Search results for: natural and anthropogenic safety
Commenced in January 2007
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Edition: International
Paper Count: 9124

Search results for: natural and anthropogenic safety

6184 Assessment and Evaluation Resilience of Urban Neighborhoods in Coping with Natural Disasters in in the Metropolis of Tabriz (Case Study: Region 6 of Tabriz)

Authors: Ali panahi-Kosar Khosravi

Abstract:

Earthquake resilience is one of the most important theoretical and practical concepts in crisis management. Over the past few decades, the rapid growth of urban areas and developing lower urban areas (especially in developing countries) have made them more vulnerable to human and natural crises. Therefore, the resilience of urban communities, especially low-income and unhealthy neighborhoods, is of particular importance. The present study seeks to assess and evaluate the resilience of neighborhoods in the center of district 6 of Tabriz in terms of awareness, knowledge and personal skills, social and psychological capital, managerial-institutional, and the ability to return to appropriate and sustainable conditions. The research method in this research is descriptive-analytical. The authors used library and survey methods to collect information and a questionnaire to assess resilience. The statistical population of this study is the total households living in the four neighborhoods of Shanb Ghazan, Khatib, Gharamalek, and Abuzar alley. Three hundred eighty-four families from four neighborhoods were selected based on the Cochran formula using a simple random sampling method. A one-sample t-test, simple linear regression, and structural equations were used to test the research hypotheses. Findings showed that only two social and psychological awareness and capital indicators in district 6 of Tabriz had a favorable and approved status. Therefore, considering the multidimensional concept of resilience, district 6 of Tabriz is in an unfavorable resilience situation. Also, the findings based on the analysis of variance indicated no significant difference between the neighborhoods of district 6 in terms of resilience, and most neighborhoods are in an unfavorable situation.

Keywords: resilience, statistical analysis, earthquake, district 6 of tabriz

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6183 Development of Generally Applicable Intravenous to Oral Antibiotic Switch Therapy Criteria

Authors: H. Akhloufi, M. Hulscher, J. M. Prins, I. H. Van Der Sijs, D. Melles, A. Verbon

Abstract:

Background: A timely switch from intravenous to oral antibiotic therapy has many advantages, such as reduced incidence of IV-line related infections, a decreased hospital length of stay and less workload for healthcare professionals with equivalent patient safety. Additionally, numerous studies have demonstrated significant decreases in costs of a timely intravenous to oral antibiotic therapy switch, while maintaining efficacy and safety. However, a considerable variation in iv to oral antibiotic switch therapy criteria has been described in literature. Here, we report the development of a set of iv to oral switch criteria that are generally applicable in all hospitals. Material/methods: A RAND-modified Delphi procedure, which was composed of 3 rounds, was used. This Delphi procedure is a widely used structured process to develop consensus using multiple rounds of questionnaires within a qualified panel of selected experts. The international expert panel was multidisciplinary and composed out of clinical microbiologists, infectious disease consultants and clinical pharmacists. This panel of 19 experts appraised 6 major intravenous to oral antibiotic switch therapy criteria and operationalized these criteria using 41 measurable conditions extracted from the literature. The procedure to select a concise set of iv to oral switch criteria included 2 questionnaire rounds and a face-to-face meeting. Results: The procedure resulted in the selection of 16 measurable conditions, which operationalize 6 major intravenous to oral antibiotic switch therapy criteria. The following 6 major switch therapy criteria were selected: (1) Vital signs should be good or improving when bad. (2) Signs and symptoms related to the infection have to be resolved or improved. (3) The gastrointestinal tract has to be intact and functioning. (4) The oral route should not be compromised. (5) Absence of contra-indicated infections. (6) An oral variant of the antibiotic with good bioavailability has to exist. Conclusions: This systematic stepwise method which combined evidence and expert opinion resulted in a feasible set of 6 major intravenous to oral antibiotic switch therapy criteria operationalized by 16 measurable conditions. This set of early antibiotic iv to oral switch criteria can be used in daily practice in all adult hospital patients. Future use in audits and as rules in computer assisted decision support systems will lead to improvement of antimicrobial steward ship programs.

Keywords: antibiotic resistance, antibiotic stewardship, intravenous to oral, switch therapy

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6182 Effects of Watershed Erosion on Stream Channel Formation

Authors: Tiao Chang, Ivan Caballero, Hong Zhou

Abstract:

Streams carry water and sediment naturally by maintaining channel dimensions, pattern, and profile over time. Watershed erosion as a natural process has occurred to contribute sediment to streams over time. The formation of channel dimensions is complex. This study is to relate quantifiable and consistent channel dimensions at the bankfull stage to the corresponding watershed erosion estimation by the Revised Universal Soil Loss Equation (RUSLE). Twelve sites of which drainage areas range from 7 to 100 square miles in the Hocking River Basin of Ohio were selected for the bankfull geometry determinations including width, depth, cross-section area, bed slope, and drainage area. The twelve sub-watersheds were chosen to obtain a good overall representation of the Hocking River Basin. It is of interest to determine how these bankfull channel dimensions are related to the soil erosion of corresponding sub-watersheds. Soil erosion is a natural process that has occurred in a watershed over time. The RUSLE was applied to estimate erosions of the twelve selected sub-watersheds where the bankfull geometry measurements were conducted. These quantified erosions of sub-watersheds are used to investigate correlations with bankfull channel dimensions including discharge, channel width, channel depth, cross-sectional area, and pebble distribution. It is found that drainage area, bankfull discharge and cross-sectional area correlates strongly with watershed erosion well. Furthermore, bankfull width and depth are moderately correlated with watershed erosion while the particle size, D50, of channel bed sediment is not well correlated with watershed erosion.

Keywords: watershed, stream, sediment, channel

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6181 Using HABIT to Establish the Chemicals Analysis Methodology for Maanshan Nuclear Power Plant

Authors: J. R. Wang, S. W. Chen, Y. Chiang, W. S. Hsu, J. H. Yang, Y. S. Tseng, C. Shih

Abstract:

In this research, the HABIT analysis methodology was established for Maanshan nuclear power plant (NPP). The Final Safety Analysis Report (FSAR), reports, and other data were used in this study. To evaluate the control room habitability under the CO2 storage burst, the HABIT methodology was used to perform this analysis. The HABIT result was below the R.G. 1.78 failure criteria. This indicates that Maanshan NPP habitability can be maintained. Additionally, the sensitivity study of the parameters (wind speed, atmospheric stability classification, air temperature, and control room intake flow rate) was also performed in this research.

Keywords: PWR, HABIT, Habitability, Maanshan

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6180 Using HABIT to Estimate the Concentration of CO2 and H2SO4 for Kuosheng Nuclear Power Plant

Authors: Y. Chiang, W. Y. Li, J. R. Wang, S. W. Chen, W. S. Hsu, J. H. Yang, Y. S. Tseng, C. Shih

Abstract:

In this research, the HABIT code was used to estimate the concentration under the CO2 and H2SO4 storage burst conditions for Kuosheng nuclear power plant (NPP). The Final Safety Analysis Report (FSAR) and reports were used in this research. In addition, to evaluate the control room habitability for these cases, the HABIT analysis results were compared with the R.G. 1.78 failure criteria. The comparison results show that the HABIT results are below the criteria. Additionally, some sensitivity studies (stability classification, wind speed and control room intake rate) were performed in this study.

Keywords: BWR, HABIT, habitability, Kuosheng

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6179 Study on Accumulation of Heavy Metals in Sweet Potato, Grown in Industrially Polluted Regions

Authors: Violina Angelova, Galina Pevicharova

Abstract:

A comparative research had been carried out to allow us to determine the quantities and the centers of accumulation of Pb, Cu, Zn and Cd in the vegetative and reproductive organs of the sweet potatoes and to ascertain the possibilities for growing them on soils, polluted with heavy metals. The experiments were performed on agricultural fields contaminated by the (1) Non-Ferrous-Metal Works near Plovdiv, (2) Lead and Zinc Complex near Kardjali and (3) a copper smelter near Pirdop, Bulgaria. The soils used in this experiment were characterized by acid, neutral and slightly alkaline reaction, loamy texture and a moderate content of organic matter. The total content of Zn, Pb, and Cd was high and exceeded the limit value in agriculture soils. Sweet potatoes were in a 2-year rotation scheme on three blocks in the experimental field. On reaching commercial ripeness the sweet potatoes were gathered and the contents of heavy metals in their different parts – root, tuber (peel and core), leaves and stems, were determined after microwave mineralization. The quantitative measurements were carried out with inductively coupled plasma atomic emission spectroscopy. The contamination of the sweet potatoes was due mainly to the presence of heavy metals in the soil, which entered the plants through their root system, as well as by diffusion through the peel. Pb, Cu, Zn, and Cd were selectively accumulated in the underground parts of the sweet potatoes, and most of all in the root system and the peel. Heavy metals have an impact on the development and productivity of the sweet potatoes. The high anthropogenic contamination leads to an increased assimilation of heavy metals which reduces the yield and the quality of the production of sweet potatoes, as well as leads to decrease of the absolute dry substance and the quantity of sugars in sweet potatoes. Sweet potatoes could be grown on soils, which are light to medium polluted with lead, zinc, and cadmium, as they do not accumulate these elements. On heavily polluted soils, however, (Pb – 1504 mg/kg, Zn – 3322 mg/kg, Cd – 47 mg/kg) the growing of sweet potatoes is not allowed, as the accumulation of Pb and Cd in the core of the potatoes exceeds the Maximum Acceptable Concentration. Acknowledgment: The authors gratefully acknowledge the financial support by the Bulgarian National Science Fund (Project DFNI DH04/9).

Keywords: heavy metals, polluted soils, sweet potatoes, uptake

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6178 Assessment of Water Quality of Euphrates River at Babylon Governorate, for Drinking, Irrigation and general, Using Water Quality Index (Canadian Version) (CCMEWQI)

Authors: Amer Obaid Saud

Abstract:

Water quality index (WQI) is considered as an effective tool in categorization of water resources for its quality and suitability for different uses. The Canadian version of water quality index (CCME WQI) which based on the comparison of the water quality parameters to regulatory standards and give a single value to the water quality of a source was applied in this study to assess the water quality of Euphrates river in Iraq at Babylon Governorate north of Baghdad and determine its suitability for aquatic environment (GWQI), drinking water (PWSI) and irrigation(IWQI). Five stations were selected on the river in Babylon (Euphrates River/AL-Musiab, Hindia barrage, two stations at Hilla city and the fifth station at Al-Hshmeya north of Hilla. Fifteen water samples were collected every month during August 2013 to July 2014 at the study sites and analyzed for the physico-chemical parameters like (Temperature, pH, Electrical Conductivity, Total Dissolved Solids(TDS), Total Suspended Solids(TSS), Total Alkalinity, Total Hardness, Calcium and Magnesium Concentration, some of nutrient like Nitrite, Nitrate, Phosphate also the study of concentration of some heavy metals (Fe, Pb, Zn, Cu, Mn, and Cd) in water and comparison of measures to benchmarks such as guidelines and objectives to assess change in water quality. The result of Canadian version of(CCME .WQI) to assess the irrigation water quality (IWQI) of Euphrates river was (83-good) at site one during second seasonal period while the lowest was (66-Fair) in the second station during the fourth seasonal period, the values of potable water supply index (PWSI)that the highest value was (68-Fair) in the fifth site during the second period while the lowest value (42 -Poor) in the second site during the first seasonal period,the highest value for general water quality (GWQI) was (74-Fair) in site five during the second seasonal period, the lowest value (48-Marginal) in the second site during the first seasonal period. It was observed that the main cause of deterioration in water quality was due to the lack of, unprotected river sites ,high anthropogenic activities and direct discharge of industrial effluent.

Keywords: Babylon governorate, Canadian version, water quality, Euphrates river

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6177 A Natural Method for Reducing Pain in Female Patients

Authors: Seyed Ali Hossein Zahraei, Iman Dianat

Abstract:

The role of midwives and healthcare providers in applying pain relief methods to female patients is very important. different therapies like hydropathy, flavorer remedies, and respiratory techniques for pain relief do not work properly as what we expected. Lack of recognition of the physiological property of birth, despite findings that coming will attenuate the consequences of hurting, suggests the necessity for bigger awareness among expectant oldsters, educators, and health professionals of the potential of coming as a way of pain relief. Method: In our method we have 5 steps to achieve activation of oxytocin and dopamine pathways in order to reduce pain in all possible fields and reasons instead of using other treatments such as chemical painkillers. Step 1: First of all the patient should start by rubbing the clitoris up and down till occurring first clitoral orgasm. Step 2: Without stop rubing clitoris the patient must continue stimulate the clitoris in different way like circular motion in clock pathway until occurring second clitoral orgasm. Step 3: Immedietly the patient can change the position from clitoris to urethral opening where vestibular glands located. In this step the patient nock the urethral area very slowly without pressure and just like touching the area till feeling want to pee. But because of activation of sympathic nerves the gi tract is inactive. Step 4: In this step the patient should apply more pressure and change the motion to circular on urethral area in which the pee sensation increase but actually it is vestibular gland fluid. The patient should release it in small amount in this step. Step 5: The last step is combination of clitoral and urethral stimulation in up and down motion that cause more pee feeling and after clitoral orgasm occurred the amount of released fluid can be about 400ml.

Keywords: female, natural, method, pain

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6176 Technologies of Isolation and Separation of Anthraquinone Derivatives

Authors: Dmitry Yu. Korulkin, Raissa A. Muzychkina

Abstract:

In review the generalized data about different methods of extraction, separation and purification of natural and modify anthraquinones is presented. The basic regularity of an isolation process is analyzed. Action of temperature, pH, and polarity of extragent, catalysts and other factors on an isolation process is revealed.

Keywords: anthraquinones; isolation; extraction; polarity; chromatography; precipitation; bioactivity; phytopreparation; chrysophanol; aloe-emodin; emodin; physcion.

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6175 Investigation of the Heavy Metal Pollution of the River Ecosystems in the Lake Sevan Basin, Armenia

Authors: G. Gevorgyan, S. Khudaverdyan, A. Vaseashta

Abstract:

The Lake Sevan basin is situated in the eastern part of the Republic of Armenia (Gegharquniq marz/district). The heavy metal pollution of the some tributaries of Lake Sevan was investigated. Water sampling was performed in August and December, 2014 from the 4 observation sites: 1) Sotq river upstream (about 600 meters upstream from the Sotq gold mine); 2) Sotq river mouth; 3) Masrik river mouth; 4) Dzknaget river mouth. Heavy metal (V, Fe, Ni, Cu, As, Mo, Pb) concentrations in the water samples were determined by the standard methods using an atomic absorption spectrophotometer. The results of the study showed that heavy metal content mainly increased from the upstream of the Sotq river to the mouth of the Masrik river which may have been conditioned by the influence of gold mining activity as the Masrik and its tributary-Sotq rivers passing through the gold mining area were exposed to heavy metal pollution. The observation sites can be ranked by pollution degree as follows: №3> №2> №1> №4. The highest heavy metal pollution degree was observed in the Masrik river mouth which may have been conditioned by the direct impact of gold mining activity and the pressure of its tributary–the Sotq river which flows through the gold mining area. The lowest heavy metal pollution degree was registered in the Dzknaget river mouth which flowing through rural areas wasn’t subject to significant heavy metal pollution. According to the observation sites of the Sotq and Masrik rivers, high positive correlation was mainly observed between the concentrations of the investigated heavy metals (except nickel) which indicated that all the heavy metals except the nickel had the same anthropogenic pollution source which was the activity of the Sotq gold mine. In general, it is possible to state that the activity of the Sotq gold mine in the Lake Sevan basin caused the heavy metal pollution of the Sotq and Masrik rivers which may have posed environmental hazards. