Search results for: flow experience
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 9441

Search results for: flow experience

6681 Hydraulic Performance of Curtain Wall Breakwaters Based on Improved Moving Particle Semi-Implicit Method

Authors: Iddy Iddy, Qin Jiang, Changkuan Zhang

Abstract:

This paper addresses the hydraulic performance of curtain wall breakwaters as a coastal structure protection based on the particles method modelling. The hydraulic functions of curtain wall as wave barriers by reflecting large parts of incident waves through the vertical wall, a part transmitted and a particular part was dissipating the wave energies through the eddy flows formed beneath the lower end of the plate. As a Lagrangian particle, the Moving Particle Semi-implicit (MPS) method which has a robust capability for numerical representation has proven useful for design of structures application that concern free-surface hydrodynamic flow, such as wave breaking and overtopping. In this study, a vertical two-dimensional numerical model for the simulation of violent flow associated with the interaction between the curtain-wall breakwaters and progressive water waves is developed by MPS method in which a higher precision pressure gradient model and free surface particle recognition model were proposed. The wave transmission, reflection, and energy dissipation of the vertical wall were experimentally and theoretically examined. With the numerical wave flume by particle method, very detailed velocity and pressure fields around the curtain-walls under the action of waves can be computed in each calculation steps, and the effect of different wave and structural parameters on the hydrodynamic characteristics was investigated. Also, the simulated results of temporal profiles and distributions of velocity and pressure in the vicinity of curtain-wall breakwaters are compared with the experimental data. Herein, the numerical investigation of hydraulic performance of curtain wall breakwaters indicated that the incident wave is largely reflected from the structure, while the large eddies or turbulent flows occur beneath the curtain-wall resulting in big energy losses. The improved MPS method shows a good agreement between numerical results and analytical/experimental data which are compared to related researches. It is thus verified that the improved pressure gradient model and free surface particle recognition methods are useful for enhancement of stability and accuracy of MPS model for water waves and marine structures. Therefore, it is possible for particle method (MPS method) to achieve an appropriate level of correctness to be applied in engineering fields through further study.

Keywords: curtain wall breakwaters, free surface flow, hydraulic performance, improved MPS method

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6680 Intellectual Property Rights (IPR) in the Relations among Nations: Towards a Renewed Hegemony or Not

Authors: Raju K. Thadikkaran

Abstract:

Introduction: The IPR have come to the centre stage of development discourse today for a variety of reasons: It ranges from the arbitrariness in the enforcement, overlapping and mismatch with various international agreements and conventions, divergence in the definition, nature and content and the duration as well as severe adverse consequences to technologically weak developing countries. In turn, the IPR have acquired prominence in the foreign policy making as well as in the relations among nations. Quite naturally, there is ample scope for an examination of the correlation between Technology, IPR and International Relations in the contemporary world. Nature and Scope: A cursory examination of the realm of IPR and its protection shall reveals the acute divergence that exists in the perspectives, on all matters related to the very definition, nature, content, scope and duration. The proponents of stronger protection, mostly technologically advanced countries, insist on a stringent IP Regime whereas technologically weak developing countries seem to advocate for flexibilities. From the perspective of developing countries like India, one of the most crucial concerns is related to the patenting of life forms and the protection of TK and BD. There have been several instances of Bio-piracy and Bio-prospecting of the resources related to BD and TK from the Bio-rich Global South. It is widely argued that many provisions in the TRIPS are capable of offsetting the welcome provisions in the CBD such as the Access and Benefit Sharing and Prior Informed Consent. The point that is being argued out is as to how the mismatch between the provisions in the TRIPS Agreement and the CBD could be addressed in a healthy manner so that the essential minimum legitimate interests of all stakeholders could be secured thereby introducing a new direction to the international relations. The findings of this study reveal that the challenges roused by the TRIPS Regime over-weigh the opportunities. The mismatch in the provisions in this regard has generated various crucial issues such as Bio-piracy and Bio-prospecting. However, there is ample scope for managing and protecting IP through institutional innovation, legislative, executive and administrative initiative at the global, national and regional levels. The Indian experience is quite reflective of the same and efforts are being made through the new national IPR policy. This paper, employing Historical Analytical Method, has Three Sections. The First Section shall trace the correlation between the Technology, IPR and international relations. The Second Section shall review the issues and potential concerns in the protection and management of IP related to the BD and TK in the developing countries in the wake of the TRIPS and the CBD. The Final Section shall analyze the Indian Experience in this regard and the experience of the bio-rich Kerala in particular.

Keywords: IPR, technology and international relations, bio-diversity, traditional knowledge

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6679 A Novel Approach to 3D Thrust Vectoring CFD via Mesh Morphing

Authors: Umut Yıldız, Berkin Kurtuluş, Yunus Emre Muslubaş

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Thrust vectoring, especially in military aviation, is a concept that sees much use to improve maneuverability in already agile aircraft. As this concept is fairly new and cost intensive to design and test, computational methods are useful in easing the preliminary design process. Computational Fluid Dynamics (CFD) can be utilized in many forms to simulate nozzle flow, and there exist various CFD studies in both 2D mechanical and 3D injection based thrust vectoring, and yet, 3D mechanical thrust vectoring analyses, at this point in time, are lacking variety. Additionally, the freely available test data is constrained to limited pitch angles and geometries. In this study, based on a test case provided by NASA, both steady and unsteady 3D CFD simulations are conducted to examine the aerodynamic performance of a mechanical thrust vectoring nozzle model and to validate the utilized numerical model. Steady analyses are performed to verify the flow characteristics of the nozzle at pitch angles of 0, 10 and 20 degrees, and the results are compared with experimental data. It is observed that the pressure data obtained on the inner surface of the nozzle at each specified pitch angle and under different flow conditions with pressure ratios of 1.5, 2 and 4, as well as at azimuthal angle of 0, 45, 90, 135, and 180 degrees exhibited a high level of agreement with the corresponding experimental results. To validate the CFD model, the insights from the steady analyses are utilized, followed by unsteady analyses covering a wide range of pitch angles from 0 to 20 degrees. Throughout the simulations, a mesh morphing method using a carefully calculated mathematical shape deformation model that simulates the vectored nozzle shape exactly at each point of its travel is employed to dynamically alter the divergent part of the nozzle over time within this pitch angle range. The mesh morphing based vectored nozzle shapes were compared with the drawings provided by NASA, ensuring a complete match was achieved. This computational approach allowed for the creation of a comprehensive database of results without the need to generate separate solution domains. The database contains results at every 0.01° increment of nozzle pitch angle. The unsteady analyses, generated using the morphing method, are found to be in excellent agreement with experimental data, further confirming the accuracy of the CFD model.

