Search results for: academic information system

Authors: Abhishek Kumar Gupta

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Atomistic Molecular Dynamics (MD) Simulations have been performed to study the effect of monovalent salt i.e. NaCl concentration (Cs) and chain degree of neutralization (f) on the structure and dynamics of anionic poly(methacrylic acid) (PMA) in dilute aqueous solutions. In the present study, the attention is to unveil the conformational structure, hydrogen-bonding, local polyion-counterion structure, h-bond dynamics, chain dynamics and thermodynamic enthalpy of solvation of a-PMA in dilute aqueous solutions as a function of salt concentration, Cs and f. The results have revealed that at low salt concentration, the conformational radius of gyration (Rg) increases and then decreases reaching a maximum in agreement with the reported light scattering experimental results. The Rg at f = 1 shows a continual decrease and acquire a plateau value at higher salt concentration in agreement with results obtained by light scattering experiments. The radial distribution functions between PMA, salt and water atoms has been computed with respect to atom and centre-of-mass to understand the intermolecular structure in detail. The results pertaining to PMA chain conformations and hydrogen bond autocorrelation function showcasing the h-bond dynamics will be presented. The results pertaining to chain dynamics will be presented. The results pertaining to counterion condensation on the PMA chain shows greater condensation of Na+ ions on to the carboxylate ions with increase in salt concentration. Moreover, the solvation enthalpy of the system as a function of salt concentration will be presented.

Keywords: conformations, molecular dynamics simulations, NaCl concentration, radial distribution functions

Procedia PDF Downloads 108

Authors: Manaf Bashir

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Corporate social responsibility (CSR) has become a tool for corporations to meet the expectations of different stakeholders about economic, social and environmental issues. It has become indispensable for an organization’s success, positive image and reputation. Equally important is how corporations communicate and report their CSR. Employing the stakeholder theory, the purpose of this research is to analyse CSR content of leading Kuwaiti corporations. No research analysis of CSR reporting has been conducted in Kuwait and this study is an attempt to redress in part this empirical deficit in the country and the region. It attempts to identify the issues and stakeholders of the CSR and if corporations are following CSR reporting standards. By analysing websites, annual and CSR reports of the top 100 Kuwaiti corporations, this study found low mentions of the CSR issues and even lower mentions of CSR stakeholders. Environmental issues were among the least mentioned despite an increasing global concern toward the environment. ‘Society’ was mentioned the most as a stakeholder and ‘The Environment’ was among the least mentioned. Cross-tabulations found few significant relationships between type of industry and the CSR issues and stakeholders. Independent sample t-tests found no significant difference between the issues and stakeholders that are mentioned on the websites and the reports. Only two companies from the sample followed reporting standards and both followed the Global Reporting Initiative. Successful corporations would be keen to identify the issues that meet the expectations of different stakeholders and address them through their corporate communication. Kuwaiti corporations did not show this keenness. As the stakeholder theory suggests, extending the spectrum of stakeholders beyond investors can open mutual dialogue and understanding between corporations and various stakeholders. However, Kuwaiti corporations focus on few CSR issues and even fewer CSR stakeholders. Kuwaiti corporations need to pay more attention to CSR and particularly toward environmental issues. They should adopt a strategic approach and allocate specialized personnel such as marketers and public relations practitioners to manage it. The government and non-profit organizations should encourage the private sector in Kuwait to do more CSR and meet the needs and expectations of different stakeholders and not only shareholders. This is in addition to reporting the CSR information professionally because of its benefits to corporate image, reputation, and transparency.

Keywords: corporate social responsibility, environmental responsibility, Kuwait, stakeholder theory

Procedia PDF Downloads 145

Authors: Rahila Yilangai, Sonali Saha, Amartya Saha, Augustine Ezealor

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Gallery forests in sub-Saharan Africa are drastically disappearing due to intensive anthropogenic activities thus reducing ecosystem services, one of which is water provisioning. The role played by forest cover in regulating streamflow and water yield is not well understood, especially in West Africa. This pioneering 2-year study investigated the interrelationships between plant cover and hydrology in protected and unprotected gallery forests. Rainfall, streamflow, and evapotranspiration (ET) measurements/estimates over 2015-2016 were obtained to form a water balance for both catchments. In addition, transpiration in the protected gallery forest with high vegetation cover was calculated from stomatal conductance readings of selected species chosen from plot level data of plant diversity and abundance. Results showed that annual streamflow was significantly higher in the unprotected site than the protected site, even when normalized by catchment area. However, streamflow commenced earlier and lasted longer in the protected site than the degraded unprotected site, suggesting regulation by the greater tree density in the protected site. Streamflow correlated strongly with rainfall with the highest peak in August. As expected, transpiration measurements were less than potential evapotranspiration estimates, while rainfall exceeded ET in the water cycle. The water balance partitioning suggests that the lower vegetation cover in the unprotected catchment leads to a larger runoff in the rainy season and less infiltration, thereby leading to streams drying up earlier, than in the protected catchment. This baseline information is important in understanding the contribution of plants in water cycle regulation, for modeling integrative water management in applied research and natural resource management in sustaining water resources with changing the land cover and climate uncertainties in this data-poor region.

Keywords: evapotranspiration, gallery forest, rainfall, streamflow, transpiration

Procedia PDF Downloads 164

Authors: L. Tonia, I. Daglis, W. Kurth

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The sound of the universe creates an affinity with the sounds of music. The analysis of the sound of space focuses on the existence of a tone material, the microstructure and macrostructure, and the form of the sound through the signals recorded during the flight of the spacecraft Van Allen Probes and Cassini’s mission. The sound becomes from the frequencies that belong to electromagnetic waves. Plasma Wave Science Instrument and Electric and Magnetic Field Instrument Suite and Integrated Science (EMFISIS) recorded the signals from space. A transformation of that signals to audio gave the opportunity to study and analyze the sound. Due to the fact that the musical tone pitch has a frequency and every electromagnetic wave produces a frequency too, the creation of a musical score, which appears as the sound of space, can give information about the form, the symmetry, and the harmony of the sound. The conversion of space radio emissions to audio provides a number of tone pitches corresponding to the original frequencies. Through the process of these sounds, we have the opportunity to present a music score that “composed” from space. In this score, we can see some basic features associated with the music form, the structure, the tone center of music material, the construction and deconstruction of the sound. The structure, which was built through a harmonic world, includes tone centers, major and minor scales, sequences of chords, and types of cadences. The form of the sound represents the symmetry of a spiral movement not only in micro-structural but also to macro-structural shape. Multiple glissando sounds in linear and polyphonic process of the sound, founded in magnetic fields around Earth, Saturn, and Jupiter, but also a spiral movement appeared on the spectrogram of the sound. Whistles, Auroral Kilometric Radiations, and Chorus emissions reveal movements similar to musical excerpts of works by contemporary composers like Sofia Gubaidulina, Iannis Xenakis, EinojuhamiRautavara.

