Search results for: alloy-environment combination
273 Dueling Burnout: The Dual Role Nurse
Authors: Melissa Dorsey
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Moral distress and compassion fatigue plague nurses in the Cardiothoracic Intensive Care Unit (CTICU) and cause an unnecessary level of turnover. Dueling Burnout describes an initiative that was implemented in the CTICU to reduce the level of burnout the nurses endure by encouraging dual roles with collaborating departments. Purpose: Critical care nurses are plagued by burnout, moral distress, and compassion fatigue due to the intensity of care provided. The purpose of the dual role program was to decrease these issues by providing relief from the intensity of the critical care environment while maintaining full-time employment. Relevance/Significance: Burnout, moral distress, and compassion fatigue are leading causes of Cardiothoracic Critical Care (CTCU) turnover. A contributing factor to burnout is the workload related to serving as a preceptor for a constant influx of new nurses (RN). As a result of these factors, the CTICU averages 17% nursing turnover/year. The cost, unit disruption, and, most importantly, distress of the clinical nurses required an innovative approach to create an improved work environment and experience. Strategies/Implementation/Methods: In May 2018, a dual role pilot was initiated for nurses. The dual role constitutes .6 full-time equivalent hours (FTE) worked in CTICU in combination with .3 FTE worked in the Emergency Department (ED). ED nurses who expressed an interest in cross-training to CTICU were also offered the dual role opportunity. The initial hypothesis was that full-time employees would benefit from a change in clinical setting leading to increased engagement and job satisfaction. The dual role also presents an opportunity for professional development through the expansion of clinical skills in another specialty. Success of the pilot led to extending the dual role to areas beyond the ED. Evaluation/Outcomes/Results: The number of dual role clinical nurses has grown to 22. From the dual role cohort, only one has transferred out of CTICU. This is a 5% turnover rate for this group of nurses as compared to the average turnover rate of 17%. A role satisfaction survey conducted with the dual role cohort found that because of working in a dual role, 76.5% decreased their intent to leave, 100% decreased their level of burnout, and 100% reported an increase in overall job satisfaction. Nurses reported the ability to develop skills that are transferable between departments. Respondents emphasized the appreciation gained from working in multiple environments; the dual role served to transform their care. Conclusions/Implications: Dual role is an effective strategy to retain experienced nurses, decrease burnout and turnover, improve collaboration, and provide flexibility to meet staffing needs. The dual role offers RNs an expansion of skills, relief from high acuity and orientee demands, while improving job satisfaction.Keywords: nursing retention, burnout, pandemic, strategic staffing, leadership
Procedia PDF Downloads 182272 Professional Learning, Professional Development and Academic Identity of Sessional Teachers: Underpinning Theoretical Frameworks
Authors: Aparna Datey
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This paper explores the theoretical frameworks underpinning professional learning, professional development, and academic identity. The focus is on sessional teachers (also called tutors or adjuncts) in architectural design studios, who may be practitioners, masters or doctoral students and academics hired ‘as needed’. Drawing from Schön’s work on reflective practice, learning and developmental theories of Vygotsky (social constructionism and zones of proximal development), informal and workplace learning, this research proposes that sessional teachers not only develop their teaching skills but also shape their identities through their 'everyday' work. Continuing academic staff develop their teaching through a combination of active teaching, self-reflection on teaching, as well as learning to teach from others via formalised programs and informally in the workplace. They are provided professional development and recognised for their teaching efforts through promotion, student citations, and awards for teaching excellence. The teaching experiences of sessional staff, by comparison, may be discontinuous and they generally have fewer opportunities and incentives for teaching development. In the absence of access to formalised programs, sessional teachers develop their teaching informally in workplace settings that may be supportive or unhelpful. Their learning as teachers is embedded in everyday practice applying problem-solving skills in ambiguous and uncertain settings. Depending on their level of expertise, they understand how to teach a subject such that students are stimulated to learn. Adult learning theories posit that adults have different motivations for learning and fall into a matrix of readiness, that an adult’s ability to make sense of their learning is shaped by their values, expectations, beliefs, feelings, attitudes, and judgements, and they are self-directed. The level of expertise of sessional teachers depends on their individual attributes and motivations, as well as on their work environment, the good practices they acquire and enhance through their practice, career training and development, the clarity of their role in the delivery of teaching, and other factors. The architectural design studio is ideal for study due to the historical persistence of the vocational learning or apprenticeship model (learning under the guidance of experts) and a pedagogical format using two key approaches: project-based problem solving and collaborative learning. Hence, investigating the theoretical frameworks underlying academic roles and informal professional learning in the workplace would deepen understanding of their professional development and how they shape their academic identities. This qualitative research is ongoing at a major university in Australia, but the growing trend towards hiring sessional staff to teach core courses in many disciplines is a global one. This research will contribute to including transient sessional teachers in the discourse on institutional quality, effectiveness, and student learning.Keywords: academic identity, architectural design learning, pedagogy, teaching and learning, sessional teachers
Procedia PDF Downloads 123271 Effect of Exercise and Mindfulness on Cognitive and Psycho-Emotional Functioning in Children with ADHD
Authors: Hannah Bigelow, Marcus D. Gottlieb, Michelle Ogrodnik, Jeffrey, D. Graham, Barbara Fenesi
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Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders affecting approximately 6% of children worldwide. ADHD is characterized by a combination of persistent deficits including impaired inhibitory control, working memory and task-switching. Many children with ADHD also have comorbid mental health issues such as anxiety and depression. There are several treatment options to manage ADHD impairments, including drug and behavioural management therapy, but they all have drawbacks, such as worsening mood disturbances or being inaccessible to certain demographics. Both physical exercise and mindfulness meditation serve as alternative options to potentially help mitigate ADHD symptoms. Although there is extensive support for the benefits of long-term physical exercise or mindfulness meditation programs, there is insufficient research investigating how acute bouts (i.e., single, short bouts) can help children with ADHD. Thus, the current study aimed to understand how single, short bouts of exercise and mindfulness meditation impacts executive functioning and psycho-emotional well-being in children with ADHD, as well as to directly compare the efficacy of these two interventions. The study used a a pre- post-test, within-subjects design to assess the effects of a 10-minute bout of moderate intensity exercise versus a 10-minute bout of mindfulness meditation (versus 10 minutes of a reading control) on the executive functioning and psycho-emotional well-being of 16 children and youth with ADHD aged 10-14 (male=11; White=80%). Participants completed all three interventions: 10 minutes of exercise, 10 minutes of mindfulness meditation, and 10 minutes of reading (control). Executive functioning (inhibitory control, working memory, task-switching) and psycho-emotional well-being (mood, self-efficacy) were assessed before and after each intervention. Mindfulness meditation promoted executive functioning, while exercise enhanced positive mood and self-efficacy. Critically, this work demonstrates that a single, short bout of mindfulness meditation session can promote inhibitory control among children with ADHD. This is especially important for children with ADHD as inhibitory control deficits are among the most pervasive challenges that they face. Furthermore, the current study provides preliminary evidence for the benefit of acute exercise for promoting positive mood and general self-efficacy for children and youth with ADHD. These results may increase the accessibility of acute exercise for children with ADHD, providing guardians and teachers a feasible option to incorporate just 10 minutes of exercise to assist children emotionally. In summary, this research supports the use of acute exercise and mindfulness meditation on varying aspects of executive functioning and psycho-emotional well-being in children and youth with ADHD. This work offers important insight into how behavioural interventions could be personalized according to a child’s needs.Keywords: attention-deficit hyperactivity disorder (ADHD), acute exercise, mindfulness meditation, executive functioning, psycho-emotional well-being
Procedia PDF Downloads 130270 Constitutive Androstane Receptor (CAR) Inhibitor CINPA1 as a Tool to Understand CAR Structure and Function
Authors: Milu T. Cherian, Sergio C. Chai, Morgan A. Casal, Taosheng Chen
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This study aims to use CINPA1, a recently discovered small-molecule inhibitor of the xenobiotic receptor CAR (constitutive androstane receptor) for understanding the binding modes of CAR and to guide CAR-mediated gene expression profiling studies in human primary hepatocytes. CAR and PXR are xenobiotic sensors that respond to drugs and endobiotics by modulating the expression of metabolic genes that enhance detoxification and elimination. Elevated levels of drug metabolizing enzymes and efflux transporters resulting from CAR activation promote the elimination of chemotherapeutic agents leading to reduced therapeutic effectiveness. Multidrug resistance in tumors after chemotherapy could be associated with errant CAR activity, as shown in the case of neuroblastoma. CAR inhibitors used in combination with existing chemotherapeutics could be utilized to attenuate multidrug resistance and resensitize chemo-resistant cancer cells. CAR and PXR have many overlapping modulating ligands as well as many overlapping target genes which confounded attempts to understand and regulate receptor-specific activity. Through a directed screening approach we previously identified a new CAR inhibitor, CINPA1, which is novel in its ability to inhibit CAR function without activating PXR. The cellular mechanisms by which CINPA1 inhibits CAR function were also extensively examined along with its pharmacokinetic properties. CINPA1 binding was shown to change CAR-coregulator interactions as well as modify CAR recruitment at DNA response elements of regulated genes. CINPA1 was shown to be broken down in the liver to form two, mostly inactive, metabolites. The structure-activity differences of CINPA1 and its metabolites were used to guide computational modeling using the CAR-LBD structure. To rationalize how ligand binding may lead to different CAR pharmacology, an analysis of the docked poses of human CAR bound to CITCO (a CAR activator) vs. CINPA1 or the metabolites was conducted. From our modeling, strong hydrogen bonding of CINPA1 with N165 and H203 in the CAR-LBD was predicted. These residues were validated to be important for CINPA1 binding using single amino-acid CAR mutants in a CAR-mediated functional reporter assay. Also predicted were residues making key hydrophobic interactions with CINPA1 but not the inactive metabolites. Some of these hydrophobic amino acids were also identified and additionally, the differential coregulator interactions of these mutants were determined in mammalian two-hybrid systems. CINPA1 represents an excellent starting point for future optimization into highly relevant probe molecules to study the function of the CAR receptor in normal- and pathophysiology, and possible development of therapeutics (for e.g. use for resensitizing chemoresistant neuroblastoma cells).Keywords: antagonist, chemoresistance, constitutive androstane receptor (CAR), multi-drug resistance, structure activity relationship (SAR), xenobiotic resistance