Keywords: thrust vectoring, computational fluid dynamics, 3d mesh morphing, mathematical shape deformation model

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6678 A Review of the Factors That Influence on Nutrient Removal in Upflow Filters

Authors: Ali Alzeyadi, Edward Loffill, Rafid Alkhaddar Ali Alattabi

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Phosphate, ammonium, and nitrates are forms of nutrients; they are released from different sources. High nutrient levels contribute to the eutrophication of water bodies by accelerating the extraordinary growth of algae. Recently, many filtration and treatment systems were developed and used for different removal processes. Due to enhanced operational aspects for the up-flow, continuous, granular Media filter researchers became more interested in further developing this technology and its performance for nutrient removal from wastewater. Environmental factors significantly affect the filtration process performance, and understanding their impact will help to maintain the nutrient removal process. Phosphate removal by phosphate sorption materials PSMs and nitrogen removal biologically are the methods of nutrient removal that have been discussed in this paper. Hence, the focus on the factors that influence these processes is the scope of this work. The finding showed the presence of factors affecting both removal processes; the size, shape, and roughness of the filter media particles play a crucial role in supporting biofilm formation. On the other hand, all of which are effected on the reactivity of surface between the media and phosphate. Many studies alluded to factors that have significant influence on the biological removal for nitrogen such as dissolved oxygen, temperature, and pH; this is due to the sensitivity of biological processes while the phosphate removal by PSMs showed less affected by these factors. This review work provides help to the researchers in create a comprehensive approach in regards study the nutrient removal in up flow filtration systems.

Keywords: nitrogen biological treatment, nutrients, psms, upflow filter, wastewater treatment

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6677 Impact of Obesity on Outcomes in Breast Reconstruction: A Systematic Review and Meta-Analysis

Authors: Adriana C. Panayi, Riaz A. Agha, Brady A. Sieber, Dennis P. Orgill

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Background: Increased rates of both breast cancer and obesity have resulted in more women seeking breast reconstruction. These women may be at increased risk for perioperative complications. A systematic review was conducted to assess the outcomes in obese women who have undergone breast reconstruction following mastectomy. Methods: Cochrane, PUBMED and EMBASE electronic databases were screened and data was extracted from included studies. The clinical outcomes assessed were surgical complications, medical complications, length of postoperative hospital stay, reoperation rate and patient satisfaction. Results: 33 studies met the inclusion criteria for the review and 29 provided enough data to be included in the meta-analysis (71368 patients, 20061 of which were obese). Obese women were 2.3 times more likely to experience surgical complications (95 percent CI 2.19 to 2.39; P < 0.00001), 2.8 times more likely to have medical complications (95 percent CI 2.41 to 3.26; P < 0.00001) and had a 1.9 times higher risk of reoperation (95 percent CI 1.75 to 2.07; P < 0.00001). The most common complication, wound dehiscence, was 2.5 times more likely in obese women (95 percent CI 1.80 to 3.52; P < 0.00001). Sensitivity analysis confirmed that obese women were more likely to experience surgical complications (RR 2.36, 95% CI 2.22–2.52; P < 0.00001). Conclusions: This study provides evidence that obesity increases the risk of complications in both implant and autologous reconstruction. Additional prospective and observational studies are needed to determine if weight reduction prior to reconstruction reduces the perioperative risks associated with obesity.

Keywords: autologous reconstruction, breast cancer, breast reconstruction, literature review, obesity, oncology, prosthetic reconstruction

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6676 Management of Renal Malignancies with IVC Thrombus: Our Experience

Authors: Sujeet Poudyal

Abstract:

Introduction: Renal cell carcinoma is the most common malignancy associated with Inferior vena cava (IVC) thrombosis. Radical nephrectomy with tumor thrombectomy provides durable cancer-free survival. Other renal malignancies like Wilms’ tumors are also associated with IVC thrombus. We describe our experience with the management of renal malignancies associated with IVC thrombus. Methods: This prospective study included 28 patients undergoing surgery for renal malignancies associated with IVC thrombus from February 2017 to March 2023. Demographics of patients, types of renal malignancy, level of IVC thrombus, intraoperative details, need for venovenous bypass, cardiopulmonary bypass and postoperative outcomes were all documented. Results: Out of a total of 28 patients, 24 patients had clear cell Renal Cell Carcinoma,1 had renal osteosarcoma and 3 patients had Wilms tumor. The levels. of thrombus were II in eight, III in seven, and IV in six patients. The mean age of RCC was 62.81±10.2 years, renal osteosarcoma was 26 years and Wilms tumor was 23 years. There was a need for venovenous bypass in four patients and cardiopulmonary bypass in four patients, and the Postoperative period was uneventful in most cases except for two mortalities, one in Level III due to pneumonia and one in Level IV due to sepsis. All cases followed up till now have no local recurrence and metastasis except one case of RCC with Level IV IVC thrombus, which presented with paraaortic nodal recurrence and is currently managed with sunitinib. Conclusion: The complexity in the management of renal malignancy with IVC thrombus increases with the level of IVC thrombus. As radical nephrectomy with tumor thrombectomy provides durable cancer-free survival in most cases, the surgery should be undertaken in an expert and experienced setup with a strong cardiovascular backup to minimize morbidity and mortality associated with the procedure.

Keywords: renal malignancy, IVC thrombus, radical nephrectomy with tumor thrombectomy, renal cell carcinoma

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6675 Collaborative and Experimental Cultures in Virtual Reality Journalism: From the Perspective of Content Creators

Authors: Radwa Mabrook

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Virtual Reality (VR) content creation is a complex and an expensive process, which requires multi-disciplinary teams of content creators. Grant schemes from technology companies help media organisations to explore the VR potential in journalism and factual storytelling. Media organisations try to do as much as they can in-house, but they may outsource due to time constraints and skill availability. Journalists, game developers, sound designers and creative artists work together and bring in new cultures of work. This study explores the collaborative experimental nature of VR content creation, through tracing every actor involved in the process and examining their perceptions of the VR work. The study builds on Actor Network Theory (ANT), which decomposes phenomena into their basic elements and traces the interrelations among them. Therefore, the researcher conducted 22 semi-structured interviews with VR content creators between November 2017 and April 2018. Purposive and snowball sampling techniques allowed the researcher to recruit fact-based VR content creators from production studios and media organisations, as well as freelancers. Interviews lasted up to three hours, and they were a mix of Skype calls and in-person interviews. Participants consented for their interviews to be recorded, and for their names to be revealed in the study. The researcher coded interviews’ transcripts in Nvivo software, looking for key themes that correspond with the research questions. The study revealed that VR content creators must be adaptive to change, open to learn and comfortable with mistakes. The VR content creation process is very iterative because VR has no established work flow or visual grammar. Multi-disciplinary VR team members often speak different languages making it hard to communicate. However, adaptive content creators perceive VR work as a fun experience and an opportunity to learn. The traditional sense of competition and the strive for information exclusivity are now replaced by a strong drive for knowledge sharing. VR content creators are open to share their methods of work and their experiences. They target to build a collaborative network that aims to harness VR technology for journalism and factual storytelling. Indeed, VR is instilling collaborative and experimental cultures in journalism.

Keywords: collaborative culture, content creation, experimental culture, virtual reality

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6674 Influence of Precipitation and Land Use on Extreme Flow in Prek Thnot River Basin of Mekong River in Cambodia

Authors: Chhordaneath Hen, Ty Sok, Ilan Ich, Ratboren Chan, Chantha Oeurng

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The damages caused by hydrological extremes such as flooding have been severe globally, and several research studies indicated extreme precipitations play a crucial role. Cambodia is one of the most vulnerable countries exposed to floods and drought as consequences of climate impact. Prek Thnot River Basin in the southwest part of Cambodia, which is in the plate and plateau region and a part of the Mekong Delta, was selected to investigate the changes in extreme precipitation and hydrological extreme. Furthermore, to develop a statistical relationship between these phenomena in this basin from 1995 to 2020 using Multiple Linear Regression. The precipitation and hydrological extreme were assessed via the attributes and trends of rainfall patterns during the study periods. The extreme flow was defined as a dependent variable, while the independent variables are various extreme precipitation indices. The study showed that all extreme precipitations indices (R10, R20, R35, CWD, R95p, R99p, and PRCPTOT) had increasing decency. However, the number of rain days per year had a decreasing tendency, which can conclude that extreme rainfall was more intense in a shorter period of the year. The study showed a similar relationship between extreme precipitation and hydrological extreme and land use change association with hydrological extreme. The direct combination of land use and precipitation equals 37% of the flood causes in this river. This study provided information on these two causes of flood events and an understanding of expectations of climate change consequences for flood and water resources management.

Keywords: extreme precipitation, hydrological extreme, land use, land cover, Prek Thnot river basin

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6673 Applied Behavior Analysis and Speech Language Pathology Interprofessional Practice to Support Autistic Children with Complex Communication Needs

Authors: Kimberly Ho, Maeve Donnelly

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In this paper, a speech-language pathologist (SLP) and Board Certified Behavior Analysts® (BCBA) with a combined professional experience of almost 50 years will discuss their experiences working with individuals on the autism spectrum. Some autistic children require augmentative and alternative communication (AAC) to meet their communication needs. These learners present with unique strengths and challenges, often requiring intervention from a team of professionals to generalize skills across environments. Collaboration between SLPs and BCBAs will be discussed in terms of strengths and challenges. Applied behavior analysis (ABA) will be defined and explained in the context of the treatment of learners on the autism spectrum with complex communication needs (CCN). The requirement for collaboration will be discussed by the governing boards for both BCBAs and SLPs. The strengths of each discipline will be compared along with difficulties faced when professionals experience disciplinary centrism. The challenges in teaching autistic learners with CCN will be reviewed. Case studies will be shared in which BCBAs and SLPs engage in interprofessional practice to support autistic children who use AAC to participate in a social skills group. Learner outcomes will be shared and assessed through both an SLP and BCBA perspective. Finally, ideas will be provided to promote the interprofessional practice, including establishing a shared framework, avoiding professional jargon and moving towards common terminology, and focusing on the data to ensure the efficacy of treatment.

Keywords: autism, cross disciplinary collaboration, augmentative and alternative communication, generalization

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6672 Goals, Rights and Obligations, and Moral Order: An Evaluation Approach to Chinese-Kenyan Relating Experience

Authors: Zhaohui Tian

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China’s growing and deepening engagement in Africa has attracted numerous controversial debates on Chinese-African social-racial relations both in the media and academia. Most research tends to discuss this issue and the tensions involved at the state level, but limited attention has been given to the individual relating processes of those two racial groups from an intercultural politeness evaluation angle. Thus, taking Kenya as a country focus and putting it under recent perspectives on pragmatics and politeness, this study explores the Chinese-Kenyan workplace relating experience in Chinese-owned companies with the aim to offer new insights on Chinese-African social-racial tensions. The original data were collected through 25 interviews from 29 Chinese and Kenyan participants working in different Chinese companies and industries, some of which had been later on converted into 182 short story data in order to better capture the process and content dimensions of their experiences using Spencer &Kádár’s politeness evaluation model. Both interview and story data were analysed in MAXQDA to understand the personal relating process and the criteria they were drawing from when making evaluative judgements of their relations. The result particular draws attention to tensions around goals, rights, and obligations, and social-moral dimensions that had been underrepresented in intercultural and pragmatics literature. The study offers alternative empirical insights into Chinese-Kenyan relations from an intercultural politeness management perspective and the possible mismatches of the evaluative criteria that potentially cause tension in this context.

Keywords: chinese-kenyan, evaluation, relating, workplace

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6671 Adverse Childhood Experience of Domestic Violence and Domestic Mental Health Leading to Youth Violence: An Analysis of Selected Boroughs in London

Authors: Sandra Smart-Akande, Chaminda Hewage, Imtiaz Khan, Thanuja Mallikarachchi

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According to UK police-recorded data, there has been a substantial increase in knife-related crime and youth violence in the UK since 2014 particularly in the London boroughs. These crime rates are disproportionally distributed across London with the majority of these crimes occurring in the highly deprived areas of London and among young people aged 11 to 24 with large discrepancies across ethnicity, age, gender and borough of residence. Comprehensive studies and literature have identified risk factors associated with a knife carrying among youth to be Adverse Childhood Experience (ACEs), poor mental health, school or social exclusion, drug dealing, drug using, victim of violent crime, bullying, peer pressure or gang involvement, just to mention a few. ACEs are potentially traumatic events that occur in childhood, this can be experiences or stressful events in the early life of a child and can lead to an increased risk of damaging health or social outcomes in the latter life of the individual. Research has shown that children or youths involved in youth violence have had childhood experience characterised by disproportionate adverse childhood experiences and substantial literature link ACEs to be associated with criminal or delinquent behavior. ACEs are commonly grouped by researchers into: Abuse (Physical, Verbal, Sexual), Neglect (Physical, Emotional) and Household adversities (Mental Illness, Incarcerated relative, Domestic violence, Parental Separation or Bereavement). To the author's best knowledge, no study to date has investigated how household mental health (mental health of a parent or mental health of a child) and domestic violence (domestic violence on a parent or domestic violence on a child) is related to knife homicides across the local authorities areas of London. This study seeks to address the gap by examining a large sample of data from the London Metropolitan Police Force and Characteristics of Children in Need data from the UK Department for Education. The aim of this review is to identify and synthesise evidence from data and a range of literature to identify the relationship between adverse childhood experiences and youth violence in the UK. Understanding the link between ACEs and future outcomes can support preventative action.

