Search results for: auditory tube dysfunction
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1197

Search results for: auditory tube dysfunction

987 Adaptor Protein APPL2 Could Be a Therapeutic Target for Improving Hippocampal Neurogenesis and Attenuating Depressant Behaviors and Olfactory Dysfunctions in Chronic Corticosterone-induced Depression

Authors: Jiangang Shen

Abstract:

Olfactory dysfunction is a common symptom companied by anxiety- and depressive-like behaviors in depressive patients. Chronic stress triggers hormone responses and inhibits the proliferation and differentiation of neural stem cells (NSCs) in the hippocampus and subventricular zone (SVZ)-olfactory bulb (OB), contributing to depressive behaviors and olfactory dysfunction. However, the cellular signaling molecules to regulate chronic stress mediated olfactory dysfunction are largely unclear. Adaptor proteins containing the pleckstrin homology domain, phosphotyrosine binding domain, and leucine zipper motif (APPLs) are multifunctional adaptor proteins. Herein, we tested the hypothesis that APPL2 could inhibit hippocampal neurogenesis by affecting glucocorticoid receptor (GR) signaling, subsequently contributing to depressive and anxiety behaviors as well as olfactory dysfunctions. The major discoveries are included: (1) APPL2 Tg mice had enhanced GR phosphorylation under basic conditions but had no different plasma corticosterone (CORT) level and GR phosphorylation under stress stimulation. (2) APPL2 Tg mice had impaired hippocampal neurogenesis and revealed depressive and anxiety behaviors. (3) GR antagonist RU486 reversed the impaired hippocampal neurogenesis in the APPL2 Tg mice. (4) APPL2 Tg mice displayed higher GR activity and less capacity for neurogenesis at the olfactory system with lesser olfactory sensitivity than WT mice. (5) APPL2 negatively regulates olfactory functions by switching fate commitments of NSCs in adult olfactory bulbs via interaction with Notch1 signaling. Furthermore, baicalin, a natural medicinal compound, was found to be a promising agent targeting APPL2/GR signaling and promoting adult neurogenesis in APPL2 Tg mice and chronic corticosterone-induced depression mouse models. Behavioral tests revealed that baicalin had antidepressant and olfactory-improving effects. Taken together, APPL2 is a critical therapeutic target for antidepressant treatment.

Keywords: APPL2, hippocampal neurogenesis, depressive behaviors and olfactory dysfunction, stress

Procedia PDF Downloads 75
986 Implicit Responses for Assessment of Autism Based on Natural Behaviors Obtained Inside Immersive Virtual Environment

Authors: E. Olmos-Raya, A. Cascales Martínez, N. Minto de Sousa, M. Alcañiz Raya

Abstract:

The late detection and subjectivity of the assessment of Autism Spectrum Disorder (ASD) imposed a difficulty for the children’s clinical and familiar environment. The results showed in this paper, are part of a research project about the assessment and training of social skills in children with ASD, whose overall goal is the use of virtual environments together with physiological measures in order to find a new model of objective ASD assessment based on implicit brain processes measures. In particular, this work tries to contribute by studying the differences and changes in the Skin Conductance Response (SCR) and Eye Tracking (ET) between a typical development group (TD group) and an ASD group (ASD group) after several combined stimuli using a low cost Immersive Virtual Environment (IVE). Subjects were exposed to a virtual environment that showed natural scenes that stimulated visual, auditory and olfactory perceptual system. By exposing them to the IVE, subjects showed natural behaviors while measuring SCR and ET. This study compared measures of subjects diagnosed with ASD (N = 18) with a control group of subjects with typical development (N=10) when exposed to three different conditions: only visual (V), visual and auditory (VA) and visual, auditory and olfactory (VAO) stimulation. Correlations between SCR and ET measures were also correlated with the Autism Diagnostic Observation Schedule (ADOS) test. SCR measures showed significant differences among the experimental condition between groups. The ASD group presented higher level of SCR while we did not find significant differences between groups regarding DF. We found high significant correlations among all the experimental conditions in SCR measures and the subscale of ADOS test of imagination and symbolic thinking. Regarding the correlation between ET measures and ADOS test, the results showed significant relationship between VA condition and communication scores.

Keywords: autism, electrodermal activity, eye tracking, immersive virtual environment, virtual reality

Procedia PDF Downloads 138
985 Early and Mid-Term Results of Anesthetic Management of Minimal Invasive Coronary Artery Bypass Grafting Using One Lung Ventilation

Authors: Devendra Gupta, S. P. Ambesh, P. K Singh

Abstract:

Introduction: Minimally invasive coronary artery bypass grafting (MICABG) is a less invasive method of performing surgical revascularization. Minimally invasive direct coronary artery bypass (MIDCAB) provides many anesthetic challenges including one lung ventilation (OLV), managing myocardial ischemia, and pain. We present an early and midterm result of the use of this technique with OLV. Method: We enrolled 62 patients for analysis operated between 2008 and 2012. Patients were anesthetized and left endobronchial tube was placed. During the procedure left lung was isolated and one lung ventilation was maintained through right lung. Operation was performed utilizing off pump technique of coronary artery bypass grafting through a minimal invasive incision. Left internal mammary artery graft was done for single vessel disease and radial artery was utilized for other grafts if required. Postoperative ventilation was done with single lumen endotracheal tube. Median follow-up is 2.5 years (6 months to 4 years). Results: Median age was 58.5 years (41-77) and all were male. Single vessel disease was present in 36, double vessel in 24 and triple vessel disease in 2 patients. All the patients had normal left ventricular size and function. In 2 cases difficulty were encounter in placement of endobronchial tube. In 1 case cuff of endobronchial tube was ruptured during intubation. High airway pressure was developed on OLV in 1 case and surgery was accomplished with two lung anesthesia with low tidal volume. Mean postoperative ventilation time was 14.4 hour (11-22). There was no perioperative and 30 day mortality. Conversion to median sternotomy to complete the operation was done in 3.23% (2 out of 62 patients). One patient had acute myocardial infarction postoperatively and there were no deaths during follow-up. Conclusion: MICABG is a safe and effective method of revascularization with OLV in low risk candidates for coronary artery bypass grafting.

