Search results for: emergency department visits
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2740

Search results for: emergency department visits

670 Bridging between Shariah Law and Legal Framework: A Study of Problems and Solutions of Islamic Banking System in Bangladesh

Authors: Md. Abdul Kader, Md. Akiz Uddin

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The Islamic banking system is based on the Islamic shariah principles. Islamic banking is set up to avoid riba (interest)--which is prohibited in Islam-- and to prevent unscrupulous practices and participate actively in achieving the welfare-oriented Islamic economy. In the process of offering Islamic banking services, practitioners have been facing several challenges. Out of many challenges, this paper particularly highlights the need for a centralized legal framework for Islamic banks that should be compliant with the shariah law. The researchers employed a qualitative method to collect case studies from high-profile Islamic Bankers and analyzed respective legal documents and policy papers to conduct the study. This study investigates the Shariah Governance Framework (SGF), amended Banking Companies Act, 1991 (Act No. 14 of 1991), and the Shariah Supervisory Board (SSB) of Islamic banks in Bangladesh to evaluate how legal framework supervise and/or monitor Islamic banking system under the jurisdiction of shariah law. The study reveals that the Shariah governance system in Bangladesh is mainly voluntary rather than regulatory, and there is an absence of full-fledged SGF. Though there is no complete Islamic Banking Act for controlling, guiding, and supervising the Islamic banks in Bangladesh, some Islamic banking provisions have already been incorporated in the amended Banking Companies Act, 1991 (Act No. 14 of 1991). Bangladesh Bank did not set up any separate Department at its Head Office to control, guide and supervise the operation of the Islamic banks. So, ensuring the implementation of Shariah principles concurrent with the legal framework of banking policies is recommended in this study. This study also prescribes that the government should enact a law or policy for the operations of Islamic banks in order to improve the Islamic Banking system of Bangladesh. In addition, the central bank can set up a Central Shariah Supervisory Board (CSSB) or authorize the existing Central Shariah Board for Islamic Banks of Bangladesh (CSBIB) to supervise and monitor overall activities of Islamic banks and resolve the disputes among the stakeholders concerning the Shariah issues of Islamic banks.

Keywords: islamic banking, shariah law, banking policies, shariah governance framework (SGF)

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669 Assessing the Quality of Maternity Care in Sub-Saharan Africa Using the Donabedian Quality of Care Framework: A Systematic Scoping Review

Authors: Bernice Boafoaa Gyapong, Anne Jones, Sam Bassett, Janet Anderson

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Background: Maternal mortality and morbidity are global concerns, especially in sub-Saharan Africa (SSA). Most maternal mortalities occur at the time of birth. Quality intrapartum care is essential for improving maternal and newborn health outcomes. This scoping review aimed to assess and describe the quality of care during childbirth in SSA to provide an overview of the regional trend of the quality of intrapartum care, the challenges to quality care provision, and identify research gaps. Methods: A scoping review based on Arksey and O’Malley’s scoping review framework was conducted. Medline, CINAHL, PsycINFO, and maternal-infant databases were searched to identify the relevant studies for this review. A narrative summary was presented using themes based on the Donabedian structure, process, and outcome quality of care model. Results: A total of five hundred and forty-seven (547) publications were identified. Fifty-six (56) studies conducted in twenty (20) countries were included in the review. Thirty-four (34) were quantitative, sixteen (16) were qualitative, and six (6) were mixed methods. Most of the studies were related to the process component of quality of care. The provision of emergency obstetric care services, infrastructure, and availability of essential staff and equipment for perinatal care was inadequate in many facilities, particularly rural and peripheral health facilities. Many women experienced disrespectful care during childbirth. Routine care during labour and delivery was observed to be sub-optimal, yet some women reported high satisfaction with care. The use of health facilities for delivery was lower in health centres compared to hospitals. Conclusion: There are variations in the quality of maternity care provided in SSA. Intrapartum care quality is generally deficient in SSA, particularly in peripheral health facilities, health centres, and community clinics. Many of the quality-of-care issues identified are related to the structure component. Stakeholders must develop interventions that comprehensively address these interrelated issues to improve maternal healthcare quality, especially in primary healthcare facilities.

Keywords: quality of care, maternity health, Sub-Saharan Africa, intrapartum

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668 Characterization, Classification and Fertility Capability Classification of Three Rice Zones of Ebonyi State, Southeastern Nigeria

Authors: Sunday Nathaniel Obasi, Chiamak Chinasa Obasi

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Soil characterization and classification provide the basic information necessary to create a functional evaluation and soil classification schemes. Fertility capability classification (FCC) on the other hand is a technical system that groups the soils according to kinds of problems they present for management of soil physical and chemical properties. This research was carried out in Ebonyi state, southeastern Nigeria, which is an agrarian state and a leading rice producing part of southeastern Nigeria. In order to maximize the soil and enhance the productivity of rice in Ebonyi soils, soil classification, and fertility classification information need to be supplied. The state was grouped into three locations according to their agricultural zones namely; Ebonyi north, Ebonyi central and Ebonyi south representing Abakaliki, Ikwo and Ivo locations respectively. Major rice growing areas of the soils were located and two profile pits were sunk in each of the studied zones from which soils were characterized, classified and fertility capability classification (FCC) developed. Soil classification was done using United State Department of Agriculture (USDA) Soil Taxonomy and correlated with World Reference Base for soil resources. Results obtained classified Abakaliki 1 and Abakaliki 2 as Typic Fluvaquents (Ochric Fluvisols). Ikwo 1 was classified as Vertic Eutrudepts (Eutric Vertisols) while Ikwo 2 was classified as Typic Eutrudepts (Eutric Cambisols). Ivo 1 and Ivo 2 were both classified as Aquic Eutrudepts (Gleyic Leptosols). Fertility capability classification (FCC) revealed that all studied soils had mostly loamy topsoils and subsoils except Ikwo 1 with clayey topsoil. Limitations encountered in the studied soils include; dryness (d), low ECEC (e), low nutrient capital reserve (k) and water logging/ anaerobic condition (gley). Thus, FCC classifications were Ldek for Abakaliki 1 and 2, Ckv for Ikwo 1, LCk for Ikwo 2 while Ivo 1 and 2 were Legk and Lgk respectively.

Keywords: soil classification, soil fertility, limitations, modifiers, Southeastern Nigeria

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667 Robots for City Life: Design Guidelines and Strategy Recommendations for Introducing Robots in Cities

Authors: Akshay Rege, Lara Gomaa, Maneesh Kumar Verma, Sem Carree

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The aim of this paper is to articulate design strategies and recommendations for introducing robots into the city life of people based on experiments conducted with robots and semi-autonomous systems in three cities in the Netherlands. This research was carried out by the Spot robotics team of Impact Lab housed within YES!Delft, a start-up accelerator located in Delft, The Netherlands. The premise of this research is to inform the development of the ‘region of the future’ by the Municipality of Rotterdam-Den Haag (MRDH). The paper starts by reporting the desktop research carried out to find and develop multiple use cases for robots to support humans in various activities. Further, the paper reports the user research carried out by crowdsourcing responses collected in public spaces of Rotterdam-Den Haag region and on the internet. Furthermore, based on the knowledge gathered in the initial research, practical experiments were carried out using robots and semi-autonomous systems in order to test and validate our initial research. These experiments were conducted in three cities in the Netherlands which were Rotterdam, The Hague, and Delft. Custom sensor box, Drone, and Boston Dynamics' Spot robot were used to conduct these experiments. Out of thirty use cases, five were tested with experiments which were skyscraper emergency evacuation, human transportation and security, bike lane delivery, mobility tracking, and robot drama. The learnings from these experiments provided us with insights into human-robot interaction and symbiosis in cities which can be used to introduce robots in cities to support human activities, ultimately enabling the transitioning from a human only city life towards a blended one where robots can play a role. Based on these understandings, we formulated design guidelines and strategy recommendations for incorporating robots in the Rotterdam-Den Haag’s region of the future. Lastly, we discuss how our insights in the Rotterdam-Den Haag region can inspire and inform the incorporation of robots in different cities of the world.