Keywords: adverse childhood experiences, domestic violence, mental health, youth violence, prediction analysis, London knife crime

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6670 A Framework for Secure Information Flow Analysis in Web Applications

Authors: Ralph Adaimy, Wassim El-Hajj, Ghassen Ben Brahim, Hazem Hajj, Haidar Safa

Abstract:

Huge amounts of data and personal information are being sent to and retrieved from web applications on daily basis. Every application has its own confidentiality and integrity policies. Violating these policies can have broad negative impact on the involved company’s financial status, while enforcing them is very hard even for the developers with good security background. In this paper, we propose a framework that enforces security-by-construction in web applications. Minimal developer effort is required, in a sense that the developer only needs to annotate database attributes by a security class. The web application code is then converted into an intermediary representation, called Extended Program Dependence Graph (EPDG). Using the EPDG, the provided annotations are propagated to the application code and run against generic security enforcement rules that were carefully designed to detect insecure information flows as early as they occur. As a result, any violation in the data’s confidentiality or integrity policies is reported. As a proof of concept, two PHP web applications, Hotel Reservation and Auction, were used for testing and validation. The proposed system was able to catch all the existing insecure information flows at their source. Moreover and to highlight the simplicity of the suggested approaches vs. existing approaches, two professional web developers assessed the annotation tasks needed in the presented case studies and provided a very positive feedback on the simplicity of the annotation task.

Keywords: web applications security, secure information flow, program dependence graph, database annotation

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6669 Using Groundwater Modeling System to Create a 3-D Groundwater Flow and Solute Transport Model for a Semiarid Region: A Case Study of the Nadhour Saouaf Sisseb El Alem Aquifer, Central Tunisia

Authors: Emna Bahri Hammami, Zammouri Mounira, Tarhouni Jamila

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The Nadhour Saouaf Sisseb El Alem (NSSA) system comprises some of the most intensively exploited aquifers in central Tunisia. Since the 1970s, the growth in economic productivity linked to intensive agriculture in this semiarid region has been sustained by increasing pumping rates of the system’s groundwater. Exploitation of these aquifers has increased rapidly, ultimately causing their depletion. With the aim to better understand the behavior of the aquifer system and to predict its evolution, the paper presents a finite difference model of the groundwater flow and solute transport. The model is based on the Groundwater Modeling System (GMS) and was calibrated using data from 1970 to 2010. Groundwater levels observed in 1970 were used for the steady-state calibration. Groundwater levels observed from 1971 to 2010 served to calibrate the transient state. The impact of pumping discharge on the evolution of groundwater levels was studied through three hypothetical pumping scenarios. The first two scenarios replicated the approximate drawdown in the aquifer heads (about 17 m in scenario 1 and 23 m in scenario 2 in the center of NSSA) following an increase in pumping rates by 30% and 50% from their current values, respectively. In addition, pumping was stopped in the third scenario, which could increase groundwater reserves by about 7 Mm3/year. NSSA groundwater reserves could be improved considerably if the pumping rules were taken seriously.

Keywords: pumping, depletion, groundwater modeling system GMS, Nadhour Saouaf

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6668 Hydrodynamic and Morphological Simulation of Karnafuli River Using CCHE2D Model

Authors: Shah Md. Imran Kabir, Md. Mostafa Ali

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Karnafuli is one of the most important rivers of Bangladesh which is playing a vital role in our national economy. The major sea port of Bangladesh is the Chittagong port located on the right bank of Karnafuli River Bangladesh. Karnafuli river port is considered as the lifeline of the economic activities of the country. Therefore, it is always necessary to keep the river active and live in terms of its navigability. Due to man-made intervention, the river flow becomes interrupted and thereby may cause the change in the river morphology. The specific objective of this study is the application of 2D model to assess different hydrodynamic and morphological characteristics of the river due to normal flow condition and sea level rise condition. The model has been set with the recent bathymetry data collected from CPA hydrography division. For model setup, the river reach is selected between Kalurghat and Khal no-18. Time series discharge and water level data are used as boundary condition at upstream and downstream. Calibration and validation have been carried out with the recent water level data at Khal no-10 and Sadarghat. The total reach length of the river has been divided into four parts to determine different hydrodynamic and morphological assessments like variation of velocity, sediment erosion and deposition and bed level changes also have been studied. This model has been used for the assessment of river response due sediment transport and sea level rise. Model result shows slight increase in velocity. It also changes the rate of erosion and deposition at some location of the selected reach. It is hoped that the result of the model simulation will be helpful to suggest the effect of possible future development work to be implemented on this river.

Keywords: CCHE 2D, hydrodynamic, morphology, sea level rise

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6667 Application of Finite Volume Method for Numerical Simulation of Contaminant Transfer in a Two-Dimensional Reservoir

Authors: Atousa Ataieyan, Salvador A. Gomez-Lopera, Gennaro Sepede

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Today, due to the growing urban population and consequently, the increasing water demand in cities, the amount of contaminants entering the water resources is increasing. This can impose harmful effects on the quality of the downstream water. Therefore, predicting the concentration of discharged pollutants at different times and distances of the interested area is of high importance in order to carry out preventative and controlling measures, as well as to avoid consuming the contaminated water. In this paper, the concentration distribution of an injected conservative pollutant in a square reservoir containing four symmetric blocks and three sources using Finite Volume Method (FVM) is simulated. For this purpose, after estimating the flow velocity, classical Advection-Diffusion Equation (ADE) has been discretized over the studying domain by Backward Time- Backward Space (BTBS) scheme. Then, the discretized equations for each node have been derived according to the initial condition, boundary conditions and point contaminant sources. Finally, taking into account the appropriate time step and space step, a computational code was set up in MATLAB. Contaminant concentration was then obtained at different times and distances. Simulation results show how using BTBS differentiating scheme and FVM as a numerical method for solving the partial differential equation of transport is an appropriate approach in the case of two-dimensional contaminant transfer in an advective-diffusive flow.

