Search results for: combined care

Authors: Wisam Ismail, Chole Wright, Elizabeth Baker, Cathy Tait, Mohamed Salhab, Richard Linforth

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Background: Post-mastectomy breast reconstruction is an important treatment option for women with breast cancer with psychosocial, emotional and quality of life benefits. Despite this, Asian patients are one-fifth as likely as Caucasian patients to undergo reconstruction after mastectomy. Aim: This study aimed to assess the difference in breast reconstruction rates between Asian and Caucasian patients treated at Bradford Teaching Hospitals between May 2011 – December 2015.The long-term goal is to equip healthcare professionals to improve breast cancer treatment outcome by increasing breast reconstruction rates in this sub-population. Methods: All patients undergoing mastectomy were identified using a prospectively collected departmental database. Further data was obtained via retrospective electronic case note review. Bradford city population is about 530.000 by the end of 2015, with 67.44% of the city's population was White ethnic groups and 26.83% Asian Ethnic Groups (UK population consensus). The majority of Asian population speaks Urdu, hence an Urdu speaking breast care nurse was appointed to facilitate communications and deliver a better understanding of the reconstruction options and pathways. Statistical analysis was undertaken using the SAS program. Patients were stratified by age, self-reported ethnicity, axillary surgery and reconstruction. Relative odds were calculated using univariate and multivariate logistic regression analyses with adjustment for known confounders. An Urdu speaking breast care nurse was employed throughout this period to facilitate communication and patient decision making. Results: 506 patients underwent Mastectomy over 5 years. 72 (14%) Asian v. 434 (85%) Caucasian. Overall median age is 64 years (SD1.1). Asian median age is 62 (SD0.9), versus Caucasian 65 (SD1.2). Total axillary clearance rate was 30% (42% Asian v.30% Caucasian). Overall reconstruction rate was 126 patients (28.9%).Only 6 of 72 Asian patients (<1%) underwent breast reconstruction versus 121of 434 Caucasian (28%) (p < 0.04), Odds ratio 0.68, (95% confidence interval 0.57-0.79). Conclusions: There is a significant difference in post-mastectomy reconstruction rates between Asian and Caucasian patients. This difference is likely to be multi-factorial. Higher rates of axillary clearance in Asian patients might suggest later disease presentation and/or higher rates of subsequent adjuvant therapy, both of which, can impact on the suitability of breast reconstruction. Strategies aimed at reducing racial disparities in breast reconstruction should include symptom awareness to enable earlier presentation and facilitated communication to ensure informed decision-making.

Keywords: aesthetic, Asian, breast, reconstruction

Procedia PDF Downloads 273

Authors: M. Illias Kanchan

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The death of a woman during pregnancy and childbirth is not only a health issue, but also a matter of social injustice. This study makes an attempt to explore the association between maternal death and associated factors in West Bengal using the approaches of facility-based and community-based maternal death review. Bivariate and binary logistic regression analysis have been performed to understand the causes and circumstances of maternal deaths in West Bengal. Delay in seeking care was the major contributor in maternal deaths, near about one-third women died due to this factor. The most common cause of maternal death is found to be hypertensive disorders of pregnancy or eclampsia. We believe that these deaths can be averted by reducing hypertensive disorders of pregnancy or eclampsia.

Keywords: maternal death, facility-based, community-based, review, west Bengal, eclampsia

Procedia PDF Downloads 423

Authors: Vijay Pal Singh, Yogesh Chandra Kotiyal

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Structures are a combination of various load carrying members which transfer the loads to the foundation from the superstructure safely. At the design stage, the loading of the structure is defined and appropriate material choices are made based upon their properties, mainly related to strength. The strength of materials kept on reducing with time because of many factors like environmental exposure and deformation caused by unpredictable external loads. Hence, to predict the strength of materials used in structures, various techniques are used. Among these techniques, Non-Destructive Techniques (NDT) are the one that can be used to predict the strength without damaging the structure. In the present study, the compressive strength of concrete has been predicted using Artificial Neural Network (ANN). The predicted strength was compared with the experimentally obtained actual compressive strength of concrete and equations were developed for different models. A good co-relation has been obtained between the predicted strength by these models and experimental values. Further, the co-relation has been developed using two NDT techniques for prediction of strength by regression analysis. It was found that the percentage error has been reduced between the predicted strength by using combined techniques in place of single techniques.

Keywords: rebound, ultra-sonic pulse, penetration, ANN, NDT, regression

Procedia PDF Downloads 418

Authors: Almudena Konrad, Tomás Galguera

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Lack of motivation and interest is a serious obstacle to students’ learning computing skills. A need exists for a knowledge base on effective pedagogy and curricula to teach computer programming. This paper presents results from research evaluating a six-year project designed to teach complex concepts in computer programming collaboratively, while supporting students to continue developing their computer thinking and related coding skills individually. Utilizing a quasi-experimental, mixed methods design, the pedagogical approaches and methods were assessed in two contrasting groups of students with different socioeconomic status, gender, and age composition. Analyses of quantitative data from Likert-scale surveys and an evaluation rubric, combined with qualitative data from reflective writing exercises and semi-structured interviews yielded convincing evidence of the project’s success at both teaching and inspiring students.