Keywords: space sound analysis, spiral, space music, analysis

Procedia PDF Downloads 168

Authors: Md. Mizanur Rahman, Anquan Liu, Anna Frostegård, Johan Frostegård

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The role of the human immune system is essential in cardiovascular diseases and atherosclerosis. Activated cells in atherosclerosis produce abundant amounts of cytokines, but the exact mechanisms involved in the effects of these inflammatory cytokines are not clear in atherosclerosis. In a large clinical cohort, we have previously determined that antibodies against phosphorylcholine (anti-PC) are negatively and independently associated with both development of atherosclerosis and also a low risk of cardiovascular disease. Further, we reported that rheumatoid arthritis patients who were non-responders to TNF-inhibitors, where those with low anti-PC levels. Upon anti-TNF treatment, anti-PC levels increased. We, therefore, hypothesised that proinflammatory cytokines such as TNF could play a role in anti-PC regulation. Peripheral blood mononuclear cells (PBMC) were cultured with or without TNF and anti-TNF. The cell supernatants were collected after six days for ELISA measurements. In separate experiments, cells were cultured for 24 hours in both polystyrene plates and ELISPOT plates under a similar condition for ELISA and ELISPOT assays respectively. Total RNA was extracted after 6 hours of cell culture to perform RT-qPCR. Cell viability was confirmed by trypan blue staining and MTT assays. ELISA measurements detected less than 40% of anti-PC in TNF-treated cells, in comparison to control cells, whereas anti-PC production was recovered by anti-TNF treatment. ELISPOT assays showed that TNF suppresses anti-PC production by inhibiting anti-PC producing B-cells. In addition, RT-qPCR and ELISA showed that TNF also has effects also on B-cell activation as BAFF expression was inhibited by TNF treatment. Atherosclerosis is a major cause of cardiovascular diseases, but anti-PC is a protection marker for atherosclerosis development. Our findings show that TNF is a negative regulator of anti-PC production. Immune modulation and rising of anti-PC could be of major significance for the patients.

Keywords: anti-PC, Anti-TNF, atherosclerosis, cardiovascular diseases, phosphorylecholine

Procedia PDF Downloads 237

Authors: Yvonne Nanaama Brew, Bismark Jampim Abrokwah

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Children with disabilities in Ghana are not routinely registered, and this can imply that they may be neglected in national policy planning since global estimates may not be near the exact numbers. Although there are some studies with reports on the prevalence of disability among children in Ghana, reliable information on the prevalence, types of disability in children, and children who die with disabilities in the Greater Accra region are lacking. The current study seeks to investigate the incidence of disability among children two to fourteen years at selected districts in the Greater Accra region of Ghana. A cross-sectional design is adapted with a quantitative method for this study. Parents with disabled children who access child welfare clinics at the Greater Accra regional hospital, Maamobi hospital, Ga west, and Ga south district hospitals will be selected through purposive sampling for the study. An adapted UNICEF structured Ten Questions will be used to collect relevant data about participants. The responses to the questions will be either 'Yes' or 'No'. Parents with children who answer 'Yes' to a disability and purposively sampled parents with children who answer 'No' to disability will be invited to Child Health Clinic at the Greater Accra regional hospital for a free clinical assessment. Data will be entered into Microsoft Office Excel 2013 and imported into STATA version 15 for analysis. The study is expected to provide reliable disaggregated data on less than fourteen years of children with disabilities in the Greater Accra region. The findings and recommendations of the study will demonstrate the importance of early detection of disability and facilitate more quality and holistic planning of appropriate programmes that best safeguard the rights of children with disabilities in Ghana. It will help in policy and decision-making on children less than fourteen years with disabilities in Ghana. Also, findings will be useful for health facilities in Ghana to plan services for disabled children. Finally, the study is expected to add to the guides for the National Council of Persons with Disabilities to fulfill its legal mandate for disabled persons in Ghana.

Keywords: prevalence, disability, children, Ghana

Procedia PDF Downloads 125

Authors: Badamasi Tarda Ayuba

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African countries contend with many developmental challenges particularly that of overcoming ethnic and religious conflicts. There is the recent wave of terrorism which is also ascribed to religious intolerance. It is a reality that most sub-Saharan African countries/communities consist of several distinct ethnic groups. In a typical classroom, within both rural and urban contexts, children from diverse ethnic and socio-cultural backgrounds converge to learn and grow together. This implies that education has the potentials for fostering inter-communal understanding such that young people could learn, grow together and assume leadership positions to work in pursuit of common goals of nation building. However, given the spate of inter communal clashes erupting too frequently in many parts of the continent and the dangerous trend of ethnicization of serious national affairs, it is doubtful if these objectives are being realized through education. Thus, this paper argued that the current developments indicate failure of the education system in the realization of the countries’ educational goals of creating united, peaceful and indivisible nations, thus far. Further, the failure occurred and would continue to persist unless teachers are purposefully prepared in terms of professional competencies and attitudes to entrench in their students the culture of peaceful coexistence through the various professional roles they play within the schools and communities. Therefore, the paper examined the changing context and challenging roles expected of sub-Saharan African teachers in engendering peaceful coexistence and the need to purposefully develop their capacity and mindset for the new roles. The paper then recommended programs to expose and re-educate teachers towards such roles.

Keywords: sub-Saharan Africa, teacher, professional development, peaceful coexistence, multi-ethnicity, communities

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Authors: Simona Moravcova, Jiri Novotny, Zdenka Bendova

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The pineal gland of the vertebrate brain is a circumventricular organ which serves as a major neuroendocrine gland with the primary function of rhythmic secretion of neurohormone melatonin under the control of the hypothalamic suprachiasmatic nucleus (SCN). Soon after the onset of the darkness, the activity of the key rate-limiting enzyme for melatonin synthesis, arylalkylamine N-acetyltransferase (AANAT), raises due to the increased release of norepinephrine from sympathetic neurons terminating on the parenchymal cells where it binds to β-adrenergic receptors. Melatonin codes the length of the night, and it is well recognized for its anti-inflammatory effects. However, to our knowledge, less is known about the effect of the immune system on the melatonin biosynthesis and the precise role of the STAT3 in the signaling pathway leading to the expression of AANAT. Lipopolysaccharide (LPS) is the essential component in the outer surface membrane of gram-negative bacteria and acts as a strong stimulator of natural and innate immunity. STAT3 acts as an important factor in immune response. Here we investigated the effect of LPS on the components of the melatonergic synthetic pathway in the pineal gland. The experiments were performed both in vivo and in vitro. The changes in AANAT activity were determined by radioenzymatic assay. PCR analyses were carried out to detect aa-nat, icer, spi-3 and stat3 gene expression. From our results, it is apparent that the high basal level of phosphorylated forms of STAT3 can be elevated after systemic as well as in vitro administration of LPS. Our experiments have shown that LPS reduces melatonin synthesis, nevertheless, the activity of AANAT was increased. Moreover, the basal level of phosphorylated STAT3 counteracts β-adrenergic receptor-mediated aa-nat gene expression and sustains its own and spi-3 gene expression. In conclusion, LPS can affect immunomodulators such as melatonin in the pineal gland.

