Search results for: acute renal failure

Authors: Aikaterini Amanatidou

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We describe the case of a 20-year-old female patient diagnosed with Ehlers-Danlos Syndrome (EDS) who was scheduled to undergo a wisdom teeth extraction in outpatient surgery. EDS is a hereditary connective tissue disorder characterized by joint hypermobility, skin hyper-extensibility, and vascular and soft tissue fragility. There are six subtypes of Ehlers-Danlos, and in our case, the patient had EDS hyper-mobility (HT) type disorder. One important clinical feature of this syndrome is chronic pain, which is often poorly understood and treated. Our patient had a long history of articular and lumbar pain when she was diagnosed. She was prescribed analgesic treatment for acute and neuropathic pain and had multiple sessions of psychotherapy and physiotherapy to ease the pain. Unfortunately, her extensive medical history was underrated by our anesthetic team, and no further measures were taken for the operation. Despite an uneventful intra-operative phase, the patient experienced several episodes of hyperalgesia during the immediate post-operative care. Management of pain was challenging for the anesthetic team: initial opioid treatment had only a temporary effect and a paradoxical reaction after a while. Final pain relief was eventually obtained with psycho-physiologic treatment, high doses of ketamine, and patient-controlled analgesia infusion of morphine-ketamine-dehydrobenzperidol. We suspected an episode of Opioid-Induced hyperalgesia. This case report supports the hypothesis that anti-hyperalgesics such as ketamine as well as lidocaine, and dexmedetomidine should be considered intra-operatively to avoid opioid-induced hyperalgesia and may be an alternative solution to manage complex chronic pain like others in neuropathic pain syndromes.

Keywords: Ehlers-Danlos, post-operative management, hyperalgesia, opioid-induced hyperalgesia, rare disease

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Authors: Edy Wahyu Susilo

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This research discusses a comparative analysis of various anti-corruption responses of three Indonesian City Governments (Jakarta, Surabaya, and Medan) and completes previous findings on the effectiveness of the city anti-corruption program. Some factors (transparency, accountability, leadership, law enforcement, and bureaucratic reform) have been chosen in this study to diagnose the main role in the success and the failure of anti-corruption programs in these cities. These factors diagnose the relationship between factors and their dominancy, which is then utilized to create the city’s strategic anti-corruption programs. Although this study found leadership had a dominant influence both in encouraging and discouraging the performance of city transformation drastically, however, it is not the only factor that determined the performance of the city in the fight against corruption. It needs other factors as an ideal balancing element to achieve an anti-corruption program, namely KPK’s intervention and public engagement. Based on the dominance factors found, this research then develops an appropriate strategy using a policy evaluation approach to create a real practical guide regardless of the existence of good or bad leadership in the city. This research is expected to be a useful reference for stakeholders, especially the government, as a blueprint to prevent corruption by considering several important steps and guidance in efforts to eradicate corruption in the city, especially in Indonesia.

Keywords: intervention, KPK (corruption eradication commission), law enforcements, leadership, policy evaluation

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Authors: R. K. Apalowo, D. Chronopoulos, V. Thierry

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There exist a wide range of failure modes in composite structures due to the increased usage of the structures especially in aerospace industry. Moreover, temperature dependent wave response of composite and layered structures have been continuously studied, though still limited, in the last decade mainly due to the broad operating temperature range of aerospace structures. A wave finite element (WFE) and finite element (FE) based computational method is presented by which the temperature dependent wave dispersion characteristics and interaction phenomenon in composite structures can be predicted. Initially, the temperature dependent mechanical properties of the panel in the range of -100 ◦C to 150 ◦C are measured experimentally using the Thermal Mechanical Analysis (TMA). Temperature dependent wave dispersion characteristics of each waveguide of the structural system, which is discretized as a system of a number of waveguides coupled by a coupling element, is calculated using the WFE approach. The wave scattering properties, as a function of temperature, is determined by coupling the WFE wave characteristics models of the waveguides with the full FE modelling of the coupling element on which defect is included. Numerical case studies are exhibited for two waveguides coupled through a coupling element.

Keywords: finite element, temperature dependency, wave dispersion characteristics, wave finite element, wave scattering properties

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Authors: Chih Hung Shih

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Eyewitness identification is one of the efficient information to identify suspects during criminal investigation. However eyewitness identification is improved frequently, inaccurate and plays vital roles in wrongful convictions. Most eyewitness misidentifications are made during police criminal investigation stage and then accepted by juries. Four failure investigation case studies in Taiwan are conduct to demonstrate how misidentifications are caused during the police investigation context. The result shows that there are several common grounds among these cases: (1) investigators lacked for knowledge about eyewitness memory so that they couldn’t evaluate the validity of the eyewitnesses’ accounts and identifications, (2) eyewitnesses were always asked to filter out several suspects during the investigation, and received investigation information which contaminated the eyewitnesses’ memory, (3) one to one live individual identifications were made in most of cases, (4) eyewitness identifications were always used to support the hypotheses of investigators, and exaggerated theirs powers when conform with the investigation lines, (5) the eyewitnesses’ confidence didn’t t reflect the validity of their identifications , but always influence the investigators’ beliefs for the identifications, (6) the investigators overestimated the power of the eyewitness identifications and ignore the inconsistency with other evidence. Recommendations have been proposed for future academic research and police practice of eyewitness identification in Taiwan.