Keywords: computational thinking, computing education, computer programming curriculum, logic, teaching methods

Procedia PDF Downloads 311

Authors: A. B. M. Aftabuzzaman, Md. Mahin Hossain, Md. Ifran Sharif Imthi, Md. Razu Ahmed, A. Z. M. Imran

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The goals of the study are to develop a safety system that is combined with a smart helmet to reduce the likelihood of two-wheeler bike accidents and cases of drunk driving. The smart helmet and the limit switch both verify when a biker is wearing a helmet. The presence of alcohol in the rider's breath is detected using alcohol sensors. The bike remains turned off if the rider is not wearing a helmet or if the rider's breath contains alcohol. The bike will not start until the rider is wearing a helmet and there is no alcoholic substance present, indicating that the bike rider has not consumed alcohol. When the rider faces in an accident, instantly the smart helmet hits the ground and respective sensors detect the movement and tilt of the protective helmet and instantly sending the information about the location of accident to the rider's relatives and the crisis contact numbers which are introduced in the smart helmet respective device. So this project finding will ensure safe bike journey and improve safe commercial bike services in Bangladesh.

Keywords: smart helmet, GSM, GPS, bike, biker accident

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Authors: Tao Feng, Fei Xing, Ye Lu, Jun Li Fang

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NDN is a kind of future Internet architecture. Due to the NDN design introduces four privacy challenges,Many research institutions began to care about the privacy issues of naming data network(NDN).In this paper, we are in view of the major NDN’s privacy issues to investigate privacy protection,then put forwards more effectively anonymous transfer policy for NDN.Firstly,based on mutual anonymity communication for MP2P networks,we propose NDN mutual anonymity protocol.Secondly,we add interest package authentication mechanism in the protocol and encrypt the coding coefficient, security of this protocol is improved by this way.Finally, we proof the proposed anonymous transfer protocol security and anonymity.

Keywords: NDN, mutual anonymity, anonymous routing, network coding, authentication mechanism

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Authors: S. Dey, T. Mukhopadhyay, S. Adhikari

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This paper presents an exhaustive comparative investigation on sampling techniques of polynomial regression model based stochastic natural frequency of composite plates. Both individual and combined variations of input parameters are considered to map the computational time and accuracy of each modelling techniques. The finite element formulation of composites is capable to deal with both correlated and uncorrelated random input variables such as fibre parameters and material properties. The results obtained by Polynomial regression (PR) using different sampling techniques are compared. Depending on the suitability of sampling techniques such as 2k Factorial designs, Central composite design, A-Optimal design, I-Optimal, D-Optimal, Taguchi’s orthogonal array design, Box-Behnken design, Latin hypercube sampling, sobol sequence are illustrated. Statistical analysis of the first three natural frequencies is presented to compare the results and its performance.

Keywords: composite plate, natural frequency, polynomial regression model, sampling technique, uncertainty quantification

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Authors: K. A.Veselova, N. V.Gromova, I. N.Antonova, I. N. Kalakutskii

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There are many diseases and incidents that may result facial defects and deformities: cancer, trauma, burns, congenital anomalies, and autoimmune diseases. In some cases, patient may acquire atypically extensive facial defect, including more than one anatomical region or, by contrast, atypically small defect (e.g. partial auricular defect). The anaplastology gives us opportunity to help patient with facial disfigurement in cases when plastic surgery is contraindicated. Using of implant retention for facial prosthesis is strongly recommended because improves both aesthetic and functional results and makes using of the prosthesis more comfortable. Prostheticly oriented fixture position is extremely important for aesthetic and functional long-term result; however, the optimal site for fixture placement is not clear in cases with atypical configuration of facial defect. The objective of this report is to demonstrate challenges in fixture position determination we have faced with and offer the solution. In this report, four cases of implant-supported facial prosthesis are described. Extra-oral implants with four millimeter length were used in all cases. The decision regarding the quantity of surgical stages was based on anamnesis of disease. Facial prostheses were manufactured according to conventional technique. Clinical and technological difficulties and mistakes are described, and prostheticly oriented approach for determination of fixture position is demonstrated. The case with atypically large combined orbital and nasal defect resulting after arteriovenous malformation is described: the correct positioning of artificial eye was impossible due to wrong position of the fixture (with suprastructure) located in medial aspect of supraorbital rim. The suprastructure was unfixed and this fixture wasn`t used for retention in order to achieve appropriate artificial eye placement and better aesthetic result. In other case with small partial auricular defect (only helix and antihelix were absent) caused by squamoized cell carcinoma T1N0M0 surgical template was used to avoid the difficulties. To achieve the prostheticly oriented fixture position in case of extremely small defect the template was made on preliminary cast using vacuum thermoforming method. Two radiopaque markers were incorporated into template in preferable for fixture placement positions taking into account future prosthesis configuration. The template was put on remaining ear and cone-beam CT was performed to insure, that the amount of bone is enough for implant insertion in preferable position. Before the surgery radiopaque markers were extracted and template was holed for guide drill. Fabrication of implant-retained facial prostheses gives us opportunity to improve aesthetics, retention and patients’ quality of life. But every inaccuracy in planning leads to challenges on surgery and prosthetic stages. Moreover, in cases with atypically small or extended facial defects prostheticly oriented approach for determination of fixture position is strongly required. The approach including surgical template fabrication is effective, easy and cheap way to avoid mistakes and unpredictable result.

