Search results for: nurses with fixed and rotating shifts

Authors: Panatda Intanin, Sangutid Thongsawad, Chirapha Tannanonta, Todsaporn Fuangrod

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Stereotactic radiosurgery (SRS) is a highly precision delivery technique that requires comprehensive quality assurance (QA) tests prior to treatment delivery. An isocenter of delivery beam plays a critical role that affect the treatment accuracy. The uncertainty of isocenter is traditionally accessed using circular cone equipment, Winston-Lutz (WL) phantom and film. This technique is considered time consuming and highly dependent on the observer. In this work, the development of multileaf collimator (MLC)-based isocenter verification tool using electronic portal imaging device (EPID) was proposed and evaluated. A mechanical isocenter alignment with ball bearing diameter 5 mm and circular cone diameter 10 mm fixed to gantry head defines the radiation field was set as the conventional WL test method. The conventional setup was to compare to the proposed setup; using MLC (10 x 10 mm) to define the radiation filed instead of cone. This represents more realistic delivery field than using circular cone equipment. The acquisition from electronic portal imaging device (EPID) and radiographic film were performed in both experiments. The gantry angles were set as following: 0°, 90°, 180° and 270°. A software tool was in-house developed using MATLAB/SIMULINK programming to determine the centroid of radiation field and shadow of WL phantom automatically. This presents higher accuracy than manual measurement. The deviation between centroid of both cone-based and MLC-based WL tests were quantified. To compare between film and EPID image, the deviation for all gantry angle was 0.26±0.19mm and 0.43±0.30 for cone-based and MLC-based WL tests. For the absolute deviation calculation on EPID images between cone and MLC-based WL test was 0.59±0.28 mm and the absolute deviation on film images was 0.14±0.13 mm. Therefore, the MLC-based isocenter verification using EPID present high sensitivity tool for SRS QA.

Keywords: isocenter verification, quality assurance, EPID, SRS

Procedia PDF Downloads 128

Authors: Lauren Dhugga, Meena Parameswaran, David Blundell, Abbas Khushnood

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Context: A multidisciplinary weekly safety briefing was implemented at the Paediatric Cardiothoracic Unit at the Freeman Hospital in Newcastle-upon-Tyne. It is a tertiary referral centre with a quarternary cardiac paediatric intensive care unit and provides complexed care including heart and lung transplants, mechanical support and advanced heart failure assessment. Aim: The aim of this briefing is to provide a structured platform of communication, in an effort to improve efficiency, safety, and patient care. Problem: The paediatric cardiothoracic unit is made up of a vast multidisciplinary team including doctors, intensivists, anaesthetists, surgeons, specialist nurses, echocardiogram technicians, physiotherapists, psychologists, dentists, and dietitians. It provides care for children with congenital and acquired cardiac disease and is one of only two units in the UK to offer paediatric heart transplant. The complexity of cases means that there can be many teams involved in providing care to each patient, and frequent movement of children between ward, high dependency, and intensive care areas. Currently, there is no structured forum for communicating important information across the department, for example, staffing shortages, prescribing errors and significant events. Strategy: An initial survey questioning the need for better communication found 90% of respondents agreed that they could think of an incident that had occurred due to ineffective communication, and 85% felt that incident could have been avoided had there been a better form of communication. Lastly, 80% of respondents felt that a weekly 60 second safety briefing would be beneficial to improve communication within our multidisciplinary team. Based on those promising results, a weekly 60 second safety briefing was implemented to be conducted on a Monday morning. The safety briefing covered four key areas (SAFE): staffing, awareness, fix and events. This was to highlight any staffing gaps, any incident reports to be learned from, any issues that required fixing and any events including teachings for the week ahead. The teams were encouraged to email suggestions or issues to be raised for the week or to approach in person with information to add. The safety briefing was implemented using change theory. Effect: The safety briefing has been trialled over 6 weeks and has received a good buy in from staff across specialties. The aim is to embed this safety briefing into a weekly meeting using the PDSA cycle. There will be a second survey in one month to assess the efficacy of the safety briefing and to continue to improve the delivery of information. The project will be presented at the next clinical governance briefing to attract wider feedback and input from across the trust. Lessons: The briefing displays promise as a tool to improve vigilance and communication in a busy multi-disciplinary unit. We have learned about how to implement quality improvement and about the culture of our hospital - how hierarchy influences change. We demonstrate how to implement change through a grassroots process, using a junior led briefing to improve the efficiency, safety, and communication in the workplace.

Keywords: briefing, communication, safety, team

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Authors: G. Balaji, R. Balasundaraprabhu, S. Prasanna, M. D. Kannan, K. Sivakumaran, David Mcilroy

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Copper Zin tin sulphide (Cu2ZnSnS4 or CZTS) is found to be better alternative to Copper Indium gallium diselenide as absorber layers in thin film based solar cells due to the utilisation of earth-abundant materials in the midst of lower toxicity. In the present study, Cu2ZnSnS4 thin films were prepared on soda lime glass using (CuS, ZnS, SnS) targets and were deposited by three different stacking orders, using RF Magnetron sputtering. The substrate temperature was fixed at 300 °C during the depositions. CZTS thin films were characterized using X-ray diffraction, X-ray photoelectron spectroscopy, Raman spectroscopy and UV-Vis-NIR spectroscopy. All the samples exhibited X-ray peaks pertaining to (112) kesterite phase of CZTS, along with the presence of a predominant wurtzite CZTS phase. X-ray photoelectron spectroscopy revealed the presence of all the elements in all the samples. The change in stacking order clearly shows that it affects the structural and phase properties of the films. Relative atomic concentrations of Zn, Cu, Sn and S, which are determined by high-resolution XPS core level spectra integrated peak areas revealed that the CZTS films exhibit inhomogeneity in both stoichiometry and elemental composition. Raman spectroscopy studies on the film showed the presence of CZTS phase. The energy band gap of the CZTS thin films was found to be in the range of 1.5 eV to 1.6 eV. The films were then annealed at 450 °C for 5 hrs and it was found that the predominant nature of the X-ray peaks has transformed from Wurtzite to Kesterite phase which is highly desirable for absorber layers in thin film solar cells. The optimized CZTS layer was used as an absorber layer in thin film solar cells. ZnS and CdS were used as buffer layers which in turn prepared by Hot wall epitaxy technique. Gallium doped Zinc oxide was used as a transparent conducting oxide. The solar cell structure Glass/Mo/CZTS/CdS or ZnS/GZO has been fabricated, and solar cell parameters were measured.

Keywords: earth-abundant, Kesterite, RF sputtering, thin film solar cells

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Authors: C. O. Igberi, M. U. Amadi

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This research paper on the impact of import restriction on rice production in Nigeria is aimed at finding/proffering valid solutions to the age long problem of rice self-sufficiency, through a better understanding of policy measures used in the past, in this case, the effectiveness of rice import restriction of the early 90’s. It tries to answer the questions of; import restriction boosting domestic rice production and the macroeconomic determining factors of Gross Domestic Rice Product (GDRP). The research probe is investigated through literature and analytical frameworks, such that time series data on the GDRP, Gross Fixed Capital Formation (GFCF), average foreign rice producers’ prices(PPF), domestic producers’ prices (PPN) and the labour force (LABF) are collated for analysis (with an import restriction dummy variable, POL1). The research objectives/hypothesis are analysed using; Cointegration, Vector Error Correction Model (VECM), Impulse Response Function (IRF) and Granger Causality Test(GCT) methodologies. Results show that in the short-run error correction specification for GDRP, a percentage (1%) deviation away from the long-run equilibrium in a current quarter is only corrected by 0.14% in the subsequent quarter. Also, the rice import restriction policy had no significant effect on the GDRP at this time. Other findings show that the policy period has, in fact, had effects on the PPN and LABF. The choice variables used are valid macroeconomic factors that explain the GDRP of Nigeria, as adduced from the IRF and GCT, and in the long-run. Policy recommendations suggest that the import restriction is not disqualified as a veritable tool for improving domestic rice production, rather better enforcement procedures and strict adherence to the policy dictates is needed. Furthermore, accompanying policies which drive public and private capital investment and accumulation must be introduced. Also, employment rate and labour substitution in the agricultural sector should not be drastically changed, rather its welfare and efficiency be improved.