Procedia PDF Downloads 285269 Sustainability in Space: Material Efficiency in Space Missions
Authors: Hamda M. Al-Ali
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From addressing fundamental questions about the history of the solar system to exploring other planets for any signs of life have always been the core of human space exploration. This triggered humans to explore whether other planets such as Mars could support human life on them. Therefore, many planned space missions to other planets have been designed and conducted to examine the feasibility of human survival on them. However, space missions are expensive and consume a large number of various resources to be successful. To overcome these problems, material efficiency shall be maximized through the use of reusable launch vehicles (RLV) rather than disposable and expendable ones. Material efficiency is defined as a way to achieve service requirements using fewer materials to reduce CO2 emissions from industrial processes. Materials such as aluminum-lithium alloys, steel, Kevlar, and reinforced carbon-carbon composites used in the manufacturing of spacecrafts could be reused in closed-loop cycles directly or by adding a protective coat. Material efficiency is a fundamental principle of a circular economy. The circular economy aims to cutback waste and reduce pollution through maximizing material efficiency so that businesses can succeed and endure. Five strategies have been proposed to improve material efficiency in the space industry, which includes waste minimization, introduce Key Performance Indicators (KPIs) to measure material efficiency, and introduce policies and legislations to improve material efficiency in the space sector. Another strategy to boost material efficiency is through maximizing resource and energy efficiency through material reusability. Furthermore, the environmental effects associated with the rapid growth in the number of space missions include black carbon emissions that lead to climate change. The levels of emissions must be tracked and tackled to ensure the safe utilization of space in the future. The aim of this research paper is to examine and suggest effective methods used to improve material efficiency in space missions so that space and Earth become more environmentally and economically sustainable. The objectives used to fulfill this aim are to identify the materials used in space missions that are suitable to be reused in closed-loop cycles considering material efficiency indicators and circular economy concepts. An explanation of how spacecraft materials could be re-used as well as propose strategies to maximize material efficiency in order to make RLVs possible so that access to space becomes affordable and reliable is provided. Also, the economic viability of the RLVs is examined to show the extent to which the use of RLVs has on the reduction of space mission costs. The environmental and economic implications of the increase in the number of space missions as a result of the use of RLVs are also discussed. These research questions are studied through detailed critical analysis of the literature, such as published reports, books, scientific articles, and journals. A combination of keywords such as material efficiency, circular economy, RLVs, and spacecraft materials were used to search for appropriate literature.Keywords: access to space, circular economy, material efficiency, reusable launch vehicles, spacecraft materials
Procedia PDF Downloads 111268 Use of Socially Assistive Robots in Early Rehabilitation to Promote Mobility for Infants with Motor Delays
Authors: Elena Kokkoni, Prasanna Kannappan, Ashkan Zehfroosh, Effrosyni Mavroudi, Kristina Strother-Garcia, James C. Galloway, Jeffrey Heinz, Rene Vidal, Herbert G. Tanner
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Early immobility affects the motor, cognitive, and social development. Current pediatric rehabilitation lacks the technology that will provide the dosage needed to promote mobility for young children at risk. The addition of socially assistive robots in early interventions may help increase the mobility dosage. The aim of this study is to examine the feasibility of an early intervention paradigm where non-walking infants experience independent mobility while socially interacting with robots. A dynamic environment is developed where both the child and the robot interact and learn from each other. The environment involves: 1) a range of physical activities that are goal-oriented, age-appropriate, and ability-matched for the child to perform, 2) the automatic functions that perceive the child’s actions through novel activity recognition algorithms, and decide appropriate actions for the robot, and 3) a networked visual data acquisition system that enables real-time assessment and provides the means to connect child behavior with robot decision-making in real-time. The environment was tested by bringing a two-year old boy with Down syndrome for eight sessions. The child presented delays throughout his motor development with the current being on the acquisition of walking. During the sessions, the child performed physical activities that required complex motor actions (e.g. climbing an inclined platform and/or staircase). During these activities, a (wheeled or humanoid) robot was either performing the action or was at its end point 'signaling' for interaction. From these sessions, information was gathered to develop algorithms to automate the perception of activities which the robot bases its actions on. A Markov Decision Process (MDP) is used to model the intentions of the child. A 'smoothing' technique is used to help identify the model’s parameters which are a critical step when dealing with small data sets such in this paradigm. The child engaged in all activities and socially interacted with the robot across sessions. With time, the child’s mobility was increased, and the frequency and duration of complex and independent motor actions were also increased (e.g. taking independent steps). Simulation results on the combination of the MDP and smoothing support the use of this model in human-robot interaction. Smoothing facilitates learning MDP parameters from small data sets. This paradigm is feasible and provides an insight on how social interaction may elicit mobility actions suggesting a new early intervention paradigm for very young children with motor disabilities. Acknowledgment: This work has been supported by NIH under grant #5R01HD87133.Keywords: activity recognition, human-robot interaction, machine learning, pediatric rehabilitation
Procedia PDF Downloads 291267 The Development of Modernist Chinese Architecture from the Perspective of Cultural Regionalism in Taiwan: Spatial Practice by the Fieldoffice Architects
Authors: Yilei Yu
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Modernism, emerging in the Western world of the 20th century, attempted to create a universal international style, which pulled the architectural and social systems created by classicism back to an initial pure state. However, out of the introspection of the Modernism, Regionalism attempted to restore a humanistic environment and create flexible buildings during the 1950s. Meanwhile, as the first generation of architects came back, the wind of the Regionalism blew to Taiwan. However, with the increasing of political influence and the tightening of free creative space, from the second half of the 1950s to the 1980s, the "real" Regional Architecture, which should have taken roots in Taiwan, becomes the "fake" Regional Architecture filled with the oriental charm. Through the Comparative Method, which includes description, interpretation, juxtaposition, and comparison, this study analyses the difference of the style of the Modernist Chinese Architecture between the period before the 1980s and the after. The paper aims at exploring the development of Regionalism Architecture in Taiwan, which includes three parts. First, the burgeoning period of the "modernist Chinese architecture" in Taiwan was the beginning of the Chinese Nationalist Party's coming to Taiwan to consolidate political power. The architecture of the "Ming and Qing Dynasty Palace Revival Style" dominated the architectural circles in Taiwan. These superficial "regional buildings" have nearly no combination with the local customs of Taiwan, which is difficult to evoke the social identity. Second, in the late 1970s, the second generation of architects headed by Baode Han began focusing on the research and preservation of traditional Taiwanese architecture, and creating buildings combined the terroirs of Taiwan through the imitation of styles. However, some scholars have expressed regret that very few regionalist architectural works that appeared in the 1980s can respond specifically to regional conditions and forms of construction. Instead, most of them are vocabulary-led representations. Third, during the 1990s, by the end of the period of martial law, community building gradually emerged, which made the object of Taiwan's architectural concern gradually extended to the folk and ethnic groups. In the Yilan area, there are many architects who care about the local environment, such as the Field office Architects. Compared with the hollow regionality of the passionate national spirits that emerged during the martial law period, the local practice of the architect team in Yilan can better link the real local environmental life and reflect the true regionality. In conclusion, with the local practice case of the huge construction team in Yilan area, this paper focuses on the Spatial Practice by the Field office Architects to explore the spatial representation of the space and the practical enlightenment in the process of modernist Chinese architecture development in Taiwan.Keywords: regionalism, modernism, Chinese architecture, political landscape, spatial representation
Procedia PDF Downloads 128266 The Role of People in Continuing Airworthiness: A Case Study Based on the Royal Thai Air Force
Authors: B. Ratchaneepun, N.S. Bardell
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It is recognized that people are the main drivers in almost all the processes that affect airworthiness assurance. This is especially true in the area of aircraft maintenance, which is an essential part of continuing airworthiness. This work investigates what impact English language proficiency, the intersection of the military and Thai cultures, and the lack of initial and continuing human factors training have on the work performance of maintenance personnel in the Royal Thai Air Force (RTAF). A quantitative research method based on a cross-sectional survey was used to gather data about these three key aspects of “people” in a military airworthiness environment. 30 questions were developed addressing the crucial topics of English language proficiency, impact of culture, and human factors training. The officers and the non-commissioned officers (NCOs) who work for the Aeronautical Engineering Divisions in the RTAF comprised the survey participants. The survey data were analysed to support various hypotheses by using a t-test method. English competency in the RTAF is very important since all of the service manuals for Thai military aircraft are written in English. Without such competency, it is difficult for maintenance staff to perform tasks and correctly interpret the relevant maintenance manual instructions; any misunderstandings could lead to potential accidents. The survey results showed that the officers appreciated the importance of this more than the NCOs, who are the people actually doing the hands-on maintenance work. Military culture focuses on the success of a given mission, and leverages the power distance between the lower and higher ranks. In Thai society, a power distance also exists between younger and older citizens. In the RTAF, such a combination tends to inhibit a just reporting culture and hence hinders safety. The survey results confirmed this, showing that the older people and higher ranks involved with RTAF aircraft maintenance believe that the workplace has a positive safety culture and climate, whereas the younger people and lower ranks think the opposite. The final area of consideration concerned human factors training and non-technical skills training. The survey revealed that those participants who had previously attended such courses appreciated its value and were aware of its benefits in daily life. However, currently there is no regulation in the RTAF to mandate recurrent training to maintain such knowledge and skills. The findings from this work suggest that the people involved in assuring the continuing airworthiness of the RTAF would benefit from: (i) more rigorous requirements and standards in the recruitment, initial training and continuation training regarding English competence; (ii) the development of a strong safety culture that exploits the uniqueness of both the military culture and the Thai culture; and (iii) providing more initial and recurrent training in human factors and non-technical skills.Keywords: aircraft maintenance, continuing airworthiness, military culture, people, Royal Thai Air Force