Keywords: AANAT, lipopolysaccharide, pineal gland, rat, STAT3

Procedia PDF Downloads 166

Authors: Thea Freese

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Environmental legislation to protect North and Baltic Sea areas from harmful vessel-source emissions has received increased political attention in recent years. Legislative measures are expected to show positive effects on the health of the marine environment and society. At the same time, compliance might increase the costs to industry and have effects on freight rates and volumes shipped with potential negative repercussions on the environment. Building on an exploratory sequential mixed methods approach, this research project will study the economic effects of maritime environmental legislation in two phases. In Phase I, exploratory in-depth interviews were conducted with 12 experts from various stakeholder groups aiming at identifying variables influencing the relationship between environmental legislation, freight rates and volumes shipped. Influencing factors like compliance, enforcement and modal shift were identified and studied. Phase II will comprise of a quantitative study conducted with the aim of verifying the theory build in Phase I and quantifying economic effects of rules on shipping pollution. Research in this field might inform policy-makers about determinants of behaviour of ship operators in the face of the law and might further the development of a comprehensive legal system for marine environmental protection. At the present stage of research, first tentative results from the qualitative phase may be examined and open research questions to be addressed in the quantitative phase as well as possible research designs for phase II may be discussed. Input from other researchers will be highly valuable at this point.

Keywords: clean shipping operations, compliance, maritime environmental legislation, maritime law and economics, mixed methods research, North and Baltic Sea area

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Authors: Marjeta Misigoj Durakovic, Maroje Soric, Lovro Stefan

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Background and aim: Physical inactivity has been linked with increased morbidity and premature mortality and adolescence has been recognised as the critical period for a decline in physical activity (PA) level. In order to properly direct interventions aimed at increasing PA, high-risk groups of individuals should be identified. Therefore, the aim of this study is to describe gender differences in: a) PA level; b) weekly PA patterns. Methods: This investigation is a part of the CRO-PALS study which is an on-going longitudinal study conducted in a representative sample of urban youth in Zagreb (Croatia). CRO-PALS involves 903 adolescents and for the purpose of this study data from a subgroup of 190 participants with information on objective PA level were analysed (116 girls; mean age [SD]=15.6[0.3] years). Duration of moderate and vigorous PA was measured during 5 consecutive by a multiple-sensor physical activity monitor (SenseWear Armband, BodyMedia inc., Pittsburgh, USA). Gender differences in PA level were evaluated using independent samples t-test. Differences in school week and weekend levels of activity were assessed using mixed ANOVA with gender as between-subjects factor. The amount of vigorous PA had to be log-transformed to achieve normality in the distribution. Results: Boys were more active than girls. Duration of moderate-to-vigorous PA averaged 111±44 min/day in boys and 80±38 min/day in girls (mean difference=31 min/day, 95%CI=20-43 min/day). Vigorous PA was 2.5 times higher in boys compared to girls (95%CI=1.9-3.5). Participants were more active during school days than on weekends. The magnitude of the difference in moderate-to-vigorous PA was similar in both gender (p value for time*gender interaction = 0.79) and averaged 19 min/day (95%CI=11-27 min/day). Similarly, vigorous PA was 36% lower on weekends compared with school days (95%CI=22-46%) with no gender difference (p value for time*gender interaction = 0.52). Conclusion: PA level was higher in boys than in girls throughout the week. Still, in both boys and girls, the amount of PA reduced markedly on weekends compared with school days.

Keywords: adolescence, multiple-sensor physical activity monitor, physical activity level, weekly physical activity pattern

Procedia PDF Downloads 250

Authors: Ehsan Pegah, Huabei Liu

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Characterizing the deformation properties of fill materials in a wide stress range always has been an important issue in geotechnical engineering. The hyperbolic Duncan-Chang model is a very popular model of stress-strain relationship that captures the nonlinear deformation of granular geomaterials in a very tractable manner. It consists of a particular set of the model parameters, which are generally measured from an extensive series of laboratory triaxial tests. This practice is both time-consuming and costly, especially in large projects. In addition, undesired effects caused by soil disturbance during the sampling procedure also may yield a large degree of uncertainty in the results. Accordingly, non-invasive geophysical seismic approaches may be utilized as the appropriate alternative surveys for measuring the model parameters based on the seismic wave velocities. To this end, the conventional seismic refraction profiles were carried out in the test sites with the granular fill materials to collect the seismic waves information. The acquired shot gathers are processed, from which the P- and S-wave velocities can be derived. The P-wave velocities are extracted from the Seismic Refraction Tomography (SRT) technique while S-wave velocities are obtained by the Multichannel Analysis of Surface Waves (MASW) method. The velocity values were then utilized with the equations resulting from the rigorous theories of elasticity and soil mechanics to evaluate the Duncan-Chang model parameters. The derived parameters were finally compared with those from laboratory tests to validate the reliability of the results. The findings of this study may confidently serve as the useful references for determination of nonlinear deformation parameters of granular fill geomaterials. Those are environmentally friendly and quite economic, which can yield accurate results under the actual in-situ conditions using the surface seismic methods.