Keywords: anaplastology, facial prosthesis, implant-retained facial prosthesis., maxillofacil prosthese

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Authors: Yaowaporn Sangsen, Kittisak Likhitwitayawuid, Boonchoo Sritularak, Kamonthip Wiwattanawongsa, Ruedeekorn Wiwattanapatapee

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Novel solid lipid nanoparticles (SLNs) were developed to improve oral bioavailability of oxyresveratrol (OXY). The SLNs were prepared by a high speed homogenization technique, at an effective speed and time, using Compritol® 888 ATO (5% w/w) as the solid lipid. The appropriate weight proportions (0.3% w/w) of OXY affected the physicochemical properties of blank SLNs. The effects of surfactant types on the properties of the formulations such as particle size and entrapment efficacy were also investigated. Conclusively, Tween 80 combined with soy lecithin was the most appropriate surfactant to stabilize OXY-loaded SLNs. The mean particle size of the optimized formulation was 134.40 ± 0.57 nm. In vitro drug release study, the selected S2 formulation showed a retarded release profile for OXY with no initial burst release compared to OXY suspension in the simulated gastrointestinal fluids. Therefore, these SLNs could provide a suitable system to develop for the oral OXY delivery.

Keywords: solid lipid nanoparticles, physicochemical properties, in vitro drug release, oxyresveratrol

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Authors: Pedro Pablo Ramírez Sánchez, Alassane Ballé Ndiaye, Roberto Rendeiro Martín-Cejas

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The aim of this paper is to analyse the different environmental policies adopted in Europe for car emissions, to comment on some of the possible perverse effects generated and point out these policies which are considered more efficient under the environmental perspective. This paper is focused on passenger cars as this category is the most significant in road transport. The utility of this research lies in this being the first step or basis to improve and optimise actual policies. The methodology applied in this paper refers to a comparative analysis from a practical and theoretical point of view of European environmental policies in road transport. This work describes an overview of the road transport industry in Europe pointing out some relevant aspects such as the contribution of road transport to total emissions and the vehicle fleet in Europe. Additionally, we propose a brief practice guide with the combined policies in order to optimise their aim.

Keywords: air quality, climate change, emission, environment, perverse effect, road transport, tax policy

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Authors: Roman Klas, František Pochylý, Pavel Rudolf

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This paper is focused on the CFD simulation of the radiaxial pump (i.e. mixed flow pump) with the aim to detect the reasons of Y-Q characteristic instability. The main reasons of pressure pulsations were detected by means of the analysis of velocity and pressure fields within the pump combined with the theoretical approach. Consequently, the modifications of spiral case and pump suction area were made based on the knowledge of flow conditions and the shape of dissipation function. The primary design of pump geometry was created as the base model serving for the comparison of individual modification influences. The basic experimental data are available for this geometry. This approach replaced the more complicated and with respect to convergence of all computational tasks more difficult calculation for the compressible liquid flow. The modification of primary pump consisted in inserting the three fins types. Subsequently, the evaluation of pressure pulsations, specific energy curves and visualization of velocity fields were chosen as the criterion for successful design.

Keywords: CFD, radiaxial pump, spiral case, stability

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Authors: E. V. Fakhrutdinova, K. R. Maksimova, P. B. Chursin

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At the present stage of the society progress the health care is an integral part of both the economic system and social, while in the second case the medicine is a major component of a number of basic and necessary social programs. Since the foundation of the health system are highly qualified health professionals, it is logical proposition that increase of doctor`s professionalism improves the effectiveness of the system as a whole. Professionalism of the doctor is a collection of many components, essential role played by such personal-psychological factors as honesty, willingness and desire to help people, and motivation. A number of researchers consider motivation as an expression of basic human needs that have passed through the “filter” which is a worldview and values learned in the process of socialization by the individual, to commit certain actions designed to achieve the expected result. From this point of view a number of researchers propose the following classification of highly skilled employee’s needs: 1. the need for confirmation the competence (setting goals that meet the professionalism and receipt of positive emotions in their decision), 2. The need for independence (the ability to make their own choices in contentious situations arising in the process carry out specialist functions), 3. The need for ownership (in the case of health care workers, to the profession and accordingly, high in the eyes of the public status of the doctor). Nevertheless, it is important to understand that in a market economy a significant motivator for physicians (both legal and natural persons) is to maximize its own profits. In the case of health professionals duality motivational structure creates an additional contrast, as in the public mind the image of the ideal physician; usually a altruistically minded person thinking is not primarily about their own benefit, and to assist others. In this context, the question of the real motivation of health workers deserves special attention. The survey conducted by the American researcher Harrison Terni for the magazine "Med Tech" in 2010 revealed the opinion of more than 200 medical students starting courses, and the primary motivation in a profession choice is "desire to help people", only 15% said that they want become a doctor, "to earn a lot". From the point of view of most of the classical theories of motivation this trend can be called positive, as intangible incentives are more effective. However, it is likely that over time the opinion of the respondents may change in the direction of mercantile motives. Thus, it is logical to assume that well-designed system of motivation of doctor`s labor should be based on motivational foundations laid during training in higher education.

Keywords: motivation, quality of working life, health system, personal-psychological factors, motivational structure

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Authors: Chia-Chi Chen, Tai-Sheng Huang

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Ageing society has been spread around the world. The global population is not only ageing but also declining. The structure of population has changed, which has a significant impact on both the economies and industries. Thus, how to be a healthy senior citizen to relieve the burden to the family and society will be a popular issue. Although fitness equipment manufacturing industry has been mature, the ageing population is still increasing. Therefore, this study aims to design an innovative style of fitness equipment for senior citizens, based on BMLT presented by Dr. Koyama Hirofumi. The analysis of current fitness equipment on the market and the future trend will be applied in the study. With the coming of information age, senior citizens in the future are the users of information product for sure, and the new style of fitness equipment will be combined with information technology as well. Through this study, it is believed to design an innovative style of fitness equipment for seniors and help them live heartier and happier lives.

Keywords: aging society, BMLT (Beginning Movement Load Training), seniors, new style of fitness equipment

Procedia PDF Downloads 208

Authors: Abdelsabour G. A. Khaled, Galal A.R. El-Sherbeny, Ahmed M. Hassanein, Gameel M. G. Aly

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Classical methods of identification, based on agronomical characterization, are not always the most accurate way due to the instability of these characteristics under the influence of the different environments. In order to estimate the genetic diversity, molecular markers provided excellent tools. In this study, Genetic variation of nine Egyptian jojoba shrubs was tested using ISSR (inter simple sequences repeats), RAPD (random amplified polymorphic DNA) markers and based on the morphological characterization. The average of the percentage of polymorphism (%P) ranged between 58.17% and 74.07% for ISSR and RAPD markers, respectively. The range of genetic similarity percents among shrubs based on ISSR and RAPD markers were from 82.9 to 97.9% and from 85.5 to 97.8%, respectively. The average of PIC (polymorphism information content) values were 0.19 (ISSR) and 0.24 (RAPD). In the present study, RAPD markers were more efficient than the ISSR markers. Where the RAPD technique exhibited higher marker index (MI) average (1.26) compared to ISSR one (1.11). There was an insignificant correlation between the ISSR and RAPD data (0.076, P > 0.05). The dendrogram constructed by the combined RAPD and ISSR data gave a relatively different clustering pattern.

Keywords: correlation, molecular markers, polymorphism, marker index

Procedia PDF Downloads 473

Authors: G. Kontochristopoulos, T. Spiliopoulos, V. Markantoni, E. Platsidaki, A. Kouris, E. Balamoti, C. Bokotas, G. Haidemenos

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Introduction: There is a high patient demand for periorbital rejuvenation since the facial area is often the first to show visible signs of aging. With advancing age, there are sometimes marked changes that occur in the skin, fat, muscle and bone of the periorbital region, resulting to wrinkles and skin laxity. These changes are among the easiest areas to correct using several minimally invasive techniques, which have become increasingly popular over the last decade. Lasers, radiofrequency, botulinum toxin, fat grafting and fillers are available treatments sometimes in combination to traditional blepharoplasty. This study attempts to show the benefits of a minimally invasive approach to periorbital wrinkles and skin laxity that combine microneedling and 10% trichloroacetic acid (TCA) peels. Method: Eleven female patients aged 34-72 enrolled in the study. They all gave informed consent after receiving detailed information regarding the treatment procedure. Exclusion criteria in the study were previous treatment for the same condition in the past six months, pregnancy, allergy or hypersensitivity to the components, infection, inflammation and photosensitivity on the affected region. All patients had diffuse periorbital wrinkles and mild to moderate upper or lower eyelid skin laxity. They were treated with Automatic Microneedle Therapy System-Handhold and topical application of 10% trichloroacetic acid solution to each periorbital area for five minutes. Needling at a 0,25 mm depth was performed in both latelar (x-y) directions. Subsequently, the peeling agent was applied to each periorbital area for five minutes. Patients were subjected to the above combination every two weeks for a series of four treatments. Subsequently they were followed up regularly every month for two months. The effect was photo-documented. A Physician's and a Patient's Global Assessment Scale was used to evaluate the efficacy of the treatment (0-25% indicated poor response, 25%-50% fair, 50%-75% good and 75%-100% excellent response). Safety was assessed by monitoring early and delayed adverse events. Results: At the end of the study, almost all patients demonstrated significant aesthetic improvement. Physicians assessed a fair and a good improvement in 9(81.8% of patients) and 2(18.1% of patients) participants respectively. Patients Global Assessment rated a fair and a good response in 6 (54.5%) and 5 (45.4%) participants respectively. The procedure was well tolerated and all patients were satisfied. Mild discomfort and transient erythema were quite common during or immediately after the procedure, however only temporary. During the monthly follow up, no complications or scars were observed. Conclusions: Microneedling is known as a simple, office–based collagen induction therapy. Low concentration TCA solution applied to the epidermis that has been more permeable by microneedling, can reach the dermis more effectively. In the present study, chemical peels with 10% TCA acted as an adjuvant to microneedling, as it causes controlled skin damage, promoting regeneration and rejuvenation of tissues. This combined therapy improved periorbital fine lines, wrinkles, and overall appearance of the skin. Thus it constitutes an alternative treatment of periorbital skin aging, with encouraging results and minor side-effects.

Keywords: chemical peels, microneedling, periorbital wrinkles, skin laxity

Procedia PDF Downloads 347

Authors: Tomas Menard

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The design of control-law for engineering systems has been investigated for many decades. While many results are concerned with continuous systems with continuous output, nowadays, many controlled systems have to transmit their output measurements through network, hence making it discrete-time. But it is well known that the sampling of a system whose control-law is based on the continuous output may render the system unstable, especially when this sampling period is long compared to the system dynamics. The control design then has to be adapted in order to cope with this issue. In this paper, we consider systems which can be modeled as double integrator with uncertainty on the input since many mechanical systems can be put under such form. We present a control scheme based on an observer using only discrete time measurement and which provides continuous time estimation of the state, combined with a continuous control law, which stabilized a system with second-order dynamics even in the presence of uncertainty. It is further shown that arbitrarily long sampling periods can be dealt with properly setting the control scheme parameters.

