors: Niroshan K. Walgama Wellalage, Tieling Zhang, Richard Dwight

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State-based Markov deterioration models (SMDM) sometimes fail to find accurate transition probability matrix (TPM) values, and hence lead to invalid future condition prediction or incorrect average deterioration rates mainly due to drawbacks of existing nonlinear optimization-based algorithms and/or subjective function types used for regression analysis. Furthermore, a set of separate functions for each condition state with age cannot be directly derived by using Markov model for a given bridge element group, which however is of interest to industrial partners. This paper presents a new approach for generating Homogeneous SMDM model output, namely, the Modified Weibull approach, which consists of a set of appropriate functions to describe the percentage condition prediction of bridge elements in each state. These functions are combined with Bayesian approach and Metropolis Hasting Algorithm (MHA) based Markov Chain Monte Carlo (MCMC) simulation technique for quantifying the uncertainty in model parameter estimates. In this study, factors contributing to rail bridge deterioration were identified. The inspection data for 1,000 Australian railway bridges over 15 years were reviewed and filtered accordingly based on the real operational experience. Network level deterioration model for a typical bridge element group was developed using the proposed Modified Weibull approach. The condition state predictions obtained from this method were validated using statistical hypothesis tests with a test data set. Results show that the proposed model is able to not only predict the conditions in network-level accurately but also capture the model uncertainties with given confidence interval.

Keywords: bridge deterioration modelling, modified weibull approach, MCMC, metropolis-hasting algorithm, bayesian approach, Markov deterioration models

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476 Graphic User Interface Design Principles for Designing Augmented Reality Applications

Authors: Afshan Ejaz, Syed Asim Ali

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The reality is a combination of perception, reconstruction, and interaction. Augmented Reality is the advancement that layer over consistent everyday existence which includes content based interface, voice-based interfaces, voice-based interface and guide based or gesture-based interfaces, so designing augmented reality application interfaces is a difficult task for the maker. Designing a user interface which is not only easy to use and easy to learn but its more interactive and self-explanatory which have high perceived affordability, perceived usefulness, consistency and high discoverability so that the user could easily recognized and understand the design. For this purpose, a lot of interface design principles such as learnability, Affordance, Simplicity, Memorability, Feedback, Visibility, Flexibly and others are introduced but there no such principles which explain the most appropriate interface design principles for designing an Augmented Reality application interfaces. Therefore, the basic goal of introducing design principles for Augmented Reality application interfaces is to match the user efforts and the computer display (‘plot user input onto computer output’) using an appropriate interface action symbol (‘metaphors’) or to make that application easy to use, easy to understand and easy to discover. In this study by observing Augmented reality system and interfaces, few of well-known design principle related to GUI (‘user-centered design’) are identify and through them, few issues are shown which can be determined through the design principles. With the help of multiple studies, our study suggests different interface design principles which makes designing Augmented Reality application interface more easier and more helpful for the maker as these principles make the interface more interactive, learnable and more usable. To accomplish and test our finding, Pokémon Go an Augmented Reality game was selected and all the suggested principles are implement and test on its interface. From the results, our study concludes that our identified principles are most important principles while developing and testing any Augmented Reality application interface.

Keywords: GUI, augmented reality, metaphors, affordance, perception, satisfaction, cognitive burden

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475 Partitioning of Non-Metallic Nutrients in Lactating Crossbred Cattle Fed Buffers

Authors: Awadhesh Kishore

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The goal of the study was to determine how different non-metallic nutrients are partitioned from feed in various physiological contexts and how buffer addition in ruminant nutrition affects these processes. Six lactating crossbred dairy cows were selected and divided into three groups on the basis of their phenotypic and productive features (374±14 kg LW). Two treatments, T1 and T2, were randomly assigned to one animal from each group. Animals under T1 and T2 were moved to T2 and T1, respectively, after 30 days. T2 was the only group to receive buffers containing magnesium oxide and sodium bicarbonate at 0.0 and 0.01% of LW (the real amounts are equivalent to 75.3±4.0 and 30 7.7±2.0 g/d, respectively). T1 was used as the control. Wheat straw and berseem were part of the base diet, whereas wheat grain and mustard cake were part of the concentrate mixture. Following a 21-day feeding period, metabolic and milk production trials were carried out for seven consecutive days. The Kearl equation used the urine's calorific value to determine its volume. Chemical analyses were performed to determine the levels of nitrogen, carbohydrates, calories, and phosphorus in samples of feed, waste, buffer, mineral mixture, water, feces, urine, and milk that were collected. The information was analyzed statistically. Notable results included decreased nitrogen and carbohydrate partitioning to feces from feed, while increased calorie partitioning to milk and body storage, and increased carbohydrate partitioning to body storage. Phosphorus balance was significantly better in T2. The application of buffers in ruminant diets was found to increase the output of calories in milk, as well as the number of calories and carbohydrates stored in the body, while decreasing the amount of nitrogen in faeces. As a result, it may be advised to introduce buffers to feed crossbred dairy cattle.

Keywords: cattle, Magnesium oxide, non-metallic nutrients, partitioning, Sodium bicarbonate

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474 Next-Generation Laser-Based Transponder and 3D Switch for Free Space Optics in Nanosatellite

Authors: Nadir Atayev, Mehman Hasanov

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Future spacecraft will require a structural change in the way data is transmitted due to the increase in the volume of data required for space communication. Current radio frequency communication systems are already facing a bottleneck in the volume of data sent to the ground segment due to their technological and regulatory characteristics. To overcome these issues, free space optics communication plays an important role in the integrated terrestrial space network due to its advantages such as significantly improved data rate compared to traditional RF technology, low cost, improved security, and inter-satellite free space communication, as well as uses a laser beam, which is an optical signal carrier to establish satellite-ground & ground-to-satellite links. In this approach, there is a need for high-speed and energy-efficient systems as a base platform for sending high-volume video & audio data. Nano Satellite and its branch CubeSat platforms have more technical functionality than large satellites, wheres cover an important part of the space sector, with their Low-Earth-Orbit application area with low-cost design and technical functionality for building networks using different communication topologies. Along the research theme developed in this regard, the output parameter indicators for the FSO of the optical communication transceiver subsystem on the existing CubeSat platforms, and in the direction of improving the mentioned parameters of this communication methodology, 3D optical switch and laser beam controlled optical transponder with 2U CubeSat structural subsystems and application in the Low Earth Orbit satellite network topology, as well as its functional performance and structural parameters, has been studied accordingly.

Keywords: cubesat, free space optics, nano satellite, optical laser communication.

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473 Assessing the Disability-Free Life Expectancy and Decomposition of Its Difference: A Gender Perspective on India over the Decade 2001-2011

Authors: Kajori Banerjee, Laxmi Kant Dwivedi

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“Health transition” is defined to be “a process through which high levels of mortality, morbidity and disability are reduced to low levels by influencing cultural, social and behavioural factors”. Life expectancy in India has been on the rise and parallel the burden of disease and disability has also risen noticeably. Borrowing data from Indian Census (2001, 2011), this study identifies the gender-wise burden of disability by calculating disability free life expectancy (DFLE) and life lived with disability (LWD). Sullivan’s method of calculating DFLE using proportion of disabled is used for this purpose. The change in person years lived with disability in the decade 2001-11 is further decomposed using Arriaga’s method into mortality and disability effects (ME and DE) to check the magnitude and direction of contribution of mortality and disability. Nationally, along with DFLE, LWD has amplified too. Despite having the highest life expectancy and DFLE, LWD in Kerala, was highest for both sexes in 2001. But in 2011, the LWD was highest among the males of Orissa and females of Rajasthan. For the overall population, DE is positive for the prime working age groups of 20-40years indicating that there has been an increase in the disability proportion holding mortality constant for 2001-2011. Females exhibit higher positive DE implying greater loss of healthy years due to disability than males. The findings call for an immediate attention to the causes of rising disability burden among the working population, especially females, as this might heavily effect the availability of quality labour force and its relative economic output in the Indian labour market. This also hints at the degrading quality of the elongated life and needs to be given the required attention to enhance the quality of life lead in the Nation.

Keywords: disability-free life expectancy, disability effect, life expectancy, mortality effect

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472 Impact of Urbanization on Natural Drainage Pattern in District of Larkana, Sindh Pakistan

Authors: Sumaira Zafar, Arjumand Zaidi

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During past few years, several floods have adversely affected the areas along lower Indus River. Besides other climate related anomalies, rapidly increasing urbanization and blockage of natural drains due to siltation or encroachments are two other critical causes that may be responsible for these disasters. Due to flat topography of river Indus plains and blockage of natural waterways, drainage of storm water takes time adversely affecting the crop health and soil properties of the area. Government of Sindh is taking a keen interest in revival of natural drainage network in the province and has initiated this work under Sindh Irrigation and Drainage Authority. In this paper, geospatial techniques are used to analyze landuse/land-cover changes of Larkana district over the past three decades (1980-present) and their impact on natural drainage system. Satellite derived Digital Elevation Model (DEM) and topographic sheets (recent and 1950) are used to delineate natural drainage pattern of the district. The urban landuse map developed in this study is further overlaid on drainage line layer to identify the critical areas where the natural floodwater flows are being inhibited by urbanization. Rainfall and flow data are utilized to identify areas of heavy flow, whereas, satellite data including Landsat 7 and Google Earth are used to map previous floods extent and landuse/cover of the study area. Alternatives to natural drainage systems are also suggested wherever possible. The output maps of natural drainage pattern can be used to develop a decision support system for urban planners, Sindh development authorities and flood mitigation and management agencies.

Keywords: geospatial techniques, satellite data, natural drainage, flood, urbanization

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471 The European Pharmacy Market: The Density and its Influencing Factors

Authors: Selina Schwaabe

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Community pharmacies deliver high-quality health care and are responsible for medication safety. During the pandemic, accessibility to the nearest pharmacy became more essential to get vaccinated against Covid-19 and to get medical aid. The government's goal is to ensure nationwide, reachable, and affordable medical health care services by pharmacies. Therefore, the density of community pharmacies matters. Overall, the density of community pharmacies is fluctuating, with slightly decreasing tendencies in some countries. So far, the literature has shown that changes in the system affect prices and density. However, a European overview of the development of the density of community pharmacies and its triggers is still missing. This research is essential to counteract against decreasing density consulting in a lack of professional health care through pharmacies. The analysis focuses on liberal versus regulated market structures, mail-order prescription drug regulation, and third-party ownership consequences. In a panel analysis, the relative influence of the measures is examined across 27 European countries over the last 21 years. In addition, the paper examines seven selected countries in depth, selected for the substantial variance in their pharmacy system: Germany, Austria, Portugal, Denmark, Sweden, Finland and Poland. Overall, the results show that regulated pharmacy markets have over 10.75 pharmacies/100.000 inhabitants more than liberal markets. Further, mail-order prescription drugs decrease the density by -17.98 pharmacies/100.000 inhabitants. Countries allowing third-party ownership have 7.67 pharmacies/100.000 inhabitants more. The results are statistically significant at a 0.001 level. The output of this analysis recommends regulated pharmacy markets, with a ban on mail-order prescription drugs allowing third-party ownership to support nationwide medical health care through community pharmacies.

Keywords: community pharmacy, market conditions, pharmacy, pharmacy market, pharmacy lobby, prescription, e-prescription, ownership structures

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470 Employability Potential of Differently Abled in the Indian Apparel Industry

Authors: Gunjita Shami, Noopur Anand

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The pilot run of 50 days was undertaken to test employability potential of people with visual and hearing & speech impairment. Various roles in an apparel manufacturing set up like spreading of fabric for cutting, folding, sealing and labeling cartons, pasting size barcode stickers on packed garments, removing tickets from the garments in the finishing stage were studied. Their performance was quantified basis timesheets for all the days and improvement per day was quantified. Their final day output was compared to that of the able-bodied worker. For example in the carton making activity on day one visually impaired worker was making one box every three minutes which improved to four boxes per minute on day 28 displaying 91.6% improvement compared or an improvement of 3.6% per day which was comparable to the able-bodied seasoned workers, who were making 5 boxes per minute. The performance of persons with hearing and speech impairment in the finishing department was 10% higher than that of able-bodied seasoned workers in the same process. Overall in all the activities the differently abled showed day to day improvement of 65% while able bodied displayed improvement of 52%. On the first day performance of able-bodied worker was 75% better than that of differently abled while on the 50th day it was only 20% better. Therefore the performance of persons with disabilities was found comparable to the able bodied person. The results, though on a small scale, showed a big promise of employment of persons with disability in the apparel industry. Armed with the promising result a full-scale study has been undertaken to identify the roles suitable for certain kind of disability in apparel production, work-aids required to assist the differently abled to improve performance and measures to be undertaken to make production floor 'friendlier' for them. The results have been discussed in this paper which opens doors for integrating differently abled into the world projected and assumed for only able-bodied.

Keywords: apparel sector, differently abled, employability, performance, work-aid

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469 Design and Development of High Strength Aluminium Alloy from Recycled 7xxx-Series Material Using Bayesian Optimisation

Authors: Alireza Vahid, Santu Rana, Sunil Gupta, Pratibha Vellanki, Svetha Venkatesh, Thomas Dorin

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Aluminum is the preferred material for lightweight applications and its alloys are constantly improving. The high strength 7xxx alloys have been extensively used for structural components in aerospace and automobile industries for the past 50 years. In the next decade, a great number of airplanes will be retired, providing an obvious source of valuable used metals and great demand for cost-effective methods to re-use these alloys. The design of proper aerospace alloys is primarily based on optimizing strength and ductility, both of which can be improved by controlling the additional alloying elements as well as heat treatment conditions. In this project, we explore the design of high-performance alloys with 7xxx as a base material. These designed alloys have to be optimized and improved to compare with modern 7xxx-series alloys and to remain competitive for aircraft manufacturing. Aerospace alloys are extremely complex with multiple alloying elements and numerous processing steps making optimization often intensive and costly. In the present study, we used Bayesian optimization algorithm, a well-known adaptive design strategy, to optimize this multi-variable system. An Al alloy was proposed and the relevant heat treatment schedules were optimized, using the tensile yield strength as the output to maximize. The designed alloy has a maximum yield strength and ultimate tensile strength of more than 730 and 760 MPa, respectively, and is thus comparable to the modern high strength 7xxx-series alloys. The microstructure of this alloy is characterized by electron microscopy, indicating that the increased strength of the alloy is due to the presence of a high number density of refined precipitates.

Keywords: aluminum alloys, Bayesian optimization, heat treatment, tensile properties

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468 A Data-Driven Agent Based Model for the Italian Economy