Keywords: criminal investigation, eyewitness identification, investigative bias, investigative failures

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Authors: Hardisiswo Soedjana, Inne Caroline

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Deep dermal or full thickness burns are inevitably lead to post-burn contractures. These contractures remain to be one of the most concerning late complications of burn injuries. Surgical management includes releasing the contracture followed by resurfacing the defect accompanied by post-operative rehabilitation. Optimal treatment of post-burn contractures depends on the characteristics of the contractures. This study is aimed to describe clinical characteristics, problems, and management of post-burn contractures in adults and children. A retrospective analysis was conducted from medical records of patients suffered from contractures after burn injuries admitted to Hasan Sadikin general hospital between January 2016 and January 2018. A total of 50 patients with post burn contractures were included in the study. There were 17 adults and 33 children. Most patients were male, whose age range within 15-59 years old and 5-9 years old. Educational background was mostly senior high school among adults, while there was only one third of children who have entered school. Etiology of burns was predominantly flame in adults (82.3%); whereas flame and scald were the leading cause of burn injury in children (11%). Based on anatomical regions, hands were the most common affected both in adults (35.2%) and children (48.5%). Contractures were identified in 6-12 months since the initial burns. Most post-burn hand contractures were resurfaced with full-thickness skin graft (FTSG) both in adults and children. There were 11 patients who presented with recurrent contracture after previous history of contracture release. Post-operative rehabilitation was conducted for all patients; however, it is important to highlight that it is still challenging to control splinting and exercise when patients are discharged and especially the compliance in children. In order to improve quality of life in patients with history of deep burn injuries, prevention of contractures should begin right after acute care has been established. Education for the importance of splinting and exercise should be administered as comprehensible as possible for adult patients and parents of pediatric patients.

Keywords: burn, contracture, education, exercise, splinting

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Authors: Mojahid F. Saeed Osman

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Repairable items inventory system is a management tool used to incorporate all information concerning inventory levels and movements for repaired and new items. This paper presents development of an effective simulation model for managing the inventory of repairable items for a production system where production lines send their faulty items to a repair shop considering the stochastic failure behavior and repair times. The developed model imitates the process of handling the on-hand inventory of repaired items and the replenishment of the inventory of new items using Economic Order Quantity and Reorder Point ordering policy in a flexible and risk-free environment. We demonstrate the appropriateness and effectiveness of the proposed simulation model using an illustrative case problem. The developed simulation model can be used as a reliable tool for estimating a healthy on-hand inventory of new and repaired items, backordered items, and downtime due to unavailability of repaired items, and validating and examining Economic Order Quantity and Reorder Point ordering policy, which would further be compared with other ordering strategies as future work.

Keywords: inventory system, repairable items, simulation, maintenance, economic order quantity, reorder point

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Authors: Yu-Zhou Zheng, Wen-Wei Wang

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In this paper, a new strengthening technique for reinforced concrete (RC) beams is proposed by combining Basalt Fibre Reinforced Polymer (BFRP) grid and Engineered Cementitious Composites (ECC) as a composite reinforcement layer (CRL). Five RC beams externally bonded with the CRL at the soffit and one control RC beam was tested to investigate their flexural behaviour. The thickness of BFRP grids (i.e., 1mm, 3mm and 5mm) and the sizes of CRL in test program were selected as the test parameters, while the thickness of CRL was fixed approximately at 30mm. The test results showed that there is no debonding of CRL to occur obviously in the strengthened beams. The final failure modes were the concrete crushing or the rupture of BFRP grids, indicating that the proposed technique is effective in suppressing the debonding of externally bonded materials and fully utilizing the material strengths. Compared with the non-strengthened beam, the increments of crack loading for strengthened beams were 58%~97%, 15%~35% for yield loading and 4%~33% for the ultimate loading, respectively. An analytical model is also presented to predict the full-range load-deflection responses of the strengthened beams and validated through comparisons with the test results.

Keywords: basalt fiber-reinforced polymer (BFRP) grid, ECC, RC beams, strengthening

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Authors: Michelle Hartanto, Risheka Suthantirakumar

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Introduction Staff redeployment, increased numbers of acutely unwell patients requiring resuscitation decision-making conversations, visiting restrictions, and varying guidance regarding resuscitation for patients with COVID-19 disrupted clinicians’ management of resuscitation and escalation decision-making processes. While it was generally accepted that the COVID-19 pandemic disturbed numerous aspects of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process in the United Kingdom, a process which establishes a patient’s CPR status and treatment escalation plans, the impact of the pandemic on clinicians’ attitudes towards these resuscitation and decision-making conversations was unknown. This was the first study to examine the impact of the COVID-19 pandemic on clinicians’ knowledge, skills, and attitudes towards the ReSPECT process. Methods A cross-sectional survey of clinicians at one acute teaching hospital in the UK was conducted. A questionnaire with a defined five-point Likert scale was distributed and clinicians were asked to recall their pre-pandemic views on ReSPECT and report their current views at the time of survey distribution (May 2020, end of the first COVID-19 wave in the UK). Responses were received from 171 clinicians, and self-reported views before and during the pandemic were compared. Results Clinicians reported they found managing ReSPECT conversations more challenging during the pandemic, especially when conducted over the telephone with relatives, and they experienced an increase in negative emotions before, during, and after conducting ReSPECT conversations. Our findings identified that due to the pandemic there was now a need for clinicians to receive training and support in conducting resuscitation and escalation decision-making conversations over the telephone with relatives and managing these processes.