Keywords: MIDCABG, one lung ventilation, coronary artery bypass grafting, endobronchial tube

Procedia PDF Downloads 423
984 Plasma Properties Effect on Fluorescent Tube Plasma Antenna Performance

Authors: A. N. Dagang, E. I. Ismail, Z. Zakaria

Abstract:

This paper presents the analysis on the performance of monopole antenna with fluorescent tubes. In this research, the simulation and experimental approach is conducted. The fluorescent tube with different length and size is designed using Computer Simulation Technology (CST) software and the characteristics of antenna parameter are simulated throughout the software. CST was used to simulate antenna parameters such as return loss, resonant frequency, gain and directivity. Vector Network Analyzer (VNA) was used to measure the return loss of plasma antenna in order to validate the simulation results. In the simulation and experiment, the supply frequency is set starting from 1 GHz to 10 GHz. The results show that the return loss of plasma antenna changes when size of fluorescent tubes is varied, correspond to the different plasma properties. It shows that different values of plasma properties such as plasma frequency and collision frequency gives difference result of return loss, gain and directivity. For the gain, the values range from 2.14 dB to 2.36 dB. The return loss of plasma antenna offers higher value range from -22.187 dB to -32.903 dB. The higher the values of plasma frequency and collision frequency, the higher return loss can be obtained. The values obtained are comparative to the conventional type of metal antenna.

Keywords: plasma antenna, fluorescent tube, CST, plasma parameters

Procedia PDF Downloads 385
983 COVID-19’s Effect on Pre-Existing Hearing Loss

Authors: Jonathan A. Mikhail, Arsenio Paez

Abstract:

It is not uncommon for a viral infection to cause hearing loss. Many viral infections are associated with sudden-onset, often unilateral, idiopathic sensorineural hearing loss. We conducted an exploratory study with thirty patients with pre-existing hearing loss between 50 and 64 to evaluate if COVID-19 was associated with exacerbated hearing loss. We hypothesized that hearing loss would be exacerbated by COVID-19 infection in patients with pre-existing hearing loss. A statistically significant paired T-test between pure tone averages (PTAs) at the patient’s original diagnosis and a current, updated audiometric assessment indicated a regression in hearing (p-value < .001) sensitivity following the contraction of COVID-19. Speech reception thresholds (SRTs) and word recognition scores (WRSs) were also considered, as well as the participants' gender. SRTs between each ear exhibited a statistically significant change (p-value of .002 and p-value < .001). WRSs did not show statistically significant differences (p-value of .290 and p-value of .098). A non-statistically significant Two-Way ANOVA was performed to evaluate gender’s potential role in exacerbated hearing loss and proved to be statistically insignificant (p-value of .214). This study discusses practical implications for clinical and educational pursuits in understanding COVID-19's effect on the auditory system and the need to evaluate the deadly virus further.

Keywords: audiology, COVID-19, sensorineural hearing loss, otology, auditory research

Procedia PDF Downloads 77
982 Investigation of Ignition Delay for Low Molecular Hydrocarbon Fuel and Oxygen Mixture behind the Reflected Shock

Authors: K. R. Guna, Aldin Justin Sundararaj, B. C. Pillai, A. N. Subash

Abstract:

A systematic study has been made for ignition delay times measurement behind a reflected shock wave for the low molecular weight hydrocarbon fuel in argon simulated gas mixtures. The low molecular hydrocarbon fuel–oxygen was diluted with argon for desired concentration is taken for the study. The suitability of the shock tube for measuring the ignition delay time is demonstrated by measuring the ignition delay for the liquefied petroleum gas for equivalence ratios (ф=0.5 & 1) in the temperature range 1150-1650 K. The pressure range was fixed from 5-15 bar. The ignition delay was measured by recording the ignition-induced pressure jump and emission from CH radical simultaneously. From conducting experiments, it was found that the ignition delay time for liquefied petroleum gas reduces with increase in temperature. The shock tube was calibrated for ethane-oxygen gas mixture and the results obtained from this study is compared with the earlier reported values and found to be comparably well suited for the measurement of ignition delay times. The above work was carried out using the shock tube facility at propulsion and high enthalpy laboratory, Karunya University.

Keywords: ignition delay, LPG, reflected shock, shock wave

Procedia PDF Downloads 250
981 Beneficial Effects of Curcumin against Stress Oxidative and Mitochondrial Dysfunction Induced by Trinitrobenzene Sulphonic Acid in Colon

Authors: Souad Mouzaoui, Bahia Djerdjouri

Abstract:

Oxidative stress is one of the main factors involved in the onset and chronicity of inflammatory bowel disease (IBD). In this study, we investigated the beneficial effects of a potent natural antioxidant, curcumin (Cur) on colitis and mitochondrial dysfunction in trinitrobenzene sulfonic acid (TNBS)-induced colitis in mice. Rectal instillation of the chemical irritant TNBS (30 mg kg-1) induced the disruption of distal colonic architecture and a massive inflammatory cells influx to the mucosa and submucosa layers. Under these conditions, daily administration of Cur (25 mg kg-1) efficiently decreased colitis scores in the inflamed distal colon by reducing leukocyte infiltrate as attested by reduced myeloperoxidase (MPO) activity. Moreover, the levels of nitrite, an end product of inducible NO synthase activity (iNOS) and malonyl dialdehyde (MDA), a marker of lipid peroxidation increased in a time depending manner in response to TNBS challenge. Conversely, the markers of the antioxidant pool, reduced glutathione (GSH) and catalase activity (CAT) were drastically reduced. Cur attenuated oxidative stress markers and partially restored CAT and GSH levels. Moreover, our results expanded the effect of Cur on TNBS-induced colonic mitochondrial dysfunction. In fact, TNBS induced mitochondrial swelling and lipids peroxidation. These events reflected in the opening of mitochondrial transition pore and could be an initial indication in the cascade process leading to cell death. TNBS inhibited also mitochondrial respiratory activity, caused overproduction of mitochondrial superoxide anion (O2-.) and reduced level of mitochondrial GSH. Nevertheless, Cur reduced the extent of mitochondrial oxidative stress induced by TNBS and restored colonic mitochondrial function. In conclusion, our results showed the critical role of oxidative stress in TNBS-induced colitis. They highlight the role of colonic mitochondrial dysfunction induced by TNBS, as a potential source of oxidative damages. Due to its potent antioxidant properties, Cur opens a promising therapeutic approach against oxidative inflammation in IBD.