Procedia PDF Downloads 129265 Anthropogenic Impact on Surface and Groundwaters Quality in the Western Part of the River Nile, Elsaff Village, Giza
Authors: Mohamed Elkashouty, Mohamed Yehia, Ahmed Tawfuk
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The study area is located in the southern part of Giza Governorate at both side of the Nile Valley. A combination of major and trace elements have been used to classify surface- and ground-waters in El Kurimat village, Egypt. The main purpose of the project is to investigate the surface-and ground-waters quality and hydrochemical evaluation. The situation is further complicated by contamination with lithogenic and anthropogenic (agricultural and sewage wastewaters) sources and low groundwater management strategies. The Quaternary aquifer consists of sands and gravels of Pleistocene age intercalated with clay lenses and overlain by silty clay aquitard (Holocene). The semi-pervious silty clay aquitard of the Holocene Nile sediments cover the Quaternary aquifer in most areas. The groundwater flows generally from southwest to northeast. To achieve this target, thirty five and seventy three samples were collected from surface– and ground-waters within summer and winter seasons 2009-2010). Total dissolved solids (TDS), cations, anions, NO2, NO3, PO4 , Al, Ba, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Zn, As, F, Sb, Se, Sn, Sr and V) were determined in water samples. Grain size analysis was achieved to eight soil samples and measured the organic matter percent in different fractions. The TDS concentration is high in Arab El Ein canal by lithogenic and anthropogenic sources. The average concentrations of TDS in the River Nile are 245 (summer) and 254 ppm (winter). NO3 content ranges from 1.7 to 12 mg/l (summer), while in winter it ranges from 0.4 to 2.4. Most of the toxic metal concentrations are below the drinking and irrigation guidelines except Mn, V, Cr, Al, and Fe, which are higher than the guidelines in some canals and drains. The TDS concentration in groundwater increases toward northeastern and northwestern part of the study area (i.e. toward limestone plateau). It is due to hydrogeological interconnection between Quaternary and Eocene aquifer (saline water), wastewater dump and recharge from wadi El Atfihi wastewater. There is a good match between the hydrogeology and the hydrogeochemistry. Total dissolved solid in groundwater increases toward southwestern part, may be due to hydrogeological interconnection between Quaternary and Eocene aquifer and leakage from agricultural waste water of El Mohut drain. Fe, Mn, Cr, Al, PO4 and NO3 concentrations are high due to anthropogenic sources, therefore they are unsuitable for drinking. The average concentration of Cr, Cu, Fe, Mn &Zn are higher in winter than those in summer due to winter drought. The organic matter content in soil are increases in the northeastern and southwestern part, with different fractions, sue to agricultural wastewaters. Reused of contaminated surface- and ground-waters samples by mixing with fresh water (By AquaChem) was estimated to increase the income per capita.Keywords: surface water, groundwater, major ions, toxic metals
Procedia PDF Downloads 292264 For Whom Is Legal Aid: A Critical Analysis of the State-Funded Legal Aid in Criminal Cases in Tajikistan
Authors: Umeda Junaydova
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Legal aid is a key element of access to justice. According to UN Principles and Guidelines on Access to Legal Aid in Criminal Justice Systems, state members bear the obligation to put in place accessible, effective, sustainable, and credible legal aid systems. Regarding this obligation, developing countries, such as Tajikistan, faced challenges in terms of financing this system. Thus, many developed nations have launched rule-of-law programs to support these states and ensure access to justice for all. Following independence from the Soviet Union, Tajikistan committed to introducing the rule of law and providing access to justice. This newly established country was weak, and the sudden outbreak of civil war aggravated the situation even more. The country needed external support and opened its door to attract foreign donors to assist it in its way to development. In 2015, Tajikistan, with the financial support of development partners, was able to establish a state-funded legal aid system that provides legal assistance to vulnerable and marginalized populations, including in criminal cases. In the beginning, almost the whole system was financed from donor funds; by that time, the contribution of the government gradually increased, and currently, it covers 80% of the total budget. All these governments' actions toward ensuring access to criminal legal aid for disadvantaged groups look promising; however, the reality is completely different. Currently, not all disadvantaged people are covered by these services, and their cases are most of the time considered without appropriate defense, which leads to violation of fundamental human rights. This research presents a comprehensive exploration of the interplay between donor assistance and the effectiveness of legal aid services in Tajikistan, with a specific focus on criminal cases involving vulnerable groups, such as women and children. In the context of Tajikistan, this study addresses a pressing concern: despite substantial financial support from international donors, state-funded legal aid services often fall short of meeting the needs of poor and vulnerable populations. The study delves into the underlying complexities of this issue and examines the structural, operational, and systemic challenges faced by legal aid providers, shedding light on the factors contributing to the ineffectiveness of legal aid services. Furthermore, it seeks to identify the root causes of these issues, revealing the barriers that hinder the delivery of adequate legal aid services. The research adopts a socio-legal methodology to ensure an appropriate combination of multiple methodologies. The findings of this research hold significant implications for both policymakers and practitioners, offering insights into the enhancement of legal aid services and access to justice for disadvantaged and marginalized populations in Tajikistan. By addressing these pressing questions, this study aims to fill the gap in legal literature and contribute to the development of a more equitable and efficient legal aid system that better serves the needs of the most vulnerable members of society.Keywords: access to justice, legal aid, rule of law, rights for council
Procedia PDF Downloads 49263 Fodder Production and Livestock Rearing in Relation to Climate Change and Possible Adaptation Measures in Manaslu Conservation Area, Nepal
Authors: Bhojan Dhakal, Naba Raj Devkota, Chet Raj Upreti, Maheshwar Sapkota
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A study was conducted to find out the production potential, nutrient composition, and the variability of the most commonly available fodder trees along with the varying altitude to help optimize the dry matter requirement during winter lean period. The study was carried out from March to June, 2012 in Lho and Prok Village Development Committee of Manaslu Conservation Area (MCA), located in Gorkha district of Nepal. The other objective of the research was to learn the impact of climate change on livestock production linking it with feed availability. The study was conducted in two parts: social and biological. Accordingly, a households (HHs) survey was conducted to collect primary data from 70 HHs, focusing on the perception of respondents on impacts of climatic variability on the feeding management. The next part consisted of understanding yield potential and nutrient composition of the four most commonly available fodder trees (M. azedirach, M. alba, F. roxburghii, F. nemoralis), within two altitudes range: (1500-2000 masl and 2000-2500 masl) by using a RCB design in 2*4 factorial combination of treatments, each replicated four times. Results revealed that majority of the farmers perceived the change in climatic phenomenon more severely within the past five years. Farmers were using different adaptation technologies such as collection of forage from jungle, reducing unproductive animals, fodder trees utilization, and crop by product feeding at feed scarcity period. Ranking of the different fodder trees on the basis of indigenous knowledge and experiences revealed that F. roxburghii was the best-preferred fodder tree species (index value 0.72) in terms overall preferability whereas M. azedirach had highest growth and productivity (index value 0.77), F. roxburghii had highest adoptability (index value 0.69) and palatability (index value 0.69) as well. Similarly, fresh yield and dry matter yield of the each fodder trees was significant (P < 0.01) between the altitude and within species. Fodder trees yield analysis revealed that the highest dry matter (DM) yield (28 kg/tree) was obtained for F. roxburghii but that remained statistically similar (P > 0.05) to the other treatment. On the other hand, most of the parameters: ether extract (EE), acid detergent lignin (ADL), acid detergent fibre (ADF), cell wall digestibility (CWD), relative digestibility (RD), digestible nutrient (TDN), and Calcium (Ca) among the treatments were highly significant (P < 0.01). This indicates the scope of introducing productive and nutritive fodder trees species even at the high altitude to help reduce fodder scarcity problem during winter. The finding also revealed the scope of promoting all available local fodder trees species as crude protein content of these species were similar.Keywords: fodder trees, yield potential, climate change, nutrient composition
Procedia PDF Downloads 308262 Impact of 6-Week Brain Endurance Training on Cognitive and Cycling Performance in Highly Trained Individuals
Authors: W. Staiano, S. Marcora