Keywords: city life, design guidelines, human-robot Interaction, robot use cases, robotic experiments, strategy recommendations, user research

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666 Role of Intralesional Tranexamic Acid in Comparison of Oral Tranexamic Acid in the Treatment of Melasma

Authors: Lubna Khondker

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Background: Melasma is a common pigmentary dermatosis, manifested by hyperpigmented macules or patches on the face, commonly occurring in females due to an acquired disorder in the melanogenesis process. Although several treatments are currently used, it remains a great challenge due to recurrence and refractory nature. It was recently reported that tranexamic acid (TA-plasmin inhibitor) is an effective treatment for melasma. Objective: This study aims to compare the efficacy and side effects of intralesional injection of Tranexamic acid with oral Tranexamic acid in the treatment of melasma. Methods: A clinical trial was done in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, for a period of 4 years. A total of 100 patients with melasma who did not respond to topical therapy were included in the study as group A and group B. Group A Patients were administered intralesional injection (10 mg/ml) of Tranexamic acid( TA) weekly for 6 weeks, and group B patients were treated with oral tranexamic acid 250 mg 12 hourly for 12 weeks after taking informed consent. The severity and extent of pigmentation were assessed by the modified melasma area severity index (MASI). The response to treatment was assessed by MASI at 4 weeks, 8 weeks, and 12 weeks after stopping treatment. Results: The study showed the MASI scores at the baseline, 4 weeks, 8 weeks, and 12 weeks in group A were 18.23±1.22, 6.14±3.26, 3.21±2.14 and 2.11±2.01 respectively, and in group B, 17.87±1.12, 11.21±6.25, 6.57±4.26 and 6.41±4.17 respectively. The mean MASI significantly reduced in group A compared to group B in the 4th, 8th, and 12th weeks. The present study showed that among group A patients, 56% rated excellent (>75% reduction) in outcome, 32% good (50-75% reduction), 8% moderate (25-50% reduction) and only 4% (<25% reduction) was unsatisfactory and among group B patients, 14% rated excellent in outcome, 28% good, 36% moderate and 22% was unsatisfactory. Overall improvement in our study in group A was 96% and in group B 78%. Side effects were negligible, and all the patients tolerated the treatment well. Conclusion: Based on our results, intralesional Tranexamic acid (10 mg/ml) is more effective and safer than oral Tranexamic acid in the treatment of melasma.

Keywords: intralesional tranexamic acid, melasma, oral tranexamic acid, MASI score

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665 Training Student Teachers to Work in Partnership with Parents of Students with Special Needs

Authors: Alicia Greenbank, Efrat Bengio

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The aim of this research was to examine the efficacy of the first course in Israel, whose objective is to train student teachers in the special education department to work cooperatively with parents of children with special needs. Studies often highlight the importance of cooperation between teachers and parents of students with special needs. Israel’s Special Education Law defines parents as complete partners, and the Ministry of Education encourages and even requires that partnership be present. Yet this partnership is difficult to achieve many kindergarten teachers, and teachers have a lot of difficulties establishing and managing a pattern of cooperation with their students’ parents. Often we see different perspectives on the child's development and needs, distrust, lack of appreciation, and communication difficulties on both sides – parents & teachers. The course describes a method of instilling the need for cooperation at an early stage of teacher training-in the teacher training program. 22 students in the special education program for early childhood education in the fourth year of learning took part in the course. The fourth-year is the experiential training year and the first time that students have worked in a school. The course consisted of 14 sessions. Seven parents of students with different disabilities participated at 6 of the sessions. The changes in the students' attitudes towards partnership and their ability to manage this partnership were carried out by examining the reports written by the students before the meetings with the parents and the reflections they wrote after each meeting with the parents and at the end of the course. Three themes emerged from the narrative analysis, corresponding to the three preconditions for joint activities with parents — Approach, Attitude, Appropriate Atmosphere, according to the Four A’s Model. The findings showed that a course combining meetings with parents of children with special needs offers many benefits for teacher training. The course raised student awareness of the question partnership, changed students’ approaches and attitudes towards the parents, stressed the importance of partnership, and provided students with tools for working with parents through the school. Based on the findings of this study, courses in this format can be applied in order to cooperate between teachers and parents, for example, parents of gifted children with special needs.

Keywords: Partnership with parents in special education, parents of children with disabilities, parents of children with special needs, parents’ involvement in special education

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664 Comparison of Peri- and Post-Operative Outcomes of Three Left Atrial Incisions: Conventional Direct, Transseptal and Superior Septal Left Atriotomy

Authors: Estelle Démoulin, Dionysios Adamopoulos, Tornike Sologashvili, Mathieu Van Steenberghe, Jalal Jolou, Haran Burri, Christoph Huber, Mustafa Cikirikcioglu

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Background & objective: Mitral valve surgeries are mainly performed by median sternotomy with conventional direct atriotomy. Good exposure to the mitral valve is challenging, especially for acute pathologies, where left atrium dilation does not occur. Other atriotomies, such as transseptal or superior septal, are used as they allow better access and visualization. Peri- and postoperative outcomes of these three different left atriotomies were compared. Methods: Patients undergoing mitral valve surgery between January 2010 and December 2020 were included and divided into three groups: group 1 (conventional direct, n=115), group 2 (transseptal, n=33) and group 3 (superior septal, n=59). To improve the sampling size, all patients underwent mitral valve surgery with or without associated procedures (CABG, aortic-tricuspid surgery, Maze procedure). The study protocol was approved by SwissEthics. Results: No difference was shown for the etiology of mitral valve disease, except endocarditis, which was more frequent in group 3 (p = 0.014). Elective surgeries and isolated mitral valve surgery were more frequent in group 1 (p = 0.008, p = 0.011) and aortic clamping and cardiopulmonary bypass were shorter (p = 0.002, p<0.001). Group 3 had more emergency procedures (p = 0.011) and longer lengths of intensive care unit and hospital stay (p = 0.000, p = 0.003). There was no difference in permanent pacemaker implantation, postoperative complications and mortality between the groups. Conclusion: Mitral valve surgeries can be safely performed using those three left atriotomies. Conventional direct may lead to shorter aortic clamping and cardiopulmonary bypass times. Superior septal is mostly used for acute pathologies, and it does not increase postoperative arrhythmias and permanent pacemaker implantation. However, intensive care unit and hospital lengths of stay were found to be longer in this group. In our opinion, this outcome is more related to the pathology and type of surgery than the incision itself.

Keywords: Mitral valve surgery, cardiac surgery, atriotomy, Operative outcomes

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663 Effects of Anti-FGL2 Monoclonal Antibody SPF89 on Vascular Inflammation

Authors: Ying Sun, Biao Cheng, Qing Lu, Xuefei Tao, Xiaoyu Lai, Cheng Guo, Dan Wang

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Fibrinogen-like protein 2 (FGL2) has recently been identified to play an important role in inflammatory diseases such as atherosclerosis through a thrombin-dependent manner. Here, a murine monoclonal antibody was raised against the critical residue Ser(89) of FGL2, and the effects of the anti-FGL2 mAb (SPF89) were analyzed in human umbilical vein endothelial cells (HUVECs) and THP-1 cells. Firstly, it was proved that SPF89, which belongs to the IgG1 subtype with a KD value of 44.5 pM, could specifically show the expression levels of protein FGL2 in different cell lines of known target gene status. The lipopolysaccharide (LPS)-mediated endothelial cell proliferation was significantly inhibited with a decline of phosphorylation nuclear factor-κB (NF-κB) in a dose-dependent manner after SPF89 treatment. Furthermore, SPF89 reduced LPS-induced expression of adhesion molecules and inflammatory cytokines such as vascular cell adhesion molecule-1, tumor necrosis factor-α, Matrix metalloproteinase MMP-2, Integrin αvβ3, and interleukin-6 in HUVECs. In macrophage-like THP-1 cells, SPF89 effectively inhibited LPS and low-density lipoprotein-induced foam cell formation. However, these anti-inflammatory and anti-atherosclerotic effects of anti-FGL2 mAb in HUVECs and THP-1 cells were significantly reduced after treatment with an NF-κB inhibitor PDTC. All the above suggest, by efficiently inhibiting LPS-induced pro-inflammatory effects in vascular endothelial cells by attenuating NF-κB dependent pathway, the new anti-FGL2 mAb SPF89 could to be a potential therapeutic candidate for protecting the vascular endothelium against inflammatory diseases such as atherosclerosis. This work was supported by the Program of Sichuan Science and Technology Department (2017FZ0069) and Collaborative Innovation Program of Sichuan for Elderly Care and Health(YLZBZ1511).