Keywords: Duncan-Chang deformation parameters, granular fill materials, seismic waves velocity, multichannel analysis of surface waves, seismic refraction tomography

Procedia PDF Downloads 179

Authors: Nadilla Saskia, Octoria Nur, Assegaf Zareeva

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Mass transport infrastructures are essential to enhance the connectivity between regions and regional equity in Indonesia. Indonesia’s capital city, Jakarta, ranked the 10th highest congestion rate in the world based on the 2019 traffic index, contributing to air pollution and energy consumption. Other than that, the World Air Quality Report in 2019 depicted Jakarta’s air pollutant concentration at 49.4 mg, the 5th highest in the world. Issues of severe traffic congestion, lack of sufficient urban infrastructure in Jakarta, and greenhouse gas emissions have to be addressed through mass transportation. Indonesia’s government is currently constructing The Greater Jakarta LRT (Light Rapid Transit) as convenient, efficient, and environmentally friendly transportation connecting Jakarta with Bekasi and Cibubur areas and plans to serve the passengers in August 2023. Greater Jakarta LRT is operated with Grade of Automation (GoA) No.3, Driverless Train Operation (DTO). Hence, the automated technology used in rail infrastructure is anticipated to address these issues with greater results. The paper will be validated and establish the extent to which the automation system would increase energy efficiency, help reduce carbon emissions, and benefit the environment. Based on the calculated CO2 emissions and fuel consumption for the existing condition (2015) during the feasibility study of the LRT Project and the predicted condition in 2030, it is obtained that Greater Jakarta LRT with GoA3 operation will reduce the CO2 emissions and fuel consumption by more than 50% in 2030. In the bigger picture, Greater Jakarta LRT supports the government's goal of achieving Jakarta Net-Zero Emissions (NZE) 2050.

Keywords: LRT, Grade of Automation (GoA), energy efficiency, carbon emissions, railway infrastructure, DKI Jakarta

Procedia PDF Downloads 75

Authors: Zeynep Şahin, Züleyha Yılmaz, Fikret Çankaya

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In today's business world, in which it is difficult to survive, the economic life of products, services or knowledge is considerably reduced. Competitors produce similar products or extra-featured ones instantly. In this environment, the contribution of companies to the social and economic environment is a preferred criterion by consumers alongside products or services. Therefore, consumers need to obtain more detailed information about companies. Besides, this drastic change in the market encourages companies to become sustainable. Sustainable business means the company puts consumed products back. Corporate sustainability, corresponds to sustainability at the level of the company, and gives equal importance to company growth and profitability together with environmental and social issues. The BIST Sustainability Index started to be calculated by the Istanbul Stock Exchange (BIST) in 2014 to evaluate the sustainability performance of companies in Turkey. The main objective of this study is to present the importance of sustainability reports in Turkey. To this aim, the performances of 15 companies in the BIST Sustainability Index were compared the periods before and after entering the index. On the other hand, sustainability reporting practices should be encouraged to increase studies on this issue. In this context, to remain on the agenda of the issue is a further objective of this study. To achieve these objectives, the financial data of the companies in the period before and after entering to the BIST Sustainability Index were analyzed using t-test in Statistical Package for the Social Sciences (SPSS) package. The results of the study showed that no significant difference between the performances of the companies in terms of the net profit margin, the return on assets and equity capital in these periods could be found. Therefore, it can be said that insufficient importance is given to sustainability issues in Turkey. The reasons for this situation might be considered as a lack of awareness due to the recent introduction and calculation of the index. It is expected that the awareness of firms and investors about sustainability will increase, and that they will demonstrate the necessary importance to this issue over time.

Keywords: sustainability reporting, sustainability index, firm performance, BIST sustainability index

Procedia PDF Downloads 271

Authors: Dagnew Dessie Mengie

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The purpose of this study was to investigate German tourists' demand for Ethiopian tourism destinations. The author has made every effort to identify the differences in the preferences of German visitors’ demand in Ethiopia comparing with Egypt, Kenya, Tanzania, and South African tourism sectors if they are invited to visit at the same time. However, the demand of international tourism for Ethiopia currently lags behind these African countries. Therefore, to offer demand-driven tourism products, the Ethiopian government, Tour & Travel operators need to understand the important factors that affect international tourists’ decision to visit Ethiopian tourist destinations. The aim of this study was intended to analyze German Tourists’ Demand towards Ethiopian destination. The researcher aimed to identify the demand for German tourists’ preference to Ethiopian tourist destinations comparing to the above-mentioned African countries. For collecting and analysing data for this study, both quantitative and qualitative methods of research are being used in this study. The most significant data are collected by using the primary data collection method i.e. survey and interviews which are the most and large number of potential responses and feedback from nine German active tourists,12 Ethiopian tourism officials, four African embassies, and four well functioning private tour companies and secondary data collected from books, journals, previous research and electronic websites. based on the data analysis of the information gathered from interviews and questionnaires, the study disclosed that majority of German tourists have not that much high demand on Ethiopian Tourist destinations due to the following reasons; Many Germans are fascinated by adventures, safari and simply want to lie on the beach and relax. These interests have leaded them to look for other African countries which have these accesses. Uncomfortable infrastructure and transport problems attributed for the decreasing the number of German tourists in the country. Inadequate marketing operation of Ethiopian Tourism Authority and its delegates in advertising and clarifying the above irregularities which are raised by the tourists.

Keywords: environmental benefits of tourism, social benefits of tourism, economical benefits of tourism, political factors in tourism

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Authors: Stephen Rulisa, Aimee Nyiramahirwe

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Background: Strategies to increase the uptake of contraception services have been adopted in Rwanda, but the unmet need for family planning remains high. Women in the postpartum period are at higher risk for unintended pregnancy due to the silent conversion from lactational amenorrhea to reactivation of ovulatory cycles. The purpose of this study was to explore the role of male partners in the uptake of postpartum contraception. Methods: A prospective cross-sectional study was conducted among women who delivered at the University Teaching Hospital of Kigali for a period of 3 months with random sampling. A questionnaire was used to collect socio-demographic and antenatal data, information on male companionship, and intent to use postpartum contraception at admission. Participants were contacted six weeks later to collect data on contraceptive use. The outcome variables were uptake of postpartum contraception and types of contraceptives taken (long-acting vs. short-acting), controlling for male companionship during the antenatal period. A Chi-square test was used and a p-value ≤0.05 was considered significant. Results: A total of 209 women were recruited with a mean age of 30.8±5.2 years. The majority (60.9%) were multigravida, and 66.5% were multiparous. More than half (55%) had male partner companionship, 18.3% had companionship for four antenatal visits, and 28.2% had education on contraception with their male partner. Factors significantly associated with uptake of postpartum contraception were: age above 30 years, owning or heading a business, multigravidity, multiparity, antenatal care at a health center or district hospital, cesarean delivery, and previous utilization of contraception. Male companionship significantly increased the intent to use contraception, uptake of modern contraception in general, and uptake of long active contraceptives but did not predict the uptake of short-acting contraceptives. Conclusions: Our study demonstrates a positive association between male companionship during antenatal care, labor and delivery with the uptake of postpartum family planning. Our study suggests more sensitization to involve the male partners, improving the education on contraception during antenatal care and further research to assess the sustained uptake of contraception beyond the postpartum period.