Keywords: import restriction, gross domestic rice production, cointegration, VECM, Granger causality, impulse response function

Procedia PDF Downloads 181

Authors: Leszek Szpakowski, Daniel Celiński, Sławomir Pilip, Grzegorz Michalak

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The aim of the study was to analyse the usefulness of the 'E-rescuer' pilot project planned to be implemented in a chosen area of Eastern Poland in the cases of suspected sudden cardiac arrests in the extra-urban areas. Inventing an application allowing to dispatch simultaneously both Medical Emergency Teams and the E-rescuer to the place of the accident is the crucial assumption of the mentioned pilot project. The E-rescuer is defined to be the trained person able to take effective basic life support and to use automated external defibrillator. Having logged in using a smartphone, the E-rescuer's readiness is reported online to provide cardiopulmonary resuscitation exactly at the given location. Due to the accurately defined location of the E-rescuer, his arrival time is possible to be precisely fixed, and the substantive support through the displayed algorithms is capable of being provided as well. Having analysed the medical records in the years 2015-2016, cardiopulmonary resuscitation was considered to be effective when an early indication of circulation was provided, and the patient was taken to hospital. In the mentioned term, there were 2.291 cases of a sudden cardiac arrest. Cardiopulmonary resuscitation was taken in 621 patients in total including 205 people in the urban area and 416 in the extra-urban areas. The effectiveness of cardiopulmonary resuscitation in the extra-urban areas was much lower (33,8%) than in the urban (50,7%). The average ambulance arrival time was respectively longer in the extra-urban areas, and it was 12,3 minutes while in the urban area 3,3 minutes. There was no significant difference in the average age of studied patients - 62,5 and 64,8 years old. However, the average ambulance arrival time was 7,6 minutes for effective resuscitations and 10,5 minutes for ineffective ones. Hence, the ambulance arrival time is a crucial factor influencing on the effectiveness of cardiopulmonary resuscitation, especially in the extra-urban areas where it is much longer than in the urban. The key role of trained E-rescuers being nearby taking basic life support before the ambulance arrival can effectively support Emergency Medical Services System in Poland.

Keywords: basic life support, bystander, effectiveness, resuscitation

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Authors: Peter Falanga

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During the process of de-Stalinization that began in 1956 with the Twentieth Congress of the Soviet Communist Party, many filmmakers in Hungary chose to explore their country’s political discomforts by using Socialist Realism as a negative model against which they could react to the dominating ideology. A renewed national film industry and a more permissive political regime would allow filmmakers to take to task the plight of the preceding generation who had experienced the fatal political turmoil of both World Wars and the purges of Stalin. What follows is no longer the multigenerational unity found in Socialist Realism wherein both the old and the young embrace Stalin’s revolutionary optimism; instead, the protagonists are parentless, and thus their connection to the previous generation is partially severed. In these films, violent historical forces leave one generation to search for both a connection with their family’s past, and for moral guidance to direct their future. István Szabó’s Father (1966), Márta Mészáros Diary for My Children (1984), and Pál Gábor’s Angi Vera (1978) each consider the fraught relationship between successive generations through the lens of postwar youth. A characteristic each of their protagonist’s share is that they are all missing one or both parents, and cope with familial loss either through recalling memories of their parents in dream-like sequences, or, in the case of Angi Vera, through embracing the surrogate paternalism that the Communist Party promises to provide. This paper considers the argument these films present about the progress of Hungarian history, and how this topic is explored in more recent films that similarly focus on the transmission of generational values. Scholars such as László Strausz and John Cunningham have written on the continuous concern with the transmission of generational values in more recent films such as István Szabó’s Sunshine (1999), Béla Tarr’s Werckmeister Harmonies (2000), György Pálfi’s Taxidermia (2006), Ágnes Kocsis’ Pál Adrienn (2010), and Kornél Mundruczó’s Evolution (2021). These films, they argue, make intimate portrayals of the various sweeping political changes in Hungary’s history and question how these epochs or events have impacted Hungarian identities. If these films attempt to personalize historical shifts of Hungary, then what is the significance of featuring characters who have lost one or both parents? An attempt to understand this coherent trend in Hungarian cinema will profit from examining the earlier, celebrated films of Szabó, Mészáros, and Gábor, who inaugurated this preoccupation with generational values. The pervasive interplay of dreams and memory in their films invites an additional element to their argument concerning historical progression. This paper incorporates Richard Teniman’s notion of the “dialectics of memory” in which memory is in a constant process of negation and reinvention to explain why these Directors prefer to explore Hungarian identity through the disarranged form of psychological realism over the linear causality structure of historical realism.

Keywords: film theory, Eastern European Studies, film history, Eastern European History

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Authors: Nurlan Smagulov, Aiman Konkabayeva, Akerke Sadykova, Arailym Serik

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Introduction. Adverse environmental factors do not immediately lead to pathological changes in the body. They can exert the growth of pre-pathology characterized by shifts in physiological, biochemical, immunological and other indicators of the body state. These disorders are unstable, reversible and indicative of body reactions. There is an opportunity to objectively judge the internal structure of the adaptive body reactions at the level of individual organs and systems. In order to obtain a stable response of the body to the chronic effects of unfavorable environmental factors of low intensity (compared to production environment factors), a time called the «lag time» is needed. The obtained results without considering this factor distort reality and, for the most part, cannot be a reliable statement of the main conclusions in any work. A technique is needed to reduce methodological errors and combine mathematical logic using statistical methods and a medical point of view, which ultimately will affect the obtained results and avoid a false correlation. Objective. Development of a methodology for assessing and predicting the environmental factors impact on the population health considering the «lag time.» Methods. Research objects: environmental and population morbidity indicators. The database on the environmental state was compiled from the monthly newsletters of Kazhydromet. Data on population morbidity were obtained from regional statistical yearbooks. When processing static data, a time interval (lag) was determined for each «argument-function» pair. That is the required interval, after which the harmful factor effect (argument) will fully manifest itself in the indicators of the organism's state (function). The lag value was determined by cross-correlation functions of arguments (environmental indicators) with functions (morbidity). Correlation coefficients (r) and their reliability (t), Fisher's criterion (F) and the influence share (R2) of the main factor (argument) per indicator (function) were calculated as a percentage. Results. The ecological situation of an industrially developed region has an impact on health indicators, but it has some nuances. Fundamentally opposite results were obtained in the mathematical data processing, considering the «lag time». Namely, an expressed correlation was revealed after two databases (ecology-morbidity) shifted. For example, the lag period was 4 years for dust concentration, general morbidity, and 3 years – for childhood morbidity. These periods accounted for the maximum values of the correlation coefficients and the largest percentage of the influencing factor. Similar results were observed in relation to the concentration of soot, dioxide, etc. The comprehensive statistical processing using multiple correlation-regression variance analysis confirms the correctness of the above statement. This method provided the integrated approach to predicting the degree of pollution of the main environmental components to identify the most dangerous combinations of concentrations of leading negative environmental factors. Conclusion. The method of assessing the «environment-public health» system (considering the «lag time») is qualitatively different from the traditional (without considering the «lag time»). The results significantly differ and are more amenable to a logical explanation of the obtained dependencies. The method allows presenting the quantitative and qualitative dependence in a different way within the «environment-public health» system.

Keywords: ecology, morbidity, population, lag time

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Authors: Siming Wang, Qing Ni, Yu Wu, Ruihai Xu, Hong Ye

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Porous electric heaters, compared to conventional electric heaters, exhibit excellent heating performance due to their large specific surface area. Porous electric heaters employ porous metallic materials or conductive porous ceramics as the heating element. The former attains a low heating power with a fixed current due to the low electrical resistivity of metal. Although the latter can bypass the inherent challenges of porous metallic materials, the fabrication process of the conductive porous ceramics is complicated and high cost. This work proposed a porous ceramic electric heater with dielectric honeycomb ceramic as a substrate and surface conductive coating as a heating element. The conductive coating was prepared by the sol-gel method using silica sol and methyl trimethoxysilane as raw materials and graphite powder as conductive fillers. The conductive mechanism and degradation reason of the conductive coating was studied by electrical resistivity and thermal stability analysis. The heating performance of the proposed heater was experimentally investigated by heating air and deionized water. The results indicate that the electron transfer is achieved by forming the conductive network through the contact of the graphite flakes. With 30 wt% of graphite, the electrical resistivity of the conductive coating can be as low as 0.88 Ω∙cm. The conductive coating exhibits good electrical stability up to 500°C but degrades beyond 600°C due to the formation of many cracks in the coating caused by the weight loss and thermal expansion. The results also show that the working medium has a great influence on the volume power density of the heater. With air under natural convection as the working medium, the volume power density attains 640.85 kW/m3, which can be increased by 5 times when using deionized water as the working medium. The proposed honeycomb ceramic electric heater has the advantages of the simple fabrication method, low cost, and high volume power density, demonstrating great potential in the fluid heating field.