Keywords: monoclonal antibody, fibrinogen like protein 2, inflammation, endothelial cells

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662 Seismic Assessment of Non-Structural Component Using Floor Design Spectrum

Authors: Amin Asgarian, Ghyslaine McClure

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Experiences in the past earthquakes have clearly demonstrated the necessity of seismic design and assessment of Non-Structural Components (NSCs) particularly in post-disaster structures such as hospitals, power plants, etc. as they have to be permanently functional and operational. Meeting this objective is contingent upon having proper seismic performance of both structural and non-structural components. Proper seismic design, analysis, and assessment of NSCs can be attained through generation of Floor Design Spectrum (FDS) in a similar fashion as target spectrum for structural components. This paper presents the developed methodology to generate FDS directly from corresponding Uniform Hazard Spectrum (UHS) (i.e. design spectra for structural components). The methodology is based on the experimental and numerical analysis of a database of 27 real Reinforced Concrete (RC) buildings which are located in Montreal, Canada. The buildings were tested by Ambient Vibration Measurements (AVM) and their dynamic properties have been extracted and used as part of the approach. Database comprises 12 low-rises, 10 medium-rises, and 5 high-rises and they are mostly designated as post-disaster\emergency shelters by the city of Montreal. The buildings are subjected to 20 compatible seismic records to UHS of Montreal and Floor Response Spectra (FRS) are developed for every floors in two horizontal direction considering four different damping ratios of NSCs (i.e. 2, 5, 10, and 20 % viscous damping). Generated FRS (approximately 132’000 curves) are statistically studied and the methodology is proposed to generate the FDS directly from corresponding UHS. The approach is capable of generating the FDS for any selection of floor level and damping ratio of NSCs. It captures the effect of: dynamic interaction between primary (structural) and secondary (NSCs) systems, higher and torsional modes of primary structure. These are important improvements of this approach compared to conventional methods and code recommendations. Application of the proposed approach are represented here through two real case-study buildings: one low-rise building and one medium-rise. The proposed approach can be used as practical and robust tool for seismic assessment and design of NSCs especially in existing post-disaster structures.

Keywords: earthquake engineering, operational and functional components, operational modal analysis, seismic assessment and design

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661 Mobile App versus Website: A Comparative Eye-Tracking Case Study of Topshop

Authors: Zofija Tupikovskaja-Omovie, David Tyler, Sam Dhanapala, Steve Hayes

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The UK is leading in online retail and mobile adoption. However, there is a dearth of information relating to mobile apparel retail, and developing an understanding about consumer browsing and purchase behavior in m-retail channel would provide apparel marketers, mobile website and app developers with the necessary understanding of consumers’ needs. Despite the rapid growth of mobile retail businesses, no published study has examined shopping behaviour on fashion mobile websites and apps. A mixed method approach helped to understand why fashion consumers prefer websites on mobile devices, when mobile apps are also available. The following research methods were employed: survey, eye-tracking experiments, observation, and interview with retrospective think aloud. The mobile gaze tracking device by SensoMotoric Instruments was used to understand frustrations in navigation and other issues facing consumers in mobile channel. This method helped to validate and compliment other traditional user-testing approaches in order to optimize user experience and enhance the development of mobile retail channel. The study involved eight participants - females aged 18 to 35 years old, who are existing mobile shoppers. The participants used the Topshop mobile app and website on a smart phone to complete a task according to a specified scenario leading to a purchase. The comparative study was based on: duration and time spent at different stages of the shopping journey, number of steps involved and product pages visited, search approaches used, layout and visual clues, as well as consumer perceptions and expectations. The results from the data analysis show significant differences in consumer behaviour when using a mobile app or website on a smart phone. Moreover, two types of problems were identified, namely technical issues and human errors. Having a mobile app does not guarantee success in satisfying mobile fashion consumers. The differences in the layout and visual clues seem to influence the overall shopping experience on a smart phone. The layout of search results on the website was different from the mobile app. Therefore, participants, in most cases, behaved differently on different platforms. The number of product pages visited on the mobile app was triple the number visited on the website due to a limited visibility of products in the search results. Although, the data on traffic trends held by retailers to date, including retail sector breakdowns for visits and views, data on device splits and duration, might seem a valuable source of information, it cannot explain why consumers visit many product pages, stay longer on the website or mobile app, or abandon the basket. A comprehensive list of pros and cons was developed by highlighting issues for website and mobile app, and recommendations provided. The findings suggest that fashion retailers need to be aware of actual consumers’ behaviour on the mobile channel and their expectations in order to offer a seamless shopping experience. Added to which is the challenge of retaining existing and acquiring new customers. There seem to be differences in the way fashion consumers search and shop on mobile, which need to be explored in further studies.

Keywords: consumer behavior, eye-tracking technology, fashion retail, mobile app, m-retail, smart phones, topshop, user experience, website

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660 Clinical Audit of Selected Nephrology Nursing Procedures Performed in Nephrology Unit of AIIMS with a View to Develop Nephrology Nursing Procedure Protocol

Authors: Mamta Thakur, Dr. Shashi Mawar, Ms. Levis Murry, Dr. D.k.sharma

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Aim: The aim of this study is to develop nephrology nursing procedure protocol after clinical audit of current nephrology nursing practices. Materials and methods: This descriptive observational study was conducted on 40 nurses who were working in Nephrology Department of AIIMS, New Delhi to observe their current practices to assess the existing gaps in the practice. The nurses were enrolled through total enumerative sampling. Sociodemographic profile of nurses and clinical profile for site of procedure was collected. Observation checklist was formed on the basis of standard nursing practices, which included 7 dimensions for hemodialysis procedure and 3 dimensions for procedure of assisting renal biopsy. Based on the gaps identified, nephrology nursing procedure protocol will be developed. Nurses were observed during two shifts, and each nurse was observed once. Scoring of items were done in each dimension, and for acceptable practices, nurses have to score ≥80% in each dimension. Results: Data was analyzed using descriptive statistics. Majority of nurses (73.7%) in nephrology ward and (80.9%) in hemodialysis unit have not undergone any special training in nephrology. Most of nurses (80.9%) followed the acceptable nursing practices for procedure of connection for hemodialysis. None of nurses followed the acceptable level (≥80%) of nursing practices for the procedure of predialysis assessment, the procedure for site preparation, during dialysis assessment and post dialysis assessment. None (100%) showed the acceptable level of nursing practices for all the dimensions of assisting renal biopsy procedure. Nephrology nursing procedure protocol was developed by researcher following a rigorous process, and this will reduce the gaps in the nursing practice. Conclusion: Clinical audit found that there were gaps in the existing nursing practices compared to the standardised nursing practices for procedure of hemodialysis and assisting renal biopsy, and these gaps have been addressed by the development of the protocol.