Keywords: colitis, curcumin, mitochondria, oxidative stress, TNBS

Procedia PDF Downloads 253
980 Failure and Stress Analysis of Super Heater Tubes of a 67 TPH Coke Dry Quenching Boiler

Authors: Subodh N. Patel, Abhijit Pusty, Manashi Adhikary, Sandip Bhattacharyya

Abstract:

The steam superheater (SH) is a coil type heat exchanger which is used to produce superheated steam or to convert the wet steam to dry steam (69.6 kg/cm² and 495°C), generated by a boiler. There were two superheaters in the system, SH I and SH II. SH II is a set of tubes that faces the initial interaction with flue gas at high temperature followed by SH I tubes. After a service life of 2100 hours, a tube in the SH II found to be punctured. Dye penetrant test revealed that out of 50 such tubes, 14 more tubes had severe cracks at a similar location. The failure was investigated in detail. The materials and scale were characterized by optical microscope and advance characterization technique. Scale, observed on fracture surface, was characterized under scanning electron microscope and Raman spectroscopy. Stresses acting on the tubes in working condition were analyzed by finite element method software, ANSYS. Cyclic stresses were observed in the simulation at the same prone location due to restriction in expansion of tubes. Based on scale characterization and stress analysis, it was concluded that the tube failed in thermo-mechanical fatigue. Finally, prevention and control measures were taken to avoid such failure in the future.

Keywords: finite element analysis, oxide scale, superheater tube, thermomechanical fatigue

Procedia PDF Downloads 116
979 Numerical Investigation of Hot Oil Velocity Effect on Force Heat Convection and Impact of Wind Velocity on Convection Heat Transfer in Receiver Tube of Parabolic Trough Collector System

Authors: O. Afshar

Abstract:

A solar receiver is designed for operation under extremely uneven heat flux distribution, cyclic weather, and cloud transient cycle conditions, which can include large thermal stress and even receiver failure. In this study, the effect of different oil velocity on convection coefficient factor and impact of wind velocity on local Nusselt number by Finite Volume Method will be analyzed. This study is organized to give an overview of the numerical modeling using a MATLAB software, as an accurate, time efficient and economical way of analyzing the heat transfer trends over stationary receiver tube for different Reynolds number. The results reveal when oil velocity is below 0.33m/s, the value of convection coefficient is negligible at low temperature. The numerical graphs indicate that when oil velocity increases up to 1.2 m/s, heat convection coefficient increases significantly. In fact, a reduction in oil velocity causes a reduction in heat conduction through the glass envelope. In addition, the different local Nusselt number is reduced when the wind blows toward the concave side of the collector and it has a significant effect on heat losses reduction through the glass envelope.

Keywords: receiver tube, heat convection, heat conduction, Nusselt number

Procedia PDF Downloads 354
978 To Study Small for Gestational Age as a Risk Factor for Thyroid Dysfunction

Authors: Shilpa Varghese, Adarsh Eregowda

Abstract:

Introduction: The normal development and maturation of the central nervous system is significantly influenced by thyroid hormones. Small for gestational age (SGA) babies have a distinct hormonal profile than kids born at an acceptable birth weight for gestational age, according to several studies (AGA). In SGA babies, thyroid size is larger when expressed as a percentage of body weight, indicating that low thyroid hormone levels throughout foetal life may be partially compensated for. Numerous investigations have found that compared to full-term and preterm AGA neonates, SGA babies exhibit considerably decreased thyroid plasma levels. According to our hypothesis, term and preterm SGA newborns have greater thyroid-stimulating hormone (TSH) concentrations than those that are normal for gestational age (AGA) and a higher incidence of thyroid dysfunction. Need for the study: Clinically diagnosed Assessment of term SGA babies confirming thyroid dysfunction unclear Requirement and importance of ft4 along with tsh and comparative values of ft4 in SGA babies as compared to AGA babies unclear. Inclusion criteria : SGA infants including preterm (<37 weeks of gestation) term (37-40 weeks) – comparing with preterm and term AGA infants. 3.76 7.66 0 2 4 6 8 10 12 AGA Babies SGA Babies Mean Mean TSH Comparison 2.73 1.52 0 0.5 1 1.5 2 2.5 3 3.5 4 AGA Babies SGA Babies Mean Mean FT4 Comparison Discussion : According to this study, neonates with SGA had considerably higher TSH levels than newborns with AGA. Our findings have been supported by results from earlier research. The TSH level range was established to 7.5 mU/L in the study by Bosch-Giménez et al, found greater TSH concentrations in SGA newborns. Thyroid hormone levels from newborns that are tiny for gestational age were found to be higher than AGA in our investigation. According to Franco et al., blood T4 concentrations are lower in both preterm and term SGA infants, while TSH concentrations are only noticeably greater in term SGA infants compared to AGA ones. According to our study analysis, the SGA group had considerably greater FT4 concentrations. Therefore, our findings are consistent with those of the two studies that SGA babies have a higher incidence of transient hypothyroidism and need close follow-up. Conclusions: A greater frequency of thyroid dysfunction and considerably higher TSH values within the normal range were seen in preterm and term SGA babies. The SGA babies who exhibit these characteristics should have ongoing endocrinologic testing and periodic TFTs.

Keywords: thyroid hormone, thyroid function tests, small for gestationl age, appropriate for gestational age

Procedia PDF Downloads 63
977 Efficacy of Transcranial Magnetic Therapy on Balance in Patients with Vestibular Dysfunction

Authors: Ibrahim M. I. Hamoda, Ahmed R. Z. Baghdadi, Mohammed K. Mohamed, Nawal A. Abu-Shady

Abstract:

Background: Most of patients with vestibular dysfunction suffering from balance disorders, Abnormality in balance increase effort and exertion which affect the independency, so this study might be a guide in managing balance problem and consequently improve walking with less exertion and maximum function. Purpose: to analyze and discuss the effect of transcranial magnetic therapy on balance in patients with vestibular dysfunction. Methods: forty subjects from both sexes were classified to divided randomly into two equal groups; Group I study group: this group received transcranial magnetic therapy, with a selected physical therapy program for improving balance and vestibular disorders (Balance training, Cawthorne-Cooksey Exercises) and group II (control group): this group received a selected physical therapy program as group I without transcranial magnetic therapy. This treatment procedure will be applied three times weekly for three months. The mean age was 54.53±3.44 and 55.33±2.32 years and BMI 35.7±3.03 and 35.73±1.03 kg/m2 for group I and II respectively. The Biodex Balance System, Berge balances scale (BBS) and brain MRI were used for assessment. Assessments were conducted before and after treatment. The treatment program for group I included balance training, Cawthorne-Cooksey Exercises and pulsed magnetic therapy (Parameters used in the program of 20 minutes, Intensity 2 gausses, Frequency 1 Hz). This selected program was done in approximately one hour every other day for three month. The treatment program group II Patients received the same program as group A without transcranial magnetic therapy. Results: The One-way ANOVA revealed that there were no significant differences in BBS scores, overall balance index, Anterior / posterior balance index, Medial / lateral balance index and dynamic limits of stability between both groups. Moreover, the BBS scores increased and overall balance index, Anterior / posterior balance index, Medial / lateral balance index and dynamic limits of stability decreased significantly after treatment in group I and II compared with before treatment. Interpretation/Conclusion: Adding pulsed magnetic therapy to balance training, Cawthorne-Cooksey Exercises has no effect on static and dynamic balance in patients with balance problems due to benign positional paroxysmal vertigo.

Keywords: balance, transcranial magnetic therapy, vestibular dysfunction, biomechanic

Procedia PDF Downloads 479
976 Test Method Development for Evaluation of Process and Design Effect on Reinforced Tube

Authors: Cathal Merz, Gareth O’Donnell

Abstract:

Coil reinforced thin-walled (CRTW) tubes are used in medicine to treat problems affecting blood vessels within the body through minimally invasive procedures. The CRTW tube considered in this research makes up part of such a device and is inserted into the patient via their femoral or brachial arteries and manually navigated to the site in need of treatment. This procedure replaces the requirement to perform open surgery but is limited by reduction of blood vessel lumen diameter and increase in tortuosity of blood vessels deep in the brain. In order to maximize the capability of these procedures, CRTW tube devices are being manufactured with decreasing wall thicknesses in order to deliver treatment deeper into the body and to allow passage of other devices through its inner diameter. This introduces significant stresses to the device materials which have resulted in an observed increase in the breaking of the proximal segment of the device into two separate pieces after it has failed by buckling. As there is currently no international standard for measuring the mechanical properties of these CRTW tube devices, it is difficult to accurately analyze this problem. The aim of the current work is to address this discrepancy in the biomedical device industry by developing a measurement system that can be used to quantify the effect of process and design changes on CRTW tube performance, aiding in the development of better performing, next generation devices. Using materials testing frames, micro-computed tomography (micro-CT) imaging, experiment planning, analysis of variance (ANOVA), T-tests and regression analysis, test methods have been developed for assessing the impact of process and design changes on the device. The major findings of this study have been an insight into the suitability of buckle and three-point bend tests for the measurement of the effect of varying processing factors on the device’s performance, and guidelines for interpreting the output data from the test methods. The findings of this study are of significant interest with respect to verifying and validating key process and design changes associated with the device structure and material condition. Test method integrity evaluation is explored throughout.

Keywords: neurovascular catheter, coil reinforced tube, buckling, three-point bend, tensile

Procedia PDF Downloads 116
975 The Proportion of and Factors Associated With Thyroid Dysfunction among Individuals Referred To A Tertiary Care Facility in Kabul, Afghanistan

Authors: Mohammad Naeem Lakanwall

Abstract:

Background:The thyroid gland, located just below the vocal cord on each side of and anterior to the trachea, is one of the main endocrine glands. Its normal weight is 15 to 20 grams in adults. The thyroid secretes two most important hormones, thyroxine and triiodothyronine, usually called T4 and T3, respectively. These hormones greatly increase the metabolic rate of the body. In addition to T3 and T4, the thyroid gland secrets calcitonin as well which is a significant hormone for calcium metabolism. Objective: The aim of this study is to estimate the proportion of and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Material and Methods: An analytical cross-sectional study design was conducted from July to Sep 2018. Blood samples were obtained, serum TSH levels were measured, and the patients were divided into three diagnostic categories according to their serum TSH concentrations. 1) Hypothyroidism 2) Hyperthyroidism 3) Normal thyroid Results: A total of 127 individuals were part of the sample for the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction and the majority of the female participants, (85%) were not pregnant in the last two years. Furthermore, 98% of participants, were non-smokers. Conclusion: The findings of the current study showed a high prevalence of thyroid dysfunctions in individuals coming to FMIC for thyroid functions tests. The findings also indicated that aging and smoking are the factors associated with thyroid dysfunctions. Further studies are needed to find out the prevalence of and factors associated with thyroid dysfunctions.

Keywords: Afghanistan, Kabul, hypothyroidism, hyperthyroidism, triiodothyronine, thyroxine

Procedia PDF Downloads 174
974 Analysis of Control by Flattening of the Welded Tubes

Authors: Hannachi Med Tahar, H. Djebaili, B. Daheche

Abstract:

In this approach, we have tried to describe the flattening of welded tubes, and its experimental application. The test is carried out at the (National product processing company dishes and tubes production). Usually, the final products (tubes) undergo a series of non-destructive inspection online and offline welding, and obviously destructive mechanical testing (bending, flattening, flaring, etc.). For this and for the purpose of implementing the flattening test, which applies to the processing of round tubes in other forms, it took four sections of welded tubes draft (before stretching hot) and welded tubes finished (after drawing hot and annealing), it was also noted the report 'health' flattened tubes must not show or crack or tear. The test is considered poor if it reveals a lack of ductility of the metal.

Keywords: flattening, destructive testing, tube drafts, finished tube, Castem 2001

Procedia PDF Downloads 445
973 Lexical-Semantic Deficits in Sinhala Speaking Persons with Post Stroke Aphasia: Evidence from Single Word Auditory Comprehension Task

Authors: D. W. M. S. Samarathunga, Isuru Dharmarathne

Abstract:

In aphasia, various levels of symbolic language processing (semantics) are affected. It is shown that Persons with Aphasia (PWA) often experience more problems comprehending some categories of words than others. The study aimed to determine lexical semantic deficits seen in Auditory Comprehension (AC) and to describe lexical-semantic deficits across six selected word categories. Thirteen (n =13) persons diagnosed with post-stroke aphasia (PSA) were recruited to perform an AC task. Foods, objects, clothes, vehicles, body parts and animals were selected as the six categories. As the test stimuli, black and white line drawings were adapted from a picture set developed for semantic studies by Snodgrass and Vanderwart. A pilot study was conducted with five (n=5) healthy nonbrain damaged Sinhala speaking adults to decide familiarity and applicability of the test material. In the main study, participants were scored based on the accuracy and number of errors shown. The results indicate similar trends of lexical semantic deficits identified in the literature confirming ‘animals’ to be the easiest category to comprehend. Mann-Whitney U test was performed to determine the association between the selected variables and the participants’ performance on AC task. No statistical significance was found between the errors and the type of aphasia reflecting similar patterns described in aphasia literature in other languages. The current study indicates the presence of selectivity of lexical semantic deficits in AC and a hierarchy was developed based on the complexity of the categories to comprehend by Sinhala speaking PWA, which might be clinically beneficial when improving language skills of Sinhala speaking persons with post-stroke aphasia. However, further studies on aphasia should be conducted with larger samples for a longer period to study deficits in Sinhala and other Sri Lankan languages (Tamil and Malay).