Keywords: conductive coating, honeycomb ceramic electric heater, high specific surface area, high volume power density

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Authors: Tugba Altin

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In an era where the impacts of climate change resonate more pronouncedly than ever, communities globally grapple with events bearing both tangible and intangible ramifications. Situating this within the evolving landscapes of Psychological and Behavioral Sciences, this research probes the profound psychological and behavioral responses evoked by such events. The Lytton Creek Fire of 2021 epitomizes these challenges. While tangible destruction is immediate and evident, the intangible repercussions—emotional distress, disintegration of cultural landscapes, and disruptions in place attachment (PA)—require meticulous exploration. PA, emblematic of the emotional and cognitive affiliations individuals nurture with their environments, emerges as a cornerstone for comprehending how environmental cataclysms influence cultural identity and bonds to land. This study, harmonizing the core tenets of an interpretive phenomenological approach with a hermeneutic framework, underscores the pivotal nature of this attachment. It delves deep into the realm of individuals' experiences post the Lytton Creek Fire, unraveling the intricate dynamics of PA amidst such calamity. The study's methodology deviates from conventional paradigms. Instead of traditional interview techniques, it employs walking audio sessions and photo elicitation methods, granting participants the agency to immerse, re-experience, and vocalize their sentiments in real-time. Such techniques shed light on spatial narratives post-trauma and capture the otherwise elusive emotional nuances, offering a visually rich representation of place-based experiences. Central to this research is the voice of the affected populace, whose lived experiences and testimonies form the nucleus of the inquiry. As they renegotiate their bonds with transformed environments, their narratives reveal the indispensable role of cultural landscapes in forging place-based identities. Such revelations accentuate the necessity of integrating both tangible and intangible trauma facets into community recovery strategies, ensuring they resonate more profoundly with affected individuals. Bridging the domains of environmental psychology and behavioral sciences, this research accentuates the intertwined nature of tangible restoration with the imperative of emotional and cultural recuperation post-environmental disasters. It advocates for adaptation initiatives that are rooted in the lived realities of the affected, emphasizing a holistic approach that recognizes the profundity of human connections to landscapes. This research advocates the interdisciplinary exchange of ideas and strategies in addressing post-disaster community recovery strategies. It not only enriches the climate change discourse by emphasizing the human facets of disasters but also reiterates the significance of an interdisciplinary approach, encompassing psychological and behavioral nuances, for fostering a comprehensive understanding of climate-induced traumas. Such a perspective is indispensable for shaping more informed, empathetic, and effective adaptation strategies.

Keywords: place attachment, community recovery, disaster response, restorative landscapes, sensory response, visual methodologies

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Authors: Ferdinando Montemari, Antonio Vitale, Nicola Genito, Giovanni Cuciniello

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The introduction of tilt-rotor aircraft into the existing civilian air transportation system will provide beneficial effects due to tilt-rotor capability to combine the characteristics of a helicopter and a fixed-wing aircraft into one vehicle. The disposability of reliable tilt-rotor simulation models supports the development of such vehicle. Indeed, simulation models are required to design automatic control systems that increase safety, reduce pilot's workload and stress, and ensure the optimal aircraft configuration with respect to flight envelope limits, especially during the most critical flight phases such as conversion from helicopter to aircraft mode and vice versa. This article presents a process to build a simplified tilt-rotor simulation model, derived from the analysis of flight data. The model aims to reproduce the complex dynamics of tilt-rotor during the in-flight conversion phase. It uses a set of scheduled linear transfer functions to relate the autopilot reference inputs to the most relevant rigid body state variables. The model also computes information about the rotor flapping dynamics, which are useful to evaluate the aircraft control margin in terms of rotor collective and cyclic commands. The rotor flapping model is derived through a mixed theoretical-empirical approach, which includes physical analytical equations (applicable to helicopter configuration) and parametric corrective functions. The latter are introduced to best fit the actual rotor behavior and balance the differences existing between helicopter and tilt-rotor during flight. Time-domain system identification from flight data is exploited to optimize the model structure and to estimate the model parameters. The presented model-building process was applied to simulated flight data of the ERICA Tilt-Rotor, generated by using a high fidelity simulation model implemented in FlightLab environment. The validation of the obtained model was very satisfying, confirming the validity of the proposed approach.

Keywords: flapping dynamics, flight dynamics, system identification, tilt-rotor modeling and simulation

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Authors: Kausar Harun, Ahmad Azmin Mohamad

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Zinc oxide (ZnO) has been extensively used in optoelectronic devices, with recent interest as photoanode material in dye-sensitize solar cell. Numerous methods employed to experimentally synthesized ZnO, while some are theoretically-modeled. Both approaches provide information on ZnO properties, but theoretical calculation proved to be more accurate and timely effective. Thus, integration between these two methods is essential to intimately resemble the properties of synthesized ZnO. In this study, experimentally-grown ZnO nanoparticles were prepared by sol-gel storage method with zinc acetate dihydrate and methanol as precursor and solvent. A 1 M sodium hydroxide (NaOH) solution was used as stabilizer. The optimum time to produce ZnO nanoparticles were recorded as 12 hours. Phase and structural analysis showed that single phase ZnO produced with wurtzite hexagonal structure. Further work on quantitative analysis was done via Rietveld-refinement method to obtain structural and crystallite parameter such as lattice dimensions, space group, and atomic coordination. The lattice dimensions were a=b=3.2498Å and c=5.2068Å which were later used as main input in first-principles calculations. By applying density-functional theory (DFT) embedded in CASTEP computer code, the structure of synthesized ZnO was built and optimized using several exchange-correlation functionals. The generalized-gradient approximation functional with Perdew-Burke-Ernzerhof and Hubbard U corrections (GGA-PBE+U) showed the structure with lowest energy and lattice deviations. In this study, emphasize also given to the modification of valence electron energy level to overcome the underestimation in DFT calculation. Both Zn and O valance energy were fixed at Ud=8.3 eV and Up=7.3 eV, respectively. Hence, the following electronic and optical properties of synthesized ZnO were calculated based on GGA-PBE+U functional within ultrasoft-pseudopotential method. In conclusion, the incorporation of Rietveld analysis into first-principles calculation was valid as the resulting properties were comparable with those reported in literature. The time taken to evaluate certain properties via physical testing was then eliminated as the simulation could be done through computational method.

Keywords: density functional theory, first-principles, Rietveld-refinement, ZnO nanoparticles

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Authors: Garreth Kestell, Lukah Dykes, Danielle Zerk, Kyla Trewartha, Rhianon Marshall, Elena Rudnik

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Adolescent mental health is an international priority and the impact of innovative service models must be evaluated. Secondary school-based mental health services (SBMHS) involving private general practitioners and psychologists are a model of care being trialed in South Australia. Measures of depression, anxiety, and stress are routinely collected throughout psychotherapy sessions. This research set out to quantify the impact of psychotherapy for rural adolescents in a school setting and explore the importance of session frequency. Methods: Demographics, session date and DASS21 scores from students (n=65) seen in 2016 by three psychologists working at the SBMHS were recorded. Students were aged 13-18 years (M=15.43, SD= 1.24), mostly female (F=51, M=14), attended between 1 and 23 sessions with a median of 6 sessions (MAD 5.93) in one-year. The treating psychologist collected self-administered DASS21 scores. A mixed model analysis was used with age, sex, treating psychologist, months from first session, and session number as fixed effects, with response variables of DASS depression, anxiety, and stress scores. Results: 71.5% were classified as having extreme or severe anxiety and half had extreme or severe depression and/or stress scores. On average males had a greater increase in DASS scores over time but males attending more sessions benefited most from therapy. Discussion: Psychologists are treating rural adolescents in schools for severe anxiety, depression, and stress. This pilot study indicates that a predictive model combining demographics, session frequency, and DASS scores may help identify who is most likely to benefit from individual psychotherapy. Variations in DAS scores of individuals over time indicate the need for the collection of information such as living situation and exposure to alcohol. A larger sample size and additional data are currently being collected to allow for a more robust analysis.