Authors: Michele Catalano, Jacopo Di Domenico, Luca Riccetti, Andrea Teglio

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We develop a data-driven agent based model (ABM) for the Italian economy. We calibrate the model for the initial condition and parameters. As a preliminary step, we replicate the Monte-Carlo simulation for the Austrian economy. Then, we evaluate the dynamic properties of the model: the long-run equilibrium and the allocative efficiency in terms of disequilibrium patterns arising in the search and matching process for final goods, capital, intermediate goods, and credit markets. In this perspective, we use a randomized initial condition approach. We perform a robustness analysis perturbing the system for different parameter setups. We explore the empirical properties of the model using a rolling window forecast exercise from 2010 to 2022 to observe the model’s forecasting ability in the wake of the COVID-19 pandemic. We perform an analysis of the properties of the model with a different number of agents, that is, with different scales of the model compared to the real economy. The model generally displays transient dynamics that properly fit macroeconomic data regarding forecasting ability. We stress the model with a large set of shocks, namely interest policy, fiscal policy, and exogenous factors, such as external foreign demand for export. In this way, we can explore the most exposed sectors of the economy. Finally, we modify the technology mix of the various sectors and, consequently, the underlying input-output sectoral interdependence to stress the economy and observe the long-run projections. In this way, we can include in the model the generation of endogenous crisis due to the implied structural change, technological unemployment, and potential lack of aggregate demand creating the condition for cyclical endogenous crises reproduced in this artificial economy.

Keywords: agent-based models, behavioral macro, macroeconomic forecasting, micro data

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467 Indigenous Hair Treatment in Abyssinia

Authors: Makda Yeshitela Kifele

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Hair treatment prevents the hair from loss of volume, changing colour, and damaging its properties of the hair. Hair is the beauty of human beings that makes people beautiful and takes the other hearts to see them and to give them an appreciation for their effort to treat their hair and save it from damage. There are different methods to protect human hair from loss and damage that influence human psychology better than the problems. Chemicals products are available in the world that keeps safely the hair and provide beauty for the hair. But chemical products have side effects and are not cost-effective. Even some of the chemicals are allergic for users and left some changes in the hair. Indigenous hair treatment is an effective method that reduces the bad effects and the problems of the chemical that are lefts in human being’slife. Indigenous hair treatment can treat the hair safely and effectively that does not have much effect or spots in the human hair the users rather, it improves some attributes of the hair such that shine, quality, quantity improvements, length, and flexibility can be modified by these indigenous treatments. Rate is the local plant that plays a significant role in hair treatment. Rate is the local plant that can be available everywhere in the country, and anybody can be used for hair treatments. For this research, 50 women are identified as sample populations with different hair characteristics. The treatments were collected from the fields and squeezed into the pots to be prepared as specimens. The squeezed plants were deposited in the refrigerator for three days with some amounts of salts to prevent some bacteria. Chemical analysis has been done to sort out some detrimental substances. So the result showed that there are no detrimental substances that affect the hair properties and the health of the users. The sample population used the oil for one month without any other oily cosmetics that disturbs the treatment. The output is very effective and brings shining the hair, preventing greying of the hair, showing fast-growing, increasing the volume of the hair, and becoming flexible and curly, straight hair, thicker, and with no allergic effects.

Keywords: indigenous, chemicals, curly, treatment

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466 Study on the Integration Schemes and Performance Comparisons of Different Integrated Solar Combined Cycle-Direct Steam Generation Systems

Authors: Liqiang Duan, Ma Jingkai, Lv Zhipeng, Haifan Cai

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The integrated solar combined cycle (ISCC) system has a series of advantages such as increasing the system power generation, reducing the cost of solar power generation, less pollutant and CO2 emission. In this paper, the parabolic trough collectors with direct steam generation (DSG) technology are considered to replace the heat load of heating surfaces in heat regenerator steam generation (HRSG) of a conventional natural gas combined cycle (NGCC) system containing a PG9351FA gas turbine and a triple pressure HRSG with reheat. The detailed model of the NGCC system is built in ASPEN PLUS software and the parabolic trough collectors with DSG technology is modeled in EBSILON software. ISCC-DSG systems with the replacement of single, two, three and four heating surfaces are studied in this paper. Results show that: (1) the ISCC-DSG systems with the replacement heat load of HPB, HPB+LPE, HPE2+HPB+HPS, HPE1+HPE2+ HPB+HPS are the best integration schemes when single, two, three and four stages of heating surfaces are partly replaced by the parabolic trough solar energy collectors with DSG technology. (2) Both the changes of feed water flow and the heat load of the heating surfaces in ISCC-DSG systems with the replacement of multi-stage heating surfaces are smaller than those in ISCC-DSG systems with the replacement of single heating surface. (3) ISCC-DSG systems with the replacement of HPB+LPE heating surfaces can increase the solar power output significantly. (4) The ISCC-DSG systems with the replacement of HPB heating surfaces has the highest solar-thermal-to-electricity efficiency (47.45%) and the solar radiation energy-to-electricity efficiency (30.37%), as well as the highest exergy efficiency of solar field (33.61%).

Keywords: HRSG, integration scheme, parabolic trough collectors with DSG technology, solar power generation

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465 Developing a Spatial Transport Model to Determine Optimal Routes When Delivering Unprocessed Milk

Authors: Sunday Nanosi Ndovi, Patrick Albert Chikumba

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In Malawi, smallholder dairy farmers transport unprocessed milk to sell at Milk Bulking Groups (MBGs). MBGs store and chill the milk while awaiting collection by processors. The farmers deliver milk using various modes of transportation such as foot, bicycle, and motorcycle. As a perishable food, milk requires timely transportation to avoid deterioration. In other instances, some farmers bypass the nearest MBGs for facilities located further away. Untimely delivery worsens quality and results in rejection at MBG. Subsequently, these rejections lead to revenue losses for dairy farmers. Therefore, the objective of this study was to optimize routes when transporting milk by selecting the shortest route using time as a cost attribute in Geographic Information Systems (GIS). A spatially organized transport system impedes milk deterioration while promoting profitability for dairy farmers. A transportation system was modeled using Route Analysis and Closest Facility network extensions. The final output was to find the quickest routes and identify the nearest milk facilities from incidents. Face-to-face interviews targeted leaders from all 48 MBGs in the study area and 50 farmers from Namahoya MBG. During field interviews, coordinates were captured in order to create maps. Subsequently, maps supported the selection of optimal routes based on the least travel times. The questionnaire targeted 200 respondents. Out of the total, 182 respondents were available. Findings showed that out of the 50 sampled farmers that supplied milk to Namahoya, only 8% were nearest to the facility, while 92% were closest to 9 different MBGs. Delivering milk to the nearest MBGs would minimize travel time and distance by 14.67 hours and 73.37 km, respectively.

Keywords: closest facility, milk, route analysis, spatial transport

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464 Static Test Pad for Solid Rocket Motors

Authors: Svanik Garg

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Static Test Pads are stationary mechanisms that hold a solid rocket motor, measuring the different parameters of its operation including thrust and temperature to better calibrate it for launch. This paper outlines a specific STP designed to test high powered rocket motors with a thrust upwards of 4000N and limited to 6500N. The design includes a specific portable mechanism with cost an integral part of the design process to make it accessible to small scale rocket developers with limited resources. Using curved surfaces and an ergonomic design, the STP has a delicately engineered façade/case with a focus on stability and axial calibration of thrust. This paper describes the design, operation and working of the STP and its widescale uses given the growing market of aviation enthusiasts. Simulations on the CAD model in Fusion 360 provided promising results with a safety factor of 2 established and stress limited along with the load coefficient A PCB was also designed as part of the test pad design process to help obtain results, with visual output and various virtual terminals to collect data of different parameters. The circuitry was simulated using ‘proteus’ and a special virtual interface with auditory commands was also created for accessibility and wide-scale implementation. Along with this description of the design, the paper also emphasizes the design principle behind the STP including a description of its vertical orientation to maximize thrust accuracy along with a stable base to prevent micromovements. Given the rise of students and professionals alike building high powered rockets, the STP described in this paper is an appropriate option, with limited cost, portability, accuracy, and versatility. There are two types of STP’s vertical or horizontal, the one discussed in this paper is vertical to utilize the axial component of thrust.

Keywords: static test pad, rocket motor, thrust, load, circuit, avionics, drag

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463 Theoretical Comparisons and Empirical Illustration of Malmquist, Hicks–Moorsteen, and Luenberger Productivity Indices

Authors: Fatemeh Abbasi, Sahand Daneshvar

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Productivity is one of the essential goals of companies to improve performance, which as a strategy-oriented method, determines the basis of the company's economic growth. The history of productivity goes back centuries, but most researchers defined productivity as the relationship between a product and the factors used in production in the early twentieth century. Productivity as the optimal use of available resources means that "more output using less input" can increase companies' economic growth and prosperity capacity. Also, having a quality life based on economic progress depends on productivity growth in that society. Therefore, productivity is a national priority for any developed country. There are several methods for calculating productivity growth measurements that can be divided into parametric and non-parametric methods. Parametric methods rely on the existence of a function in their hypotheses, while non-parametric methods do not require a function based on empirical evidence. One of the most popular non-parametric methods is Data Envelopment Analysis (DEA), which measures changes in productivity over time. The DEA evaluates the productivity of decision-making units (DMUs) based on mathematical models. This method uses multiple inputs and outputs to compare the productivity of similar DMUs such as banks, government agencies, companies, airports, Etc. Non-parametric methods are themselves divided into the frontier and non frontier approaches. The Malmquist productivity index (MPI) proposed by Caves, Christensen, and Diewert (1982), the Hicks–Moorsteen productivity index (HMPI) proposed by Bjurek (1996), or the Luenberger productivity indicator (LPI) proposed by Chambers (2002) are powerful tools for measuring productivity changes over time. This study will compare the Malmquist, Hicks–Moorsteen, and Luenberger indices theoretically and empirically based on DEA models and review their strengths and weaknesses.

Keywords: data envelopment analysis, Hicks–Moorsteen productivity index, Leuenberger productivity indicator, malmquist productivity index

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462 Nursing Experience in Caring for a Patient with Terminal Gastric Cancer and Abdominal Aortic Aneurysm

Authors: Pei-Shan Liang

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Objective: This article explores the nursing experience of caring for a patient with terminal gastric cancer complicated by an abdominal aortic aneurysm. The patient experienced physical discomfort due to the disease, initially unable to accept the situation, leading to anxiety, and eventually accepting the need for surgery. Methods: The nursing period was from June 6 to June 10, 2024. Through observation, direct care, conversations, and physical assessments, and using Gordon's eleven functional health patterns for a one-on-one holistic assessment, interdisciplinary team meetings were held with the critical care team and family. Three nursing health issues were identified: pain related to the disease and invasive procedures, anxiety related to uncertainty about disease recovery, and decreased cardiac tissue perfusion related to hemodynamic instability. Results: Open communication techniques and empathetic care were employed to establish a trusting nurse-patient relationship, and patient-centered nursing interventions were developed. Pain was assessed using a 10-point pain scale, and pain medications were adjusted by a pharmacist. Initially, Fentanyl 500mcg with pump run at 1ml/hr was administered, later changed to Ultracet 37.5mg/325mg, 1 tablet every 6 hours orally, reducing the pain score to 3. Lavender aromatherapy and listening to crystal music were used as distractions to alleviate pain, allowing the patient to sleep uninterrupted for at least 7 hours. The patient was encouraged to express feelings and fears through LINE messages or drawings, and a psychologist was invited to provide support. Family members were present at least twice a day for over an hour each time, reducing psychological distress and uncertainty about the prognosis. According to the Beck Anxiety Inventory, the anxiety score dropped from 17 (moderate anxiety) to 6 (no anxiety). Focused nursing care was implemented with close monitoring of vital signs maintaining systolic blood pressure between 112-118 mmHg to ensure adequate myocardial perfusion. The patient was encouraged to get out of bed for postoperative rehabilitation and to strengthen cardiopulmonary function. A chest X-ray showed no abnormalities, and breathing was smooth with Triflow use, maintaining at least 5 seconds with 2 balls four times a day, and SpO2 >96%. Conclusion: The care process highlighted the importance of addressing psychological care in addition to maintaining life when the patient’s condition changes. The presence of family often provided the greatest source of comfort for the patient, helping to reduce anxiety and pain. Nurses must play multiple roles, including advocate, coordinator, educator, and consultant, using various communication techniques and fostering hope by listening to and accepting the patient’s emotional responses. It is hoped that this report will provide a reference for clinical nursing staff and contribute to improving the quality of care.

Keywords: intensive care, gastric cancer, aortic aneurysm, quality of care

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461 Implementing a Comprehensive Emergency Care and Life Support Course in a Low- and Middle-Income Country Setting: A Survey of Learners in India

Authors: Vijayabhaskar Reddy Kandula, Peter Provost Taillac, Balasubramanya M. A., Ram Krishnan Nair, Gokul Toshnival, Vibhu Dhawan, Vijaya Karanam, Buffy Cramer

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Introduction: The lack of Emergency Care Services (ECS) is a cause of extensive and serious public health problems in low- and middle-income countries (LMIC), Many LMIC countries have ambulance services that allow timely transfer of ill patients but due to poor care during the ‘Golden Hour’ many deaths occur which are otherwise preventable. Lack of adequate training as evidenced by a study in India is a major reason for poor care during the ‘Golden Hour’. Adapting developed country models which includes staffing specialty-trained doctors in emergency care, is neither feasible nor guarantees cost-effective ECS. Methods: Based on our assessment and felt needs by first-line doctors providing emergency care in 2014, Rajiv Gandhi Health Sciences University’s JeevaRaksha Trust in partnership with the University of Utah, USA, designed, piloted and successfully implemented a 4-day Comprehensive-Emergency Care and Life Support course (C-ECLS) for allopathic doctors. 1730 doctors completed the 4-day course between June 2014 and December- 2020. Subsequently, we conducted a survey to investigate the utilization rates and usefulness of the training. 1662 were contacted but only 309 completed the survey. The respondents had the following designations: Senior faculty (33%), junior faculty (25), Resident (16%), Private-Practitioners (8%), Medical-Officer (16%) and not-working (11%). 51% were generalists (51%) and the rest were specialists (>30 specialties). Results: 97% (271/280) felt they are better doctors because of C-ECLS. 79% (244/309) reported that training helped to save life- specialists more likely than generalists (91% v/s 68%. P<0.05). 64% agreed that they were confident of managing COVID-19 symptomatic patients better because of C-ECLS. 27% (77) were neutral; 9% (24) disagreed. 66% agreed that training helps to be confident in managing COVID-19 critically ill patients. 26% (72) were neutral; 8% (23) disagreed. Frequency of use of C-ECLS skills: Hemorrhage-control (70%), Airway (67%), circulation skills (62%), Safe-transport and communication (60%), managing critically ill patients (58%), cardiac arrest (51%), Trauma (49%), poisoning/animal bites/stings (44%), neonatal-resuscitation (39%), breathing (36%), post-partum-hemorrhage and eclampsia (35%). Among those who used the skills, the majority (ranging from (88%-94%) reported that they were able to apply the skill more effectively because of ECLS training. Conclusion: JeevaRaksha’s C-ECLS is the world’s first comprehensive training. It improves the confidence of front-line doctors and enables them to provide quality care during the ‘Golden Hour’ of emergency. It also prepares doctors to manage unknown emergencies (e.g., COVID-19). C-ECLS was piloted in Morocco, and Uzbekistan and implemented countrywide in Bhutan. C-ECLS is relevant to most settings and offers a replicable model across LMIC.

Keywords: comprehensive emergency care and life support, training, capacity building, low- and middle-income countries, developing countries

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