Keywords: nursing practice, nephrology nursing procedure, nursing protocol, renal biopsy, hemodialysis

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659 Development of a Model for Predicting Radiological Risks in Interventional Cardiology

Authors: Stefaan Carpentier, Aya Al Masri, Fabrice Leroy, Thibault Julien, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: During an 'Interventional Radiology (IR)' procedure, the patient's skin-dose may become very high for a burn, necrosis, and ulceration to appear. In order to prevent these deterministic effects, a prediction of the peak skin-dose for the patient is important in order to improve the post-operative care to be given to the patient. The objective of this study is to estimate, before the intervention, the patient dose for ‘Chronic Total Occlusion (CTO)’ procedures by selecting relevant clinical indicators. Materials and methods: 103 procedures were performed in the ‘Interventional Cardiology (IC)’ department using a Siemens Artis Zee image intensifier that provides the Air Kerma of each IC exam. Peak Skin Dose (PSD) was measured for each procedure using radiochromic films. Patient parameters such as sex, age, weight, and height were recorded. The complexity index J-CTO score, specific to each intervention, was determined by the cardiologist. A correlation method applied to these indicators allowed to specify their influence on the dose. A predictive model of the dose was created using multiple linear regressions. Results: Out of 103 patients involved in the study, 5 were excluded for clinical reasons and 2 for placement of radiochromic films outside the exposure field. 96 2D-dose maps were finally used. The influencing factors having the highest correlation with the PSD are the patient's diameter and the J-CTO score. The predictive model is based on these parameters. The comparison between estimated and measured skin doses shows an average difference of 0.85 ± 0.55 Gy for doses of less than 6 Gy. The mean difference between air-Kerma and PSD is 1.66 Gy ± 1.16 Gy. Conclusion: Using our developed method, a first estimate of the dose to the skin of the patient is available before the start of the procedure, which helps the cardiologist in carrying out its intervention. This estimation is more accurate than that provided by the Air-Kerma.

Keywords: chronic total occlusion procedures, clinical experimentation, interventional radiology, patient's peak skin dose

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658 Incident Management System: An Essential Tool for Oil Spill Response

Authors: Ali Heyder Alatas, D. Xin, L. Nai Ming

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An oil spill emergency can vary in size and complexity, subject to factors such as volume and characteristics of spilled oil, incident location, impacted sensitivities and resources required. A major incident typically involves numerous stakeholders; these include the responsible party, response organisations, government authorities across multiple jurisdictions, local communities, and a spectrum of technical experts. An incident management team will encounter numerous challenges. Factors such as limited access to location, adverse weather, poor communication, and lack of pre-identified resources can impede a response; delays caused by an inefficient response can exacerbate impacts caused to the wider environment, socio-economic and cultural resources. It is essential that all parties work based on defined roles, responsibilities and authority, and ensure the availability of sufficient resources. To promote steadfast coordination and overcome the challenges highlighted, an Incident Management System (IMS) offers an essential tool for oil spill response. It provides clarity in command and control, improves communication and coordination, facilitates the cooperation between stakeholders, and integrates resources committed. Following the preceding discussion, a comprehensive review of existing literature serves to illustrate the application of IMS in oil spill response to overcome common challenges faced in a major-scaled incident. With a primary audience comprising practitioners in mind, this study will discuss key principles of incident management which enables an effective response, along with pitfalls and challenges, particularly, the tension between government and industry; case studies will be used to frame learning and issues consolidated from previous research, and provide the context to link practice with theory. It will also feature the industry approach to incident management which was further crystallized as part of a review by the Joint Industry Project (JIP) established in the wake of the Macondo well control incident. The authors posit that a common IMS which can be adopted across the industry not only enhances response capacity towards a major oil spill incident but is essential to the global preparedness effort.

Keywords: command and control, incident management system, oil spill response, response organisation

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657 Effect of Probiotic (RE3) Supplement on Growth Performance, Diarrhea Incidence and Blood Parameters of N'dama Calves

Authors: Y. Abdul Aziz, E. L. K. Osafo, S. O. Apori, A. Osman

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A sixteen week trial was conducted at the Research Farm (Technology Village) of the Department of Animal Science, School of Agriculture, University of Cape Coast, Cape Coast, Ghana. This study sought to investigate the effects of Probiotic (RE3) on growth performance, diarrhea incidence and blood parameters of N’dama calves. Sixteen N’dama calves aged 3 months of an average initial weight of 44.2 kg were randomly assigned to one of four dietary treatments according to their body weight, age, and sex. Treatment 1 (T1) serve as a control animal (No RE3 supplementation). Treatment 2 (T2) receives 0.03 ml RE3 per kg body weight. Treatment 3 (T3) receives 0.06 ml RE3 per kg body weight, and Treatment 4 (T4) also receives 0.09 ml RE3 per kg body weight in a Completely Randomize Design (CRD). There were 4 replicates per treatment. The calves were allowed access to feed and water ad libitum. The body weight of the calves was recorded at the start of the experiment and thereafter regularly at two weeks interval. Weighing was done early morning before the calves are allowed to access feed and water and were also observed in their pens for occurrence of diarrhea and faecal scores recorded. Blood samples were obtained from each calf at the end of the study through jugular vein puncture. Supplementation of RE3 to calves had showed a beneficial effect by reducing the incidence of diarrhea. The highest faecal score was recorded in T1 and the least faecal score was recorded in T3. There was significant difference (P < 0.05) in the faecal score between the treatment group and the control after two weeks of the experiment. There was no significant difference (P > 0.05) in the average daily gain of the animals. Hematological and biochemical indices of calves were all within the normal range except in treatments (1, 3 and 4) which recorded high White Blood Cell (WBC) count with no significant difference (P > 0.05).

Keywords: probiotics (RE3), diarrhea incidence, blood parameters, N’dama calves

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656 Exploring Academic Writing Challenges of First Year English as an Additional Language Students at an ODeL Institution in South Africa

Authors: Tumelo Jaquiline Ntsopi

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This study explored the academic writing challenges of first-year students who use English as an Additional Language (EAL) registered in the EAW101 module at an ODeL institution. Research shows that academic writing is a challenge for EAL teaching and learning contexts across the globe in higher education institutions (HEIs). Academic writing is an important aspect of academic literacy in any institution of higher learning, more so in an ODeL institution. This has probed research that shows that academic writing is and continues to pose challenges for EAL teaching and learning contexts in higher education institutions. This study stems from the researcher’s experience in teaching academic writing to first-year students in the EAW101 module. The motivation for this study emerged from the fact that EAW101 is a writing module that has a high number of students in the Department of English Studies with an average of between 50-80 percent pass rate. These statistics elaborate on the argument that most students registered in this module struggle with academic writing, and they need intervention to assist and support them in achieving competence in the module. This study is underpinned by Community of Inquiry (CoI) framework and Transactional distance theory. This study adopted a qualitative research methodology and utilised a case study approach as a research design. Furthermore, the study gathered data from first year students and the EAW101 module’s student support initiatives. To collect data, focus group discussions, structured open-ended evaluation questions, and an observation schedule were used to gather data. The study is vital towards exploring academic writing challenges that first-year students in EAW101 encounter so that lecturers in the module may consider re-evaluating their methods of teaching to improve EAL students’ academic writing skills. This study may help lecturers towards enhancing academic writing in a ODeL context by assisting first year students through using student support interventions.