Keywords: adolescent health, psychotherapy, school based mental health services, DAS21

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Authors: Hanan Badr, Fahad Manee, Rao Shashidhar, Omar Bayoumy

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Introduction: Hypertension is the major risk factor for cardiovascular diseases and stroke and a universe leading cause of disability-adjusted life years and mortality. Adopting an unhealthy lifestyle is thought to be associated with developing hypertension regardless of predisposing genetic factors. This study aimed to examine the association between recreational physical activity (RPA), and sedentary behaviors with a risk of hypertension among ministry employees, where there is no role for occupational physical activity (PA), and to scrutinize participants’ time spent in RPA and sedentary behaviors on the working and weekend days. Methods: A cross-sectional study was conducted among randomly selected 2562 employees working at ten randomly selected ministries in Kuwait. To have a representative sample, the proportional allocation technique was used to define the number of participants in each ministry. A self-administered questionnaire was used to collect data about participants' socio-demographic characteristics, health status, and their 24 hours’ time use during a regular working day and a weekend day. The time use covered a list of 20 different activities practiced by a person daily. The New Zealand Physical Activity Questionnaire-Short Form (NZPAQ-SF) was used to assess the level of RPA. The scale generates three categories according to the number of hours spent in RPA/week: relatively inactive, relatively active, and highly active. Gender-matched trained nurses performed anthropometric measurements (weight and height) and measuring blood pressure (two readings) using an automatic blood pressure monitor (95% accuracy level compared to a calibrated mercury sphygmomanometer). Results: Participants’ mean age was 35.3±8.4 years, with almost equal gender distribution. About 13% of the participants were smokers, and 75% were overweight. Almost 10% reported doctor-diagnosed hypertension. Among those who did not, the mean systolic blood pressure was 119.9±14.2 and the mean diastolic blood pressure was 80.9±7.3. Moreover, 73.9% of participants were relatively physically inactive and 18% were highly active. Mean systolic and diastolic blood pressure showed a significant inverse association with the level of RPA (means of blood pressure measures were: 123.3/82.8 among relatively inactive, 119.7/80.4 among relatively active, and 116.6/79.6 among highly active). Furthermore, RPA occupied 1.6% and 1.8% of working and weekend days, respectively, while sedentary behaviors (watching TV, using electronics for social media or entertaining, etc.) occupied 11.2% and 13.1%, respectively. Sedentary behaviors were significantly associated with high levels of systolic and diastolic blood pressure. Binary logistic regression revealed that physical inactivity (OR=3.13, 95% CI: 2.25-4.35) and sedentary behaviors (OR=2.25, CI: 1.45-3.17) were independent risk factors for high systolic and diastolic blood pressure after adjustment for other covariates. Conclusions: Physical inactivity and sedentary lifestyle were associated with a high risk of hypertension. Further research to examine the independent role of RPA in improving blood pressure levels and cultural and occupational barriers for practicing RPA are recommended. Policies should be enacted in promoting PA in the workplace that might help in decreasing the risk of hypertension among sedentary occupation workers.

Keywords: physical activity, sedentary behaviors, hypertension, workplace

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Authors: Erwin Geroleo, Higinio Mappala

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Introduction Overt Hepatic Encephalopathy (OHE) is the most dreaded outcome of liver cirrhosis. Aside from the triggering factors which are already known to precipitate OHE, there is growing evidence that an altered gut microbiota profile (dysbiosis) can also trigger OHE. MHE is the mildest form of hepatic encephalopathy(HE), affecting about one-third of patients with cirrhosis, and close 80% of patients with cirrhosis and manifests as abnormalities in central nervous system function. Since these symptoms are subclinical most patients are not being treated to prevent OHE. The gut microbiota have been evaluated by several studies as a therapeutic option for MHE, especially in decreasing the levels of ammonia, thus preventing progression to OHE Objectives This study aims to evaluate the efficacy of probiotics in terms of reduction of ammonia levels in patient with minimal hepatic encephalopathies and to determine if Probiotics has role in the prevention of progression to overt hepatic encephalopathy in adult patients with minimal hepatic encephalopathy (MHE) Methods and Analysis The literature search strategy was restricted to human studies in adults subjects from 2004 to 2022. The Jadad Score Calculation was utilized in the assessment of the final studies included in this study. Eight (8) studies were included. Cochrane’s Revman Web, the Fixed Effects model and the Ztest were all used in the overall analysis of the outcomes. A p value of less than 0.0005 was statistically significant. Results. These results show that Probiotics significantly lowers the level of Ammonia in Cirrhotic patients with OHE. It also shows that the use of Probiotics significantly prevents the progression of MHE to OHE. The overall risk of bias graph indicates low risk of publication bias among the studies included in the meta-analysis. Main findings This research found that plasma ammonia concentration was lower among participants treated with probiotics (p<0.00001).) Ammonia level of the probiotics group is lower by 13.96 μmol/ on the average. Overall risk of developing overt hepatic encephalopathy in the probiotics group is shown to be decreased by 15% as compared to the placebo group Conclusion The analysis showed that compared with placebo, probiotics can decrease serum ammonia, may improve MHE and may prevent OHE.

Keywords: minimal hepatic encephalopathy, probiotics, liver cirrhosis, overt hepatic encephalopathy

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Authors: Pedro Llanos, Diego García

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Spaceflight is considered the last frontier in terms of science, technology, and engineering. But it is also the next frontier in terms of human physiology and performance. After more than 200,000 years humans have evolved under earth’s gravity and atmospheric conditions, spaceflight poses environmental stresses for which human physiology is not adapted. Hypoxia, accelerations, and radiation are among such stressors, our research involves suborbital flights aiming to develop effective countermeasures in order to assure sustainable human space presence. The physiologic baseline of spaceflight participants is subject to great variability driven by age, gender, fitness, and metabolic reserve. The objective of the present study is to characterize different physiologic variables in a population of STEM practitioners during an aerobatic flight. Cardiovascular and pulmonary responses were determined in Science Astronaut Candidates (SACs) during unusual attitude aerobatic flight indoctrination. Physiologic data recordings from 20 subjects participating in high-G flight training were analyzed. These recordings were registered by wearable sensor-vest that monitored electrocardiographic tracings (ECGs), signs of dysrhythmias or other electric disturbances during all the flight. The same cardiovascular parameters were also collected approximately 10 min pre-flight, during each high-G/unusual attitude maneuver and 10 min after the flights. The ratio (pre-flight/in-flight/post-flight) of the cardiovascular responses was calculated for comparison of inter-individual differences. The resulting tracings depicting the cardiovascular responses of the subjects were compared against the G-loads (Gs) during the aerobatic flights to analyze cardiovascular variability aspects and fluid/pressure shifts due to the high Gs. In-flight ECG revealed cardiac variability patterns associated with rapid Gs onset in terms of reduced heart rate (HR) and some scattered dysrhythmic patterns (15% premature ventricular contractions-type) that were considered as triggered physiological responses to high-G/unusual attitude training and some were considered as instrument artifact. Variation events were observed in subjects during the +Gz and –Gz maneuvers and these may be due to preload and afterload, sudden shift. Our data reveal that aerobatic flight influenced the breathing rate of the subject, due in part by the various levels of energy expenditure due to the increased use of muscle work during these aerobatic maneuvers. Noteworthy was the high heterogeneity in the different physiological responses among a relatively small group of SACs exposed to similar aerobatic flights with similar Gs exposures. The cardiovascular responses clearly demonstrated that SACs were subjected to significant flight stress. Routine ECG monitoring during high-G/unusual attitude flight training is recommended to capture pathology underlying dangerous dysrhythmias in suborbital flight safety. More research is currently being conducted to further facilitate the development of robust medical screening, medical risk assessment approaches, and suborbital flight training in the context of the evolving commercial human suborbital spaceflight industry. A more mature and integrative medical assessment method is required to understand the physiology state and response variability among highly diverse populations of prospective suborbital flight participants.