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Introduction: It has been proposed that acute negative effect of mental fatigue (MF) could potentially become a training stimulus for the brain (Brain endurance training (BET)) to adapt and improve its ability to attenuate MF states during sport competitions. Purpose: The aim of this study was to test the efficacy of 6 weeks of BET on cognitive and cycling tests in a group of well-trained subjects. We hypothesised that combination of BET and standard physical training (SPT) would increase cognitive capacity and cycling performance by reducing rating of perceived exertion (RPE) and increase resilience to fatigue more than SPT alone. Methods: In a randomized controlled trial design, 26 well trained participants, after a familiarization session, cycled to exhaustion (TTE) at 80% peak power output (PPO) and, after 90 min rest, at 65% PPO, before and after random allocation to a 6 week BET or active placebo control. Cognitive performance was measured using 30 min of STROOP coloured task performed before cycling performance. During the training, BET group performed a series of cognitive tasks for a total of 30 sessions (5 sessions per week) with duration increasing from 30 to 60 min per session. Placebo engaged in a breathing relaxation training. Both groups were monitored for physical training and were naïve to the purpose of the study. Physiological and perceptual parameters of heart rate, lactate (LA) and RPE were recorded during cycling performances, while subjective workload (NASA TLX scale) was measured during the training. Results: Group (BET vs. Placebo) x Test (Pre-test vs. Post-test) mixed model ANOVA’s revealed significant interaction for performance at 80% PPO (p = .038) or 65% PPO (p = .011). In both tests, groups improved their TTE performance; however, BET group improved significantly more compared to placebo. No significant differences were found for heart rate during the TTE cycling tests. LA did not change significantly at rest in both groups. However, at completion of 65% TTE, it was significantly higher (p = 0.043) in the placebo condition compared to BET. RPE measured at ISO-time in BET was significantly lower (80% PPO, p = 0.041; 65% PPO p= 0.021) compared to placebo. Cognitive results in the STROOP task showed that reaction time in both groups decreased at post-test. However, BET decreased significantly (p = 0.01) more compared to placebo despite no differences accuracy. During training sessions, participants in the BET showed, through NASA TLX questionnaires, constantly significantly higher (p < 0.01) mental demand rates compared to placebo. No significant differences were found for physical demand. Conclusion: The results of this study provide evidences that combining BET and SPT seems to be more effective than SPT alone in increasing cognitive and cycling performance in well trained endurance participants. The cognitive overload produced during the 6-week training of BET can induce a reduction in perception of effort at a specific power, and thus improving cycling performance. Moreover, it provides evidence that including neurocognitive interventions will benefit athletes by increasing their mental resilience, without affecting their physical training load and routine.Keywords: cognitive training, perception of effort, endurance performance, neuro-performance
Procedia PDF Downloads 118261 The Lived Experience of Pregnant Saudi Women Carrying a Fetus with Structural Abnormalities
Authors: Nasreen Abdulmannan
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Fetal abnormalities are categorized as a structural abnormality, non-structural abnormality, or a combination of both. Fetal structural abnormalities (FSA) include, but are not limited, to Down syndrome, congenital diaphragmatic hernia, and cleft lip and palate. These abnormalities can be detected in the first weeks of pregnancy, which is almost around 9 - 20 weeks gestational. Etiological factors for FSA are unknown; however, transmitted genetic risk can be one of these factors. Consanguineous marriage often referred to as inbreeding, represents a significant risk factor for FSA due to the increased likelihood of deleterious genetic traits shared by both biological parents. In a country such as the Kingdom of Saudi Arabia (KSA), consanguineous marriage is high, which creates a significant risk of children being born with congenital abnormalities. Historically, the practice of consanguinity occurred commonly among European royalty. For example, Great Britain’s Queen Victoria married her German first cousin, Prince Albert of Coburg. Although a distant blood relationship, the United Kingdom’s Queen Elizabeth II married her cousin, Prince Philip of Greece and Denmark—both of them direct descendants of Queen Victoria. In Middle Eastern countries, a high incidence of consanguineous unions still exists, including in the KSA. Previous studies indicated that a significant gap exists in understanding the lived experiences of Saudi women dealing with an FSA-complicated pregnancy. Eleven participants were interviewed using a semi-structured interview format for this qualitative phenomenological study investigating the lived experiences of pregnant Saudi women carrying a child with FSA. This study explored the gaps in current literature regarding the lived experiences of pregnant Saudi women whose pregnancies were complicated by FSA. In addition, the researcher acquired knowledge about the available support and resources as well as the Saudi cultural perspective on FSA. This research explored the lived experiences of pregnant Saudi women utilizing Giorgi’s (2009) approach to data collection and data management. Findings for this study cover five major themes: (1) initial maternal reaction to the FSA diagnosis per ultrasound screening; (2) strengthening of the maternal relationship with God; (3) maternal concern for their child’s future; (4) feeling supported by their loved ones; and (5) lack of healthcare provider support and guidance. Future research in the KSA is needed to explore the network support for these mothers. This study recommended further clinical nursing research, nursing education, clinical practice, and healthcare policy/procedures to provide opportunities for improvement in nursing care and increase awareness in KSA society.Keywords: fetal structural abnormalities, psychological distress, health provider, health care
Procedia PDF Downloads 154260 An Investigation of Wind Loading Effects on the Design of Elevated Steel Tanks with Lattice Tower Supporting Structures
Authors: J. van Vuuren, D. J. van Vuuren, R. Muigai
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In recent times, South Africa has experienced extensive droughts that created the need for reliable small water reservoirs. These reservoirs have comparatively quick fabrication and installation times compared to market alternatives. An elevated water tank has inherent potential energy, resulting in that no additional water pumps are required to sustain water pressure at the outlet point – thus ensuring that, without electricity, a water source is available. The initial construction formwork and the complex geometric shape of concrete towers that requires casting can become time-consuming, rendering steel towers preferable. Reinforced concrete foundations, cast in advance, are required to be of sufficient strength. Thereafter, the prefabricated steel supporting structure and tank, which consist of steel panels, can be assembled and erected on site within a couple of days. Due to the time effectiveness of this system, it has become a popular solution to aid drought-stricken areas. These sites are normally in rural, schools or farmland areas. As these tanks can contain up to 2000kL (approximately 19.62MN) of water, combined with supporting lattice steel structures ranging between 5m and 30m in height, failure of one of the supporting members will result in system failure. Thus, there is a need to gain a comprehensive understanding of the operation conditions because of wind loadings on both the tank and the supporting structure. The aim of the research is to investigate the relationship between the theoretical wind loading on a lattice steel tower in combination with an elevated sectional steel tank, and the current wind loading codes, as applicable to South Africa. The research compares the respective design parameters (both theoretical and wind loading codes) whereby FEA analyses are conducted on the various design solutions. The currently available wind loading codes are not sufficient to design slender cantilever latticed steel towers that support elevated water storage tanks. Numerous factors in the design codes are not comprehensively considered when designing the system as these codes are dependent on various assumptions. Factors that require investigation for the study are; the wind loading angle to the face of the structure that will result in maximum load; the internal structural effects on models with different bracing patterns; the loading influence of the aspect ratio of the tank; and the clearance height of the tank on the structural members. Wind loads, as the variable that results in the highest failure rate of cantilevered lattice steel tower structures, require greater understanding. This study aims to contribute towards the design process of elevated steel tanks with lattice tower supporting structures.Keywords: aspect ratio, bracing patterns, clearance height, elevated steel tanks, lattice steel tower, wind loads
Procedia PDF Downloads 150259 Mapping the Suitable Sites for Food Grain Crops Using Geographical Information System (GIS) and Analytical Hierarchy Process (AHP)
Authors: Md. Monjurul Islam, Tofael Ahamed, Ryozo Noguchi
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Progress continues in the fight against hunger, yet an unacceptably large number of people still lack food they need for an active and healthy life. Bangladesh is one of the rising countries in the South-Asia but still lots of people are food insecure. In the last few years, Bangladesh has significant achievements in food grain production but still food security at national to individual levels remain a matter of major concern. Ensuring food security for all is one of the major challenges that Bangladesh faces today, especially production of rice in the flood and poverty prone areas. Northern part is more vulnerable than any other part of Bangladesh. To ensure food security, one of the best way is to increase domestic production. To increase production, it is necessary to secure lands for achieving optimum utilization of resources. One of the measures is to identify the vulnerable and potential areas using Land Suitability Assessment (LSA) to increase rice production in the poverty prone areas. Therefore, the aim of the study was to identify the suitable sites for food grain crop rice production in the poverty prone areas located at the northern part of Bangladesh. Lack of knowledge on the best combination of factors that suit production of rice has contributed to the low production. To fulfill the research objective, a multi-criteria analysis was done and produced a suitable map for crop production with the help of Geographical Information System (GIS) and Analytical Hierarchy Process (AHP). Primary and secondary data were collected from ground truth information and relevant offices. The suitability levels for each factor were ranked based on the structure of FAO land suitability classification as: Currently Not Suitable (N2), Presently Not Suitable (N1), Marginally Suitable (S3), Moderately Suitable (S2) and Highly Suitable (S1). The suitable sites were identified using spatial analysis and compared with the recent raster image from Google Earth Pro® to validate the reliability of suitability analysis. For producing a suitability map for rice farming using GIS and multi-criteria analysis tool, AHP was used to rank the relevant factors, and the resultant weights were used to create the suitability map using weighted sum overlay tool in ArcGIS 10.3®. Then, the suitability map for rice production in the study area was formed. The weighted overly was performed and found that 22.74 % (1337.02 km2) of the study area was highly suitable, while 28.54% (1678.04 km2) was moderately suitable, 14.86% (873.71 km2) was marginally suitable, and 1.19% (69.97 km2) was currently not suitable for rice farming. On the other hand, 32.67% (1920.87 km2) was permanently not suitable which occupied with settlements, rivers, water bodies and forests. This research provided information at local level that could be used by farmers to select suitable fields for rice production, and then it can be applied to other crops. It will also be helpful for the field workers and policy planner who serves in the agricultural sector.Keywords: AHP, GIS, spatial analysis, land suitability
Procedia PDF Downloads 240258 Modeling the International Economic Relations Development: The Prospects for Regional and Global Economic Integration
Authors: M. G. Shilina