Keywords: academic writing, academic writing challenge, ODeL, EAL

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655 Utilization of Silicon for Sustainable Rice Yield Improvement in Acid Sulfate Soil

Authors: Bunjirtluk Jintaridth

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Utilization of silicon for sustainable rice cultivation in acid sulfate soils was studied for 2 years. The study was conducted on Rungsit soils in Amphoe Tanyaburi, Pathumtani Province. The objectives of this study were to assess the effect of high quality organic fertilizer in combination with silicon and chemical fertilizer on rice yield, chemical soil properties after using soil amendments, and also to assess the economic return. A Randomized Complete Block Design (RCBD) with 10 treatments and 3 replications were employed. The treatments were as follows: 1) control 2) chemical fertilizer (recommended by Land Development Department, LDD 3) silicon 312 kg/ha 4) high quality organic fertilizer at 1875 kg/ha (the recommendation rate by LDD) 5) silicon 156 kg/ha in combination with high quality organic fertilizer 1875 kg/ha 6) silicon at the 312 kg/ha in combination with high quality organic fertilizer 1875 kg/ha 7) silicon 156 kg/ha in combination with chemical fertilizer 8) silicon at the 312 kg/ha in combination with chemical fertilizer 9) silicon 156 kg/ha in combination with ½ chemical fertilizer rate, and 10) silicon 312 kg/ha in combination with ½ chemical fertilizer rate. The results of 2 years indicated the treatment tended to increase soil pH (from 5.1 to 4.7-5.5), percentage of organic matter (from 2.43 to 2.54 - 2.94%); avail. P (from 7.5 to 7-21 mg kg-1 P; ext. K (from 616 to 451-572 mg kg-1 K), ext Ca (from 1962 to 2042.3-4339.7 mg kg-1 Ca); ext Mg (from 1586 to 808.7-900 mg kg-1 Mg); but decrease the ext. Al (from 2.56 to 0.89-2.54 cmol kg-1 Al. Two years average of rice yield, the highest yield was obtained from silicon 156 kg/ha application in combination with high quality organic fertilizer 300 kg/rai (3770 kg/ha), or using silicon at the 312 kg/ha combination with high quality organic fertilizer 300 kg/rai. (3,750 kg/ha). It was noted that chemical fertilizer application with 156 and 312 kg/ha silicon gave only 3,260 และ 3,133 kg/ha, respectively. On the other hand, half rate of chemical fertilizer with 156 and 312 kg/ha with silicon gave the yield of 2,934 และ 3,218 kg/ha, respectively. While high quality organic fertilizer only can produce 3,318 kg/ha as compare to rice yield of 2,812 kg/ha from control. It was noted that the highest economic return was obtained from chemical fertilizer treated plots (886 dollars/ha). Silicon application at the rate of 156 kg/ha in combination with high quality organic fertilizer 1875 kg/ha gave the economic return of 846 dollars/ha, while 312 kg/ha of silicon with chemical fertilizer gave the lowest economic return (697 dollars/ha).

Keywords: rice, high quality organic fertilizer, acid sulfate soil, silicon

Procedia PDF Downloads 161
654 A Case Study on How Biomedical Engineering (BME) Outreach Programmes Serve as An Alternative Educational Approach to Form and Develop the BME Community in Hong Kong

Authors: Sum Lau, Wing Chung Cleo Lau, Wing Yan Chu, Long Ching Ip, Wan Yin Lo, Jo Long Sam Yau, Ka Ho Hui, Sze Yi Mak

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Biomedical engineering (BME) is an interdisciplinary subject where knowledge about biology and medicine is applied to novel applications, solving clinical problems. This subject is crucial for cities such as Hong Kong, where the burden on the medical system is rising due to reasons like the ageing population. Hong Kong, who is actively boosting technological advancements in recent years, sets BME, or biotechnology, as a major category, as reflected in the 2018-19 Budget, where biotechnology was one of the four pillars for development. Over the years, while resources in terms of money and space have been provided, there has been a lack of talents expressed by both the academia and industry. While exogenous factors, such as COVID, may have hindered talents from outside Hong Kong to come, endogenous factors should also be considered. In particular, since there are already a few local universities offering BME programmes, their curriculum or style of education requires to be reviewed to intensify the network of the BME community and support post-academic career development. It was observed that while undergraduate (UG) studies focus on knowledge teaching with some technical training and postgraduate (PG) programmes concentrate on upstream research, the programmes are generally confined to the academic sector and lack connections to the industry. In light of that, a “Biomedical Innovation and Outreach Programme 2022” (“B.I.O.2022”) was held to connect students and professors from academia with clinicians and engineers from the industry, serving as a comparative approach to conventional education methods (UG and PG programmes from tertiary institutions). Over 100 participants, including undergraduates, postgraduates, secondary school students, researchers, engineers, and clinicians, took part in various outreach events such as conference and site visits, all held from June to July 2022. As a case study, this programme aimed to tackle the aforementioned problems with the theme of “4Cs” (connection, communication, collaboration, and commercialisation). The effectiveness of the programme is investigated by its ability to serve as an adult and continuing education and the effectiveness of causing social change to tackle current societal challenges, with the focus on tackling the lack of talents engaging in biomedical engineering. In this study, B.I.O.2022 is found to be able to complement the traditional educational methods, particularly in terms of knowledge exchange between the academia and the industry. With enhanced communications between participants from different career stages, there were students who followed up to visit or even work with the professionals after the programme. Furthermore, connections between the academia and industry could foster the generation of new knowledge, which ultimately pointed to commercialisation, adding value to the BME industry while filling the gap in terms of human resources. With the continuation of events like B.I.O.2022, it provides a promising starting point for the development and relationship strengthening of a BME community in Hong Kong, and shows potential as an alternative way of adult education or learning with societal benefits.

Keywords: biomedical engineering, adult education for social change, comparative methods and principles, lifelong learning, faced problems, promises, challenges and pitfalls

Procedia PDF Downloads 114
653 Standard Protocol Selection for Acquisition of Breast Thermogram in Perspective of Early Breast Cancer Detection

Authors: Mrinal Kanti Bhowmik, Usha Rani Gogoi Jr., Anjan Kumar Ghosh, Debotosh Bhattacharjee

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In the last few decades, breast thermography has achieved an average sensitivity and specificity of 90% for breast tumor detection. Breast thermography is a non-invasive, cost-effective, painless and radiation-free breast imaging modality which makes a significant contribution to the evaluation and diagnosis of patients, suspected of having breast cancer. An abnormal breast thermogram may indicate significant biological risk for the existence or the development of breast tumors. Breast thermography can detect a breast tumor, when the tumor is in its early stage or when the tumor is in a dense breast. The infrared breast thermography is very sensitive to environmental changes for which acquisition of breast thermography should be performed under strictly controlled conditions by undergoing some standard protocols. Several factors like air, temperature, humidity, etc. are there to be considered for characterizing thermal images as an imperative tool for detecting breast cancer. A detailed study of various breast thermogram acquisition protocols adopted by different researchers in their research work is provided here in this paper. After going through a rigorous study of different breast thermogram acquisition protocols, a new standard breast thermography acquisition setup is proposed here in this paper for proper and accurate capturing of the breast thermograms. The proposed breast thermogram acquisition setup is being built in the Radiology Department, Agartala Government Medical College (AGMC), Govt. of Tripura, Tripura, India. The breast thermograms are captured using FLIR T650sc thermal camera with the thermal sensitivity of 20 mK at 30 degree C. The paper is an attempt to highlight the importance of different critical parameters of breast thermography like different thermography views, patient preparation protocols, acquisition room requirements, acquisition system requirements, etc. This paper makes an important contribution by providing a detailed survey and a new efficient approach on breast thermogram capturing.

Keywords: acquisition protocol, breast cancer, breast thermography, infrared thermography

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652 Service Evaluation of Consent for Hand and Wrist Surgery and Formulation of Evidence-Based Guidelines

Authors: Parsa Keyvani, Alistair Phillips, David Warwick

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Background: The current process for gaining patient consent for hand and wrist surgery at University Hospital Southampton (UHS) is paper-based and makes use of generic forms provided by the NHS and no patient information leaflet is available relating to hand and wrist surgery. Aims: To evaluate the process of obtaining clinical consent and suggest ways in which the service can be improved. Methods: A log-book review of four orthopaedic surgeons at UHS was carried out over a three-month period in order to identify the 10 most common types of elective hand and wrist surgeries performed. A literature review was carried out to identify the complications of these surgeries. The surgeries were then divided into 6 types: nerve, bone, ligament, joint, tendon and dupuytren’s surgery. A digitised consent form was created covering the complications of all 6 surgery types. Finally, the surgeons at the orthopaedic department of UHS were asked whether they prefer the old paper-based or the digitised consent form. Results: All of the surgeons felt that the procedure type-based form was easier to read, use and understand. Conclusion: This research highlights a number of problems related to the use of current NHS consent forms. The proposed solution is to use a set of digitised, procedure type-based consent forms. Digital consent forms can be filled in in advance and sent to the patient electronically along with any relevant information leaflets, thus giving them time to absorb the information and come up with any questions before they have their pre-procedure discussion with their doctor. This would allow the doctor to focus the consultation on the patient rather than writing out the consent form and would ultimately be a step forward in making the NHS a global digital leader and fully embrace the opportunity offered by technology.

Keywords: digitised consent form, elective surgery, hand surgery complications, informed consent, procedure type-based consent form

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651 Evaluation of Natural Gums: Gum Tragacanth, Xanthan Gum, Guar Gum and Gum Acacia as Potential Hemostatic Agents

Authors: Himanshu Kushwah, Nidhi Sandal, Meenakshi K. Chauhan, Gaurav Mittal

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Excessive bleeding is the primary factor of avoidable death in both civilian trauma centers as well as the military battlefield. Hundreds of Indian troops die every year due to blood loss caused by combat-related injuries. These deaths are avoidable and can be prevented to a large extent by making available a suitable hemostatic dressing in an emergency medical kit. In this study, natural gums were evaluated as potential hemostatic agents in combination with calcium gluconate. The study compares the hemostatic activity of Gum Tragacanth (GT), Guar Gum (GG), Xanthan Gum (XG) and Gum Acacia (GA) by carrying out different in-vitro and in-vivo studies. In-vitro studies were performed using the Lee-White method and Eustrek method, which includes the visual and microscopic analysis of blood clotting. MTT assay was also performed using human lymphocytes to check the cytotoxicity of the gums. The in-vivo studies were performed in Sprague Dawley rats using tail bleeding assay to evaluate the hemostatic efficacy of the gums and compared with a commercially available hemostatic sponge, Surgispon. Erythrocyte agglutination test was also performed to check the interaction between blood cells and the natural gums. Other parameters like blood loss, adherence strength of the developed hemostatic dressing material incorporating these gums, re-bleeding, and survival of the animals were also studied. The data obtained from the MTT assay showed that Guar gum, Gum Tragacanth, and Gum Acacia were not significantly cytotoxic, but substantial cytotoxicity was observed in Xanthan gum samples at high concentrations. Also, Xanthan gum took the least time with its minimum concentration to achieve hemostasis, (approximately 50 seconds at 3mg concentration). Gum Tragacanth also showed efficient hemostasis at a concentration of 35mg at the same time, but the other two gums tested were not able to clot the blood in significantly less time. A sponge dressing made of Tragacanth gum was found to be more efficient in achieving hemostasis and showed better practical applicability among all the gums studied and also when compared to the commercially available product, Surgispon, thus making it a potentially better alternative.

Keywords: cytotoxicity, hemostasis, natural gums, sponge

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650 Selection of Indigenous Tree Species and Microbial Inoculation for the Restoration of Degraded Uplands

Authors: Nelly S. Aggangan, Julieta A. Anarna

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Indigenous tree species are priority planting materials for the National Greening Program of the Department of Environment and Natural Resources. Areas for reforestation are marginal grasslands where plant growth is stunted and seedling survival is low. This experiment was conducted to compare growth rates and seedling survival of seven indigenous reforestation species. Narra (Pterocarpus indicus), salago (Wikstroemia lanceolata), kisubeng (Sapindus saponaria), tuai (Biscofia javanica), batino (Alstonia macrophylla), bani (Pongamina pinnata) and ipil (Intsia bijuga) were inoculated with Mykovam® (mycorrhizal fungi) and Bio-N® (N2-fixing bacteria) during pricking. After five months in the nursery, the treated seedlings were planted in degraded upland acidic red soil in Cavinti, Laguna (Luzon). During outplanting, all mycorrhiza inoculated seedlings had 50-80% mycorrhizal roots while the control ones had 5-10% mycorrhizal roots. Mykovam increased height of narra, salago and kisubeng. Stem diameter was bigger in mycorrhizal salago than the control. After two years in the field, Mykovam®+Bio-N® inoculated narra, salago and bani gave 95% survival while non-mycorrhizal tuai gave the lowest survival (25%). Inoculated seedlings grew faster than the control. Highest height increase was in batino (103%), followed by bani (95%), ipil (59%), narra (58%), tuai (53%) and kisubeng was the lowest (10%). Stem diameter was increased by Mykovam® from 13-39% over the control. Highest stem diameter was obtained from narra (50%), followed by bani (40%), batino (36%), ipil (33%), salago (28%), kisubeng and tuai (12%) had the lowest. In conclusion, Mykovam® inoculated batino, bani, narra, salago and ipil can be selected to restore degraded upland acidic red soil in the Philippines.

Keywords: Azospirillum spp., Bio-N®, Mykovam®, nitrogen fixing bacteria, acidic red soil

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649 Age Estimation from Teeth among North Indian Population: Comparison and Reliability of Qualitative and Quantitative Methods

Authors: Jasbir Arora, Indu Talwar, Daisy Sahni, Vidya Rattan

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Introduction: Age estimation is a crucial step to build the identity of a person, both in case of deceased and alive. In adults, age can be estimated on the basis of six regressive (Attrition, Secondary dentine, Dentine transparency, Root resorption, Cementum apposition and Periodontal Disease) changes in teeth qualitatively using scoring system and quantitatively by micrometric method. The present research was designed to establish the reliability of qualitative (method 1) and quantitative (method 2) of age estimation among North Indians and to compare the efficacy of these two methods. Method: 250 single-rooted extracted teeth (18-75 yrs.) were collected from Department of Oral Health Sciences, PGIMER, Chandigarh. Before extraction, periodontal score of each tooth was noted. Labiolingual sections were prepared and examined under light microscope for regressive changes. Each parameter was scored using Gustafson’s 0-3 point score system (qualitative), and total score was calculated. For quantitative method, each regressive change was measured quantitatively in form of 18 micrometric parameters under microscope with the help of measuring eyepiece. Age was estimated using linear and multiple regression analysis in Gustafson’s method and Kedici’s method respectively. Estimated age was compared with actual age on the basis of absolute mean error. Results: In pooled data, by Gustafson’s method, significant correlation (r= 0.8) was observed between total score and actual age. Total score generated an absolute mean error of ±7.8 years. Whereas, for Kedici’s method, a value of correlation coefficient of r=0.5 (p<0.01) was observed between all the eighteen micrometric parameters and known age. Using multiple regression equation, age was estimated, and an absolute mean error of age was found to be ±12.18 years. Conclusion: Gustafson’s (qualitative) method was found to be a better predictor for age estimation among North Indians.