Keywords: postpartum, family planning, contraception, male partner, uptake

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Authors: Maarja Karbus, Elsbet Lippmaa, Kadri Kööp, Mare Tupits

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Aim: The aim is to describe the experiences and needs of mothers of children with cancer in coping with the child's illness. Background: Cancer affects different life areas. Especially if it is a child, in this case the whole family is involved. Loved ones are mentally affected, there are limitations, and life changes need to be made to make the whole treatment regimen and recovery as comfortable as possible. Also, the whole process is expensive and time consuming. The research is part of a larger project that covers the experiences and needs of parents of children with chronic illness and coping strategies related to the child's illness. Design: Qualitative, empirical, descriptive research. Method: Semi-structured interviews were used to collect data and inductive content analysis was used to analyze the data. The interviews were conducted in the autumn of 2020, 5 respondents participated in the research. Results and Conclusions: The research revealed that the mothers' experiences of coping with a child's disease included health-related experiences, material aspects, changes in lifestyle, support systems and contact with professionals. Regarding the organizational and material aspects of life, the subjects presented experiences with economic problems, adaptation of changes in lifestyle, access to information and changes in the treatment process. With regard to health, the respondents identified experiences with the mother's physical and mental health and experiences with the health of an ill child. The experience of different support systems was related to the support of family, friends, acquaintances, various organizations and specialists. Experiences with specialist support included experiences with family relationships and positive and negatiive experiences with staff. The mothers' needs in dealing with the child's disease included the mother's emotional needs, the support of other family members, and the need for various support systems and services. The needs of coping with the child were the need for understanding, support, confidence, the need to be strong and courageous, the need to ignore one's own needs, and the need for personal time and rest. The needs of other family members included the needs of an ill child and the need to pay attention to other children in the family. The needs of different supporters and services were related to different helpers and different services.

Keywords: cancer, mother, coping, child, need, experience, illness

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Authors: Yori Gidron, Laura Caton, Irit Ben-Aharon

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Background: Many patients and even certain clinicians attribute cancer development to psychosocial factors. Yet, empirical data supports more the prognostic role, rather than the etiological role, of psychosocial factors in cancer. Part of the inconsistency may result from not considering possible moderating factors in the etiological role of psychosocial factors. One important candidate moderating factor is the vagal nerve, whose activity is indexed by heart-rate variability (HRV). The vagal nerve may prevent cancer since it reduces inflammation on the one hand, and since it increases anti-tumor immunity on the other hand. This study examined the moderating role of the vagus in the relation between life threatening events (LTE) and cancer development. Method: We re-analyzed data from the Lifelines Dutch longitudinal cohort study of over 150,000 people. The present study included 82,751 adults, who initially were cancer-free. We extracted information on background factors (e.g., age, gender, fat consumption), whether they ever experienced LTE, HRV and cancer diagnosis as reported by patients in annual clinic visits. HRV was derived from brief ECGs. Results: Of the full sample, 1011 people developed cancer during a follow-up. In the full sample, LTE significantly predicted cancer development (R.R = 1.063 p < .01) and HRV significantly predicted a reduced risk of cancer development (R.R = .506 p <.001). Importantly, LTE significantly predicted cancer only when HRV was low (R.R = 1.056, 95% CI: 1.007 - 1.108, p < .05) but not when HRV was high (R.R = 1.014; 95% CI: 0.916 - 1.122, p > 0.05), independent of confounders. Conclusions: To the best of our knowledge, this is the first study showing in a large sample that LTE predict cancer development, and that this occurs only when vagal nerve activity (HRV) is relatively low. These results could result from lack of vagal modulation of inflammation and also from lack of vagal modulation of stress responses. Results are in line with the cancer-protective role of the vagus. HRV needs to be routinely monitored in the population and future intervention trials need to examine whether vagal nerve activation can prevent cancer in people with LTE and with other cancer risk factors.

Keywords: cancer development, life-events, moderation, vagal nerve

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Authors: Leo Paul Vaurs, Sonia Heaven, Charles Banks

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Municipal solid waste (MSW) is a virtually unlimited source of lignocellulosic material in the form of a waste paper/cardboard mixture which can be converted into fermentable sugars via cellulolytic enzyme hydrolysis in a biorefinery. The extraction of the lignocellulosic fraction and its preparation, however, are energy and water demanding processes. The waste water generated is a rich organic liquor with a high Chemical Oxygen Demand that can be partially cleaned while generating biogas in an Upflow Anaerobic Sludge Blanket bioreactor and be further re-used in the process. In this work, an experiment was designed to determine the critical contaminant concentrations in water affecting either anaerobic digestion or enzymatic hydrolysis by simulating multiple water re-circulations. It was found that re-using more than 16.5 times the same water could decrease the hydrolysis yield by up to 65 % and led to a complete granules desegregation. Due to the complexity of the water stream, the contaminant(s) responsible for the performance decrease could not be identified but it was suspected to be caused by sodium, potassium, lipid accumulation for the anaerobic digestion (AD) process and heavy metal build-up for enzymatic hydrolysis. The experimental data were incorporated into a Water Pinch technology based model that was used to optimize the water re-utilization in the modelled system to reduce fresh water requirement and wastewater generation while ensuring all processes performed at optimal level. Multiple scenarios were modelled in which sub-process requirements were evaluated in term of importance, operational costs and impact on the CAPEX. The best compromise between water usage, AD and enzymatic hydrolysis yield was determined for each assumed contaminant degradations by anaerobic granules. Results from the model will be used to build the first MSW based biorefinery in the USA.

Keywords: anaerobic digestion, enzymatic hydrolysis, municipal solid waste, water optimization

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Authors: Preeti Tiwari, Jay Wood, Duncan Babbage

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Family planning plays a role in saving lives across the globe by preventing unwanted pregnancies. The purpose of this multidisciplinary research was to determine the impact of mHealth tools have on psychosocial determinants of behaviour for family planning. The present study examines a topic that is very relevant in times where human-technology interaction is at its peak. It is probably one of the first studies that have investigated the impact of mobile phone technology on the underlying mechanisms of behaviour change for family planning using primary data. To examine the association between exposure to mHealth tools and predictors of behaviour, data was collected from mHealth intervention areas in India. A post-intervention quasi-experimental study with a 2x2 factorial design was conducted among 831 men and women from the state of Bihar. The quantitative data analysis evaluated the extent of influence that predictors of behaviour (beliefs, social norms, perceived behaviour control, and outcome behaviour) have on a woman’s decisions about family planning. The results indicated an association between exposure to mHealth tools and improved communication about family planning among various family members after receiving health information from a health worker (H1). A relationship between exposure to mHealth tools and increased support women received from their husbands and extended family (mothers-in-law specifically) and peers (H2) was also found. A further result showed that knowledge about family planning was greater among users of family planning (H4). mHealth tools empower women to communicate with family members. This has important implications for developing mobile phone-based tools, as they can be used as a crucial communication channel that can be an effective method of increasing communication among family members about contraceptives. Thus, it can be implied that where women feel nervous talking about contraception, the successful application of mHealth tools can strengthen the interactivity of the health communication and could increase the likelihood of using contraception. However, while it may improve health communication that can inform health decisions, it may be insufficient on its own to cause behaviour change.

Keywords: contraceptive, e-health, psycho-social, women

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Authors: Annapurna Basavaraju, Arianna Mastrodonato, Franz Heitmeir

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The Advisory Council for Aeronautics Research in Europe (ACARE) is creating awareness for the overall reduction of NOx emissions by 80% in its vision 2020. Hence this promotes the researchers to work on novel technologies, one such technology is the use of alternative fuels. Among these fuels hydrogen is of interest due to its one and only significant pollutant NOx. The influence of NOx formation due to hydrogen combustion depends on various parameters such as air pressure, inlet air temperature, air to fuel jet momentum ratio etc. Appropriately, this research is motivated to investigate the impact of the air to fuel jet momentum ratio onto the NOx formation in a hydrogen combustion chamber for aircraft engines. The air to jet fuel momentum is defined as the ratio of impulse/momentum of air with respect to the momentum of fuel. The experiments were performed in an existing combustion chamber that has been previously tested for methane. Premix of the reactants has not been considered due to the high reactivity of the hydrogen and high risk of a flashback. In order to create a less rich zone of reaction at the burner and to decrease the emissions, a forced internal recirculation flow has been achieved by integrating a plate similar to honeycomb structure, suitable to the geometry of the liner. The liner has been provided with an external cooling system to avoid the increase of local temperatures and in turn the reaction rate of the NOx formation. The injected air has been preheated to aim at so called flameless combustion. The air to fuel jet momentum ratio has been inspected by changing the area of fuel inlets and keeping the number of fuel inlets constant in order to alter the fuel jet momentum, thus maintaining the homogeneity of the flow. Within this analysis, promising results for a flameless combustion have been achieved. For a constant number of fuel inlets, it was seen that the reduction of the fuel inlet diameter resulted in decrease of air to fuel jet momentum ratio in turn lowering the NOx emissions.

Keywords: combustion chamber, hydrogen, jet momentum, NOx emission

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Authors: Muhammad Aown Sammar Raza, Salman Ahmad, Muhammad Farrukh Saleem, Muhammad Saqlain Zaheer, Rashid Iqbal, Imran Haider, Muhammad Usman Aslam, Muhammad Adnan Nazar

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One of the main negative effects of climate change is the increasing scarcity of water worldwide, especially for irrigation purpose. In order to ensure food security with less available water, there is a need to adopt easy and economic techniques. Two of the effective techniques are; use of ground covers and partial root zone drying (PRD). A field experiment was arranged to find out the most suitable mulch for PRD irrigation system in wheat. The experiment was comprised of two irrigation methods (I0 = irrigation on both sides of roots and I1= irrigation to only one side of the root as alternate irrigation) and four ground covers (M0= open ground without any cover, M1= black plastic cover, M2= wheat straw cover and M4= cotton sticks cover). More plant height, spike length, number of spikelets and number of grains were found in full irrigation treatment. While water use efficiency and grain nutrient (NPK) contents were more in PRD irrigation. All soil covers suppress the weeds and significantly influenced the yield attributes, final yield as well as the grain nutrient contents. However black plastic cover performed the best. It was concluded that joint use of both techniques was more effective for water conservation and increasing grain yield than their sole application and combination of PRD with black plastic mulch performed the best than other ground covers combination used in the experiment.

Keywords: ground covers, partial root zone drying, grain yield, quality traits, WUE, weed control efficiency

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Authors: Azad Hussain, Andrew Cobley

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The demand for lightweight parts with high mechanical strength(s) and integrity, in sectors such as the aerospace and automotive is ever increasing, motivated by the need for weight reduction in order to increase fuel efficiency with components usually manufactured using a high grade primary metal or alloy. For components manufactured using the squeeze casting process, this alloy is usually A356 aluminium (Al), it is one of the most versatile Al alloys; and is used extensively in castings for demanding environments. The A356 castings provide good strength to weight ratio making it an attractive option for components where strength has to be maintained, with the added advantage of weight reduction. In addition, the versatility in castabilitiy, weldability and corrosion resistance are other attributes that provide for the A356 cast alloy to be used in a large array of industrial applications. Conversely, it is rare to use remelted Al in these cases, due the nature of the applications of components in demanding environments, were material properties must be defined to meet certain specifications for example a known strength or ductility. However the use of remelted Al, especially primary grade Al such as A356, would offer significant cost and energy savings for manufacturers using primary alloys, provided that remelted aluminium can offer similar benefits in terms of material microstructure and mechanical properties. This study presents the results of the material microstructure and properties of 100% primary A356 Al and 100% remelt Al cast, manufactured via the direct squeeze cast method. The microstructures of the castings made from remelted A356 Al were then compared with the microstructures of primary A356 Al. The outcome of using remelting Al on the microstructure was examined via different analytical techniques, optical microscopy of polished and etched surfaces, and scanning electron microscopy. Microstructural analysis of the 100% remelted Al when compared with primary Al show similar α-Al phase, primary Al dendrites, particles and eutectic constituents. Mechanical testing of cast samples will elucidate further information as to the suitability of utilising 100% remelt for casting.

Keywords: A356, microstructure, remelt, squeeze casting

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Authors: Deepa Shokeen, Bani Tamber Aeri

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Food environments are believed to play a significant role in the obesity epidemic and robust research methods are required to establish which factors or aspects of the food environment are relevant to food choice and to adiposity. The relationship between the food environment and obesity is complex. While there is little research linking food access with obesity as an outcome measure in any age group, with the help of this article we will try to understand the relationship between what we eat and the environmental context in which these food choices are made. Methods: A literature search of studies published between January 2000 and December 2013 was undertaken on computerized medical, social science, health, nutrition and education databases including Google, PubMed etc. Reports of organisations such as World Health Organisation (WHO), Centre for Chronic Disease Control (CCDC) were studied to project the data. Results: Studies show that food environments play a significant role in the obesity epidemic and robust research methods are required to establish which factors or aspects of the food environment are relevant to food choice and to adiposity. Evidence indicates that the food environment may help explain the obesity and cardio-metabolic risk factors among young adults. Conclusion: Cardiovascular disease is the ever growing chronic disease, the incidence of which will increase markedly in the coming decades. Therefore, it is the need of the hour to assess the prevalence of various risk factors that contribute to the incidence of cardiovascular diseases especially in the work environment. Research is required to establish how different environments affect different individuals as individuals interact with the environment on a number of levels. We need to ascertain the impact of selected food and nutrition environments (Information, organization, community, consumer) on food choice and dietary intake of the working adults as it is important to learn how these food environments influence the eating perceptions and health behaviour of the adults.