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The interstate economic interaction phenomenon is complex. ‘Economic integration’, as one of its types, can be explored through the prism of international law, the theories of the world economy, politics and international relations. The most objective study of the phenomenon requires a comprehensive multifactoral approach. In new geopolitical realities, the problems of coexistence and possible interconnection of various mechanisms of interstate economic interaction are actively discussed. Currently, the Eurasian continent states support the direction to economic integration. At the same time, the existing international economic law fragmentation in Eurasia is seen as the important problem. The Eurasian space is characterized by a various types of interstate relations: international agreements (multilateral and bilateral), and a large number of cooperation formats (from discussion platforms to organizations aimed at deep integration). For their harmonization, it is necessary to have a clear vision to the phased international economic relations regulation options. In the conditions of rapid development of international economic relations, the modeling (including prognostic) can be optimally used as the main scientific method for presenting the phenomenon. On the basis of this method, it is possible to form the current situation vision and the best options for further action. In order to determine the most objective version of the integration development, the combination of several approaches were used. The normative legal approach- the descriptive method of legal modeling- was taken as the basis for the analysis. A set of legal methods was supplemented by the international relations science prognostic methods. The key elements of the model are the international economic organizations and states' associations existing in the Eurasian space (the Eurasian Economic Union (EAEU), the European Union (EU), the Shanghai Cooperation Organization (SCO), Chinese project ‘One belt-one road’ (OBOR), the Commonwealth of Independent States (CIS), BRICS, etc.). A general term for the elements of the model is proposed - the interstate interaction mechanisms (IIM). The aim of building a model of current and future Eurasian economic integration is to show optimal options for joint economic development of the states and IIMs. The long-term goal of this development is the new economic and political space, so-called the ‘Great Eurasian Community’. The process of achievement this long-term goal consists of successive steps. Modeling the integration architecture and dividing the interaction into stages led us to the following conclusion: the SCO is able to transform Eurasia into a single economic space. Gradual implementation of the complex phased model, in which the SCO+ plays a key role, will allow building an effective economic integration for all its participants, to create an economically strong community. The model can have practical value for politicians, lawyers, economists and other participants involved in the economic integration process. A clear, systematic structure can serve as a basis for further governmental action.Keywords: economic integration, The Eurasian Economic Union, The European Union, The Shanghai Cooperation Organization, The Silk Road Economic Belt
Procedia PDF Downloads 147257 The Use of Image Analysis Techniques to Describe a Cluster Cracks in the Cement Paste with the Addition of Metakaolinite
Authors: Maciej Szeląg, Stanisław Fic
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The impact of elevated temperatures on the construction materials manifests in change of their physical and mechanical characteristics. Stresses and thermal deformations that occur inside the volume of the material cause its progressive degradation as temperature increase. Finally, the reactions and transformations of multiphase structure of cementitious composite cause its complete destruction. A particularly dangerous phenomenon is the impact of thermal shock – a sudden high temperature load. The thermal shock leads to a high value of the temperature gradient between the outer surface and the interior of the element in a relatively short time. The result of mentioned above process is the formation of the cracks and scratches on the material’s surface and inside the material. The article describes the use of computer image analysis techniques to identify and assess the structure of the cluster cracks on the surfaces of modified cement pastes, caused by thermal shock. Four series of specimens were tested. Two Portland cements were used (CEM I 42.5R and CEM I 52,5R). In addition, two of the series contained metakaolinite as a replacement for 10% of the cement content. Samples in each series were made in combination of three w/b (water/binder) indicators of respectively 0.4; 0.5; 0.6. Surface cracks of the samples were created by a sudden temperature load at 200°C for 4 hours. Images of the cracked surfaces were obtained via scanning at 1200 DPI; digital processing and measurements were performed using ImageJ v. 1.46r software. In order to examine the cracked surface of the cement paste as a system of closed clusters – the dispersal systems theory was used to describe the structure of cement paste. Water is used as the dispersing phase, and the binder is used as the dispersed phase – which is the initial stage of cement paste structure creation. A cluster itself is considered to be the area on the specimen surface that is limited by cracks (created by sudden temperature loading) or by the edge of the sample. To describe the structure of cracks two stereological parameters were proposed: A ̅ – the cluster average area, L ̅ – the cluster average perimeter. The goal of this study was to compare the investigated stereological parameters with the mechanical properties of the tested specimens. Compressive and tensile strength testes were carried out according to EN standards. The method used in the study allowed the quantitative determination of defects occurring in the examined modified cement pastes surfaces. Based on the results, it was found that the nature of the cracks depends mainly on the physical parameters of the cement and the intermolecular interactions on the dispersal environment. Additionally, it was noted that the A ̅/L ̅ relation of created clusters can be described as one function for all tested samples. This fact testifies about the constant geometry of the thermal cracks regardless of the presence of metakaolinite, the type of cement and the w/b ratio.Keywords: cement paste, cluster cracks, elevated temperature, image analysis, metakaolinite, stereological parameters
Procedia PDF Downloads 388256 Artificial Neural Network Approach for GIS-Based Soil Macro-Nutrients Mapping
Authors: Shahrzad Zolfagharnassab, Abdul Rashid Mohamed Shariff, Siti Khairunniza Bejo
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Conventional methods for nutrient soil mapping are based on laboratory tests of samples that are obtained from surveys. The time and cost involved in gathering and analyzing soil samples are the reasons that researchers use Predictive Soil Mapping (PSM). PSM can be defined as the development of a numerical or statistical model of the relationship among environmental variables and soil properties, which is then applied to a geographic database to create a predictive map. Kriging is a group of geostatistical techniques to spatially interpolate point values at an unobserved location from observations of values at nearby locations. The main problem with using kriging as an interpolator is that it is excessively data-dependent and requires a large number of closely spaced data points. Hence, there is a need to minimize the number of data points without sacrificing the accuracy of the results. In this paper, an Artificial Neural Networks (ANN) scheme was used to predict macronutrient values at un-sampled points. ANN has become a popular tool for prediction as it eliminates certain difficulties in soil property prediction, such as non-linear relationships and non-normality. Back-propagation multilayer feed-forward network structures were used to predict nitrogen, phosphorous and potassium values in the soil of the study area. A limited number of samples were used in the training, validation and testing phases of ANN (pattern reconstruction structures) to classify soil properties and the trained network was used for prediction. The soil analysis results of samples collected from the soil survey of block C of Sawah Sempadan, Tanjung Karang rice irrigation project at Selangor of Malaysia were used. Soil maps were produced by the Kriging method using 236 samples (or values) that were a combination of actual values (obtained from real samples) and virtual values (neural network predicted values). For each macronutrient element, three types of maps were generated with 118 actual and 118 virtual values, 59 actual and 177 virtual values, and 30 actual and 206 virtual values, respectively. To evaluate the performance of the proposed method, for each macronutrient element, a base map using 236 actual samples and test maps using 118, 59 and 30 actual samples respectively produced by the Kriging method. A set of parameters was defined to measure the similarity of the maps that were generated with the proposed method, termed the sample reduction method. The results show that the maps that were generated through the sample reduction method were more accurate than the corresponding base maps produced through a smaller number of real samples. For example, nitrogen maps that were produced from 118, 59 and 30 real samples have 78%, 62%, 41% similarity, respectively with the base map (236 samples) and the sample reduction method increased similarity to 87%, 77%, 71%, respectively. Hence, this method can reduce the number of real samples and substitute ANN predictive samples to achieve the specified level of accuracy.Keywords: artificial neural network, kriging, macro nutrient, pattern recognition, precision farming, soil mapping
Procedia PDF Downloads 70255 The ‘Fun, Move, Play’ Project: Qualitative and Quantitative Findings from Irish Primary School Children (6-8 Years), Parents and Teachers
Authors: Jemma McGourty, Brid Delahunt, Fiona Hackett, Sharon Courtney, Richard English, Graham Russell, Sinéad O’Connor
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Fundamental Movement Skills (FMS) mastery is considered essential for children’s ongoing, meaningful engagement in Physical Activity (PA). There has been a dearth of Irish research on baseline FMS and their development by means of intervention in young primary school children. In addition, as children’s participation in PA is heavily influenced by both parents and teachers, it is imperative to understand their attitudes and perceptions towards PA participation and its’ promotion in children. The ‘Fun, Move, Play’ Project investigated the effect of a 6-week play based PA intervention on primary school children’s (aged 6-8 years) FMS while also exploring the attitudes and perceptions of their parents and teachers towards PA participation. The FMS intervention utilised a pre-post quasi-experimental design to determine the effect of a 6-week play based PA intervention (devised from the iCoach Kids Programme) on 176 primary school children’s FMS (N = 176: 90 girls and 86 boys; M = 7.2 years; SD = 0.48). Objective measures of 7 FMS (run, skip, vertical jump, static balance, stationary dribble, catch, kick) were made using a combination of the TGMD2 and Get Skilled, Get Active resources. One hundred parents (87 mothers; 13 fathers; M=36 years; SD=5.45) and 90 teachers (67 females; 23 males) completed surveys investigating their attitudes and perceptions towards PA participation. In addition, 19 of these parents and 9 of these teachers participated in semi-structured qualitative interviews to explore, in more depth, their views and perceptions of PA participation. Both the FMS data set and survey responses were analysed using SPSS version 23, using appropriate statistical analysis. A thematic analysis framework was used to analyse the qualitative findings. A significant improvement was observed in the children’s overall FMS score pre-post intervention (t = 16.67; df = 175; p < 0.001), while there were also significant improvements in each of the seven individual FMS measured in the children, pre-post intervention. Findings from the parent surveys and interviews indicated that parents had positive attitudes towards PA, viewed it as important and supported their child’s PA participation. However, a lack of knowledge regarding the amount and intensity of PA that children should participate in emerged as a recurrent finding. Also, there was a significant positive correlation between the PA levels of parents’ and their children (r = .41; n = 100; p < .001). Arising from the teachers’ surveys and interviews was a positive attitude towards PA and the impact that it has on a child’s health and well-being. They also reported feeling more confident teaching certain aspects of the PE curriculum (games and sports) compared to others (gymnastics, dance), where they appreciate working with specialist practitioners. Conclusion: A short-term PA intervention has a positive effect on children’s FMS. While parents are supportive of their child’s PA participation, there is a knowledge gap regarding National PA guidelines for children. Teachers appreciate the importance of PA in children, but face a number of challenges in its implementation and promotion.Keywords: fundamental movement skills, parents attitudes to physical activity, short-term intervention, teachers attitudes to physical activity
Procedia PDF Downloads 178254 Effects of Macro and Micro Nutrients on Growth and Yield Performances of Tomato (Lycopersicon esculentum MILL.)