Keywords: cardiopulmonary resuscitation, COVID-19 pandemic, DNACPR discussion, education, recommended summary plan for emergency care and treatment, resuscitation order

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Authors: Eliud Kiprop, Kenichi Matsui, Joseph Karanja, Hesborn Ondiba

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To double the share of renewable energy in the global energy mix by 2030 as part of actions for the Paris Agreement, policymakers in each ratifying country must accelerate their efforts within the next few years by implementing their own renewable energy strategies. Kenya has increased its funding for research and development in renewable energy sources largely because it intends to reduce greenhouse gas GHG emissions by 30% from business as usual (BAU) levels (143 MtCO₂eq) by 2030. In 2013, the Kenyan government launched an ambitious plan to increase the installed power generation capacity from 1,768MW to more than 5,000MW by the end of 2017. This paper examines the formulation and implementation process of this plan and shows how this plan will affect Kenya’s renewable energy industry and national policy implementation in general. Results demonstrate that, despite having a well- documented policy in place, the Kenyan government cannot meet its target of 5000MW by the end of 2017. Among other factors, we find that the main reason is attributable to the failure in adhering to the main principles of the policy plan. We also find that the government has failed to consider the future energy demand. Had the policy been implemented on time, we argue that there would have been excess power.

Keywords: policy implementation, policy plan, renewable energy, sustainable development

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Authors: Sreekanth T. G., Kishorekumar S., Sowndhariya Kumar J., Karthick R., Shanmugasuriyan S.

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Composites are increasingly being used in industries due to their unique properties, such as high specific stiffness and specific strength, higher fatigue and wear resistances, and higher damage tolerance capability. Composites are prone to failures or damages that are difficult to identify, locate, and characterize due to their complex design features and complicated loading conditions. The lack of understanding of the damage mechanism of the composites leads to the uncertainties in the structural integrity and durability. Delamination is one of the most critical failure mechanisms in laminated composites because it progressively affects the mechanical performance of fiber-reinforced polymer composite structures over time. The identification and severity characterization of delamination in engineering fields such as the aviation industry is critical for both safety and economic concerns. The presence of delamination alters the vibration properties of composites, such as natural frequencies, mode shapes, and so on. In this study, numerical analysis and experimental analysis were performed on delaminated and non-delaminated glass fiber reinforced polymer (GFRP) plate, and the numerical and experimental analysis results were compared, and error percentage has been found out.

Keywords: composites, delamination, natural frequency, mode shapes

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Authors: Ph. Fauquet-Alekhine

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Decision-making occurs several times an hour when working in high risk industry and an erroneous choice might have undesirable outcomes for people and the environment surrounding the industrial plant. Industrial decisions are very often made in a context of acute stress. Time pressure is a crucial stressor leading decision makers sometimes to boost up the decision-making process and if it is not possible then shift to the simplest strategy. We thus found it interesting to update the characterization of the stress factors impairing decision-making at Chinon Nuclear Power Plant (France) in order to optimize decision making contexts and/or associated processes. The investigation was based on the analysis of reports addressing safety events over the last 3 years. Among 93 reports, those explicitly addressing decision-making issues were identified. Characterization of each event was undertaken in terms of three criteria: stressors, biases impairing decision making and weaknesses of the decision-making process. The statistical analysis showed that biases were distributed over 10 possibilities among which the hypothesis confirmation bias was clearly salient. No significant correlation was found between criteria. The analysis indicated that the main stressor was time pressure and highlights an unexpected form of stressor: the trust asymmetry principle of the expert. The analysis led to the conclusion that this stressor impaired decision-making from a psychological angle rather than from a physiological angle: it induces defensive bias of self-esteem, self-protection associated with a bias of confirmation. This leads to the hypothesis that this stressor can intervene in some cases without being detected, and to the hypothesis that other stressors of the same kind might occur without being detected too. Further investigations addressing these hypotheses are considered. The analysis also led to the conclusion that dealing with these issues implied i) decision-making methods being well known to the workers and automated and ii) the decision-making tools being well known and strictly applied. Training was thus adjusted.

Keywords: bias, expert, high risk industry, stress.

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Authors: Shaker A. Aladwan

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This paper aims to explore the Barriers to innovation leadership in Jordanian public sector organizations. Qualitative approach was adopted, and content analysis was used to analyze the 18 assessment reports which are extracted from the public innovation award in Jordan, then, 20 semi-structured interviews were conducted with the key persons who are involved with innovation initiatives in the public sector organizations in Jordan. Several Barriersthat face the innovation leadership in the Jordanian public sector organizations. Managerially, the challenges include lack of innovation vision, implementation lack of innovation core values, lack of strategic planning for innovation, bad bureaucracy culture, and excessive centralization. Technically, the challenges include lack of task assignment for employees, lack of resources, lack of innovative training programs, lack of knowledge sharing, and the failure of governments to formulate policies and regulations. most of the studies focused on innovation in the non-public sector organizations, and most of them were conducted in the American and Western countries, which are different in terms of culture, kinds of innovation, barriers, and drivers. Thus, this paper provides new insights into barriers to innovation leadership in the public sector and in a new research context. This paper also provides a theoretical contribution by diagnosing the barriers facing innovation within the context of public administration in developing countries.

Keywords: innovation, excellence award, challenges, public sector, jordan

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Authors: Abraham J. Rizkalla, Tristan D. Yan

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Atrial myxoma is the most common primary cardiac tumor, and can result in cardiac failure secondary to obstruction, or systemic embolism due to fragmentation. Traditionally, excision of atrial an myxoma has been performed through median sternotomy, however the robotic approach offers several advantages including less pain, improved cosmesis, and faster recovery. Here, we highlight the less well recognized advantages and technical aspects to robotic myxoma resection. This video-presentation demonstrates the resection of a papillary subtype left atrial myxoma using the DaVinci© Xi surgical robot. The 10x magnification and 3D vision allows for the interface between the tumor and the interatrial septum to be accurately dissected, without the need to patch the interatrial septum. Several techniques to avoid tumor fragmentation and embolization are demonstrated throughout the procedure. The tumor was completely excised with clear margins. There was no atrial septal defect or mitral valve injury on post operative transesophageal echocardiography. The patient was discharged home on the fourth post-operative day. This video-presentation highlights the advantages of the robotic approach in atrial myxoma resection compared with sternotomy, as well as emphasizing several technical considerations to avoid potential complications.

Keywords: cardiac surgery, left atrial myxoma, cardiac tumour, robotic resection

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Authors: Ho-A Kim, Jae-Soo Noh

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During reactor operation, hydride blister can occur in spent nuclear fuel (SNF) claddings, and it could worsen the integrity of the claddings locally. Hydride blister can be critical when a pinch-type load is applied in the process of SNF handling and transportation. Micro-cantilever tests were performed to evaluate the risk of local hydride blister by comparing the fracture toughness of local hydride blister and pre-hydrided Zr alloy matrix of SNF cladding on a microscale. Hydride blister was generated by a gaseous charging procedure to simulate an SNF cladding. Micro-cantilevers and pre-cracks were ion-milled with the Ga+ ion beam of FEI Helios 600 at 30kV acceleration voltage. Micro-cantilever tests were conducted using PI 85 pico-indenter (HYSTRON) with for sided conductive diamond flat tip (1 μm x 1 μm) at a speed of 5 nm/sec. The results show that the hydride blister specimen could be fractured in the elastic deformation region, and the fracture toughness of the hydride blister specimen could drop up to 60% of that of the pre-hydrided Zr alloy matrix. Therefore, local hydride blister can degrade the integrity of SNF cladding, and the effect of hydride blister should be taken into account when evaluating failure criteria of claddings during handling, storage, and transportation of SNF.

Keywords: fracture toughness, hydride blister, micro-cantilever test, spent nuclear fuel cladding.

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Authors: Wenru Wang

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Over the past decades, Asia has emerged as the ‘diabetes epicentre’ in the world due to rapid economic development, urbanization and nutrition transition. There is an urgent need to develop more effective and cost-effective care management strategies in response to this rising diabetes epidemic. This study aims to develop and compare a nurse-led smartphone-based self-management programme with an existing nurse-led diabetes service on health-related outcomes among type 2 diabetes patients with poor glycemic control in Singapore. We proposed a randomized controlled trial with pre- and repeated post-tests control group design. A total of 128 type 2 diabetes patients with poor glycemic control will be recruited from the diabetes clinic of an acute public hospital in Singapore through convenience sampling. Study participants will be either randomly allocated to the experimental group or control group. Outcome measures used will include the 10-item General Self-Efficacy Scale, 11-item Revised Summary of Diabetes Self-care Activities, and 19-item Diabetes-Dependent Quality of Life. Data will be collected at 3-time points: baseline, three months and six months from the baseline, respectively. It is expected that this programme will be an alternative offered to diabetes patients to master their self-care management skills, in addition to the existing diabetes service provided in diabetes clinics in Singapore hospitals. Also, the self-supporting and less resource-intensive nature of this programme, through the use of smartphone app as a mode of intervention delivery, will greatly reduce nurses’ direct contact time with patients and allow more time to be allocated to those who require more attention. The study has been registered with clinicaltrials.gov. The trial registration number is NCT03088475.

Keywords: type 2 diabetes, poor glycaemic control, nurse-led, smartphone-based, self-management, health-relevant outcomes

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Authors: Jaspinder Kaur, Jatinder Pal Singh

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Introduction- Delusional parasitosis is a rare psychotic illness characterized by a fixed belief of manifesting a parasite in a body when in reality, it was not. Also known as Ekbom syndrome or delusional infestations, or acarophobia. Although the patient has no primary skin pathology, but all skin findings were secondary to skin manipulation by the patient itself, which is why up to 90% of patients first seek consultation from a dermatologist. Most commonly, it was seen in older people with female to male ratio is 2:1. For treatment, the patient first need to be investigated to rule all other possible causes, as Delusional parasitosis can be caused by Vitamin B12 deficiency, pellagra, hepatic and renal disease, diabetes mellitus, multiple sclerosis, and leprosy. When all possible causes ruled out, psychiatric referral to be done. Rule out other psychiatric comorbidities, and treatment should be done accordingly. Patient with delusional parasitosis responds well to second generation antipsychotics and need to continuous medication over years, and relapse is likely if treatment is stopped. Case Presentation- A 79-year-old female, belonging to lower socio-economic status, presented with complaints of itching sensation with erythematous patches over the scalp and multiple scratch excoriations lesion over the scalp, face and neck from the past 7-8 months. She had a feeling of small insect crawling under her skin and scalp area. To reduce the itching and kill the insect, she would scratch and squeeze her skin repeatedly. When the family tried to give her explanation that there was no insect in her body, she would not get convinced, rather got angry and abuse family members for not believing her. Gradually, her sleep would remain disturbed, she would be seen awake at night, seen to be scratching her skin, pull her scalp hair, even squeeze out her healed lesions. She collected her skin debris, scalp hairs and look out for insect. Because of her continuous illness, the patient started to remain sad and had crying spells. Her appetite decreased. She became socially isolated and stopped doing her activities of daily living. Family member’s first consulted dermatologist, investigated thoroughly with routine investigations, autoimmune and malignancy workup. As all investigations were normal, following which patient was referred for psychiatric evaluation. The patient was started on Tablet Olanzapine 2.5 mg, gradually increased to 7.5 mg. Over 1 month, there was reduction in itching, skin pricking. Lesions were gradually healed, and the patient continued to take other dermatological medications and ointment and was in regular follow up with psychiatric liaison from past 2 months with 70-80 % improvement in her symptoms. Conclusion- Delusional parasitosis is a psychiatric disorder of insidious onset, seen commonly in middle and old age people. Both psychiatric and dermatology consultation liaison will help the patient for an early diagnosis and adequate treatment. If a primary psychiatric diagnosis, the patient respond well to second generation antipsychotics but always require a further evaluation and treatment management if it is secondary to some physical or other psychiatric comorbidity.

Keywords: delusional parasitosis, delusional infestations, rare, primary psychiatric diagnosis, antipsychotic agents

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Authors: Anu S. Krishna

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The paper tries to analyse the UN involvement/intervention in the case of intra-state armed conflict of El Salvador and Nepal comparatively. The peace mission in El Salvador is considered to be the most successful missions of UN ever since it started involving in the peace-building activities. Meanwhile, in the armed conflict of South Asian country, Nepal, the result seemed to be disappointing in comparison with its counterpart. The study on this paper takes three variables as the success or failure of international mediation, i.e., a) signing of the peace agreement, b) disarmament/demobilization and c) constitutional mechanism. A significant amount of scholarship looks at the case of ONUSAL (United Nations Mission in El Salvador). Meanwhile, the armed conflict of Nepal and the role of UNMIN (United Nations Mediation in Nepal) are under researched so far. The paper thus tries to throw light on these cross-regional contexts that share certain similarities and dissimilarities in the nature of conflict. In addition, the international third-party involvement and their way of approaching both the cases differ, which again affected the mediation outcome. The paper tries to argue that, since the approach of the UN led international mediation in theses peace missions were contextual and varied from case to case, thus, finally affected the mediation outcome too.

Keywords: Nepal, UNMIN, El Salvador, ONUSAL, international mediation, armed conflict

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Authors: Yi Shan Cheng, Ya Hui Yeh, Hsiao Wen Hsu

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Delirium is an acute state of confusion, which is mainly the result of the interaction of many factors, including: age>65 years, comorbidity, cognitive function and visual/auditory impairment, dehydration, pain, sleep disorder, pipeline retention, general anesthesia and major surgery… etc. Researches show the prevalence of delirium in hospitalized elderly patients over 50%. If it doesn't improve in time, may cause cognitive decline or impairment, not only prolong the length of hospital stay but also increase mortality. Some studies have shown that multiple nonpharmacological interventions are the most effective and common strategies, which are reorientation, early mobility, promoting sleep and nutritional support (including water intake), could improve or prevent delirium in the hospitalized elderly. In Taiwan, only one research to compare the delirium incidence of the older patients who have received orthopedic surgery between multi-nonpharmacological interventions and general routine care. Therefore, the purpose of this study is to address the prevention or improvement of delirium incidence density in medical hospitalized elderly, provide clinical nurses as a reference for clinical implementation, and develop follow-up related research. This study is a quasi-experimental design using purposive sampling. Samples are from two wards: the geriatric ward and the general medicine ward at a medical center in central Taiwan. The sample size estimated at least 100, and then the data will be collected through a self-administered structured questionnaire, including: demographic and professional evaluation items. Case recruiting from 5/13/2023. The research results will be analyzed by SPSS for Windows 22.0 software, including descriptive statistics and inferential statistics: logistic regression、Generalized Estimating Equation(GEE)、multivariate analysis of variance(MANOVA).

Keywords: multiple nonpharmacological interventions, hospitalized elderly, delirium incidence, delirium

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Authors: J. R. Wang, H. T. Lin, Y. S. Tseng, W. Y. Li, H. C. Chen, S. W. Chen, C. Shih

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TRACE is developed by U.S. NRC for the nuclear power plants (NPPs) safety analysis. We focus on the establishment and application of TRACE/FRAPTRAN/SNAP models for Chinshan NPP (BWR/4) spent fuel pool in this research. The geometry is 12.17 m × 7.87 m × 11.61 m for the spent fuel pool. In this study, there are three TRACE/SNAP models: one-channel, two-channel, and multi-channel TRACE/SNAP model. Additionally, the cooling system failure of the spent fuel pool was simulated and analyzed by using the above models. According to the analysis results, the peak cladding temperature response was more accurate in the multi-channel TRACE/SNAP model. The results depicted that the uncovered of the fuels occurred at 2.7 day after the cooling system failed. In order to estimate the detailed fuel rods performance, FRAPTRAN code was used in this research. According to the results of FRAPTRAN, the highest cladding temperature located on the node 21 of the fuel rod (the highest node at node 23) and the cladding burst roughly after 3.7 day.

Keywords: TRACE, FRAPTRAN, BWR, spent fuel pool

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Authors: Axel Thallemer, Martin Danzer, Dominik Diensthuber, Aleksandar Kostadinov, Bernhard Rogler

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Nature has always inspired the creative mind, to a lesser or greater extent. Introduced around the 1950s, Biomimetics served as a systematic method to treat the natural world as a ‘pattern book’ for technical solutions with the aim to create innovative products. Unfortunately, this technique is prone to failure when performed as a mere reverse engineering of a natural system or appearance. Contrary to that, a solution which looks at the principles of a natural design, promises a better outcome. One such example is the here presented case study, which shows the design process of three distinctive grippers. The devices have biomimetic properties on two levels. Firstly, they use a kinematic chain found in beaks and secondly, they have a biomimetic structural geometry, which was realized using additive manufacturing. In a next step, the manufacturing method was evaluated to estimate its efficiency for commercial production. The results show that the fabrication procedure is still in its early stage and thus it is not able to guarantee satisfactory results. To summarize the study, we claim that a novel solution can be derived using principles from nature, however, for the solution to be actualized successfully, there are parameters which are beyond reach for designers. Nonetheless, industrial designers can contribute to product innovation using biomimetics.

Keywords: biomimetics, innovation, design process, additive manufacturing

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Authors: Andreas Livera, Spyros Theocharides, Michalis Florides, Charalambos Anastassiou

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A main challenge in the quest for ensuring quality of operation, especially for photovoltaic (PV) systems, is to safeguard the reliability and optimal performance by detecting and diagnosing potential failures and performance losses at early stages or before the occurrence through real-time monitoring, supervision, fault detection, and predictive maintenance. The purpose of this work is to present the functionalities and results related to the development and validation of a software platform for PV assets diagnosis and maintenance. The platform brings together proprietary hardware sensors and software algorithms to enable the early detection and prediction of the most common and critical faults in PV systems. It was validated using field measurements from operating PV systems. The results showed the effectiveness of the platform for detecting faults and losses (e.g., inverter failures, string disconnections, and potential induced degradation) at early stages, forecasting PV power production while also providing recommendations for maintenance actions. Increased PV energy yield production and revenue can be thus achieved while also minimizing operation and maintenance (O&M) costs.

Keywords: failure detection and prediction, operation and maintenance, performance monitoring, photovoltaic, platform, recommendations, predictive maintenance

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Authors: Pallab Das, Nabam Zomleen

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Effective dissipation of lateral loads that are coming due to seismic force determines the strength, durability and safety concern of the structure. Masonry infill has high stiffness and strength capabilities which can be put into an effective utilization for lateral load dissipation by incorporating it into building construction, but masonry behaves in highly nonlinear manner, so it is highly important to find out generalized, yet a rational approach to determine its nonlinear behavior and failure mode and it’s response when it is incorporated into building. But most of the countries do not specify the procedure for design of masonry infill wall. Whereas, there are many analytical modeling method available in literature, e.g. equivalent diagonal strut method, finite element modeling etc. In this paper the masonry infill is modeled and 6-storey bare framed building and building with masonry infill is analyzed using SAP-200014 in order to find out inter-storey drift by time-history analysis and capacity curve by Pushover analysis. The analysis shows that, while, the structure is well within CP performance level for both the case, whereas, there is considerable reduction of inter-storey drift of about 28%, when the building is analyzed with masonry infill wall.

Keywords: capacity curve, masonry infill, nonlinear analysis, time history analysis

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Authors: Vikneswaran Murugaiyah, Sultan Ayesh Mohammed Saghir, Kisantini Murugesu, Mohd. Zaini Asmawi, Amirin Sadikun