Keywords: forensic odontology, age estimation, North India, teeth

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648 The Role of Continuing Professional Education in Interpretive Guiding in South Africa

Authors: Duduzile Dlamini-Boemah, Haretsebe Manwa, Lisebo Tseane-Gumbi

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The demands and expectations of twenty-first century tourists have changed, and they continue to have an impact on tour guiding in cultural and natural tourist attractions. The traditional communicative role of the tour guide as a mere presenter is not sufficient anymore; instead, there are expectations from the tourists of guides who provide effective interpretive guiding. It is always questionable if tour guides in South Africa are equipped with the skills for effective interpretation, yet limited research has been conducted to investigate the continuing professional education of tour guides in South Africa. Instead, much attention has been given to aspects of registration and certification of tour guides in South Africa. Concerns have been raised about tour guiding and have led to the development of a strategy by the Department of Tourism to professionalise tourists guiding that includes training. However, the necessity for tourism training in tour guiding in South Africa was raised as early as in the 1980s, the paper argues that there is a further need to emphasise continuing professional education in interpretive guiding in South Africa. In this study, continuing education and training are considered to involve the upgrading of the skills and knowledge of interpretation of those who are already working as tour guides at the cultural and natural attractions. The study is guided by the empowerment theory. The aim of this paper is to present issues of effective interpretive guiding and continuing professional education in interpretive guiding in South Africa. This study is based on the literature survey of secondary sources such as academic journal articles, government documents, and reports and books. The conclusions indicate that there is a need for training in interpretive delivery techniques in South Africa. The need for interpretive training in interpretive delivery techniques is attributed by the call to allow people to use indigenous knowledge, rather than formal education as a basis for becoming a field guide as well as affording the previously disadvantaged individuals to access training opportunities as tourist guides.

Keywords: continuing education, interpretive delivery skills, interpretive guiding, tour guide

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647 Savi Scout versus Wire-Guided Localization in Non-palpable Breast Lesions – Comparison of Breast Tissue Volume and Weight and Excision Safety Margin

Authors: Walid Ibrahim, Abdul Kasem, Sudeendra Doddi, Ilaria Giono, Tareq Sabagh, Muhammad Ammar, Nermin Osman

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Background: wire-guided localization (WL) is the most widely used method for the localization of non-palpable breast lesions. SAVI SCOUT occult lesion localization (SSL) is a new technique in breast-conservative surgery. SSL has the potential benefit of improving radiology workflow as well as accurate localization. Purpose: The purpose of this study is to compare the breast tissue specimen volume and weight and margin excision between WL and SSL. Materials and methods: A single institution retrospective analysis of 377 female patients who underwent wide local breast excision with SAVI SCOUT and or wire-guided technique between 2018 and 2021 in a UK University teaching hospital. Breast department. Breast tissue specimen volume and weight, and margin excision have been evaluated in the three groups of different localization. Results: Three hundred and seventy-seven patients were studied. Of these, 261 had wire localization, 88 had SCOUT and 28 had dual localization techniques. Tumor size ranged from 1 to 75mm (Median 20mm). The pathology specimen weight ranged from 1 to 466gm (Median 46.8) and the volume ranged from 1.305 to 1560cm³ (Median 106.32 cm³). SCOUT localization was associated with a significantly low specimen weight than wire or the dual technique localization (Median 41gm vs 47.3gm and 47gm, p = 0.029). SCOUT was not associated with better specimen volume with a borderline significance in comparison to wire and combined techniques (Median 108cm³ vs 105cm³ and 105cm³, p = 0.047). There was a significant correlation between tumor size and pathology specimen weight in the three groups. SCOUT showed a better >2mm safety margin in comparison to the other 2 techniques (p = 0.031). Conclusion: Preoperative SCOUT localization is associated with better specimen weight and better specimen margin. SCOUT did not show any benefits in terms of specimen volume which may be due to difficulty in getting the accurate specimen volume due to the irregularity of the soft tissue specimen.

Keywords: scout, wire, localization, breast

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646 Construction of a Dynamic Model of Cerebral Blood Circulation for Future Integrated Control of Brain State

Authors: Tomohiko Utsuki

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Currently, brain resuscitation becomes increasingly important due to revising various clinical guidelines pertinent to emergency care. In brain resuscitation, the control of brain temperature (BT), intracranial pressure (ICP), and cerebral blood flow (CBF) is required for stabilizing physiological state of brain, and is described as the essential treatment points in many guidelines of disorder and/or disease such as brain injury, stroke, and encephalopathy. Thus, an integrated control system of BT, ICP, and CBF will greatly contribute to alleviating the burden on medical staff and improving treatment effect in brain resuscitation. In order to develop such a control system, models related to BT, ICP, and CBF are required for control simulation, because trial and error experiments using patients are not ethically allowed. A static model of cerebral blood circulation from intracranial arteries and vertebral artery to jugular veins has already constructed and verified. However, it is impossible to represent the pooling of blood in blood vessels, which is one cause of cerebral hypertension in this model. And, it is also impossible to represent the pulsing motion of blood vessels caused by blood pressure change which can have an affect on the change of cerebral tissue pressure. Thus, a dynamic model of cerebral blood circulation is constructed in consideration of the elasticity of the blood vessel and the inertia of the blood vessel wall. The constructed dynamic model was numerically analyzed using the normal data, in which each arterial blood flow in cerebral blood circulation, the distribution of blood pressure in the Circle of Willis, and the change of blood pressure along blood flow were calculated for verifying against physiological knowledge. As the result, because each calculated numerical value falling within the generally known normal range, this model has no problem in representing at least the normal physiological state of the brain. It is the next task to verify the accuracy of the present model in the case of disease or disorder. Currently, the construction of a migration model of extracellular fluid and a model of heat transfer in cerebral tissue are in progress for making them parts of an integrated model of brain physiological state, which is necessary for developing an future integrated control system of BT, ICP and CBF. The present model is applicable to constructing the integrated model representing at least the normal condition of brain physiological state by uniting with such models.

Keywords: dynamic model, cerebral blood circulation, brain resuscitation, automatic control

Procedia PDF Downloads 149
645 Evaluating the Opioid Epidemic in a Large County Jail and Determining Who Is Most at Risk

Authors: Conchita Martin de Bustamante, Christopher S. Kung, Brianne Lacy, Eunsol Park, Hien Piotrowski, Mustafa Husain, Waseem Ahmed

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Objective: To explore the comorbidity of mental health conditions (major depressive disorder, borderline personality disorder, generalized anxiety disorder, and schizophrenia) with opioid use disorder in people incarcerated at a large urban jail. Background Schizophrenia, depression, bipolar disorder, and anxiety are all serious mental health conditions that are highly prevalent amongst incarcerated patients. However, it is seldom the only disorder these patients are suffering from. According to the US Department of Justice, about half of US prisoners, both at the state and federal level, suffer from substance use disorders. Although the opioid epidemic has been studied greatly in the recent years amongst the general population, little has been explored on how the opioid crisis has affected incarcerated patients in local jails, particularly regarding which of these patients are most susceptible. Method The cohort consisted of 507 people incarcerated at a large county jail who were evaluated by mental health providers in December 2020. A retrospective review was performed to evaluate associations between mental health diagnoses, substance use disorder, and other demographic variables. Results Participants had been diagnosed with various mental health conditions, including MDD (22.6%, n = 115), GAD (33.7%, n = 171), Schizophrenia (15.2%, n = 77) and BPD (27%, n = 137). Preliminary Chi square tests were conducted for these conditions against marijuana, alcohol, cocaine, opioid, methamphetamine, benzodiazepines, and sedative use disorders. The results showed significant associations between Schizophrenia (p = 0.013), GAD (p M 0.001), and MDD (p = 0.029) with opioid use disorders. Conclusions Determining the extent of these comorbid substance use and mental health disorders within an incarcerated population can help influence treatment plans for future incarcerated patients. Many federal and state jail systems lack pharmacological substance use intervention and the prevalence of these co-morbid conditions can shed light on the importance of treating conditions concurrently upon intake.