Authors: K. M. S. Weerasinghe, A. H. K. Balasooriya, S. L. Ransingha, G. D. Krishantha, R. S. Brhakamanagae, L. C. Wijethilke
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Tomato (Lycopersicon esculentum Mill.) is a major horticultural crop with an estimated global production of over 120 million metric tons and ranks first as a processing crop. The average tomato productivity in Sri Lanka (11 metric tons/ha) is much lower than the world average (24 metric tons/ha).To meet the tomato demand for the increasing population the productivity has to be intensified through the agronomic-techniques. Nutrition is one of the main factors which govern the growth and yield of tomato and the main nutrient source soil affect the plant growth and quality of the produce. Continuous cropping, improper fertilizer usage etc., cause widespread nutrient deficiencies. Therefore synthetic fertilizers and organic manures were introduced to enhance plant growth and maximize the crop yields. In this study, effects of macro and micronutrient supplementations on improvement of growth and yield of tomato were investigated. Selected tomato variety is Maheshi and plants were grown in Regional Agricultural and Research Centre Makadura under the Department of Agriculture recommended (DOA) macro nutrients and various combination of Ontario recommended dosages of secondary and micro fertilizer supplementations. There were six treatments in this experiment and each treatment was replicated in three times and each replicate consisted of six plants. Other than the DOA recommendation, five combinations of Ontario recommended dosage of secondary and micronutrients for tomato were also used as treatments. The treatments were arranged in a Randomized Complete Block Design. All cultural practices were carried out according to the DOA recommendations. The mean data was subjected to the statistical analysis using SAS package and mean separation (Duncan’s Multiple Range test at 5% probability level) procedures. Secondary and micronutrients containing treatments significantly increased most of the growth parameters. Plant height, plant girth, number of leaves, leaf area index etc. Fruits harvested from pots amended with macro, secondary and micronutrients performed best in terms of total yield; yield quality; to pots amended with DOA recommended dosage of fertilizer for tomato. It could be due to the application of all essential macro and micro nutrients that rise in photosynthetic activity, efficient translocation and utilization of photosynthates causing rapid cell elongation and cell division in actively growing region of the plant leading to stimulation of growth and yield were caused. The experiment revealed and highlighted the requirements of essential macro, secondary and micro nutrient fertilizer supplementations for tomato farming. The study indicated that, macro and micro nutrient supplementation practices can influence growth and yield performances of tomato fruits and it is a promising approach to get potential tomato yields.Keywords: macro and micronutrients, tomato, SAS package, photosynthates
Procedia PDF Downloads 474253 An Evidence-Based Laboratory Medicine (EBLM) Test to Help Doctors in the Assessment of the Pancreatic Endocrine Function
Authors: Sergio J. Calleja, Adria Roca, José D. Santotoribio
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Pancreatic endocrine diseases include pathologies like insulin resistance (IR), prediabetes, and type 2 diabetes mellitus (DM2). Some of them are highly prevalent in the U.S.—40% of U.S. adults have IR, 38% of U.S. adults have prediabetes, and 12% of U.S. adults have DM2—, as reported by the National Center for Biotechnology Information (NCBI). Building upon this imperative, the objective of the present study was to develop a non-invasive test for the assessment of the patient’s pancreatic endocrine function and to evaluate its accuracy in detecting various pancreatic endocrine diseases, such as IR, prediabetes, and DM2. This approach to a routine blood and urine test is based around serum and urine biomarkers. It is made by the combination of several independent public algorithms, such as the Adult Treatment Panel III (ATP-III), triglycerides and glucose (TyG) index, homeostasis model assessment-insulin resistance (HOMA-IR), HOMA-2, and the quantitative insulin-sensitivity check index (QUICKI). Additionally, it incorporates essential measurements such as the creatinine clearance, estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (ACR), and urinalysis, which are helpful to achieve a full image of the patient’s pancreatic endocrine disease. To evaluate the estimated accuracy of this test, an iterative process was performed by a machine learning (ML) algorithm, with a training set of 9,391 patients. The sensitivity achieved was 97.98% and the specificity was 99.13%. Consequently, the area under the receiver operating characteristic (AUROC) curve, the positive predictive value (PPV), and the negative predictive value (NPV) were 92.48%, 99.12%, and 98.00%, respectively. The algorithm was validated with a randomized controlled trial (RCT) with a target sample size (n) of 314 patients. However, 50 patients were initially excluded from the study, because they had ongoing clinically diagnosed pathologies, symptoms or signs, so the n dropped to 264 patients. Then, 110 patients were excluded because they didn’t show up at the clinical facility for any of the follow-up visits—this is a critical point to improve for the upcoming RCT, since the cost of each patient is very high and for this RCT almost a third of the patients already tested were lost—, so the new n consisted of 154 patients. After that, 2 patients were excluded, because some of their laboratory parameters and/or clinical information were wrong or incorrect. Thus, a final n of 152 patients was achieved. In this validation set, the results obtained were: 100.00% sensitivity, 100.00% specificity, 100.00% AUROC, 100.00% PPV, and 100.00% NPV. These results suggest that this approach to a routine blood and urine test holds promise in providing timely and accurate diagnoses of pancreatic endocrine diseases, particularly among individuals aged 40 and above. Given the current epidemiological state of these type of diseases, these findings underscore the significance of early detection. Furthermore, they advocate for further exploration, prompting the intention to conduct a clinical trial involving 26,000 participants (from March 2025 to December 2026).Keywords: algorithm, diabetes, laboratory medicine, non-invasive
Procedia PDF Downloads 32252 New Media and the Personal Vote in General Elections: A Comparison of Constituency Level Candidates in the United Kingdom and Japan
Authors: Sean Vincent
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Within the academic community, there is a consensus that political parties in established liberal democracies are facing a myriad of organisational challenges as a result of falling membership, weakening links to grass-roots support and rising voter apathy. During the same period of party decline and growing public disengagement political parties have become increasingly professionalised. The professionalisation of political parties owes much to changes in technology, with television becoming the dominant medium for political communication. In recent years, however, it has become clear that a new medium of communication is becoming utilised by political parties and candidates – New Media. New Media, a term hard to define but related to internet based communication, offers a potential revolution in political communication. It can be utilised by anyone with access to the internet and its most widely used platforms of communication such as Facebook and Twitter, are free to use. The advent of Web 2.0 has dramatically changed what can be done with the Internet. Websites now allow candidates at the constituency level to fundraise, organise and set out personalised policies. Social media allows them to communicate with supporters and potential voters practically cost-free. As such candidate dependency on the national party for resources and image now lies open to debate. Arguing that greater candidate independence may be a natural next step in light of the contemporary challenges faced by parties, this paper examines how New Media is being used by candidates at the constituency level to increase their personal vote. The paper will present findings from research carried out during two elections – the Japanese Lower House election of 2014 and the UK general election of 2015. During these elections a sample of candidates, totalling 150 candidates, from the three biggest parties in each country were selected and their new media output, specifically candidate websites, Twitter and Facebook output subjected to content analysis. The analysis examines how candidates are using new media to both become more functionally, through fundraising and volunteer mobilisation and politically, through the promotion of personal/local policies, independent from the national party. In order to validate the results of content analysis this paper will also present evidence from interviews carried out with 17 candidates that stood in the 2014 Japanese Lower House election or 2015 UK general election. With a combination of statistical analysis and interviews, several conclusions can be made about the use of New Media at constituency level. The findings show not just a clear difference in the way candidates from each country are using New Media but also differences within countries based upon the particular circumstances of each constituency. While it has not yet replaced traditional methods of fundraising and activist mobilisation, New Media is also becoming increasingly important in campaign organisation and the general consensus amongst candidates is that its importance will continue to grow along as politics in both countries becomes more diffuse.Keywords: political campaigns, elections, new media, political communication
Procedia PDF Downloads 225251 Effect of the Polymer Modification on the Cytocompatibility of Human and Rat Cells
Authors: N. Slepickova Kasalkova, P. Slepicka, L. Bacakova, V. Svorcik
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Tissue engineering includes combination of materials and techniques used for the improvement, repair or replacement of the tissue. Scaffolds, permanent or temporally material, are used as support for the creation of the "new cell structures". For this important component (scaffold), a variety of materials can be used. The advantage of some polymeric materials is their cytocompatibility and possibility of biodegradation. Poly(L-lactic acid) (PLLA) is a biodegradable, semi-crystalline thermoplastic polymer. PLLA can be fully degraded into H2O and CO2. In this experiment, the effect of the surface modification of biodegradable polymer (performed by plasma treatment) on the various cell types was studied. The surface parameters and changes of the physicochemical properties of modified PLLA substrates were studied by different methods. Surface wettability was determined by goniometry, surface morphology and roughness study were performed with atomic force microscopy and chemical composition was determined using photoelectron spectroscopy. The physicochemical properties were studied in relation to cytocompatibility of human osteoblast (MG 63 cells), rat vascular smooth muscle cells (VSMC), and human stem cells (ASC) of the adipose tissue in vitro. A fluorescence microscopy was chosen to study and compare cell-material interaction. Important parameters of the cytocompatibility like adhesion, proliferation, viability, shape, spreading of the cells were evaluated. It was found that the modification leads to the change of the surface wettability depending on the time of modification. Short time of exposition (10-120 s) can reduce the wettability of the aged samples, exposition longer than 150 s causes to increase of contact angle of the aged PLLA. The surface morphology is significantly influenced by duration of modification, too. The plasma treatment involves the formation of the crystallites, whose number increases with increasing time of modification. On the basis of physicochemical properties evaluation, the cells were cultivated on the selected samples. Cell-material interactions are strongly affected by material chemical structure and surface morphology. It was proved that the plasma treatment of PLLA has a positive effect on the adhesion, spreading, homogeneity of distribution and viability of all cultivated cells. This effect was even more apparent for the VSMCs and ASCs which homogeneously covered almost the whole surface of the substrate after 7 days of cultivation. The viability of these cells was high (more than 98% for VSMCs, 89-96% for ASCs). This experiment is one part of the basic research, which aims to easily create scaffolds for tissue engineering with subsequent use of stem cells and their subsequent "reorientation" towards the bone cells or smooth muscle cells.Keywords: poly(L-lactic acid), plasma treatment, surface characterization, cytocompatibility, human osteoblast, rat vascular smooth muscle cells, human stem cells