Keywords: g force, aerobatic maneuvers, suborbital flight, hypoxia, commercial astronauts

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Authors: Evonne Kaplan-Liss, Val Lantz-Gefroh

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Arts and humanities are often incorporated into medical education to help deepen understanding of the human condition and the ability to communicate from a place of compassion. However, a gap remains in our knowledge of compassionate communication training for postgraduate medical professionals (as opposed to students and residents); how training opportunities include and impact the artists themselves, and how train-the-trainer models can support learners to become teachers. In this report, the authors present results from a pilot evaluation of the UC San Diego Health: Sanford Compassionate Communication Fellowship, a 60-hour experiential program that uses theater, narrative reflection, poetry, literature, and journalism techniques to train a multidisciplinary cohort of medical professionals and artists in compassionate communication. In the culminating project, fellows design and implement their own projects as teachers of compassionate communication in their respective workplaces. Qualitative methods, including field notes and 30-minute Zoom interviews with each fellow, were used to evaluate the impact of the fellowship. The cohort included both artists (n=2) and physicians representing a range of specialties (n=7), such as occupational medicine, palliative care, and pediatrics. The authors coded the data using thematic analysis for evidence of how the multidisciplinary nature of the fellowship impacted the fellows’ experiences. The findings show that the multidisciplinary cohort contributed to a greater appreciation of compassionate communication in general. Fellows expressed that the ability to witness how those in different fields approached compassionate communication enhanced their learning and helped them see how compassion can be expressed in various contexts, which was both “exhilarating” and “humbling.” One physician expressed that the fellowship has been “really helpful to broaden my perspective on the value of good communication.” Fellows shared how what they learned in the fellowship translated to increased compassionate communication, not only in their professional roles but in their personal lives as well. A second finding was the development of a supportive community. Because each fellow brought their own experiences and expertise, there was a sense of genuine ability to contribute as well as a desire to learn from others. A “brave space” was created by the fellowship facilitators and the inclusion of arts-based activities: a space that invited vulnerability and welcomed fellows to make their own meaning without prescribing any one answer or right way to approach compassionate communication. This brave space contributed to a strong connection among the fellows and reports of increased well-being, as well as multiple collaborations post-fellowship to carry forward compassionate communication training at their places of work. Results show initial evidence of the value of a multidisciplinary fellowship for promoting compassionate communication for both artists and physicians. The next steps include maintaining the supportive fellowship community and collaborations with a post-fellowship affiliate faculty program; scaling up the fellowship with non-physicians (e.g., nurses and physician assistants); and collecting data from family members, colleagues, and patients to understand how the fellowship may be creating a ripple effect outside of the fellowship through fellows’ compassionate communication.

Keywords: compassionate communication, communication in healthcare, multidisciplinary learning, arts in medicine

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Authors: Swati Swati, Yuhang Chen, Robert Reuben

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Coronary stents are devices resembling the shape of a tube which are placed in coronary arteries, to keep the arteries open in the treatment of coronary arterial diseases. Coronary stents are routinely deployed to clear atheromatous plaque. The stent essentially applies an internal pressure to the artery because its structure is cylindrically symmetrical and this may introduce some abnormalities in final arterial shape. The goal of the project is to develop segmented circumferential arterial compliance measuring devices which can be deployed (eventually) in vivo. The segmentation of the device will allow the mechanical asymmetry of any stenosis to be assessed. The purpose will be to assess the quality of arterial tissue for applications in tailored stents and in the assessment of aortic aneurism. Arterial distensibility measurement is of utmost importance to diagnose cardiovascular diseases and for prediction of future cardiac events or coronary artery diseases. In order to arrive at some generic outcomes, a preliminary experimental set-up has been devised to establish the measurement principles for the device at macro-scale. The measurement methodology consists of a strain gauge system monitored by LABVIEW software in a real-time fashion. This virtual instrument employs a balloon within a gelatine model contained in a split cylinder with strain gauges fixed on it. The instrument allows automated measurement of the effect of air-pressure on gelatine and measurement of strain with respect to time and pressure during inflation. Compliance simple creep model has been applied to the results for the purpose of extracting some measures of arterial compliance. The results obtained from the experiments have been used to study the effect of air pressure on strain at varying time intervals. The results clearly demonstrate that with decrease in arterial volume and increase in arterial pressure, arterial strain increases thereby decreasing the arterial compliance. The measurement system could lead to development of portable, inexpensive and small equipment and could prove to be an efficient automated compliance measurement device.

Keywords: arterial compliance, atheromatous plaque, mechanical symmetry, strain measurement

Procedia PDF Downloads 255

Authors: A. Flaviana da Silva, B. Jenifer Apriani Ximenes, C. Efigenia dos Santos Pereira

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The World Health Organization's 2022 Global Oral Health Status Report reveals a staggering statistic: more than 3.5 billion people, or half of the world's population, currently suffer from untreated oral diseases, encompassing issues like tooth loss, gum disease, and oral cancers. Among these, dental caries, commonly known as tooth decay, affects over 2.5 billion people globally. Dental caries result from acid erosion of teeth due to plaque build-up and consumption of free sugars. Despite being preventable through basic measures such as regular tooth-brushing with fluoride toothpaste and reduced sugar intake, untreated dental caries poses a significant and growing public health crisis. In children, dental caries stands as the most prevalent non-communicable disease worldwide, affecting 60-90% of school children to some extent. This condition severely impacts their physical, emotional, and social well-being, hindering essential activities and overall quality of life. Timor-Leste, a small nation in South-east Asia, grapples with the escalating problem of childhood dental caries, exacerbated by its unique challenges including poor access to healthcare services and limited resources. Methods: This study analysed Secondary, cross-sectional data collected by Maluk Timor in 2022 during the School Outreach Program. A total of 1,008 children aged 4-16 from eight primary schools in the Bazartete administrative post were examined for dental caries in their primary and permanent teeth. All students were invited to participate, and consent was obtained from parents and children. A team comprising one dentist and two dental nurses conducted health promotion sessions, dental examinations, and SDF treatment. A screening form based on WHO guidelines collected demographic data and caries diagnosis, categorized as decayed or healthy. Data analysis involved entering the data into Google Sheets, verifying its accuracy, and importing it into Microsoft Excel for analysis. Variables were created to identify students with carious lesions, and prevalence tables were generated, stratified by age group, gender, and location. Results: Among the 1,008 children analysed, 58.3% had dental caries. Caries prevalence was higher in primary teeth (36.7%) compared to permanent teeth (29.5%). Conclusion: In summary, this report highlights the alarming prevalence of dental caries among children in Timor-Leste and the efforts of Maluk Timor's School Outreach Program in addressing this critical issue. The results emphasize the need for effective preventive measures and improved access to oral healthcare in this region.

Keywords: dental caries, timor-leste, oral health, children, public health, primary health care, teeth

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Authors: M. F. Abreu, A. I. Aguiar, R. Gaio, R. Duarte

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Background: Prison establishments constitute high-risk environments for the transmission and spread of tuberculosis (TB), given their epidemiological context and the difficulty of implementing preventive and control measures. Guidelines for control and prevention of tuberculosis in prisons have been described as incomplete and heterogeneous internationally, due to several identified obstacles, for example scarcity of human resources and funding of prisoner health services. In Portugal, a protocol was created in 2014 with the aim to define and standardize procedures of detection and prevention of tuberculosis within prisons. Objective: The main objective of this study was to identify and describe barriers to tuberculosis detection in prisons of Porto and Lisbon districts in Portugal. Methods: A cross-sectional study was conducted from 2ⁿᵈ January 2018 till 30ᵗʰ June 2018. Semi-structured questionnaires were applied to health care professionals working in the prisons of the districts of Porto (n=6) and Lisbon (n=8). As inclusion criteria we considered having work experience in the area of tuberculosis (either in diagnosis, treatment, or follow up). The questionnaires were self-administered, in paper format. Descriptive analyses of the questionnaire variables were made using frequencies and median. Afterwards, a hierarchical agglomerative clusters analysis was performed. After obtaining the clusters, the chi-square test was applied to study the association between the variables collected and the clusters. The level of significance considered was 0.05. Results: From the total of 186 health professionals, 139 met the criteria of inclusion and 82 health professionals were interviewed (62,2% of participation). Most were female, nurses, with a median age of 34 years, with term employment contract. From the cluster analysis, two groups were identified with different characteristics and behaviors for the procedures of this protocol. Statistically significant results were found in: elements of cluster 1 (78% of the total participants) work in prisons for a longer time (p=0.003), 45,3% work > 4 years while 50% of the elements of cluster 2 work for less than a year, and more frequently answered they know and apply the procedures of the protocol (p=0.000). Both clusters answered frequently the need of having theoretical-practical training for TB (p=0.000), especially in the areas of diagnosis, treatment and prevention and that there is scarcity of funding to prisoner health services (p=0.000). Regarding procedures for TB screening (periodic and contact screening) and procedures for transferring a prisoner with this disease, cluster 1 also answered more frequently to perform them (p=0.000). They also referred that the material/equipment for TB screening is accessible and available (p=0.000). From this clusters we identified as barriers scarcity of human resources, the need to theoretical-practical training for tuberculosis, inexperience in working in health services prisons and limited knowledge of protocol procedures. Conclusions: The barriers found in this study are the same described internationally. This protocol is mostly being applied in portuguese prisons. The study also showed the need to invest in human and material resources. This investigation bridged gaps in knowledge that could help prison health services optimize the care provided for early detection and adherence of prisoners to treatment of tuberculosis.

Keywords: barriers, health care professionals, prisons, protocol, tuberculosis

Procedia PDF Downloads 123

Authors: Yang Gon Seo, Chang-Joon Kim, Dae Hyeok Kim

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It is estimated that 1.5 billion tires are produced worldwide each year which will eventually end up as waste tires representing a major potential waste and environmental problem. Pyrolysis has been great interest in alternative treatment processes for waste tires to produce valuable oil, gas and solid products. The oil and gas products may be used directly as a fuel or a chemical feedstock. The solid produced from the pyrolysis of tires ranges typically from 30 to 45 wt% and have high carbon contents of up to 90 wt%. However, most notably the solid have high sulfur contents from 2 to 3 wt% and ash contents from 8 to 15 wt% related to the additive metals. Upgrading tire pyrolysis products to high-value products has concentrated on solid upgrading to higher quality carbon black and to activated carbon. Hydrogen sulfide and ammonia are one of the common malodorous compounds that can be found in emissions from many sewages treatment plants and industrial plants. Therefore, removing these harmful gasses from emissions is of significance in both life and industry because they can cause health problems to human and detrimental effects on the catalysts. In this work, pyrolytic carbon black from waste tires was used to develop adsorbent with good adsorption capacity for removal of hydrogen and ammonia. Pyrolytic carbon blacks were prepared by pyrolysis of waste tire chips ranged from 5 to 20 mm under the nitrogen atmosphere at 600℃ for 1 hour. Pellet-type adsorbents were prepared by a mixture of carbon black, metal oxide and sodium hydroxide or hydrochloric acid, and their adsorption capacities were estimated by using the breakthrough curve of a continuous fixed bed adsorption column at ambient condition. The adsorbent was manufactured with a mixture of carbon black, iron oxide(III), and sodium hydroxide showed the maximum working capacity of hydrogen sulfide. For ammonia, maximum working capacity was obtained by the adsorbent manufactured with a mixture of carbon black, copper oxide(II), and hydrochloric acid.

Keywords: adsorbent, ammonia, pyrolytic carbon black, hydrogen sulfide, metal oxide

Procedia PDF Downloads 236

Authors: Ruth Leitch, Joanne Hughes

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This paper presents the findings of a three-year government-funded study (ILiAD) that aimed to understand the reasons for differential educational achievement within and between socially and economically deprived areas in Northern Ireland. Previous international studies have concluded that there is a positive correlation between deprivation and underachievement. Our preliminary secondary data analysis suggested that the factors involved in educational achievement within multiple deprived areas may be more complex than this, with some areas of high multiple deprivation having high levels of student attainment, whereas other less deprived areas demonstrated much lower levels of student attainment, as measured by outcomes on high stakes national tests. The study proposed that no single explanation or disparate set of explanations could easily account for the linkage between levels of deprivation and patterns of educational achievement. Using a social capital perspective that centralizes the connections within and between individuals and social networks in a community as a valuable resource for educational achievement, the ILiAD study involved a multi-level case study analysis of seven community sites in Northern Ireland, selected on the basis of religious composition (housing areas are largely segregated by religious affiliation), measures of multiple deprivation and differentials in educational achievement. The case study approach involved three (interconnecting) levels of qualitative data collection and analysis - what we have termed Micro (or community/grassroots level) understandings, Meso (or school level) explanations and Macro (or policy/structural) factors. The analysis combines a statistical mapping of factors with qualitative, in-depth data interpretation which, together, allow for deeper understandings of the dynamics and contributory factors within and between the case study sites. Thematic analysis of the qualitative data reveals both cross-cutting factors (e.g. demographic shifts and loss of community, place of the school in the community, parental capacity) and analytic case studies of explanatory factors associated with each of the community sites also permit a comparative element. Issues arising from the qualitative analysis are classified either as drivers or inhibitors of educational achievement within and between communities. Key issues that are emerging as inhibitors/drivers to attainment include: the legacy of the community conflict in Northern Ireland, not least in terms of inter-generational stress, related with substance abuse and mental health issues; differing discourses on notions of ‘community’ and ‘achievement’ within/between community sites; inter-agency and intra-agency levels of collaboration and joined-up working; relationship between the home/school/community triad and; school leadership and school ethos. At this stage, the balance of these factors can be conceptualized in terms of bonding social capital (or lack of it) within families, within schools, within each community, within agencies and also bridging social capital between the home/school/community, between different communities and between key statutory and voluntary organisations. The presentation will outline the study rationale, its methodology, present some cross-cutting findings and use an illustrative case study of the findings from a community site to underscore the importance of attending to community differences when trying to engage in research to understand and improve educational attainment for all.

Keywords: educational achievement, multiple deprivation, community case studies, social capital

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Authors: G. Vici, L. Cesanelli, L. Belli, R. Ceci, V. Polzonetti

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Several factors contribute to success in sport and diet is one of them. Evidence-based sport nutrition guidelines underline the importance of macro- and micro-nutrients’ balance and timing in order to improve athlete’s physical status and performance. Nevertheless, a high content of proteins is commonly found in resistance training athletes’ diet with carbohydrate intake that is not enough or not well planned. The aim of the study was to evaluate the impact of different protein and carbohydrate diet contents on body composition and sport performance on a group of resistance training athletes. Subjects were divided as study group (n=16) and control group (n=14). For a period of 4 months, both groups were subjected to the same resistance training fitness program with study group following a specific diet and control group following an ab libitum diet. Body compositions were evaluated trough anthropometric measurement (weight, height, body circumferences and skinfolds) and Bioimpedence Analysis. Physical strength and training status of individuals were evaluated through the One Repetition Maximum test (RM1). Protein intake in studied group was found to be lower than in control group. There was a statistically significant increase of body weight, free fat mass and body mass cell of studied group respect to the control group. Fat mass remains almost constant. Statistically significant changes were observed in quadriceps and biceps circumferences, with an increase in studied group. The MR1 test showed improvement in study group’s strength but no changes in control group. Usually people consume hyper-proteic diet to achieve muscle mass development. Through this study, it was possible to show that protein intake fixed at 1,7 g/kg/d can meet the individual's needs. In parallel, the increased intake of carbohydrates, focusing on quality and timing of assumption, has enabled the obtainment of desired results with a training protocol supporting a hypertrophic strategy. Therefore, the key point seems related to the planning of a structured program both from a nutritional and training point of view.

Keywords: body composition, diet, exercise, protein

Procedia PDF Downloads 206

Authors: Fatemeh Rouhi, Hadi Nassiri

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Earning forecast is a key element in economic decisions but there are some situations, such as conflicts of interest in financial reporting, complexity and lack of direct access to information has led to the phenomenon of information asymmetry among individuals within the organization and external investors and creditors that appear. The adverse selection and moral hazard in the investor's decision and allows direct assessment of the difficulties associated with data by users makes. In this regard, the role of trustees in corporate governance disclosure is crystallized that includes controls and procedures to ensure the lack of movement in the interests of the company's management and move in the direction of maximizing shareholder and company value. Therefore, the earning forecast of companies in the capital market and the need to identify factors influencing this study was an attempt to make relationship between moral hazard and corporate governance with earning forecast quality companies operating in the capital market and its impact on Earnings Forecasts quality by the company to be established. Getting inspiring from the theoretical basis of research, two main hypotheses and sub-hypotheses are presented in this study, which have been examined on the basis of available models, and with the use of Panel-Data method, and at the end, the conclusion has been made at the assurance level of 95% according to the meaningfulness of the model and each independent variable. In examining the models, firstly, Chow Test was used to specify either Panel Data method should be used or Pooled method. Following that Housman Test was applied to make use of Random Effects or Fixed Effects. Findings of the study show because most of the variables are positively associated with moral hazard with earnings forecasts quality, with increasing moral hazard, earning forecast quality companies listed on the Tehran Stock Exchange is increasing. Among the variables related to corporate governance, board independence variables have a significant relationship with earnings forecast accuracy and earnings forecast bias but the relationship between board size and earnings forecast quality is not statistically significant.

Keywords: corporate governance, earning forecast quality, moral hazard, financial sciences

Procedia PDF Downloads 296

Authors: Wisam Ismail, Sarah Hosgood, Michael Nicholson

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The research hypothesis is that early post-transplant allograft fibrosis will be linked to donor factors and that acute rejection and/or delayed graft function in the recipient will be independent risk factors for the development of fibrosis. This research hypothesis is to explore whether acute rejection/delay graft function has an effect on the renal transplant fibrosis within the first year post live donor kidney transplant between 1998 and 2009. Methods: The study has been designed to identify five time points of the renal transplant biopsies [0 (pre-transplant), 1 month, 3 months, 6 months and 12 months] for 300 live donor renal transplant patients over 12 years period between March 1997 – August 2009. Paraffin fixed slides were collected from Leicester General Hospital and Leicester Royal Infirmary. These were routinely sectioned at a thickness of 4 Micro millimetres for standardization. Conclusions: Fibrosis at 1 month after the transplant was found significantly associated with baseline fibrosis (p<0.001) and HTN in the transplant recipient (p<0.001). Dialysis after the transplant showed a weak association with fibrosis at 1 month (p=0.07). The negative coefficient for HTN (-0.05) suggests a reduction in fibrosis in the absence of HTN. Fibrosis at 1 month was significantly associated with fibrosis at baseline (p 0.01 and 95%CI 0.11 to 0.67). Fibrosis at 3, 6 or 12 months was not found to be associated with fibrosis at baseline (p=0.70. 0.65 and 0.50 respectively). The amount of fibrosis at 1 month is significantly associated with graft survival (p=0.01 and 95%CI 0.02 to 0.14). Rejection and severity of rejection were not found to be associated with fibrosis at 1 month. The amount of fibrosis at 1 month was significantly associated with graft survival (p=0.02) after adjusting for baseline fibrosis (p=0.01). Both baseline fibrosis and graft survival were significant predictive factors. The amount of fibrosis at 1 month was not found to be significantly associated with rejection (p=0.64) after adjusting for baseline fibrosis (p=0.01). The amount of fibrosis at 1 month was not found to be significantly associated with rejection severity (p=0.29) after adjusting for baseline fibrosis (p=0.04). Fibrosis at baseline and HTN in the recipient were found to be predictive factors of fibrosis at 1 month. (p 0.02, p <0.001 respectively). Age of the donor, their relation to the patient, the pre-op Creatinine, artery, kidney weight and warm time were not found to be significantly associated with fibrosis at 1 month. In this complex model baseline fibrosis, HTN in the recipient and cold time were found to be predictive factors of fibrosis at 1 month (p=0.01,<0.001 and 0.03 respectively). Donor age was found to be a predictive factor of fibrosis at 6 months. The above analysis was repeated for 3, 6 and 12 months. No associations were detected between fibrosis and any of the explanatory variables with the exception of the donor age which was found to be a predictive factor of fibrosis at 6 months.

Keywords: fibrosis, transplant, renal, rejection

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Authors: Engineer Dilnawaz Shah

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Solid Waste Management (SWM) is perhaps one of the most important elements constituting the environmental health and sanitation of the urban developing sector. The management system has several components that are integrated as well as interdependent; thus, the efficiency and effectiveness of the entire system are affected when any of its functional components fails or does not perform up to the level mark of operation. Sindh Solid Waste Management Board (SSWMB) is responsible for the management of solid waste in the entire city. There is a need to adopt the engineered approach in the redesigning of the existing system. In most towns, street sweeping operations have been mechanized and done by machinery operated by vehicles. Construction of Garbage Transfer Stations (GTS) at a number of locations within the city will cut the cost of transportation of waste to disposal sites. Material processing, recovery of recyclables, compaction, volume reduction, and increase in density will enable transportation of waste to disposal sites/landfills via long vehicles (bulk transport), minimizing transport/traffic and environmental pollution-related issues. Development of disposal sites into proper sanitary landfill sites is mandatory. The transportation mechanism is through garbage vehicles using either hauled or fixed container systems employing crew for mechanical or manual loading. The number of garbage vehicles is inadequate, and due to comparatively long haulage to disposal sites, there are certain problems of frequent vehicular maintenance and high fuel costs. Foreign investors have shown interest in enterprising improvement schemes and proposed operating a solid waste management system in Karachi. The waste to Energy option is being considered to provide a practical answer to be adopted to generate power and reduce waste load – a two-pronged solution for the increasing environmental problem. The paper presents results and analysis of a recent study into waste generation and characterization probing into waste-to-energy options for Karachi City.

Keywords: waste to energy option, integrated approach, solid waste management, physical and chemical composition of waste in Karachi

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Authors: Hanen Khanchel, Karim Ben Kahla

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Pharmaceutical companies are facing competition. Indeed, the price differences between competing products can be such that it becomes difficult to compensate them by differences in value added. The conditions of competition are no longer homogeneous for the players involved. The price of a product is a given that puts a company and its customer face to face. However, price fixing obliges the company to consider internal factors relating to production costs and external factors such as customer attitudes, the existence of regulations and the structure of the market on which the firm evolved. In setting the selling price, the company must first take into account internal factors relating to its costs: costs of production fall into two categories, fixed costs and variable costs that depend on the quantities produced. The company cannot consider selling below what it costs the product. It, therefore, calculates the unit cost of production to which it adds the unit cost of distribution, enabling it to know the unit cost of production of the product. The company adds its margin and thus determines its selling price. The margin is used to remunerate the capital providers and to finance the activity of the company and its investments. Production costs are related to the quantities produced: large-scale production generally reduces the unit cost of production, which is an asset for companies with mass production markets. This shows that small and medium-sized companies with limited market segments need to make greater efforts to ensure their profit margins. As a result, and faced with high and low market prices for raw materials and increasing staff costs, the company must seek to optimize its production time in order to reduce loads and eliminate waste. Then, the customer pays only value added. Thus, and based on this principle we decided to create a project that deals with the problem of waste in our company, and having as objectives the reduction of production costs and improvement of performance indicators. This paper presents the implementation of the Value Stream Mapping (VSM) project in a pharmaceutical company. It is structured as follows: 1) determination of the family of products, 2) drawing of the current state, 3) drawing of the future state, 4) action plan and implementation.