Keywords: dynamical system, control law design, sampled output, observer design

Procedia PDF Downloads 182

Authors: Huimin Liu, Li Xiang, Yue Liu, Jing Wang

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Background: As one of typical case for the developing countries who are stepping into the aging times globally, more and more older people in China might face the problem of which they could not maintain normal life due to the functional disability. While the government take efforts to build long-term care system and further carry out related policies for the core concept, there is still lack of strong evidence to evaluating the profile of disability states in the elderly population and its transition rate. It has been proved that disability is a dynamic condition of the person rather than irreversible so it means possible to intervene timely on them who might be in a risk of severe disability. Objective: The aim of this study was to depict the picture of the disability transferring status of the older people in China, and then find out individual characteristics that change the state of disability to provide theory basis for disability prevention and early intervention among elderly people. Methods: Data for this study came from the 2011 baseline survey and the 2013 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS). Normal ADL function, 1~2 ADLs disability,3 or above ADLs disability and death were defined from state 1 to state 4. Multi-state Markov model was applied and the four-state homogeneous model with discrete states and discrete times from two visits follow-up data was constructed to explore factors for various progressive stages. We modeled the effect of explanatory variables on the rates of transition by using a proportional intensities model with covariate, such as gender. Result: In the total sample, state 2 constituent ratio is nearly about 17.0%, while state 3 proportion is blow the former, accounting for 8.5%. Moreover, ADL disability statistics difference is not obvious between two years. About half of the state 2 in 2011 improved to become normal in 2013 even though they get elder. However, state 3 transferred into the proportion of death increased obviously, closed to the proportion back to state 2 or normal functions. From the estimated intensities, we see the older people are eleven times as likely to develop at 1~2 ADLs disability than dying. After disability onset (state 2), progression to state 3 is 30% more likely than recovery. Once in state 3, a mean of 0.76 years is spent before death or recovery. In this model, a typical person in state 2 has a probability of 0.5 of disability-free one year from now while the moderate disabled or above has a probability of 0.14 being dead. Conclusion: On the long-term care cost considerations, preventive programs for delay the disability progression of the elderly could be adopted based on the current disabled state and main factors of each stage. And in general terms, those focusing elderly individuals who are moderate or above disabled should go first.

Keywords: Markov model, elderly people, disability, transition intensity

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Authors: Adji Achmad Rinaldo Fernandes

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The research was conducted to apply semiparametric SEM modeling to the timeliness of paying credit. Semiparametric SEM is structural modeling in which two combined approaches of parametric and nonparametric approaches are used. The analysis method in this research is semiparametric SEM with a nonparametric approach using a truncated spline. The data in the study were obtained through questionnaires distributed to Bank X mortgage debtors and are confidential. The study used 3 variables consisting of one exogenous variable, one intervening endogenous variable, and one endogenous variable. The results showed that (1) the effect of capacity and willingness to pay variables on timeliness of payment is significant, (2) modeling the capacity variable on willingness to pay also produces a significant estimate, (3) the effect of the capacity variable on the timeliness of payment variable is not influenced by the willingness to pay variable as an intervening variable, (4) the R^2 value of 0.763 or 76.33% indicates that the model has good predictive relevance.

Keywords: structural equation modeling semiparametric, credit bank, accuracy of payment time, willingness to pay

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Authors: Xiang Zhang, David Rey, S. Travis Waller

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Stochastic User Equilibrium (SUE) model is a widely used traffic assignment model in transportation planning, which is regarded more advanced than Deterministic User Equilibrium (DUE) model. However, a problem exists that the performance of the SUE model depends on its error term parameter. The objective of this paper is to propose a systematic method of determining the appropriate error term parameter value for the SUE model. First, the significance of the parameter is explored through a numerical example. Second, the parameter calibration method is developed based on the Logit-based route choice model. The calibration process is realized through multiple nonlinear regression, using sequential quadratic programming combined with least square method. Finally, case analysis is conducted to demonstrate the application of the calibration process and validate the better performance of the SUE model calibrated by the proposed method compared to the SUE models under other parameter values and the DUE model.

Keywords: parameter calibration, sequential quadratic programming, stochastic user equilibrium, traffic assignment, transportation planning

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Authors: N. Metidji, O. Badaoui, A. Djebli, H. Bendjebbas, R. Sellami

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The agro-industry is considered as one of the most waste producing industrial fields as a result of food processing. Upgrading and reuse of these wastes as animal or poultry food seems to be a promising alternative. Combined with the use of clean energy resources, the recovery process would contribute more to the environment protection. It is in this framework that a new solar dryer has been designed in the Unit of Solar Equipment Development. Direct solar drying has, also, many advantages compared to natural sun drying. In fact, the first does not cause product degradation as it is protected by the drying chamber from direct sun, insects and exterior environment. The aim of this work is to study the drying kinetics of waste, generated during the processing of pepper, by using a direct natural convection solar dryer at 35◦C and 55◦C. The rate of moisture removal from the product to be dried has been found to be directly related to temperature, humidity and flow rate. The characterization of these parameters has allowed the determination of the appropriate drying time for this product namely peppers waste.