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Gynura procumbens is a popular medicinal plant used as a folk medicine in Southeast Asia to treat kidney diseases, diabetes mellitus and hyperlipidemia. The present study aims to investigate the antihyperlipidemic potential of phenolic acids rich fraction (PARF) from G. procumbens in chemically-induced acute and high fat diet-induced chronic hyperlipidemic rats. Ethanolic extract of G. procumbens leaves exhibited significant reductions in total cholesterol (TC) and triglycerides (TG) levels (P < 0.01 and P < 0.001, respectively) of poloxamer 407-induced rats compared to hyperlipidemic control after 58 h of treatment. Upon bioactivity guided fractionation the antihyperlipidemic activity was found to be concentrated in the PARF, which significantly reduced the TC and TG levels (P < 0.001). HPLC analysis revealed that 3,5-dicaffeoylquinic acid; 4,5-dicaffeoylquinic acid and chlorogenic acid are the major compounds in the PARF. Likewise, chlorogenic acid (60 mg/kg) exhibited significant reductions in TC and TG levels of hyperlipidemic rats (P < 0.001). Both chlorogenic acid and PARF significantly reduced LDL, VLDL and atherogenic index (P<0.01), while PARF increased the HDL (P < 0.01) compared to hyperlipidemic control. Both were found to be not cytotoxic against normal and cancer cell lines. In addition, LD50 of orally administered PARF was more than 5,000 mg/kg. Further investigation in high fat diet-induced chronic hyperlipidemic rats revealed that chronic administration of PARF dose-dependently restored the increase in lipids parameters. In summary, the phenolic acids rich fraction of G. procumbens leaves showed promising antihyperlipidemic effect in both chemically- and diet-induced hyperlipidemic rats that warrants further elucidation on its mechanisms of action.

Keywords: Antihyperlipidemic, Gynura procumbens, phenolic acids, chlorogenic acid, poloxamer-407, high fat diet

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Authors: J. I. Aguwa, S. Sadiku, M. Abdullahi

Abstract:

This study examined the structural reliability of the Nigerian grown Opepe timber as bridge beam material. The strength of a particular specie of timber depends so much on some factors such as soil and environment in which it is grown. The steps involved are collection of the Opepe timber samples, seasoning/preparation of the test specimens, determination of the strength properties/statistical analysis, development of a computer programme in FORTRAN language and finally structural reliability analysis using FORM 5 software. The result revealed that the Nigerian grown Opepe is a reliable and durable structural bridge beam material for span of 5000mm, depth of 400mm, breadth of 250mm and end bearing length of 150mm. The probabilities of failure in bending parallel to the grain, compression perpendicular to the grain, shear parallel to the grain and deflection are 1.61 x 10^-7, 1.43 x 10^-8, 1.93 x 10^-4 and 1.51 x 10^-15 respectively. The paper recommends establishment of Opepe plantation in various Local Government Areas in Nigeria for structural applications such as in bridges, railway sleepers, generation of income to the nation as well as creating employment for the numerous unemployed youths.

Keywords: bending and deflection, bridge beam, compression, Nigerian Opepe, shear, structural reliability

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Authors: Ian McCulloh, Andrew Placona, Darren Stewart, Daniel Gause, Kevin Kiernan, Morgan Stuart, Christopher Zinner, Laura Cartwright

Abstract:

An estimated 22-25% of viable deceased donor kidneys are discarded every year in the US, while waitlisted candidates are dying every day. As many as 85% of transplanted organs are refused at least once for a patient that scored higher on the match list. There are hundreds of clinical variables involved in making a clinical transplant decision and there is rarely an ideal match. Decision makers exhibit an optimism bias where they may refuse an organ offer assuming a better match is imminent. We propose a semi-parametric Cox proportional hazard model, augmented by an accelerated failure time model based on patient specific suitable organ supply and demand to estimate a time-to-next-offer. Performance is assessed with Cox-Snell residuals and decision curve analysis, demonstrating improved decision support for up to a 5-year outlook. Providing clinical decision makers with quantitative evidence of likely patient outcomes (e.g., time to next offer and the mortality associated with waiting) may improve decisions and reduce optimism bias, thus reducing discarded organs and matching more patients on the waitlist.

Keywords: decision science, KDPI, optimism bias, organ transplant

Procedia PDF Downloads 90

Authors: Talal Alhajri, Mahmood M. Tahir, Khaled Alenezi, Mohamad Ragaee

Abstract:

This work presents the experimental tests carried out to evaluate the behaviour of different types of shear connectors proposed for cold formed steel (CFS) section integrated with ferrocement slab as potential used for composite beam. Ten push-out test specimens of cold-formed steel lipped channel sections connected with ferrocement slab were tested. Three types of shear connectors were studied comprised of bolts, self-drilling-screw and bar angle. The connection behavior is analysed in terms of its load-slip relationship and the failure mode. The parametric studies were performed to investigate the effect on the shear connector’s capacity by varying the number of layers of wire mesh used in ferrocement slab and types of shear connector used. An analytical analysis using ANSYS program and theoretical analysis (Eurocode 4) were carried out to verify the experiment results. The results show that the experimental, theoretical, and numerical values proved to have good agreement with each other.

Keywords: cold-formed steel, composite beam, ferrocement, finite element method, push-out test, shear connector

Procedia PDF Downloads 343

Authors: Annisa Ulfah Pristya, Andi Setiawan

Abstract:

Indonesia placed in sixth rank total Acute Respiratory Infection (ARI) patient in the world and Riau as one of the province with the highest number of people with respiratory infection in Indonesia reached 37 thousand people. Usually society using a mask as prevention action. Unfortunately the commercial mouth mask only can work maximum for 4 hours and the pores are too large to filter out microorganisms and viruses carried by infectious droplets nucleated 1-5 μm. On the other hand, Indonesia is rich with Titanium dioxide (TiO2) and purple sweet potato anthocyanin pigment. Therefore, offered Bio-nano-mask which is a antimicrobial and antiviral mouth mask with Nano-TiO2 coating and purple sweet potato anthocyanins utilization as an effective solution to high ARI patients in Riau, which has the advantage of the mask surface can’t be attached by infectious droplets, self-cleaning and have anthocyanins biosensors that give visual response can be understood easily by the general public in the form of a mask color change from blue/purple to pink when acid levels increase. Acid level is an indicator of microorganisms accumulation in the mouth and surrounding areas. Bio-nano mask making process begins with the preparation (design, Nano-TiO2 liquid preparation, anthocyanins biosensors manufacture) and then superimposing the Nano-TiO2 on the outer surface of spunbond color using a sprayer, then superimposing anthocyanins biosensors film on the Meltdown surface, making bio nano-mask and it pack. Bio-nano mask has the advantage is effectively preventing pathogenic microorganisms and infectious droplets and has accumulated indicator microorganisms that color changes which easily observed by the common people though.

Keywords: anthocyanins, ARI, nano-TiO2 liquid, self cleaning

Procedia PDF Downloads 545

Authors: Christopher Muhawe, Masooda Bashir

Abstract:

With increased Internet Communication Technology(ICT), the virtual world has become the new normal. At the same time, there is an unprecedented collection of massive amounts of data by both private and public entities. Unfortunately, this increase in data collection has been in tandem with an increase in data misuse and data breach. Regrettably, the majority of data breach and data misuse claims have been unsuccessful in the United States courts for the failure of proof of direct injury to physical or economic interests. The requirement to express data privacy harms from an economic or physical stance negates the fact that not all data harms are physical or economic in nature. The challenge is compounded by the fact that data breach harms and risks do not attach immediately. This research will use a descriptive and normative approach to show that not all data harms can be expressed in economic or physical terms. Expressing privacy harms purely from an economic or physical harm perspective negates the fact that data insecurity may result into harms which run counter the functions of privacy in our lives. The promotion of liberty, selfhood, autonomy, promotion of human social relations and the furtherance of the existence of a free society. There is no economic value that can be placed on these functions of privacy. The proposed approach addresses data harms from a psychological and social perspective.

Keywords: data breach and misuse, economic harms, privacy harms, psychological harms

Procedia PDF Downloads 175

Authors: Bambang Piscesa, Mario M. Attard, Dwi Presetya, Ali K. Samani

Abstract:

A numerical strategy formulated using a plasticity approach is presented to model spalling of the concrete cover in reinforced concrete columns. The stage at which the concrete cover within reinforced concrete column spalls has a direct bearing on the load capacity. The concrete cover can prematurely spall before the full cross-section can be utilized if the concrete is very brittle under compression such as for very high strength concretes. If the confinement to the core is high enough, the column can achieve a higher peak load by utilizing the core. A numerical strategy is presented to model spalling of the concrete cover. Various numerical strategies are employed to model the behavior of reinforced concrete columns which include: (1) adjusting the material properties to incorporate restrained shrinkage; (2) modifying the plastic dilation rate in the presence of the tensile pressure; (3) adding a tension cut-off failure surface and (4) giving the concrete cover region and the column core different material properties. Numerical comparisons against experimental results are carried out that shown excellent agreement with the experimental results and justify the use of the proposed strategies to predict the axial load capacity of reinforce concrete columns.

Keywords: spalling, concrete, plastic dilation, reinforced concrete columns

Procedia PDF Downloads 139

Authors: Angelis P. Barlampas

Abstract:

Purpose of Learning Objective: This case depicts the need for cooperation between the emergency department and the radiologist to achieve the best diagnostic result for the patient. The clinical picture must correlate well with the radiology report and when it does not, this is not necessarily someone’s fault. Careful interpretation and good knowledge of the limitations, advantages and disadvantages of each imaging procedure are essential for the final diagnostic goal. Methods or Background: A patient was brought to the emergency department by their relatives. He was suddenly confused and his mental status was altered. He hadn't any history of mental illness and was otherwise healthy. A computing tomography scan without contrast was done, but it was unremarkable. Because of high clinical suspicion of probable neurologic disease, he was admitted to the hospital. Results or Findings: Another T was done after 48 hours. It showed a hypodense region in both thalamic areas. Taking into account that the first CT was normal, but the initial clinical picture of the patient was alerting of something wrong, the repetitive CT exam is highly suggestive of a probable diagnosis of bilateral thalamic infractions. Differential diagnosis: Primary bilateral thalamic glioma, Wernicke encephalopathy, osmotic myelinolysis, Fabry disease, Wilson disease, Leigh disease, West Nile encephalitis, Greutzfeldt Jacob disease, top of the basilar syndrome, deep venous thrombosis, mild to moderate cerebral hypotension, posterior reversible encephalopathy syndrome, Neurofibromatosis type 1. Conclusion: As is the case of limitations for any imaging procedure, the same applies to CT. The acute ischemic attack can not depict on CT. A period of 24 to 48 hours has to elapse before any abnormality can be seen. So, despite the fact that there are no obvious findings of an ischemic episode, like paresis or imiparesis, one must be careful not to attribute the patient’s clinical signs to other conditions, such as toxic effects, metabolic disorders, psychiatric symptoms, etc. Further investigation with MRI or at least a repeated CT must be done.

Keywords: CNS, CT, thalamus, emergency department

Procedia PDF Downloads 95