Procedia PDF Downloads 227250 The Role of Intraluminal Endoscopy in the Diagnosis and Treatment of Fluid Collections in Patients With Acute Pancreatitis
Authors: A. Askerov, Y. Teterin, P. Yartcev, S. Novikov
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Introduction: Acute pancreatitis (AP) is a socially significant problem for public health and continues to be one of the most common causes of hospitalization of patients with pathology of the gastrointestinal tract. It is characterized by high mortality rates, which reaches 62-65% in infected pancreatic necrosis. Aims & Methods: The study group included 63 patients who underwent transluminal drainage (TLD) fluid collection (FC). All patients were performed transabdominal ultrasound, computer tomography of the abdominal cavity and retroperitoneal organs and endoscopic ultrasound (EUS) of the pancreatobiliary zone. The EUS was used as a final diagnostic method to determine the characteristics of FC. The indications for TLD were: the distance between the wall of the hollow organ and the FC was not more than 1 cm, the absence of large vessels on the puncture trajectory (more than 3 mm), and the size of the formation was more than 5 cm. When a homogeneous cavity with clear, even contours was detected, a plastic stent with rounded ends (“double pig tail”) was installed. The indication for the installation of a fully covered self-expanding stent was the detection of nonhomogeneous anechoic FC with hyperechoic inclusions and cloudy purulent contents. In patients with necrotic forms after drainage of the purulent cavity, a cystonasal drainage with a diameter of 7Fr was installed in its lumen under X-ray control to sanitize the cavity with a 0.05% aqueous solution of chlorhexidine. Endoscopic necrectomy was performed every 24-48 hours. The plastic stent was removed in 6 month, the fully covered self-expanding stent - in 1 month after the patient was discharged from the hospital. Results: Endoscopic TLD was performed in 63 patients. The FC corresponding to interstitial edematous pancreatitis was detected in 39 (62%) patients who underwent TLD with the installation of a plastic stent with rounded ends. In 24 (38%) patients with necrotic forms of FC, a fully covered self-expanding stent was placed. Communication with the ductal system of the pancreas was found in 5 (7.9%) patients. They underwent pancreaticoduodenal stenting. A complicated postoperative period was noted in 4 (6.3%) cases and was manifested by bleeding from the zone of pancreatogenic destruction. In 2 (3.1%) cases, this required angiography and endovascular embolization a. gastroduodenalis, in 1 (1.6%) case, endoscopic hemostasis was performed by filling the cavity with 4 ml of Hemoblock hemostatic solution. The combination of both methods was used in 1 (1.6%) patient. There was no evidence of recurrent bleeding in these patients. Lethal outcome occurred in 4 patients (6.3%). In 3 (4.7%) patients, the cause of death was multiple organ failure, in 1 (1.6%) - severe nosocomial pneumonia that developed on the 32nd day after drainage. Conclusions: 1. EUS is not only the most important method for diagnosing FC in AP, but also allows you to determine further tactics for their intraluminal drainage.2. Endoscopic intraluminal drainage of fluid zones in 45.8% of cases is the final minimally invasive method of surgical treatment of large-focal pancreatic necrosis. Disclosure: Nothing to disclose.Keywords: acute pancreatitis, fluid collection, endoscopy surgery, necrectomy, transluminal drainage
Procedia PDF Downloads 109249 Theorizing Optimal Use of Numbers and Anecdotes: The Science of Storytelling in Newsrooms
Authors: Hai L. Tran
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When covering events and issues, the news media often employ both personal accounts as well as facts and figures. However, the process of using numbers and narratives in the newsroom is mostly operated through trial and error. There is a demonstrated need for the news industry to better understand the specific effects of storytelling and data-driven reporting on the audience as well as explanatory factors driving such effects. In the academic world, anecdotal evidence and statistical evidence have been studied in a mutually exclusive manner. Existing research tends to treat pertinent effects as though the use of one form precludes the other and as if a tradeoff is required. Meanwhile, narratives and statistical facts are often combined in various communication contexts, especially in news presentations. There is value in reconceptualizing and theorizing about both relative and collective impacts of numbers and narratives as well as the mechanism underlying such effects. The current undertaking seeks to link theory to practice by providing a complete picture of how and why people are influenced by information conveyed through quantitative and qualitative accounts. Specifically, the cognitive-experiential theory is invoked to argue that humans employ two distinct systems to process information. The rational system requires the processing of logical evidence effortful analytical cognitions, which are affect-free. Meanwhile, the experiential system is intuitive, rapid, automatic, and holistic, thereby demanding minimum cognitive resources and relating to the experience of affect. In certain situations, one system might dominate the other, but rational and experiential modes of processing operations in parallel and at the same time. As such, anecdotes and quantified facts impact audience response differently and a combination of data and narratives is more effective than either form of evidence. In addition, the present study identifies several media variables and human factors driving the effects of statistics and anecdotes. An integrative model is proposed to explain how message characteristics (modality, vividness, salience, congruency, position) and individual differences (involvement, numeracy skills, cognitive resources, cultural orientation) impact selective exposure, which in turn activates pertinent modes of processing, and thereby induces corresponding responses. The present study represents a step toward bridging theoretical frameworks from various disciplines to better understand the specific effects and the conditions under which the use of anecdotal evidence and/or statistical evidence enhances or undermines information processing. In addition to theoretical contributions, this research helps inform news professionals about the benefits and pitfalls of incorporating quantitative and qualitative accounts in reporting. It proposes a typology of possible scenarios and appropriate strategies for journalists to use when presenting news with anecdotes and numbers.Keywords: data, narrative, number, anecdote, storytelling, news
Procedia PDF Downloads 78248 Comparison of Sediment Rating Curve and Artificial Neural Network in Simulation of Suspended Sediment Load
Authors: Ahmad Saadiq, Neeraj Sahu
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Sediment, which comprises of solid particles of mineral and organic material are transported by water. In river systems, the amount of sediment transported is controlled by both the transport capacity of the flow and the supply of sediment. The transport of sediment in rivers is important with respect to pollution, channel navigability, reservoir ageing, hydroelectric equipment longevity, fish habitat, river aesthetics and scientific interests. The sediment load transported in a river is a very complex hydrological phenomenon. Hence, sediment transport has attracted the attention of engineers from various aspects, and different methods have been used for its estimation. So, several experimental equations have been submitted by experts. Though the results of these methods have considerable differences with each other and with experimental observations, because the sediment measures have some limits, these equations can be used in estimating sediment load. In this present study, two black box models namely, an SRC (Sediment Rating Curve) and ANN (Artificial Neural Network) are used in the simulation of the suspended sediment load. The study is carried out for Seonath subbasin. Seonath is the biggest tributary of Mahanadi river, and it carries a vast amount of sediment. The data is collected for Jondhra hydrological observation station from India-WRIS (Water Resources Information System) and IMD (Indian Meteorological Department). These data include the discharge, sediment concentration and rainfall for 10 years. In this study, sediment load is estimated from the input parameters (discharge, rainfall, and past sediment) in various combination of simulations. A sediment rating curve used the water discharge to estimate the sediment concentration. This estimated sediment concentration is converted to sediment load. Likewise, for the application of these data in ANN, they are normalised first and then fed in various combinations to yield the sediment load. RMSE (root mean square error) and R² (coefficient of determination) between the observed load and the estimated load are used as evaluating criteria. For an ideal model, RMSE is zero and R² is 1. However, as the models used in this study are black box models, they don’t carry the exact representation of the factors which causes sedimentation. Hence, a model which gives the lowest RMSE and highest R² is the best model in this study. The lowest values of RMSE (based on normalised data) for sediment rating curve, feed forward back propagation, cascade forward back propagation and neural network fitting are 0.043425, 0.00679781, 0.0050089 and 0.0043727 respectively. The corresponding values of R² are 0.8258, 0.9941, 0.9968 and 0.9976. This implies that a neural network fitting model is superior to the other models used in this study. However, a drawback of neural network fitting is that it produces few negative estimates, which is not at all tolerable in the field of estimation of sediment load, and hence this model can’t be crowned as the best model among others, based on this study. A cascade forward back propagation produces results much closer to a neural network model and hence this model is the best model based on the present study.Keywords: artificial neural network, Root mean squared error, sediment, sediment rating curve
Procedia PDF Downloads 323247 Methodology for Risk Assessment of Nitrosamine Drug Substance Related Impurities in Glipizide Antidiabetic Formulations
Authors: Ravisinh Solanki, Ravi Patel, Chhaganbhai Patel