Keywords: food environment, prevalence, cardiovascular disease, India, worksite, risk factors

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Authors: S. M. Abdul Khader, Anurag Ayachit, Raghuvir Pai, K. A. Ahmed, V. R. K Rao, S. Ganesh Kamath

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The numerical simulation has made tremendous advances in investigating the blood flow phenomenon through elastic arteries. Such study can be useful in demonstrating the disease progression and haemodynamics of cardiovascular diseases such as atherosclerosis. In the present study, patient specific case diagnosed with partially stenosed complete right ICA and normal left carotid bifurcation without any atherosclerotic plaque formation is considered. 3D patient specific carotid bifurcation model is generated based on CT scan data using MIMICS-4.0 and numerical analysis is performed using FSI solver in ANSYS-14.5. The blood flow is assumed to be incompressible, homogenous and Newtonian, while the artery wall is assumed to be linearly elastic. The two-way sequentially-coupled transient FSI analysis is performed using FSI solver for three pulse cycles. The haemodynamic parameters such as flow pattern, Wall Shear Stress, pressure contours and arterial wall deformation are studied at the bifurcation and critical zones such as stenosis. The variation in flow behavior is studied throughout the pulse cycle. Also, the simulation results reveals that there is a considerable increase in the flow behavior in stenosed carotid in contrast to the normal carotid bifurcation system. The investigation also demonstrates the disturbed flow pattern especially at the bifurcation and stenosed zone elevating the haemodynamics, particularly during peak systole and later part of the pulse cycle. The results obtained agree well with the clinical observation and demonstrates the potential of patient specific numerical studies in prognosis of disease progression and plaque rupture.

Keywords: fluid-structure interaction, arterial stenosis, wall shear stress, carotid artery bifurcation

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Authors: Marco Jan Rafael C. Sicam, Maria Daniella C. Yambao

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The Philippines is a tectonically active archipelagic country situated near the Circum-Pacific Belt. Hence, seismic hazard assessments are important in the nation-building. In 2014, the Philippines Institute of Volcanology and Seismology (PHIVOLCS) mapped a 12-km NW-trending unnamed active fault near Boso-Boso River, Rizal. Given the limited nature of their technical report, they would like to further consolidate relevant data about this fault. As such, this study aims to characterize the surface and subsurface expression of the fault along Boso-Boso River using rangefront morphology, structural criteria, and ground penetrating radar. This fault is subdivided into two segments: the first segment located in the city of Antipolo is mainly manifested in the upper Kinabuan Formation and terminating near Mt. Qutago, and the second segment in Baras, Pinugay, Rizal cuts through recent fluvial deposits and to the Guadalupe Formation. IfSAR-derived DTM data reveals the morphological expression of the fault defined by offset streams and ridges, linear sidehill valleys, and linear valleys. Fault gouges, fault breccia, transtentional flower structures, slickensides, and other shear sense markers observed in the units of the upper Cretaceous Kinabuan Formation indicate a sinistral sense of displacement. GPR radargram profiles revealed the presence of displacement in reflectors at 3-5 meters below the surface which may be suggestive of the fault within the area. Finally, the fault in Boso-Boso river may be a segment of the larger sinistral Montalban Fault in the north or largely affected by the movement from the Marikina Valley Fault System.

Keywords: NW unnamed fault, range-front morphology, shear sense markers, ground penetrating radar, boso-boso river, antipolo

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Authors: Virginie Hergault, Siham Chebbah, Bertrand Frere

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Following in-house objectives, Central laboratory of Paris police Prefecture conducted a general review on models and Computational Fluid Dynamics (CFD) codes used to simulate pollutant dispersion in the atmosphere. Starting from that review and considering main features of Large Eddy Simulation, Central Laboratory Of Paris Police Prefecture (LCPP) postulates that the Fire Dynamics Simulator (FDS) model, from National Institute of Standards and Technology (NIST), should be well suited for air pollutant dispersion modeling. This paper focuses on the implementation and the evaluation of FDS in the frame of the European COST ES1006 Action. This action aimed at quantifying the performance of modeling approaches. In this paper, the CUTE dataset carried out in the city of Hamburg, and its mock-up has been used. We have performed a comparison of FDS results with wind tunnel measurements from CUTE trials on the one hand, and, on the other, with the models results involved in the COST Action. The most time-consuming part of creating input data for simulations is the transfer of obstacle geometry information to the format required by SDS. Thus, we have developed Python codes to convert automatically building and topographic data to the FDS input file. In order to evaluate the predictions of FDS with observations, statistical performance measures have been used. These metrics include the fractional bias (FB), the normalized mean square error (NMSE) and the fraction of predictions within a factor of two of observations (FAC2). As well as the CFD models tested in the COST Action, FDS results demonstrate a good agreement with measured concentrations. Furthermore, the metrics assessment indicate that FB and NMSE meet the tolerance acceptable.

Keywords: numerical simulations, atmospheric dispersion, cost ES1006 action, CFD model, cute experiments, wind tunnel data, numerical results

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Authors: Katerina Bakela, Ioanna Zerva, Irene Athanassakis

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Lipopolysaccharide (LPS) is commonly used in murine sepsis models, which are largely associated with immunosuppression (incretion of MDSCs cells and Tregs, imbalance of inflammatory/anti-inflammatory cytokines) and collapse of the immune system. After adapting the LPS treatment to the needs of locally bred BALB/c mice, the present study explored the protective role of Micrococcus luteus peptidoglycan (PG) pre-activated vaccine-on chip in endotoxemia. The established protocol consisted of five daily intraperitoneal injections of 0.2mg/g LPS. Such protocol allowed longer survival, necessary in the prospect of the therapeutic treatment application. The so-called vaccine-on-chip consists of a 3-dimensional laser micro-texture Si-scaffold loaded with BALB/c mouse macrophages and activated in vitro with 1μg/ml PG, which exert its action upon subcutaneous implantation. The LPS treatment significantly decreased CD4+, CD8+, CD3z+, and CD19+ cells, while increasing myeloid-derived suppressor cells (MDSCs), CD25+, and Foxp3+ cells. These results were accompanied by increased arginase-1 activity in spleen cell lysates and production of IL-6, TNF-a, and IL-18 while acquiring severe sepsis phenotype as defined by the murine sepsis scoring. The in vivo application of PG pre-activated vaccine-on chip significantly decreased the percent of CD11b+, Gr1+, CD25+, Foxp3+ cells, and arginase-1 activity in the spleen of LPS-treated animals, while decreasing IL-6 and TNF-a in the serum, allowing survival to all animals tested and rescuing the severity of sepsis phenotype. In conclusion, these results reveal a promising mode of action of PG pre-activated vaccine-on chip in LPS endotoxemia, strengthening; thus, the use of treatment is septic patients.