Keywords: aphasia, auditory comprehension, selective lexical-semantic deficits, semantic categories

Procedia PDF Downloads 252
972 Flow-Oriented Incentive Spirometry in the Reversal of Diaphragmatic Dysfunction in Bariatric Surgery Postoperative Period

Authors: Eli Maria Forti-Pazzianotto, Carolina Moraes Da Costa, Daniela Faleiros Berteli Merino, Maura Rigoldi Simões Da Rocha, Irineu Rasera-Junior

Abstract:

There is no conclusive evidence to support the use of one type or brand of incentive espirometry over others. The decision as to which equipment is best, have being based on empirical assessment of patient acceptance, ease of use, and cost. The aim was to evaluate the effects of use of two methodologies of breathing exercises, performed by flow-oriented incentive spirometry, in the reversal of diaphragmatic dysfunction in postoperative bariatric surgery. 38 morbid obese women were selected. Respiratory muscle strength was evaluated through the nasal inspiratory pressure (NIP), and the respiratory muscles endurance, through incremental test by measurement of sustained maximal inspiratory pressure (SMIP). They were randomized in 2 groups: 1- Respiron® Classic (RC) the inspirations were slow, deep and sustained for as long as possible (5 sec). 2- Respiron® Athletic1 (RA1) - the inspirations were explosive, quick and intense, raising balls by the explosive way. 6 sets of 15 repetitions with intervals of 30 to 60 seconds were performed in groups. At the end of the intervention program (second PO), the volunteers were reevaluated. The groups were homogeneous with regard to initial assessment. However on reevaluating there was a significant decline of the variable PIN (p= < 0.0001) and SMIP (p=0.0004) in RC. In the RA1 group there was a maintenance of SMIP (p=0.5076) after surgery. The use of the Respiron Athletic 1, as well as the methodology of application used, can contribute positively to preserve the inspiratory muscle endurance and improve the diaphragmatic dysfunction in postoperative period.

Keywords: bariatric surgery, incentive spirometry, respiratory muscle, physiotherapy

Procedia PDF Downloads 371
971 Investigation of Ceramic-Metal Composites Produced by Electroless Ni Plating of AlN- Astaloy Cr-M

Authors: A. Yönetken, A. Erol, A. Yakar, G. Peşmen

Abstract:

The microstructure, mechanical properties and metalgraphic characteristics of Ni plated AlN-Astaloy Cr-M powders were investigated using specimens produced by tube furnace sintering at 1000-1400 °C temperature. A uniform nickel layer on AlN powders was deposited prior to sintering using electroless plating technique. A composite consisting of ternary additions, metallic phase, Ni and ceramic phase AlN within a matrix of Astaloy Cr-M had been prepared under Ar shroud and then tube furnace sintered. The experimental results carried out by using XRD (X-Ray Diffraction) and SEM (Scanning Electron Microscope) for composition (10% AlN-Astaloy Cr-M) 10% Ni at 1400 °C suggest that the best properties as 132.45HB and permittivity were obtained at 1400 °C.

Keywords: composite, electroless nickel plating, powder metallurgy, sintering

Procedia PDF Downloads 276
970 Experimental on Free and Forced Heat Transfer and Pressure Drop of Copper Oxide-Heat Transfer Oil Nanofluid in Horizontal and Inclined Microfin Tube

Authors: F. Hekmatipour, M. A. Akhavan-Behabadi, B. Sajadi

Abstract:

In this paper, the combined free and forced convection heat transfer of the Copper Oxide-Heat Transfer Oil (CuO-HTO) nanofluid flow in horizontal and inclined microfin tubes is studied experimentally. The flow regime is laminar, and pipe surface temperature is constant. The effect of nanoparticle and microfin tube on the heat transfer rate is investigated with the Richardson number which is between 0.1 and 0.7. The results show an increasing nanoparticle concentration between 0% and 1.5% leads to enhance the combined free and forced convection heat transfer rate. According to the results, five correlations are proposed to provide estimating the free and forced heat transfer rate as the increasing Richardson number from 0.1 to 0.7. The maximum deviation of both correlations is less than 16%. Moreover, four correlations are suggested to assess the Nusselt number based on the Rayleigh number in inclined tubes from 1800000 to 7000000. The maximum deviation of the correlation is almost 16%. The Darcy friction factor of the nanofluid flow has been investigated. Furthermore, CuO-HTO nanofluid flows in inclined microfin tubes.

Keywords: nanofluid, heat transfer oil, mixed convection, inclined tube, laminar flow

Procedia PDF Downloads 254
969 Investigation of Heat Transfer Mechanism Inside Shell and Tube Latent Heat Thermal Energy Storage Systems

Authors: Saeid Seddegh, Xiaolin Wang, Alan D. Henderson, Dong Chen, Oliver Oims

Abstract:

The main objective of this research is to study the heat transfer processes and phase change behaviour of a phase change material (PCM) in shell and tube latent heat thermal energy storage (LHTES) systems. The thermal behaviour in a vertical and horizontal shell-and-tube heat energy storage system using a pure thermal conduction model and a combined conduction-convection heat transfer model is compared in this paper. The model is first validated using published experimental data available in literature and then used to study the temperature variation, solid-liquid interface, phase distribution, total melting and solidification time during melting and solidification processes of PCMs. The simulated results show that the combined convection and conduction model can better describe the energy transfer in PCMs during melting process. In contrast, heat transfer by conduction is more significant during the solidification process since the two models show little difference. Also, it was concluded that during the charging process for the horizontal orientation, convective heat transfer has a strong effect on melting of the upper part of the solid PCM and is less significant during melting of the lower half of the solid PCM. However, in the vertical orientation, convective heat transfer is the same active during the entire charging process. In the solidification process, the thermal behavior does not show any difference between horizontal and vertical systems.