Keywords: solar energy, solar dryer, energy conversion, pepper drying, forced convection solar dryer

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Authors: Emanuela Zilli, Suana Tikvina, Davide Bonaldo, Monica Varotto, Scilla Rizzardi, Barbara Ruzzante, Raffaele Napolitano, Stefano Bevilacqua, Antonella Ruffatto

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A healthy workplace increases productivity, creativity and decreases absenteeism and turnover. It also contributes to creating a more secure work environment with fewer risks of violence. In the past 3 years, the healthcare system has suffered the psychological, economic and social consequences of the COVID-19 pandemic. On the other hand, the healthcare staff reductions determine high levels of work-related stress that are often unsustainable. The Hospital of Cittadella (in the province of Padua) has 400 beds and serves a territory of 300,000 inhabitants. The hospital itself counts 1.250 healthcare employees (healthcare professionals). This year, the Medical Board of Directors has requested additional staff; however, the economic situation of Italy can not sustain additional hires. At the same time, we have initiated projects that aim to increase well-being, decrease stress and encourage activities that promote self-care. One of the projects that the hospital has organized is the psychomotor practice. It is held by therapists and trainers who operate according to the traditional method. According to the literature, the psychomotor practice is specifically intended for the staff operating in the Intensive Care Unit, Emergency Department and Pneumology Ward. The project consisted of one session of 45 minutes a week for 3 months. This method brings focus to controlled breathing, posture, muscle work and movement that help manage stress and fatigue, creating a more mindful and sustainable lifestyle. In addition, a Qigong course was held every two weeks for 5 months. It is an ancient Chinese practice designed to optimize the energy within the body, reducing stress levels and increasing general well-being. Finally, Tibetan singing crystal bowls sessions, held by a music therapist, consisted of monthly guided meditation sessions using the sounds of the crystal bowls. Sound therapy uses the vibrations created from the crystal bowls to balance the vibrations within the body to promote relaxation. In conclusion, well-being and organizational performance are closely related to each other. It is crucial for any organization to encourage and maintain better physical and mental health of the healthcare staff as it directly affects productivity and, consequently, user satisfaction of the services provided.

Keywords: health promotion, healthcare workers management, Weel being and organizational performance, Psychomotor practice

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Authors: Harisudha Kuresan, Dhanalakshmi Samiappan, T. Rama Rao

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In modern telecommunication applications, Glottal Closure Instants location finding is important and is directly evaluated from the speech waveform. Here, we study the GCI using Speech Event Detection using Residual Excitation and the Mean Based Signal (SEDREAMS) algorithm. Speech coding uses parameter estimation using audio signal processing techniques to model the speech signal combined with generic data compression algorithms to represent the resulting modeled in a compact bit stream. This paper proposes a sub-band coder SBC, which is a type of transform coding and its performance for GCI detection using SEDREAMS are evaluated. In SBCs code in the speech signal is divided into two or more frequency bands and each of these sub-band signal is coded individually. The sub-bands after being processed are recombined to form the output signal, whose bandwidth covers the whole frequency spectrum. Then the signal is decomposed into low and high-frequency components and decimation and interpolation in frequency domain are performed. The proposed structure significantly reduces error, and precise locations of Glottal Closure Instants (GCIs) are found using SEDREAMS algorithm.

Keywords: SEDREAMS, GCI, SBC, GOI

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Authors: Heena Dabas, Anju Paul, Suman Chaurasia, Ramesh Agarwal, M. Jeeva Sankar, Anurag Bajpai, Manju Saksena

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Background: Traumatic lumbar puncture (LP) is a common occurrence and causes substantial diagnostic ambiguity. There is paucity of data regarding its epidemiology. Objective: To assess the incidence and risk factors of traumatic LP in newborns. Design/Methods: In a prospective cohort study, all inborn neonates admitted in NICU and planned to undergo LP for a clinical indication of sepsis were included. Neonates with diagnosed intraventricular hemorrhage (IVH) of grade III and IV were excluded. The LP was done by operator - often a fellow or resident assisted by bedside nurse. The unit has policy of not routinely using any sedation/analgesia during the procedure. LP is done by 26 G and 0.5-inch-long hypodermic needle inserted in third or fourth lumbar space while the infant is in lateral position. The infants were monitored clinically and by continuous measurement of vital parameters using multipara monitor during the procedure. The occurrence of traumatic tap along with CSF parameters and other operator and assistant characteristics were recorded at the time of procedure. Traumatic tap was defined as presence of visible blood or more than 500 red blood cells on microscopic examination. Microscopic trauma was defined when CSF is not having visible blood but numerous RBCs. The institutional ethics committee approved the study protocol. A written informed consent from the parents and the health care providers involved was obtained. Neonates were followed up till discharge/death and final diagnosis was assigned along with treating team. Results: A total of 362 (21%) neonates out of 1726 born at the hospital were admitted during the study period (July 2016 to January, 2017). Among these neonates, 97 (26.7%) were suspected of sepsis. A total of 54 neonates were enrolled who met the eligibility criteria and parents consented to participate in the study. The mean (SD) birthweight was 1536 (732) grams and gestational age 32.0 (4.0) weeks. All LPs were indicated for late onset sepsis at the median (IQR) age of 12 (5-39) days. The traumatic LP occurred in 19 neonates (35.1%; 95% C.I 22.6% to 49.3%). Frank blood was observed in 7 (36.8%) and in the remaining, 12(63.1%) CSF was detected to have microscopic trauma. The preliminary risk factor analysis including birth weight, gestational age and operator/assistant and other characteristics did not demonstrate clinically relevant predictors. Conclusion: A significant number of neonates requiring lumbar puncture in our study had high incidence of traumatic tap. We were not able to identify modifiable risk factors. There is a need to understand the reasons and further reduce this issue for improving management in NICUs.