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Purpose: The purpose of this study is to develop a methodology for the risk assessment and evaluation of nitrosamine impurities in Glipizide antidiabetic formulations. Nitroso compounds, including nitrosamines, have emerged as significant concerns in drug products, as highlighted by the ICH M7 guidelines. This study aims to identify known and potential sources of nitrosamine impurities that may contaminate Glipizide formulations and assess their presence. By determining observed or predicted levels of these impurities and comparing them with regulatory guidance, this research will contribute to ensuring the safety and quality of combination antidiabetic drug products on the market. Factors contributing to the presence of genotoxic nitrosamine contaminants in glipizide medications, such as secondary and tertiary amines, and nitroso group-complex forming molecules, will be investigated. Additionally, conditions necessary for nitrosamine formation, including the presence of nitrosating agents, and acidic environments, will be examined to enhance understanding and mitigation strategies. Method: The methodology for the study involves the implementation of the N-Nitroso Acid Precursor (NAP) test, as recommended by the WHO in 1978 and detailed in the 1980 International Agency for Research on Cancer monograph. Individual glass vials containing equivalent to 10mM quantities of Glipizide is prepared. These compounds are dissolved in an acidic environment and supplemented with 40 mM NaNO2. The resulting solutions are maintained at a temperature of 37°C for a duration of 4 hours. For the analysis of the samples, an HPLC method is employed for fit-for-purpose separation. LC resolution is achieved using a step gradient on an Agilent Eclipse Plus C18 column (4.6 X 100 mm, 3.5µ). Mobile phases A and B consist of 0.1% v/v formic acid in water and acetonitrile, respectively, following a gradient mode program. The flow rate is set at 0.6 mL/min, and the column compartment temperature is maintained at 35°C. Detection is performed using a PDA detector within the wavelength range of 190-400 nm. To determine the exact mass of formed nitrosamine drug substance related impurities (NDSRIs), the HPLC method is transferred to LC-TQ-MS/MS with the same mobile phase composition and gradient program. The injection volume is set at 5 µL, and MS analysis is conducted in Electrospray Ionization (ESI) mode within the mass range of 100−1000 Daltons. Results: The samples of NAP test were prepared according to the protocol. The samples were analyzed using HPLC and LC-TQ-MS/MS identify possible NDSRIs generated in different formulations of glipizide. It was found that the NAP test generated a various NDSRIs. The new finding, which has not been reported yet, discovered contamination of Glipizide. These NDSRIs are categorised based on the predicted carcinogenic potency and recommended its acceptable intact in medicines. The analytical method was found specific and reproducible.Keywords: NDSRI, nitrosamine impurities, antidiabetic, glipizide, LC-MS/MS
Procedia PDF Downloads 27246 Food Sovereignty as Local Resistance to Unequal Access to Food and Natural Resources in Latin America: A Gender Perspective
Authors: Ana Alvarenga De Castro
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Food sovereignty has been brought by the international peasants’ movement, La Via Campesina, as a precondition to food security, speaking about the right of each nation to keep its own supply of foods respecting cultural, sustainable practices and productive diversity. The political conceptualization nowadays goes beyond saying that this term is about achieving the rights of farmers to control the food systems according to local specificities, and about equality in the access to natural resources and quality food. The current feminization of agroecosystems and of food insecurity identified by researchers and recognized by international agencies like the UN and FAO has enhanced the feminist discourse into the food sovereignty movement, considering the historical inequalities that place women farmers in subaltern positions inside the families and rural communities. The current tendency in many rural areas of more women taking responsibility for food production and still facing the lack of access to natural resources meets particular aspects in Latin America due to the global economic logic which places the Global South in the position of raw material supplier for the industrialized North, combined with regional characteristics. In this context, Latin American countries play the role of commodities exporters in the international labor division, including among exported items grains, soybean paste, and ores, to the expense of local food chains which provide domestic quality food supply under more sustainable practices. The connections between gender inequalities and global territorial inequalities related to the access and control of food and natural resources are pointed out by feminist political ecology - FPE - authors, and are linked in this article to the potentialities and limitations of women farmers to reproduce diversified agroecosystems in the tropical environments. The work brings the importance of local practices held by women farmers which are crucial to maintaining sustainable agricultural systems and their results on seeds, soil, biodiversity and water conservation. This work presents an analysis of documents, releases, videos and other publicized experiences launched by some peasants’ organizations in Latin America which evidence the different technical and political answers that meet food sovereignty from peasants’ groups that are attributed to women farmers. They are associated with articles presenting the empirical analysis of women farmers' practices in Latin America. The combination drove to discuss the benefits of peasants' conceptions about food systems and their connections with local realities and the gender issues linked to the food sovereignty conceptualization. Conclusion meets that reality on the field cannot reach food sovereignty's ideal homogeneously and that agricultural sustainable practices are dependent on rights' achievement and social inequalities' eradication.Keywords: food sovereignty, gender, diversified agricultural systems, access to natural resources
Procedia PDF Downloads 245245 Fear of Falling and Subjective Cognitive Decline Are Predictors of Fall Risk in Community-dwelling Older Adults Living in Low-income Settings
Authors: Ladda Thiamwong, Renata Komalasari
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Falls are the leading cause of disability and hospitalization in low-income older adults. Fear of falling is present in 20% to 85 % of older adults and has been identified as an independent risk factor of fall risk, activity restriction, and loss of independence. About 12% of American older adults have subjective cognitive decline. Cognitive impairment is also an established factor of fall risk. However, it is unclear whether measures of fear of falling and subjective cognitive decline have the greatest association with fall risk in low-income older adults. The aim of this study was to evaluate the association between fear of falling, subjective cognitive decline-functional performance (SCD-FP), and fall risk using simple screening tools. In this cross-section study, we collected data from community-dwelling older adults 60 years or older in low-income settings in Central Florida, and 86 participants were included in the data analysis. Fear of falling was assessed by the Short Fall Efficacy Scale- International (Short FES-I) with seven items. Subjective cognitive decline-functional performance (SCD-FP) was assessed by a self-reported experience of worsening or more frequent confusion or memory loss in the past 12 months and its functional implications. Fall risk was evaluated by the Centers for Disease Control and Prevention (CDC)'s Stay Independent checklist with 12 items. The majority of participants were female, and more than half of the participants were African American. More than half of the participants had a higher school degree or higher, and less than 20% had no financial problems. Less than 30% of the participants perceived their general health as very good- excellent. More than half of the participants lived alone, and less than 15% lived with a partner or spouse. About 60% of the participants had hypertension, 40% had diabetes, 16% had cancer, and 50% had arthritis. About 30% of the participants had difficulty walking up ten steps without resting, more than 40% felt unsteady when walking, and 30% had been advised to use a cane or walker to get around safely. Regression analysis showed that fall risk was associated with fear of falling ( = .524, p <.001) and subjective cognitive decline-functional performance ( = .465, p =.027). The structure coefficient showed that fear of falling (rs2 = .922) was a stronger predictor of fall risk than subjective cognitive decline-functional performance (rs2= .200). Fear of falling and subjective cognitive decline-functional performance are growing public health issues, and addressing those issues is a public priority. Proactive screening for fear of falling and subjective cognitive decline-functional performance is critical in fall prevention. A combination of all three self-reported tools (Short FES-I, SCD-FP, and CDC's Stay Independent checklist) takes less than 5 minutes to complete. Primary care providers or public health professionals should consider including these tools to screen fear of falling and subjective cognitive decline-functional performance as part of fall risk assessment, especially in low-income settings. Thus, encouraging older adults and healthcare professionals to discuss fear of falling, subjective cognitive decline, and fall risk during routine medical office visits.Keywords: falls, fall risk, fear of falling, cognition, subjective cognitive decline, low-income, older adults, community, screening, nursing, primary care
Procedia PDF Downloads 72244 Combined Pneumomediastinum and Pneumothorax Due to Hyperemesis Gravidarum
Authors: Fayez Hanna, Viet Tran
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A 20 years old lady- primigravida 6 weeks pregnant with unremarkable past history, presented to the emergency department at the Royal Hobart Hospital, Tasmania, Australia, with hyperemesis gravidarum associated with, dehydration and complicated with hematemesis and chest pain resistant. Accordingly, we conducted laboratory investigations which revealed: FBC: WBC 23.9, unremarkable U&E, LFT, lipase and her VBG showed a pH 7.4, pCo2 36.7, cK+ 3.2, cNa+ 142. The decision was made to do a chest X-ray (CXR) after explaining the risks/benefit of performing radiographic investigations during pregnancy and considering the patient's plan for the termination of the pregnancy as she was not ready for motherhood for shared decision-making and consent to look for pneumoperitoneum to suggest perforated viscus that might cause the hematemesis. However, the CXR showed pneumomediastinum but no evidence of pneumoperitoneum or pneumothorax. Consequently, a decision was made to proceed with CT oesophagography with imaging pre and post oral contrast administration to identify a potential oesophageal tear since it could not be excluded using a plain film of the CXR. The CT oesophagography could not find a leak for the administered oral contrast and thus, no oesophageal tear could be confirmed but could not exclude the Mallory-Weiss tear (lower oesophageal tear). Further, the CT oesophagography showed an extensive pneumomediastinum that could not be confirmed to be pulmonary in origin noting the presence of bilateral pulmonary interstitial emphysema and pneumothorax in the apex of the right lung that was small. The patient was admitted to the Emergency Department Inpatient Unit for monitoring, supportive therapy, and symptomatic management. Her hyperemesis was well controlled with ondansetron 8mg IV, metoclopramide 10mg IV, doxylamine 25mg PO, pyridoxine 25mg PO, esomeprazole 40mg IV and oxycodone 5mg PO was given for pain control and 2 litter of IV fluid. The patient was stabilized after 24 hours and discharged home on ondansetron 8mg every 8 hours whereas the patient had a plan for medical termination of pregnancy. Three weeks later, the patient represented with nausea and vomiting complicated by a frank hematemesis. Her observation chart showed HR 117- other vital signs were normal. Pathology showed WBC 14.3 with normal U&E and Hb. The patient was managed in the Emergency Department with the same previous regimen and was discharged home on same previous regimes. Five days later, she presented again with nausea, vomiting and hematemesis and was admitted under obstetrics and gynaecology for stabilization then discharged home with a plan for surgical termination of pregnancy after 3-days rather than the previously planned medical termination of pregnancy to avoid extension of potential oesophageal tear. The surgical termination and follow up period were uneventful. The case is considered rare as pneumomediastinum is a very rare complication of hyperemesis gravidarum where vomiting-induced barotrauma leads to a ruptured oesophagus and air leak into the mediastinum. However no rupture oesophagus in our case. Although the combination of pneumothorax and pneumomediastinum without oesophageal tear was reported only 8 times in the literature, but none of them was due to hyperemesis gravidarum.Keywords: Pneumothorax, pneumomediastinum, hyperemesis gravidarum, pneumopericardium
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