Keywords: BTBS differentiating scheme, contaminant concentration, finite volume, mass transfer, water pollution

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6666 Expert System for Road Bridge Constructions

Authors: Michael Dimmer, Holger Flederer

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The basis of realizing a construction project is a technically flawless concept which satisfies conditions regarding environment and costs, as well as static-constructional terms. The presented software system actively supports civil engineers during the setup of optimal designs, by giving advice regarding durability, life-cycle costs, sustainability and much more. A major part of the surrounding conditions of a design process is gathered and assimilated by experienced engineers subconsciously. It is a question about eligible building techniques and their practicability by considering emerging costs. Planning engineers have acquired many of this experience during their professional life and use them for their daily work. Occasionally, the planning engineer should disassociate himself from his experience to be open for new and better solutions which meet the functional demands, as well. The developed expert system gives planning engineers recommendations for preferred design options of new constructions as well as for existing bridge constructions. It is possible to analyze construction elements and techniques regarding sustainability and life-cycle costs. This way the software provides recommendations for future constructions. Furthermore, there is an option to design existing road bridges especially for heavy duty transport. This implies a route planning tool to get quick and reliable information as to whether the bridge support structures of a transport route have been measured sufficiently for a certain heavy duty transport. The use of this expert system in bridge planning companies and building authorities will save costs massively for new and existent bridge constructions. This is achieved by consequently considering parameters like life-cycle costs and sustainability for its planning recommendations.

Keywords: expert system, planning process, road bridges, software system

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6665 Numerical Study on Response of Polymer Electrolyte Fuel Cell (PEFCs) with Defects under Different Load Conditions

Authors: Muhammad Faizan Chinannai, Jaeseung Lee, Mohamed Hassan Gundu, Hyunchul Ju

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Fuel cell is known to be an effective renewable energy resource which is commercializing in the present era. It is really important to know about the improvement in performance even when the system faces some defects. This study was carried out to analyze the performance of the Polymer electrolyte fuel cell (PEFCs) under different operating conditions such as current density, relative humidity and Pt loadings considering defects with load changes. The purpose of this study is to analyze the response of the fuel cell system with defects in Balance of Plants (BOPs) and catalyst layer (CL) degradation by maintaining the coolant flow rate as such to preserve the cell temperature at the required level. Multi-Scale Simulation of 3D two-phase PEFC model with coolant was carried out under different load conditions. For detailed analysis and performance comparison, extensive contours of temperature, current density, water content, and relative humidity are provided. The simulation results of the different cases are compared with the reference data. Hence the response of the fuel cell stack with defects in BOP and CL degradations can be analyzed by the temperature difference between the coolant outlet and membrane electrode assembly. The results showed that the Failure of the humidifier increases High-Frequency Resistance (HFR), air flow defects and CL degradation results in the non-uniformity of current density distribution and high cathode activation overpotential, respectively.

Keywords: PEM fuel cell, fuel cell modeling, performance analysis, BOP components, current density distribution, degradation

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6664 Improving Pain Management for Trauma Patients at Two Rwandan Emergency Departments

Authors: Jean Pierre Hagenimana, Paulin Ruhato Banguti, Rebecca Lynn Churchill Anderson, Jean de Dieu Tuyishime, Gaston Nyirigira, Eugene Tuyishime

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Background: Little is known regarding the effectiveness of pain protocols and guidelines used in Emergency Departments (ED) in Sub-Saharan Africa (SSA). Therefore, to shed light on this research gap, this study aimed to evaluate the quality of pain management following the implementation of both the WHO pain ladder-based trauma pain management protocol in two Rwandan teaching hospitals. Methods: This was a pre-and post-intervention study. The intervention was a 1-day acute pain course training for ED clinical staff followed by 1 week of mentorship on the use of the WHO pain ladder-based trauma pain management. Results: 261 participants were enrolled in the study (124 before the intervention and 137 after the intervention). The number of patients with undocumented pain scores decreased from 58% to 24% after the intervention (p-value > 0.001), and most patients (62%) had mild pain. In addition, patients who were satisfied with the quality of pain management increased significantly from 42% before the intervention to 80% (p-value > 0.001). Barriers were identified, however, including inadequate training and experience, shortage of staff, and patient’s reluctance to report pain. Conclusion: The implementation of the WHO pain ladder-based trauma pain management protocol significantly improved the quality of pain management in both CHUK and CHUB referral Hospital emergency departments. Despite this, some barriers remain, such as inadequate training and experience, shortage of staff, and patient’s reluctance to report pain. Appropriate interventions should be implemented to address the identified barriers and ensure adequate pain management for patients admitted at the emergency departments in referral hospitals in Rwanda.

Keywords: pain management, trauma, emergency departments, Rwanda

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6663 The Bayesian Premium Under Entropy Loss

Authors: Farouk Metiri, Halim Zeghdoudi, Mohamed Riad Remita

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Credibility theory is an experience rating technique in actuarial science which can be seen as one of quantitative tools that allows the insurers to perform experience rating, that is, to adjust future premiums based on past experiences. It is used usually in automobile insurance, worker's compensation premium, and IBNR (incurred but not reported claims to the insurer) where credibility theory can be used to estimate the claim size amount. In this study, we focused on a popular tool in credibility theory which is the Bayesian premium estimator, considering Lindley distribution as a claim distribution. We derive this estimator under entropy loss which is asymmetric and squared error loss which is a symmetric loss function with informative and non-informative priors. In a purely Bayesian setting, the prior distribution represents the insurer’s prior belief about the insured’s risk level after collection of the insured’s data at the end of the period. However, the explicit form of the Bayesian premium in the case when the prior is not a member of the exponential family could be quite difficult to obtain as it involves a number of integrations which are not analytically solvable. The paper finds a solution to this problem by deriving this estimator using numerical approximation (Lindley approximation) which is one of the suitable approximation methods for solving such problems, it approaches the ratio of the integrals as a whole and produces a single numerical result. Simulation study using Monte Carlo method is then performed to evaluate this estimator and mean squared error technique is made to compare the Bayesian premium estimator under the above loss functions.