Keywords: mental health conditions, opioids, substance use disorder, comorbidity

Procedia PDF Downloads 149
644 Hydrodynamic and Water Quality Modelling to Support Alternative Fuels Maritime Operations Incident Planning & Impact Assessments

Authors: Chow Jeng Hei, Pavel Tkalich, Low Kai Sheng Bryan

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Due to the growing demand for sustainability in the maritime industry, there has been a significant increase in focus on alternative fuels such as biofuels, liquefied natural gas (LNG), hydrogen, methanol and ammonia to reduce the carbon footprint of vessels. Alternative fuels offer efficient transportability and significantly reduce carbon dioxide emissions, a critical factor in combating global warming. In an era where the world is determined to tackle climate change, the utilization of methanol is projected to witness a consistent rise in demand, even during downturns in the oil and gas industry. Since 2022, there has been an increase in methanol loading and discharging operations for industrial use in Singapore. These operations were conducted across various storage tank terminals at Jurong Island of varying capacities, which are also used to store alternative fuels for bunkering requirements. The key objective of this research is to support the green shipping industries in the transformation to new fuels such as methanol and ammonia, especially in evolving the capability to inform risk assessment and management of spills. In the unlikely event of accidental spills, a highly reliable forecasting system must be in place to provide mitigation measures and ahead planning. The outcomes of this research would lead to an enhanced metocean prediction capability and, together with advanced sensing, will continuously build up a robust digital twin of the bunkering operating environment. Outputs from the developments will contribute to management strategies for alternative marine fuel spills, including best practices, safety challenges and crisis management. The outputs can also benefit key port operators and the various bunkering, petrochemicals, shipping, protection and indemnity, and emergency response sectors. The forecasted datasets provide a forecast of the expected atmosphere and hydrodynamic conditions prior to bunkering exercises, enabling a better understanding of the metocean conditions ahead and allowing for more refined spill incident management planning

Keywords: clean fuels, hydrodynamics, coastal engineering, impact assessments

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643 Identification of Tangible and Intangible Heritage and Preparation of Conservation Proposal for the Historic City of Karanja Laad

Authors: Prachi Buche Marathe

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Karanja Laad is a city located in the Vidarbha region in the state of Maharashtra, India. It has a huge amount of tangible and intangible heritage in the form of monuments, precincts, a group of structures, festivals and procession route, which is neglected and lost with time. Three different religions Hinduism, Islam and Jainism along with associations of being a birthplace of Swami Nrusinha Saraswati, an exponent of Datta Sampradaya sect and the British colonial layer have shaped the culture and society of the place over the period. The architecture of the town Karanja Laad has enhanced its unique historic and cultural value with a combination of all these historic layers. Karanja Laad is also a traditional trading historic town with unique hybrid architectural style and has a good potential for developing as a tourist place along with the present image of a pilgrim destination of Datta Sampradaya. The aim of the research is to prepare a conservation proposal for the historic town along with the management framework. Objectives of the research are to study the evolution of Karanja town, to identify the cultural resources along with issues of the historic core of the city, to understand Datta sampradaya, and contribution of Saint Nrusinha Saraswati in the religious sect and his association as an important personality with Karanja. The methodology of the research is site visits to the Karanja city, making field surveys for documentation and discussions and questionnaires with the residents to establish heritage and identify potential and issues within the historic core thereby establishing a case for conservation. Field surveys are conducted for town level study of land use, open spaces, occupancy, ownership, traditional commodity and community, infrastructure, streetscapes, and precinct activities during the festival and non-festival period. Building level study includes establishing various typologies like residential, institutional commercial, religious, and traditional infrastructure from the mythological references like waterbodies (kund), lake and wells. One of the main issues is that the loss of the traditional footprint as well as the traditional open spaces which are getting lost due to the new illegal encroachments and lack of guidelines for the new additions to conserve the original fabric of the structures. Traditional commodities are getting lost since there is no promotion of these skills like pottery and painting. Lavish bungalows like Kannava mansion, main temple Wada (birthplace of the saint) have a huge potential to be developed as a museum by adaptive re-use which will, in turn, attract many visitors during festivals which will boost the economy. Festival procession routes can be identified and a heritage walk can be developed so as to highlight the traditional features of the town. Overall study has resulted in establishing a heritage map with 137 heritage structures identified as potential. Conservation proposal is worked out on the town level, precinct level and building level with interventions such as developing construction guidelines for further development and establishing a heritage cell consisting architects and engineers for the upliftment of the existing rich heritage of the Karanja city.

Keywords: built heritage, conservation, Datta Sampradaya, Karanja Laad, Swami Nrusinha Saraswati, procession route

Procedia PDF Downloads 158
642 Reducing the Urban Heat Island Effect by Urban Design Strategies: Case Study of Aksaray Square in Istanbul

Authors: Busra Ekinci

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Urban heat island term becomes one of the most important problem in urban areas as a reflection of global warming in local scale last years. Many communities and governments are taking action to reduce heat island effects on urban areas where the half of the world's population live today. At this point, urban design turned out to be an important practice and research area for providing an environmentally sensitive urban development. In this study, mitigating strategies of urban heat island effects by urban design are investigated in Aksaray Square and surroundings in Istanbul. Aksaray is an important historical and commercial center of Istanbul, which has an increasing density due to be the node of urban transportation. Also, Istanbul Metropolitan Municipality prepared an urban design project to respond the needs of growing population in the area for 2018. The purpose of the study is emphasizing the importance of urban design objectives and strategies that are developed to reduce the heat island effects on urban areas. Depending on this, the urban heat island effect of the area was examined based on the albedo (reflectivity) parameter which is the most effective parameter in the formation of the heat island effect in urban areas. Albedo values were calculated by Albedo Viewer web application model that was developed by Energy and Environmental Engineering Department of Kyushu University in Japan. Albedo parameter had examined for the present situation and the planned situation with urban design project. The results show that, the current area has urban heat island potential. With the Aksaray Square Project, the heat island effect on the area can be reduced, but would not be completely prevented. Therefore, urban design strategies had been developed to reduce the island effect in addition to the urban design project of the area. This study proves that urban design objectives and strategies are quite effective to reduce the heat island effects, which negatively affect the social environment and quality of life in urban areas.

Keywords: Albedo, urban design, urban heat island, sustainable design

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641 Against the Idea of Public Power as Free Will

Authors: Donato Vese

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According to the common interpretation, in a legal system, public powers are established by law. Exceptions are admitted in an emergency or particular relationship with public power. However, we currently agree that law allows public administration a margin of decision, even in the case of non-discretionary acts. Hence, the administrative decision not exclusively established by law becomes the rule in the ordinary state of things, non-only in state of exception. This paper aims to analyze and discuss different ideas on discretionary power on the Rule of Law and Rechtsstaat. Observing the legal literature in Europe and Nord and South America, discretionary power can be described as follow: it could be considered a margin that law accords to the executive power for political decisions or a choice between different interpretations of vague legal previsions. In essence, this explanation admits for the executive a decision not established by law or anyhow not exclusively established by law. This means that the discretionary power of public administration integrates the law. However, integrating law does not mean to decide according to the law, but it means to integrate law with a decision involving public power. Consequently, discretionary power is essentially free will. In this perspective, also the Rule of Law and the Rechtsstaat are notions explained differently. Recently, we can observe how the European notion of Rechtsstaat is founded on the formal validity of the law; therefore, for this notion, public authority’s decisions not regulated by law represent a problem. Thus, different systems of law integration have been proposed in legal literature, such as values, democracy, reasonableness, and so on. This paper aims to verify how, looking at those integration clauses from a logical viewpoint, integration based on the recourse to the legal system itself does not resolve the problem. The aforementioned integration clauses are legal rules that require hard work to explain the correct meaning of the law; in particular, they introduce dangerous criteria in favor of the political majority. A different notion of public power can be proposed. This notion includes two main features: (a) sovereignty belongs to persons and not the state, and (b) fundamental rights are not grounded but recognized by Constitutions. Hence, public power is a system based on fundamental rights. According to this approach, it can also be defined as the notion of public interest as concrete maximization of fundamental rights enjoyments. Like this, integration of the law, vague or subject to several interpretations, must be done by referring to the system of fundamental individual rights. We can think, for instance, to fundamental rights that are right in an objective view but not legal because not established by law.

Keywords: administrative discretion, free will, fundamental rights, public power, sovereignty

Procedia PDF Downloads 105