Keywords: VSM, waste, production time, kaizen, cartography, improvement

Procedia PDF Downloads 130

Authors: Ali Raza

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The dynamic landscape of communication has brought about significant advancements that intersect with the realms of public health and journalism. This abstract explores the evolving synergy between these fields, highlighting how their intersection has contributed to informed societies and improved public health outcomes. In the digital age, communication plays a pivotal role in shaping public perception, policy formulation, and collective action. Public health, concerned with safeguarding and improving community well-being, relies on effective communication to disseminate information, encourage healthy behaviors, and mitigate health risks. Simultaneously, journalism, with its commitment to accurate and timely reporting, serves as the conduit through which health information reaches the masses. Advancements in communication technologies have revolutionized the ways in which public health information is both generated and shared. The advent of social media platforms, mobile applications, and online forums has democratized the dissemination of health-related news and insights. This democratization, however, brings challenges, such as the rapid spread of misinformation and the need for nuanced strategies to engage diverse audiences. Effective collaboration between public health professionals and journalists is pivotal in countering these challenges, ensuring that accurate information prevails. The synergy between public health and journalism is most evident during public health crises. The COVID-19 pandemic underscored the pivotal role of journalism in providing accurate and up-to-date information to the public. However, it also highlighted the importance of responsible reporting, as sensationalism and misinformation could exacerbate the crisis. Collaborative efforts between public health experts and journalists led to the amplification of preventive measures, the debunking of myths, and the promotion of evidence-based interventions. Moreover, the accessibility of information in the digital era necessitates a strategic approach to health communication. Behavioral economics and data analytics offer insights into human decision-making and allow tailored health messages to resonate more effectively with specific audiences. This approach, when integrated into journalism, enables the crafting of narratives that not only inform but also influence positive health behaviors. Ethical considerations emerge prominently in this alliance. The responsibility to balance the public's right to know with the potential consequences of sensational reporting underscores the significance of ethical journalism. Health journalists must meticulously source information from reputable experts and institutions to maintain credibility, thus fortifying the bridge between public health and the public. As both public health and journalism undergo transformative shifts, fostering collaboration between these domains becomes essential. Training programs that familiarize journalists with public health concepts and practices can enhance their capacity to report accurately and comprehensively on health issues. Likewise, public health professionals can gain insights into effective communication strategies from seasoned journalists, ensuring that health information reaches a wider audience. In conclusion, the convergence of public health and journalism, facilitated by communication advancements, is a cornerstone of informed societies. Effective communication strategies, driven by collaboration, ensure the accurate dissemination of health information and foster positive behavior change. As the world navigates complex health challenges, the continued evolution of this synergy holds the promise of healthier communities and a more engaged and educated public.

Keywords: public awareness, journalism ethics, health promotion, media influence, health literacy

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Authors: Imad Khan, Imran Shafi, Sarmad Farooq

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Large diameter pipes, barrels, tubes, and ducts are used in a variety of applications covering civil and defense-related technologies. This may include heating/cooling networks, sign poles, bracing, casing, and artillery and tank gun barrels. These large diameter assemblies require regular inspection and cleaning to increase their life and reduce replacement costs. This paper describes the design, development, and testing results of an efficient yet simplified, low maintenance mechanical design controlled with minimal essential electronics using an electric motor for a non-technical staff. The proposed solution provides a simplified user interface and an automated cleaning mechanism that requires a single user to optimally clean pipes and barrels in the range of 105 mm to 203 mm caliber. The proposed system employs linear motion of specially designed brush along the barrel using a chain of specific strength and a pulley anchor attached to both ends of the barrel. A specially designed and manufactured gearbox is coupled with an AC motor to allow movement of contact brush with high torque to allow efficient cleaning. A suitably powered AC motor is fixed to the front adapter mounted on the muzzle side whereas the rear adapter has a pulley-based anchor mounted towards the breach block in case of a gun barrel. A mix of soft nylon and hard copper bristles-based large surface brush is connected through a strong steel chain to motor and anchor pulley. The system is equipped with limit switches to auto switch the direction when one end is reached on its operation. The testing results based on carefully established performance indicators indicate the superiority of the proposed user-friendly cleaning mechanism vis-à-vis its life cycle cost.

Keywords: pipe cleaning mechanism, limiting switch, pipe cleaning robot, large pipes

Procedia PDF Downloads 87

Authors: Alessandra Chiara Maraschin, Estelle Trengove

Abstract:

In South Africa, only 23% of engineering students attain their degrees in the minimum time of 4 years. This begs the question: Why is the 4-year throughput rate so low? Improving the throughput rate is crucial in assisting students to the shortest possible path to completion. The Electrical Engineering programme has a fixed curriculum and students must pass all courses in order to graduate. In South Africa, as is the case in several other countries, many students rely on external funding such as bursaries from companies in industry. If students fail a course, they often lose their bursaries, and most might not be able to fund their 'repeating year' fees. It is thus important to improve the throughput rate, since for many students, graduating from university is a way out of poverty for an entire family. In Electrical Engineering, it has been found that the Software Development I course (an introduction to C++ programming) is a significant hurdle course for students and has been found to have a low pass rate. It has been well-documented that students struggle with this type of course as it introduces a number of new threshold concepts that can be challenging to grasp in a short time frame. In an attempt to mitigate this situation, a part-time night-school for Software Development I was introduced in 2015 as an intervention measure. The course includes all the course material from the Software Development I module and allows students who failed the course in first semester a second chance by repeating the course through taking the night-school course. The purpose of this study is to determine whether the introduction of this intervention course could be considered a success. The success of the intervention is assessed in two ways. The study will first look at whether the night-school course contributed to improving the pass rate of the Software Development I course. Secondly, the study will examine whether the intervention contributed to improving the overall throughput from the 2nd year to the 3rd year of study at a South African University. Second year academic results for a sample of 1216 students have been collected from 2010-2017. Preliminary results show that the lowest pass rate for Software Development I was found to be in 2017 with a pass rate of 34.9%. Since the intervention course's inception, the pass rate for Software Development I has increased each year from 2015-2017 by 13.75%, 25.53% and 25.81% respectively. To conclude, the preliminary results show that the intervention course is a success in improving the pass rate of Software Development I.

Keywords: academic performance, electrical engineering, engineering education, intervention course, low pass rate, software development course, throughput

Procedia PDF Downloads 143

Authors: Kuo-Kai Lin, Po-Lun Chang

Abstract:

Research Background and Purpose: Following the development of the Internet and multimedia, the Internet and information technology have become crucial avenues of modern communication and knowledge acquisition. The advantages of using mobile devices for learning include making learning borderless and accessible. Mobile learning has become a trend in disease management and health promotion in recent years. End-stage renal disease (ESRD) is an irreversible chronic disease, and patients who do not receive kidney transplants can only rely on hemodialysis or peritoneal dialysis to survive. Due to the complexities in caregiving for patients with ESRD that stem from their advanced age and other comorbidities, the patients’ incapacity of self-care leads to an increase in the need to rely on their families or primary caregivers, although whether the primary caregivers adequately understand and implement patient care is a topic of concern. Therefore, this study explored whether primary caregivers’ health care provisions can be improved through the intervention of an automatic speech intelligent system, thereby improving the objective health outcomes of patients undergoing long-term dialysis. Method: This study developed an automatic speech intelligent system with healthcare functions such as health information voice prompt, two-way feedback, real-time push notification, and health information delivery. Convenience sampling was adopted to recruit eligible patients from a hemodialysis center at a regional teaching hospital as research participants. A one-group pretest-posttest design was adopted. Descriptive and inferential statistics were calculated from the demographic information collected from questionnaires answered by patients and primary caregivers, and from a medical record review, a health care scale (recorded six months before and after the implementation of intervention measures), a subjective health assessment, and a report of objective physiological indicators. The changes in health care behaviors, subjective health status, and physiological indicators before and after the intervention of the proposed automatic speech intelligent system were then compared. Conclusion and Discussion: The preliminary automatic speech intelligent system developed in this study was tested with 20 pretest patients at the recruitment location, and their health care capacity scores improved from 59.1 to 72.8; comparisons through a nonparametric test indicated a significant difference (p < .01). The average score for their subjective health assessment rose from 2.8 to 3.3. A survey of their objective physiological indicators discovered that the compliance rate for the blood potassium level was the most significant indicator; its average compliance rate increased from 81% to 94%. The results demonstrated that this automatic speech intelligent system yielded a higher efficacy for chronic disease care than did conventional health education delivered by nurses. Therefore, future efforts will continue to increase the number of recruited patients and to refine the intelligent system. Future improvements to the intelligent system can be expected to enhance its effectiveness even further.

Keywords: automatic speech intelligent system for health care, primary caregiver, long-term hemodialysis, health care capabilities, health outcomes

Procedia PDF Downloads 97