Keywords: bayesian estimator, credibility theory, entropy loss, monte carlo simulation

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6662 Botulism Clinical Experience and Update

Authors: Kevin Yeo, Christine Hall, Babinchak Tim

Abstract:

BAT® [Botulism Antitoxin Heptavalent (A,B,C,D,E,F,G)-(Equine)] anti-toxin is a mixture of equine immune globulin fragments indicated for the treatment of symptomatic botulism in adult and pediatric patients. The effectiveness of BAT anti-toxin is based on efficacy studies conducted in animal models. A general explanation of the pivotal animal studies, post market surveillance and outcomes of an observational patient registry for patients treated with BAT product distributed in the USA is briefly discussed. Overall it took 20 animal studies for two well-designed and appropriately powered pivotal efficacy studies – one in which the effectiveness of BAT was assessed against all 7 serotypes in the guinea pig, and the other where efficacy is confirmed in the Rhesus macaque using Serotype A. Clinical Experience for BAT to date involves approximately 600 adult and pediatric patients with suspected botulism. In pre-licensure, patient data was recorded under the US CDC expanded access program (259 adult and pediatric patients between 10 days to 88 years of age). In post licensure, greater than 350 patients to date have received BAT and been followed up by enhanced expanded access program. The analysis of the post market surveillance data provided a unique opportunity to demonstrate clinical benefit in the field study required by the animal rule. While the animal rule is applied because human efficacy studies are not ethical or feasible, a post-marketing requirement is to conduct a study to evaluate safety and clinical benefit when circumstances arise and demonstrate the favourable benefit-risk profile that supported licensure.

Keywords: botulism, threat, clinical benefit, observational patient registry

Procedia PDF Downloads 179
6661 Impact of Educational Intervention on Hygiene-knowledge and Practices of Sanitation Workers Globally: A Systematic Review

Authors: Alive Ntunja, Wilma ten Ham-Baloyi, June Teare, Oyedele Opeoluwa, Paula Melariri

Abstract:

Sanitation workers are also known as “garbage workers” who play a significant role in the sanitation chain. For many generations sanitation workers’ level of knowledge regarding hygiene practices remains low due to a lack of educational programs on hygiene. As a result, they are widely exposed to hygiene-related diseases such as cholera, skin infections and various other diseases, increasing their risk of mortality to 40%. This review aimed to explore the global impact of educational programs on the hygiene knowledge and practices of sanitation workers. The systematic literature search was conducted for studies published between 2013 and 2023 using the following databases: MEDLINE (via EBSCOHost), PubMed, and Google Scholar to identify quantitative studies on the subject. Study quality was assessed using the Joanna Briggs Institute Critical Evaluation Instruments. Data extracted from the included articles was presented using a summary of findings table and presented graphically through charts and tables, employing both descriptive and inferential statistical methods. A one-way repeated measures ANOVA assessed the pooled effect of the intervention on mean scores across studies. Statistical analysis was performed using Microsoft Office 365 (2019 version), with significance set at p<0.05. The PRISMA flow diagram was used to present the article selection process. The systematic review included 15 eligible studies from a total of 2 777 articles. At least 60% (n=9) of the reviewed studies found educational program relating to hygiene to have a positive impact on sanitation workers’ hygiene knowledge and practices. The findings further showed that the stages (pre-post) of knowledge intervention used lead to statistically significant differences in mean score obtained [F (1,7) = 22.166, p = 0.002]. Likewise, it can be observed that the stages of practice intervention used lead to statistically significant differences in mean score obtained [F (1,7) = 21.857, p = 0.003]. However, most (n=7) studies indicated that, the efficacy of programs on hygiene knowledge and practices is indirectly influenced by educational background, age and work experience (predictor factors). Educational programs regarding hygiene have the potential to significantly improve sanitation workers knowledge and practices. Findings also suggest the implementation of active and intensive intervention programs, to improve sanitation workers hygiene knowledge and practices.

Keywords: educational programs, hygiene knowledge, practices, sanitation workers

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6660 Exploration of a Blockchain Assisted Framework for Through Baggage Interlining: Blocklining

Authors: Mary Rose Everan, Michael McCann, Gary Cullen

Abstract:

International travel journeys, by their nature, incorporate elements provided by multiple service providers such as airlines, rail carriers, airports, and ground handlers. Data needs to be stored by and exchanged between these parties in the process of managing the journey. The fragmented nature of this shared management of mutual clients is a limiting factor in the development of a seamless, hassle-free, end-to-end travel experience. Traditional interlining agreements attempt to facilitate many separate aspects of co-operation between service providers, typically between airlines and, to some extent, intermodal travel operators, including schedules, fares, ticketing, through check-in, and baggage handling. These arrangements rely on pre-agreement. The development of Virtual Interlining - that is, interlining facilitated by a third party (often but not always an airport) without formal pre-agreement by the airlines or rail carriers - demonstrates an underlying demand for a better quality end-to-end travel experience. Blockchain solutions are being explored in a number of industries and offer, at first sight, an immutable, single source of truth for this data, avoiding data conflicts and misinterpretation. Combined with Smart Contracts, they seemingly offer a more robust and dynamic platform for multi-stakeholder ventures, and even perhaps the ability to join and leave consortia dynamically. Applying blockchain to the intermodal interlining space – termed Blocklining in this paper - is complex and multi-faceted because of the many aspects of cooperation outlined above. To explore its potential, this paper concentrates on one particular dimension, that of through baggage interlining.

Keywords: aviation, baggage, blocklining, intermodal, interlining

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6659 Algebraic Coupled Level Set-Volume of Fluid Method with Capillary Pressure Treatment for Surface Tension Dominant Two-Phase Flows

Authors: Majid Haghshenas, James Wilson, Ranganathan Kumar

Abstract:

In this study, an Algebraic Coupled Level Set-Volume of Fluid (A-CLSVOF) method with capillary pressure treatment is proposed for the modeling of two-phase capillary flows. The Volume of Fluid (VOF) method is utilized to incorporate one-way coupling with the Level Set (LS) function in order to further improve the accuracy of the interface curvature calculation and resulting surface tension force. The capillary pressure is determined and treated independently of the hydrodynamic pressure in the momentum balance in order to maintain consistency between cell centered and interpolated values, resulting in a reduction in parasitic currents. In this method, both VOF and LS functions are transported where the new volume fraction determines the interface seed position used to reinitialize the LS field. The Hamilton-Godunov function is used with a second order (in space and time) discretization scheme to produce a signed distance function. The performance of the current methodology has been tested against some common test cases in order to assess the reduction in non-physical velocities and improvements in the interfacial pressure jump. The cases of a static drop, non-linear Rayleigh-Taylor instability and finally a droplets impact on a liquid pool were simulated to compare the performance of the present method to other well-known methods in the area of parasitic current reduction, interface location evolution and overall agreement with experimental results.