Keywords: latent heat thermal energy storage, phase change material, natural convection, melting, shell and tube heat exchanger, melting, solidification

Procedia PDF Downloads 553
968 Design and Fabrication of Pulse Detonation Engine Based on Numerical Simulation

Authors: Vishal Shetty, Pranjal Khasnis, Saptarshi Mandal

Abstract:

This work explores the design and fabrication of a fundamental pulse detonation engine (PDE) prototype on the basis of pressure and temperature pulse obtained from numerical simulation of the same. PDE is an advanced propulsion system that utilizes detonation waves for thrust generation. PDEs use a fuel-air mixture ignited to create a supersonic detonation wave, resulting in rapid energy release, high pressures, and high temperatures. The operational cycle includes fuel injection, ignition, detonation, exhaust of combustion products, and purging of the chamber for the next cycle. This work presents details of the core operating principles of a PDE, highlighting its potential advantages over traditional jet engines that rely on continuous combustion. The design focuses on a straightforward, valve-controlled system for fuel and oxidizer injection into a detonation tube. The detonation was initiated using an electronically controlled spark plug or similar high-energy ignition source. Following the detonation, a purge valve was employed to expel the combusted gases and prepare the tube for the next cycle. Key considerations for the design include material selection for the detonation tube to withstand the high temperatures and pressures generated during detonation. Fabrication techniques prioritized readily available machining methods to create a functional prototype. This work detailed the testing procedures for verifying the functionality of the PDE prototype. Emphasis was given to the measurement of thrust generation and capturing of pressure data within the detonation tube. The numerical analysis presents performance evaluation and potential areas for future design optimization.

Keywords: pulse detonation engine, ignition, detonation, combustion

Procedia PDF Downloads 18
967 Distributed Listening in Intensive Care: Nurses’ Collective Alarm Responses Unravelled through Auditory Spatiotemporal Trajectories

Authors: Michael Sonne Kristensen, Frank Loesche, James Foster, Elif Ozcan, Judy Edworthy

Abstract:

Auditory alarms play an integral role in intensive care nurses’ daily work. Most medical devices in the intensive care unit (ICU) are designed to produce alarm sounds in order to make nurses aware of immediate or prospective safety risks. The utilisation of sound as a carrier of crucial patient information is highly dependent on nurses’ presence - both physically and mentally. For ICU nurses, especially the ones who work with stationary alarm devices at the patient bed space, it is a challenge to display ‘appropriate’ alarm responses at all times as they have to navigate with great flexibility in a complex work environment. While being primarily responsible for a small number of allocated patients they are often required to engage with other nurses’ patients, relatives, and colleagues at different locations inside and outside the unit. This work explores the social strategies used by a team of nurses to comprehend and react to the information conveyed by the alarms in the ICU. Two main research questions guide the study: To what extent do alarms from a patient bed space reach the relevant responsible nurse by direct auditory exposure? By which means do responsible nurses get informed about their patients’ alarms when not directly exposed to the alarms? A comprehensive video-ethnographic field study was carried out to capture and evaluate alarm-related events in an ICU. The study involved close collaboration with four nurses who wore eye-level cameras and ear-level binaural audio recorders during several work shifts. At all time the entire unit was monitored by multiple video and audio recorders. From a data set of hundreds of hours of recorded material information about the nurses’ location, social interaction, and alarm exposure at any point in time was coded in a multi-channel replay-interface. The data shows that responsible nurses’ direct exposure and awareness of the alarms of their allocated patients vary significantly depending on work load, social relationships, and the location of the patient’s bed space. Distributed listening is deliberately employed by the nursing team as a social strategy to respond adequately to alarms, but the patterns of information flow prompted by alarm-related events are not uniform. Auditory Spatiotemporal Trajectory (AST) is proposed as a methodological label to designate the integration of temporal, spatial and auditory load information. As a mixed-method metrics it provides tangible evidence of how nurses’ individual alarm-related experiences differ from one another and from stationary points in the ICU. Furthermore, it is used to demonstrate how alarm-related information reaches the individual nurse through principles of social and distributed cognition, and how that information relates to the actual alarm event. Thereby it bridges a long-standing gap in the literature on medical alarm utilisation between, on the one hand, initiatives to measure objective data of the medical sound environment without consideration for any human experience, and, on the other hand, initiatives to study subjective experiences of the medical sound environment without detailed evidence of the objective characteristics of the environment.

Keywords: auditory spatiotemporal trajectory, medical alarms, social cognition, video-ethography

Procedia PDF Downloads 189
966 Correlation Between Diastolic Function and Lower GLS in Hypertensive Patients

Authors: A. Kherraf, S. Ouarrak, L. Azzouzi, R. Habbal

Abstract:

Introduction: Preserved LVEF heart failure is an important cause of mortality and morbidity in hypertensive patients. A strong correlation between impaired diastolic function and longitudinal systolic dysfunction. could have several explanations, first, the diastole is an energy dependent process, especially during its first phase, it also includes active systolic components during the phase of iso volumetric relaxation, in addition, the impairment of the intrinsic myocytic function is part of hypertensive pathology as evidenced by recent studies. METHODS AND MATERIALS: This work consists of performing in a series of 333 hypertensive patients (aged 25 to 75 years) a complete echocardiographic study, including LVEF by Simpson biplane method, the calculation of the indexed left ventricular mass, the analysis of the diastolic function, and finally, the study of the longitudinal deformation of the LV by the technique of speckletracking (calculation of the GLS). Patients with secondary hypertension, leaky or stenosing valve disease, arrhythmia, and a history of coronary insufficiency were excluded from this study. RESULTS: Of the 333 hypertensive patients, 225 patients (67.5%) had impaired diastolic function, of which 60 patients (18%) had high filling pressures. 49.39% had echocardigraphic HVG, Almost all of these patients (60 patients) had low GLS. There is a statistically very significant relationship between lower GLS and increased left ventricular filling pressures in hypertensive patients. These results suggest that increased filling pressures are closely associated with atrioventricular interaction in patients with hypertension, with a strong correlation with impairment of longitudinal systolic function and diastolic function CONCLUSION: Overall, a linear relationship is established between increased left ventricular mass, diastolic dysfunction, and longitudinal LV systolic dysfunction