Keywords: myeloid-derived suppressor cells, peptidoglycan, sepsis, Si-scaffolds

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Authors: Lise Alonso, Audrey Dubost, Patricia Luis, Thomas Pommier, Yvan Moënne-Loccoz

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The Lascaux Cave in South-Est France is an archeological landmark renowned for its Paleolithic paintings dating back c.18.000 years. Extensive touristic frequenting and repeated chemical treatments have resulted in the development of microbial stains on cave walls, which is a major issue in terms of art conservation. Therefore, it is of prime importance to better understand the microbiology specific to the Lascaux Cave, in comparison to regional situations. To this end, we compared the microbial community (i.e. both prokaryotic and eukaryotic microbial populations) of Lascaux Cave with three other anthropized Périgord caves as well as three pristine caves from the same area. We used state-of-the-art metagenomic analyses of cave wall samples to obtain a global view of the composition of the microbial community colonizing cave walls. We measured the relative abundance and diversity of four DNA markers targeting different fractions of the ribosomal genes of bacteria (i.e. eubacteria), archaea (i.e. archeobacteria), fungi and other micro-eukaryotes. All groups were highly abundant and diverse in all Périgord caves, as several hundred genera of microorganisms were identified in each. However, Lascaux Cave displayed a specify microbial community, which differed from those of both pristine and anthropized caves. Comparison of stains versus non-stained samples from the Passage area of the Lascaux Cave indicated that a few taxa (e.g. the Sordiaromycetes amongst fungi) were more prevalent within than outside stains, yet the main difference was in the relative proportion of the different microbial taxonomic groups and genera, which supposedly supports the biological origin of the stains. Overall, metagenomic sequencing of cave wall samples was effective to evidence the large colonization of caves by a diversified range of microorganisms. It also showed that Lascaux Cave represented a very particular situation in comparison with neighboring caves, probably in relation to the extent of disturbance it had undergone. Our results provide key baseline information to guide conservation efforts in anthropized caves such as Lascaux and pave the way to modern monitoring of ornamented caves.

Keywords: cave conservation, Lascaux cave, microbes, paleolithic paintings

Procedia PDF Downloads 241

Authors: Bergun Meric Bingul, Cigdem Bulgan, Ozlem Tore, Mensure Aydin, Erdal Bal

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The aim of the study was to compare the effects of impact forces and some kinematic parameters with two different straight punch stance positions in boxing. 9 elite boxing athletes from the Turkish National Team (mean age± SD 19.33±2.11 years, mean height 174.22±3.79 cm, mean weight 66.0±6.62 kg) participated in this study as voluntarily. Boxing athletes performed one trial in straight punch technique for each two different stance positions (orthodox and southpaw stances) at sandbag. The trials were recorded at a frequency of 120Hz using eight synchronized high-speed cameras (Oqus 7+), which were placed, approximately at right- angles to one another. The three-dimensional motion analysis was performed with a Motion Capture System (Qualisys, Sweden). Data was transferred to Windows-based data acquisition software, which was QTM (Qualisys Track Manager). 11 segment models were used for determination of the kinematic variables (Calf, leg, punch, upperarm, lowerarm, trunk). Also, the sandbag was markered for calculation of the impact forces. Wand calibration method (with T stick) was used for field calibration. The mean velocity and acceleration of the punch; mean acceleration of the sandbag and angles of the trunk, shoulder, hip and knee were calculated. Stance differences’ data were compared with Wilcoxon test for using SPSS 20.0 program. According to the results, there were statistically significant differences found in trunk angle on the sagittal plane (yz) (p<0.05). There was a significant difference also found in sandbag acceleration and impact forces between stance positions (p < 0.05). Boxing athletes achieved more impact forces and accelerations in orthodox stance position. It is recommended that to use an orthodox stance instead of southpaw stance in straight punch technique especially for creating more impact forces.

Keywords: boxing, impact force, kinematics, straight punch, orthodox, southpaw

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Authors: An-Yi Wang, Wei-Fong Kao, Shin-Han Tsai

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Introduction: Information as patient characteristics, resuscitation scene, resuscitation provider perspectives and families wish affects on resuscitation decision-making for out-of-hospital cardiac arrest (OHCA). There is no consistency consensus on how families and emergency physicians approach this decision. The main purpose of our study is to evaluate the characteristics of withholding resuscitation efforts arrival at the hospital. Methods: We retrospectively analyzed patients with OHCA without pre-hospital return-of-spontaneous circulation (ROSC) who was sent to our emergency department (ED) between January 2014 and December 2015. Baseline characteristics, pre-hospital course, and causes of the cardiopulmonary arrest among patients were compared. Results: In 2 years, total 155 arrest patients without pre-hospital ROSC was included. 33(21.3%) patients withhold the resuscitation efforts in ED with mean resuscitation duration 4.45 ± 7.04 minutes after ED arrival. In withholding group, the initial rhythm of arrests was all non-shockable. 9 of them received endotracheal intubation before decision-making. None of the patients in withhold resuscitation group survived to discharge. There was no significant difference among gender, underlying cardiovascular disease, malignancy, chronic renal disease, nor witness collapse between withhold and continue resuscitation groups. Univariate analysis showed there was lower percentage of bystander resuscitation (32.3% vs. 50.4%, p=0.071), and the lower percentage of transport via emergency medical service (EMS) (78.8% vs. 91.8%, p=0.054) in withholding group. Multivariate analysis showed old age (adjusted odds ratio=1.06, 95% C.I.=[1.02-1.11], p<0.05), with underlying respiratory insufficiency (adjusted odds ratio=12.16, 95% C.I.=[3.34-44.29], p<0.05), living at home compared with nursing home (adjusted odds ratio=37.75, 95% C.I.=[1.09-1110.70], p<0.05) were more likely to withhold resuscitation. Transport via EMS was more likely to continue resuscitation (adjusted odds ratio=0.11, 95% C.I.=[0.02-0.71], p<0.05). Conclusion: The decision-making for families and emergency physicians to withhold or continue resuscitation for out-of-hospital cardiac arrest is complex and multi-factorial. Continue resuscitation efforts in nursing home residents is high, and further study among this population is warranted.

Keywords: cardiopulmonary resuscitation, out-of-hospital cardiac arrest, termination resuscitation, withhold resuscitation

Procedia PDF Downloads 248