Keywords: two-phase flow, capillary flow, surface tension force, coupled LS with VOF

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6658 A Left Testicular Cancer with Multiple Metastases Nursing Experience

Authors: Syue-Wen Lin

Abstract:

Objective:This article reviews the care experience of a 40-year-old male patient who underwent a thoracoscopic right lower lobectomy following a COVID-19 infection. His complex medical history included multiple metastases (lungs, liver, spleen, and left kidney) and lung damage from COVID-19, which complicated the weaning process from mechanical ventilation. The care involved managing cancer treatment, postoperative pain, wound care, and palliative care. Methods:Nursing care was provided from August 16 to August 17, 2024. Challenges included difficulty with sputum clearance, which exacerbated the patient's anxiety and fear of reintubation. Pain management strategies combined analgesic drugs, non-drug methods, essential oil massages with family members, and playing the patient’s favorite music to reduce pain and anxiety. Progressive rehabilitation began with stabilizing vital signs, followed by assistance with sitting on the edge of the bed and walking within the ward. Strict sterile procedures and advanced wound care technology were used for daily dressing changes, with meticulous documentation of wound conditions and appropriate dressing selection. Holistic cancer care and palliative measures were integrated to address the patient’s physical and psychological needs. Results:The interdisciplinary care team developed a comprehensive plan addressing both physical and psychological aspects. Respiratory therapy, lung expansion exercises, and a high-frequency chest wall oscillation vest facilitated sputum expulsion and assisted in weaning from mechanical ventilation. The integration of cancer care, pain management, wound care, and palliative care led to improved quality of life and recovery. The collaborative approach between nursing staff and family ensured that the patient received compassionate and effective care. Conclusion: The complex interplay of emergency surgery, COVID-19, and advanced cancer required a multifaceted care strategy. The care team’s approach, combining critical care with tailored cancer and palliative care, effectively improved the patient’s quality of life and facilitated recovery. The comprehensive care plan, developed with family collaboration, provided both high-quality medical care and compassionate support for the terminally ill patient.

Keywords: multiple metastases, testicular cancer, palliative care, nursing experience

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6657 Dynamic Wetting and Solidification

Authors: Yulii D. Shikhmurzaev

Abstract:

The modelling of the non-isothermal free-surface flows coupled with the solidification process has become the topic of intensive research with the advent of additive manufacturing, where complex 3-dimensional structures are produced by successive deposition and solidification of microscopic droplets of different materials. The issue is that both the spreading of liquids over solids and the propagation of the solidification front into the fluid and along the solid substrate pose fundamental difficulties for their mathematical modelling. The first of these processes, known as ‘dynamic wetting’, leads to the well-known ‘moving contact-line problem’ where, as shown recently both experimentally and theoretically, the contact angle formed by the free surfac with the solid substrate is not a function of the contact-line speed but is rather a functional of the flow field. The modelling of the propagating solidification front requires generalization of the classical Stefan problem, which would be able to describe the onset of the process and the non-equilibrium regime of solidification. Furthermore, given that both dynamic wetting and solification occur concurrently and interactively, they should be described within the same conceptual framework. The present work addresses this formidable problem and presents a mathematical model capable of describing the key element of additive manufacturing in a self-consistent and singularity-free way. The model is illustrated simple examples highlighting its main features. The main idea of the work is that both dynamic wetting and solidification, as well as some other fluid flows, are particular cases in a general class of flows where interfaces form and/or disappear. This conceptual framework allows one to derive a mathematical model from first principles using the methods of irreversible thermodynamics. Crucially, the interfaces are not considered as zero-mass entities introduced using Gibbsian ‘dividing surface’ but the 2-dimensional surface phases produced by the continuum limit in which the thickness of what physically is an interfacial layer vanishes, and its properties are characterized by ‘surface’ parameters (surface tension, surface density, etc). This approach allows for the mass exchange between the surface and bulk phases, which is the essence of the interface formation. As shown numerically, the onset of solidification is preceded by the pure interface formation stage, whilst the Stefan regime is the final stage where the temperature at the solidification front asymptotically approaches the solidification temperature. The developed model can also be applied to the flow with the substrate melting as well as a complex flow where both types of phase transition take place.

Keywords: dynamic wetting, interface formation, phase transition, solidification

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6656 Approximation of Geodesics on Meshes with Implementation in Rhinoceros Software

Authors: Marian Sagat, Mariana Remesikova

Abstract:

In civil engineering, there is a problem how to industrially produce tensile membrane structures that are non-developable surfaces. Nondevelopable surfaces can only be developed with a certain error and we want to minimize this error. To that goal, the non-developable surfaces are cut into plates along to the geodesic curves. We propose a numerical algorithm for finding approximations of open geodesics on meshes and surfaces based on geodesic curvature flow. For practical reasons, it is important to automatize the choice of the time step. We propose a method for automatic setting of the time step based on the diagonal dominance criterion for the matrix of the linear system obtained by discretization of our partial differential equation model. Practical experiments show reliability of this method. Because approximation of the model is made by numerical method based on classic derivatives, it is necessary to solve obstacles which occur for meshes with sharp corners. We solve this problem for big family of meshes with sharp corners via special rotations which can be seen as partial unfolding of the mesh. In practical applications, it is required that the approximation of geodesic has its vertices only on the edges of the mesh. This problem is solved by a specially designed pointing tracking algorithm. We also partially solve the problem of finding geodesics on meshes with holes. We implemented the whole algorithm in Rhinoceros (commercial 3D computer graphics and computer-aided design software ). It is done by using C# language as C# assembly library for Grasshopper, which is plugin in Rhinoceros.

Keywords: geodesic, geodesic curvature flow, mesh, Rhinoceros software

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6655 The Transport of Coexisting Nanoscale Zinc Oxide Particles, Cu(Ⅱ) and Cr(Ⅵ) Ions in Simulated Landfill Leachate

Authors: Xiaoyu Li, Wenchuan Ding, Yujia Yia

Abstract:

As the nanoscale zinc oxide particles (nano-ZnO) accumulate in the landfill, nano-ZnO will enter the landfill leachate and come into contact with the heavy metal ions in leachate, which will change their transport process in the landfill and, furthermore, affect each other's environmental fate and toxicity. In this study, we explored the transport of co-existing nano-ZnO, Cu(II) and Cr(VI) ions by column experiments under different stages of landfill leachate conditions (flow rate, pH, ionic strength, humic acid). The results show that Cu(II) inhibits the transport of nano-ZnO in the quartz sand column by increasing the surface potential of nano-ZnO, and nano-ZnO increases the retention of Cu(II) in the quartz sand column by adsorbing Cu(II) ions. Cr(VI) promotes the transport of nano-ZnO in the quartz sand column by neutralizing the surface potential of the nano-ZnO which reduces electrostatic attraction between nZnO and quartz sand, but the nano-ZnO has no effect on the transport of Cr(VI). The nature of landfill leachates such as flow rate, pH, ionic strength (IS) and humic acid (HA) has a certain effect on the transport of coexisting nano-ZnO and heavy metal ions. For leachate containing Cu(II) and Cr(VI) ions, at the initial stage of landfilling, the pH of leachate is acidic, ionic strength value is high, the humic acid concentration is low, and the transportability of nano-ZnO is weak. As the landfill age increased, the pH value in the leachate gradually increases, when the ions are raised to alkaline, these ions are trending to precipitated or adsorbed to the solid wastes in landfill, which resulting in low IS value of leachate. At the same time, more refractory organic matter gradually increases such as HA, which provides repulsive steric effects, so the nano-ZnO is more likely to migrate. Overall, the Cr(VI) can promote the transport of nano-ZnO more than Cu(II).