Keywords: hypertension, diastolic function, left ventricle, heart failure

Procedia PDF Downloads 125
965 Herschel-Bulkley Fluid Flow through Narrow Tubes

Authors: Santhosh Nallapu, G. Radhakrishnamacharya

Abstract:

A two-fluid model of Herschel-Bulkley fluid flow through tubes of small diameters is studied. It is assumed that the core region consists of Herschel-Bulkley fluid and Newtonian fluid in the peripheral region. The analytical solutions for velocity, flow flux, effective viscosity, core hematocrit and mean hematocrit have been derived and the effects of various relevant parameters on these flow variables have been studied. It has been observed that the effective viscosity and mean hematocrit increase with yield stress, power-law index, hematocrit and tube radius. Further, the core hematocrit decreases with hematocrit and tube radius.

Keywords: two-layered model, non-Newtonian fluid, hematocrit, Fahraeus-Lindqvist effect, plug flow

Procedia PDF Downloads 469
964 Intensification of Heat Transfer Using AL₂O₃-Cu/Water Hybrid Nanofluid in a Circular Duct Using Inserts

Authors: Muluken Biadgelegn Wollele, Mebratu Assaye Mengistu

Abstract:

Nanotechnology has created new opportunities for improving industrial efficiency and performance. One of the proposed approaches to improving the effectiveness of temperature exchangers is the use of nanofluids to improve heat transfer performance. The thermal conductivity of nanoparticles, as well as their size, diameter, and volume concentration, all played a role in influencing the rate of heat transfer. Nanofluids are commonly used in automobiles, energy storage, electronic component cooling, solar absorbers, and nuclear reactors. Convective heat transfer must be improved when designing thermal systems in order to reduce heat exchanger size, weight, and cost. Using roughened surfaces to promote heat transfer has been tried several times. Thus, both active and passive heat transfer methods show potential in terms of heat transfer improvement. There will be an added advantage of enhanced heat transfer due to the two methods adopted; however, pressure drop must be considered during flow. Thus, the current research aims to increase heat transfer by adding a twisted tap insert in a plain tube using a working fluid hybrid nanofluid (Al₂O₃-Cu) with a base fluid of water. A circular duct with inserts, a tube length of 3 meters, a hydraulic diameter of 0.01 meters, and tube walls with a constant heat flux of 20 kW/m² and a twist ratio of 125 was used to investigate Al₂O₃-Cu/H₂O hybrid nanofluid with inserts. The temperature distribution is better than with conventional tube designs due to stronger tangential contact and swirls in the twisted tape. The Nusselt number values of plain twisted tape tubes are 1.5–2.0 percent higher than those of plain tubes. When twisted tape is used instead of plain tube, performance evaluation criteria improve by 1.01 times. A heat exchanger that is useful for a number of heat exchanger applications can be built utilizing a mixed flow of analysis that incorporates passive and active methodologies.

Keywords: nanofluids, active method, passive method, Nusselt number, performance evaluation criteria

Procedia PDF Downloads 72
963 Experimental and Numerical Investigation of Heat Transfer in THTL Test Loop Shell and Tube Heat Exchanger

Authors: M. Moody, R. Mahmoodi, A. R. Zolfaghari, A. Aminottojari

Abstract:

In this study, flow inside the shell side of a shell-and-tube heat exchanger is simulated numerically for laminar and turbulent flows in both steady state and transient mode. Governing equations of fluid flow are discrete using finite volume method and central difference scheme and solved with simple algorithm which is staggered grid by using MATLAB programming language. The heat transfer coefficient is obtained using velocity field from equation Dittus-Bolter. In comparison with, heat exchanger is simulated with ANSYS CFX software and experimental data measured in the THTL test loop. Numerical results obtained from the study show good agreement with experimental data and ANSYS CFX results. In addition, by deliberation the effect of the baffle spacing and the baffle cut on the heat transfer rate for turbulent flow, it is illustrated that the heat transfer rate depends on the baffle spacing and the baffle cut directly. In other word in spied of large turbulence, if these two parameters are not selected properly in the heat exchanger, the heat transfer rate can reduce.

Keywords: shell-and-tube heat exchanger, flow and heat transfer, laminar and turbulence flow, turbulence model, baffle spacing, baffle cut

Procedia PDF Downloads 536
962 Isolation and Antifungal Susceptibility Pattern of Candida albicans from Endocervical and High Vaginal Swabs of Pregnant Women Attending State Specialist Hospital Gombe, Nigeria

Authors: Isa Shu’aibu, A. A. Mu’inat, F. U. Maigari, M. A. Mani

Abstract:

Candida albicans is the common cause of both oral and vaginal candidiasis in humans. This candidiasis leads to a wide range of physical, psychological and even physiological problems in humans particularly pregnant women. Samples of endocervical and high vaginal swab were collected from 200 women attending Gombe Specialist Hospital and inoculated on Saboraud Dextrose Agar (SDA) incorporated with chloramphenicol to get rid of the unwanted bacterial contaminants. Gram staining technique and germ tube test were employed for the identification, as Candida albicans is positive for both. Gram positive samples were 70% (n=140) and were further subjected to germ tube test. The remaining 30% (n=60) were found to be Gram negative. 90% (n=126) of the Gram positive ones isolated were also found to be positive for germ tube test; confirming the presence of Candida albicans. Antifungal susceptibility testing revealed that members of Imidazole (Ketoconazole, Miconazole) and those of Triazoles (Fluconazole and Itraconazole) were found to be more effective at concentrations of 20, 50 and 100 µg/disc compared to Griseofulvin (Fulcin) with only 26.00 mm zone of inhibition at 100 µg/disc concentration.

Keywords: Candida albicans, candidiasis, endocervical, vaginal swab, antifungal susceptibility, imidazole, triazoles

Procedia PDF Downloads 331
961 Simulation of Improving the Efficiency of a Fire-Tube Steam Boiler

Authors: Roudane Mohamed

Abstract:

In this study we are interested in improving the efficiency of a steam boiler to 4.5T/h and minimize fume discharge temperature by the addition of a heat exchanger against the current in the energy system, the output of the boiler. The mathematical approach to the problem is based on the use of heat transfer by convection and conduction equations. These equations have been chosen because of their extensive use in a wide range of application. A software and developed for solving the equations governing these phenomena and the estimation of the thermal characteristics of boiler through the study of the thermal characteristics of the heat exchanger by both LMTD and NUT methods. Subsequently, an analysis of the thermal performance of the steam boiler by studying the influence of different operating parameters on heat flux densities, temperatures, exchanged power and performance was carried out. The study showed that the behavior of the boiler is largely influenced. In the first regime (P = 3.5 bar), the boiler efficiency has improved significantly from 93.03 to 99.43 at the rate of 6.47% and 4.5%. For maximum speed, the change is less important, it is of the order of 1.06%. The results obtained in this study of great interest to industrial utilities equipped with smoke tube boilers for the preheating air temperature intervene to calculate the actual temperature of the gas so the heat exchanged will be increased and minimize temperature smoke discharge. On the other hand, this work could be used as a model of computation in the design process.

Keywords: numerical simulation, efficiency, fire tube, heat exchanger, convection and conduction

Procedia PDF Downloads 216
960 Hot Corrosion Susceptibility of Uncoated Boiler Tubes during High Vanadium Containing Fuel Oil Operation in Boiler Applications

Authors: Nicole Laws, William L. Roberts, Saumitra Saxena, Krishnamurthy Anand, Sreenivasa Gubba, Ziad Dawood, Aiping Chen

Abstract:

Boiler-fired power plants that operate steam turbines in Saudi Arabia use vanadium-containing fuel oil. In a super- or sub-critical steam cycle, the skin temperature of boiler tube metal can reach close to 600-1000°C depending on the location of the tubes. At high temperatures, corrosion by the sodium-vanadium-oxygen-sulfur eutectic can become a significant risk. The experimental work utilized a state-of-the-art high-temperature, high-pressure burner rig at KAUST, King Abdullah University of Science and Technology. To establish corrosion rates of different boiler tubes and materials, SA 213 T12, SA 213 T22, SA 213 T91, and Inconel 600, were used under various corrosive media, including vanadium to sulfur levels and vanadium to sodium ratios. The results obtained from the experiments establish a corrosion rate map for the materials involved and layout an empirical framework to rank the life of boiler tube materials under different operating conditions. Safe windows of operation are proposed for burning liquid fuels under varying vanadium, sodium, and sulfur levels before corrosion rates become a matter of significance under high-temperature conditions

Keywords: boiler tube life, hot corrosion, steam boilers, vanadium in fuel oil

Procedia PDF Downloads 231
959 Comparison of Interactive Performance of Clicking Tasks Using Cursor Control Devices under Different Feedback Modes

Authors: Jinshou Shi, Xiaozhou Zhou, Yingwei Zhou, Tuoyang Zhou, Ning Li, Chi Zhang, Zhanshuo Zhang, Ziang Chen

Abstract:

In order to select the optimal interaction method for common computer click tasks, the click experiment test adopts the ISO 9241-9 task paradigm, using four common operations: mouse, trackball, touch, and eye control under visual feedback, auditory feedback, and no feedback. Through data analysis of various parameters of movement time, throughput, and accuracy, it is found that the movement time of touch-control is the shortest, the operation accuracy and throughput are higher than others, and the overall operation performance is the best. In addition, the motion time of the click operation with auditory feedback is significantly lower than the other two feedback methods in each operation mode experiment. In terms of the size of the click target, it is found that when the target is too small (less than 14px), the click performance of all aspects is reduced, so it is proposed that the design of the interface button should not be less than 28px. In this article, we discussed in detail the advantages and disadvantages of the operation and feedback methods, and the results of the discussion of the click operation can be applied to the design of the buttons in the interactive interface.

Keywords: cursor control performance, feedback, human computer interaction, throughput

Procedia PDF Downloads 194
958 Collaboration between Dietician and Occupational Therapist, Promotes Independent Functional Eating in Tube Weaning Process of Mechanical Ventilated Patients

Authors: Inbal Zuriely, Yonit Weiss, Hilla Zaharoni, Hadas Lewkowicz, Tatiana Vander, Tarif Bader

Abstract:

early active movement, along with adjusting optimal nutrition, prevents aggravation of muscle degeneracy and functional decline. Eating is a basic activity of daily life, which reflects the patient's independence. When eating and feeding are experienced successfully, they lead to a sense of pleasure and satisfaction. However, when they are experienced as a difficulty, they might evoke feelings of helplessness and frustration. This stresses the essential process of gradual weaning off the enteral feeding tube. the work describes the collaboration of a dietitian, determining the nutritional needs of patients undergoing enteral tube weaning as part of the rehabilitation process, with the suited treatment of an occupational therapist. Occupational therapy intervention regarding eating capabilities focuses on improving the required motor and cognitive components, along with environmental adjustments and aids, imparting eating strategies and training to patients and their families. The project was conducted in the long-term, ventilated patients’ department at the Herzfeld Rehabilitation Geriatric Medical Center on patients undergoing enteral tube weaning with the staff’s assistance. Establishing continuous collaboration between the dietician and the occupational therapist, starting from the beginning of the feeding-tube weaning process: 1.The dietician updates the occupational therapist about the start of the process and the approved diet. 2.The occupational therapist performs cognitive, motor, and functional assessments and treatments regarding the patient’s eating capabilities and recommends the required adjustments for independent eating according to the FIM (Functional Independence Measure) scale. 3.The occupational therapist closely follows up on the patient’s degree of independence in eating and provides a repeated update to the dietician. 4.The dietician accordingly guides the ward staff on whether and how to feed the patient or allow independent eating. The project aimed to promote patients toward independent feeding, which leads to a sense of empowerment, enjoyment of the eating experience, and progress of functional ability, along with performing active movements that will motivate mobilization. From the beginning of 2022, 26 patients participated in the project. 79% of all patients who started the weaning process from tube feeding achieved different levels of independence in feeding (independence levels ranged from supervision (FIM-5) to complete independence (FIM-7). The integration of occupational therapy and dietary treatment is based on a patient-centered approach while considering the patient’s personal needs, preferences, and goals. This interdisciplinary partnership is essential for meeting the complex needs of prolonged mechanically ventilated patients and promotes independent functioning and quality of life.

Keywords: dietary, mechanical ventilation, occupational therapy, tube feeding weaning

Procedia PDF Downloads 77