Keywords: incidence, newborn, traumatic, lumbar puncture

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Authors: Hela Ghali, Sihem Ben Fredj, Mohamed Ben Rejeb, Sawssen Layouni, Salwa Khefacha, Lamine Dhidah, Houyem Said Laatiri

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Background: Antimicrobial resistance is a growing threat to public health and motivates to improve prevention and control programs both at international (WHO) and national levels. Despite their low pathogenicity, vancomycin-resistant enterococci (VRE) are common nosocomial pathogens in several countries. The high potential for transmission of VRE between patients and the threat to send its resistance genes to other bacteria such as staphylococcus aureus already resistant to meticilin, justify strict control measures. Indeed, in Europe, the proportion of Enterococcus faecium responsible for invasive infections, varies from 1% to 35% in 2011 and less than 5% were resistant to vancomycin. In addition, it represents the second cause of urinary tract and wound infections and the third cause of nosocomial bacteremia in the United States. The nosocomial outbreaks of VRE have been mainly described in intensive care services, hematology-oncology and haemodialysis. An epidemic of VRE has affected our hospital and the objective of this work is to describe the measures put in place. Materials/Methods: Following the alert given by the service of plastic surgery concerning a patient carrier of VRE, a team of the prevention and healthcare security service (doctor + technician) made an investigation. A review of files was conducted to draw the synoptic table and the table of cases. Results: By contacting the microbiology laboratory, we have identified four other cases of VRE and who were hospitalized in Medical resuscitation department (2 cases, one of them was transferred to the Physical rehabilitation department), and Nephrology department (2 cases). The visit has allowed to detect several malfunctions in professional practice. A crisis cell has allowed to validate, coordinate and implement control measures following the recommendations of the Technical Center of nosocomial infections. In fact, the process was to technically isolate cases in their sector of hospitalization, to restrict the use of antibiotics, to strength measures of basic hygiene, and to make a screening by rectal swab for both cases and contacts (other patients and health staff). These measures have helped to control the situation and no other case has been reported for a month. 2 new cases have been detected in the intensive care unit after a month. However, these are short-term strategies, and other measures in the medium and long term should be taken into account in order to face similar outbreaks. Conclusion: The efforts to control the outbreak were not efficient since 2 new cases have been reported after a month. Therefore, a continuous monitoring in order to detect new cases earlier is crucial to minimize the dissemination of VRE.

Keywords: hospitals, nosocomial infection, outbreak, vancomycin-resistant enterococci

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Authors: T. Ganesan, M. S. Aris, I. Elamvazuthi, Momen Kamal Tageldeen

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Terms set in power purchase agreements (PPA) challenge power utility companies in balancing between the returns (from maximizing power production) and securing long term supply contracts at capped production. The production limitation set in the PPA has driven efforts to maximize profits through efficient and economic power production. In this paper, a combined industrial-scale gas turbine (GT) - absorption chiller (AC) system is considered to cool the GT air intake for reducing the plant’s heat rate (HR). This GT-AC system is optimized while considering power output limitations imposed by the PPA. In addition, the proposed formulation accounts for uncertainties in the ambient temperature using Type-2 fuzzy programming. Using the enhanced chaotic differential evolution (CEDE), the Pareto frontier was constructed and the optimization results are analyzed in detail.

Keywords: absorption chillers (AC), turbine inlet air cooling (TIC), power purchase agreement (PPA), multiobjective optimization, type-2 fuzzy programming, chaotic differential evolution (CDDE)

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Authors: Maamar Fatouma

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Mirror optical performance can experience varying levels of stress and tolerances, which can have a notable impact on optical parametric systems. to ensure proper optical figure and position of mirror mounting within design tolerances, it is crucial to have a robust support structure in place for optical systems. The optical figure tolerance determines the allowable deviation from the ideal form of the mirror and the position tolerance determines the location and orientations of the optical axis of the optical systems. A variety of factors influence the optical figure of the mirror. Included are self-weight (Deflection), excitation from temperature change, temperature gradients and dimensional instability. This study employs an analytical approach and finite element method to examine the effects of stress resulting from mirror mounting on the wavefront passing through the mirror. The combined effect of tolerance and deflection on mirror performance is represented by an error budget. Numerical mirror mounting is presented to illustrate the space application of performance techniques.

Keywords: opto-mechanical, bonded optic, tolerance, self-weight distortion, Rayleigh criteria

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Authors: Armin Rahimi

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In this study, we reveal co-seismic signals of two combined earthquakes, the 2006 Mw8.3 thrust and 2007 Mw8.1 normal fault earthquakes of the central Kuril Islands from GRACE observations. We compute monthly full gravitational gradient tensor in the local north-east-down frame for Kuril Islands earthquakes without spatial averaging and de-striping filters. Some of the gravitational gradient components (e.g. ΔVxx, ΔVxz) enhance high frequency components of the earth gravity field and reveal more details in spatial and temporal domain. Therefore that preseismic activity can be better illustrated. We show that the positive-negative-positive co-seismic ΔVxx due to the Kuril Islands earthquakes ranges from − 0.13 to + 0.11 milli Eötvös, and ΔVxz shows a positive-negative-positive pattern ranges from − 0.16 to + 0.13 milli Eötvös, agree well with seismic model predictions.

Keywords: GRACE observation, gravitational gradient changes, Kuril island earthquakes, PSGRN/PSCMP

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Authors: Mohamed Adel Ahmed, Warda Youssef Morsy , Hanaa Ali El Feky

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Background: Literature review cited that sleep is absolutely essential for surviving and reclamation of the quality of life. Critically ill patients often have poor sleep quality with prolonged sleep latency, sleep fragmentation, decreased sleep efficiency and frequent arousals. Nurses have a unique role for the early diagnosis of sleep disorders, decreasing stressors levels and providing the necessary environmental regulations to create a therapeutic ambiance. The aim of the study: to assess perceived sleep quality and identify factors affecting sleep quality among adult critically ill patients At El Manial University Hospital. Research Design: A descriptive exploratory design was utilized. Research questions: a) how do adult critically ill patients perceive sleep quality in the Critical Care Department of El Manial University Hospital? b) What are the factors affecting sleep quality among adult critically ill patients at El Manial University Hospital? Setting: selected critical and cardiac care units at El Manial University Hospital. Sample: A samples of convenience consisting of 100 adult male and female patients were included in the study. Tools of data collection: tool 1: Socio-demographic and Medical Data Sheet, tool 2: Modified St Mary's Hospital Sleep Questionnaire tool 3: Factors Affecting Sleep Quality Questionnaire among ICU Patients Results: The current study revealed that 76.0% of the studied sample had lack of sleep disturbance before hospitalization. However, 84 % had sleep disturbances during ICU stay, of these more than two-thirds (67 %) had moderate sleep disturbance. Presence of strange and bad odors, noise, having pain, fear of death and a loud voice produced by the ICU personnel had the most significant negative impact on patients’ sleep in percentage of 52.4, 50, 61.9, 45.2, 52.4, respectively. Conclusion: Sleep disturbances in the ICU are multifactorial, and ICU patients’ perceived degrees of sleep disturbance as a moderate. Recommendations: Based on findings of the present study, the following are recommended to be done by ICU nurses; create a healing ICU environment that should incorporate noise, light and temperature controls; decrease stimuli during night time hours to promote regulation of the circadian rhythm, allow usage of sleeping aids such as relaxing music, eye patches and earplugs into their daily nursing practice; cluster nursing activities and eliminate non-essential treatments during night time hours to allow uninterrupted sleep periods of at least 90 minutes to complete one sleep cycle , and minimize staff conversation, alarm noise and light during the quiet night time hours.

Keywords: sleep quality, critically ill, patients, perception

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Authors: Androniki-Anna Doulgeroglou, Panagiotis Kotronis, Giulio Sciarra, Catherine Bouillon

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The interaction diagrams are functions that define ultimate states expressed in terms of generalized forces (axial force, bending moment and shear force). Two characteristic states for reinforced concrete (RC) sections are proposed: the first characteristic state corresponds to the yield of the reinforcement bars and the second to the peak values of the generalized forces generalized displacements curves. 3D numerical simulations are then conducted for RC columns and the global responses are compared to experimental results. Interaction diagrams for combined flexion, shear and axial force loading conditions are numerically produced for symmetrically RC square sections for different reinforcement ratios. Analytical expressions of the interaction diagrams are also proposed, satisfying the condition of convexity. Comparison with interaction diagrams from the Eurocode is finally presented for the study cases.

Keywords: analytical convex expressions, finite element method, interaction diagrams, reinforced concrete

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Authors: Shreya Saxena, Felix Miller-Molloy, Phillipa Bowen, Greg Fellows, Elizabeth Bowen

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Background: Complex fluid balance abnormalities are well-established post-neurosurgery and traumatic brain injury (TBI). The triple-phase response requires fluid management strategies reactive to urine output and sodium homeostasis as patients shift between Diabetes Insipidus (DI) and Syndrome of Inappropriate ADH (SIADH). It was observed, at a tertiary paediatric center, a relatively high prevalence of the above complications within a cohort of paediatric post-neurosurgical and TBI patients. An audit of the clinical practice against set institutional guidelines was undertaken and analyzed to understand why this was occurring. Based on those results, new guidelines were developed with structured educational packages for the specialist teams involved. This was then reaudited, and the findings were compared. Methods: Two independent audits were conducted across two time periods, pre and post guideline change. Primary data was collected retrospectively, including both qualitative and quantitative data sets from the CQUIN neurosurgical database and electronic medical records. All paediatric patients post posterior fossa (PFT) or supratentorial surgery or with a TBI were included. A literature review of evidence-based practice, initial audit data, and stakeholder feedback was used to develop new clinical guidelines and nursing standard operation procedures. Compliance against these newly developed guidelines was re-assessed and a thematic, trend-based analysis of the two sets of results was conducted. Results: Audit-1 January2017-June2018, n=80; Audit-2 January2020-June2021, n=30 (reduced operative capacity due to COVID-19 pandemic). Overall, improvements in the monitoring of both fluid balance and electrolyte trends were demonstrated; 51% vs. 77% and 78% vs. 94%, respectively. The number of clear fluid management plans documented postoperatively also increased (odds ratio of 4), leading to earlier recognition and management of evolving fluid-balance abnormalities. The local paediatric endocrine team was involved in the care of all complex cases and notified sooner for those considered to be developing DI or SIADH (14% to 35%). However, significant Na fluctuations (>12mmol in 24 hours) remained similar – 5 vs six patients – found to be due to complex pituitary hypothalamic pathology – and the recommended adaptive fluid management strategy was still not always used. Qualitative data regarding useability and understanding of fluid-balance abnormalities and the revised guidelines were obtained from health professionals via surveys and discussion in the specialist teams providing care. The feedback highlighted the new guidelines provided a more consistent approach to the post-operative care of these patients and was a better platform for communication amongst the different specialist teams involved. The potential limitation to our study would be the small sample size on which to conduct formal analyses; however, this reflects the population that we were investigating, which we cannot control. Conclusion: The revised clinical guidelines, based on audited data, evidence-based literature review and stakeholder consultations, have demonstrated an improvement in understanding of the neuro-endocrine complications that are possible, as well as increased compliance to post-operative monitoring of fluid balance and electrolytes in this cohort of patients. Emphasis has been placed on preventative rather than treatment of DI and SIADH. Consequently, this has positively impacted patient safety for the center and highlighted the importance of educational awareness and multi-disciplinary team working.

Keywords: post-operative, fluid-balance management, neuro-endocrine complications, paediatric

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