Keywords: heavy metal ions, landfill leachate, nano-ZnO, transport

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6654 Influencing Factors for Job Satisfaction and Turnover Intention of Surgical Team in the Operating Rooms

Authors: Shu Jiuan Chen, Shu Fen Wu, I. Ling Tsai, Chia Yu Chen, Yen Lin Liu, Chen-Fuh Lam

Abstract:

Background: Increased emotional stress in workplace and depressed job satisfaction may significantly affect the turnover intention and career life of personnel. However, very limited studies have reported the factors influencing the turnover intention of the surgical team members in the operating rooms, where extraordinary stress is normally exit in this isolated medical care unit. Therefore, this study aimed to determine the environmental and personal characteristic factors that might be associated with job satisfaction and turnover intention in the non-physician staff who work in the operating rooms. Methods: This was a cross-sectional, descriptive study performed in a metropolitan teaching hospital in southern Taiwan between May 2017 to July 2017. A structured self-administered questionnaire, modified from the Practice Environment Scale of the Nursing Work Index (PES-NWI), Occupational Stress Indicator-2 (OSI-2) and Maslach Burnout Inventory (MBI) manual was collected from the operating room nurses, nurse anesthetists, surgeon assistants, orderly and other non-physician staff. Numerical and categorical data were analyzed using unpaired t-test and Chi-square test, as appropriate (SPSS, version 20.0). Results: A total of 167 effective questionnaires were collected from 200 eligible, non-physician personnel who worked in the operating room (response rate 83.5%). The overall satisfaction of all responders was 45.64 ± 7.17. In comparison to those who had more than 4-year working experience in the operating rooms, the junior staff ( ≤ 4-year experience) reported to have significantly higher satisfaction in workplace environment and job contentment, as well as lower intention to quit (t = 6.325, P =0.000). Among the different specialties of surgical team members, nurse anesthetists were associated with significantly lower levels of job satisfaction (P=0.043) and intention to stay (x² = 8.127, P < 0.05). Multivariate regression analysis demonstrates job title, seniority, working shifts and job satisfaction are the significant independent predicting factors for quit jobs. Conclusion: The results of this study highlight that increased work seniorities ( > 4-year working experience) are associated with significantly lower job satisfaction, and they are also more likely to leave their current job. Increased workload in supervising the juniors without appropriate job compensation (such as promotions in job title and work shifts) may precipitate their intention to quit. Since the senior staffs are usually the leaders and core members in the operating rooms, the retention of this fundamental manpower is essential to ensure the safety and efficacy of surgical interventions in the operating rooms.

Keywords: surgical team, job satisfaction, resignation intention, operating room

Procedia PDF Downloads 255
6653 A Multi-Agent Smart E-Market Design at Work for Shariah Compliant Islamic Banking

Authors: Wafa Ghonaim

Abstract:

Though quite fast on growth, Islamic financing at large, and its diverse instruments, is a controversial matter among scholars. This is evident from the ongoing debates on its Shariah compliance. Arguments, however, are inciting doubts and concerns among clients about its credibility, which is harming this lucrative sector. The work here investigates, particularly, some issues related to the Tawarruq instrument. The work examines the issues of linking Murabaha and Wakala contracts, the reselling of commodities to same traders, and the transfer of ownerships. The work affirms that a multi-agent smart electronic market design would facilitate Shariah compliance. The smart market exploits the rational decision-making capabilities of autonomous proxy agents that enable the clients, traders, brokers, and the bank buy and sell commodities, and manage transactions and cash flow. The smart electronic market design delivers desirable qualities that terminate the need for Wakala contracts and the reselling of commodities to the same traders. It also resolves the ownership transfer issues by allowing stakeholders to trade independently. The bank administers the smart electronic market and assures reliability of trades, transactions and cash flow. A multi-agent simulation is presented to validate the concept and processes. We anticipate that the multi-agent smart electronic market design would deliver Shariah compliance of personal financing to the aspiration of scholars, banks, traders and potential clients.

Keywords: Islamic finance, share'ah compliance, smart electronic markets design, multiagent systems

Procedia PDF Downloads 317
6652 Frenotomy for Tongue Tie: The Unlikely Benefit of Massage

Authors: Kailas Bhandarkar, Talib Dar, Laura Karia, Manasvi Upadhyaya

Abstract:

Introduction: Frenotomy for tongue tie is commonly performed in breastfed infants who experience difficulty in latching after failed conservative management for tongue tie. However, there is no consensus for the routine use of massage following frenotomy. Our aim was to assess the efficacy of massage in preventing recurrence following frenotomy. Methods: The tongue tie service in our tertiary referral hospital consists of 5 consultants and a breastfeeding (BF) midwife. 3 consultants routinely advice massage post procedure. Babies are assessed by the midwife after the procedure and a follow-up consultation after a week. After due ethical approval, data were collected by two staff members who were independent of TT service on a standardized questionnaire to avoid bias. Fischer exact test was employed (p < 0.05 considered significant). Results: Six hundred and thirty-two babies attended the clinic from January 2018 to December 2018. Thirty-three of these were excluded as the procedure was not needed. Parents were contacted at a median of six months post-procedure (range 2-10 months). 282/599 were advised massage. 92/282 could be contacted. 40/ 92 adhered to massage regimen. None of these had a recurrence. 52/92 (54%), although advised, did not perform massage. Reasons cited for lack of adherence to massage included difficulty in performing massaging and conflicting advice given by other health care professionals involved in patient care like paediatricians and group practice and lack of information on the internet). Overall, 4/599 (0.66%) had recurrences, and this difference was not statistically significant. Conclusion: In our experience, the rate of recurrence after frenotomy is low enough for us to conclude that there is no significant benefit of massage after frenotomy for tongue tie. We could also conclude that among parents who were advised massage more than half failed to adhere to the advice.

Keywords: tongue tie, frenotomy, massage, recurrence

Procedia PDF Downloads 135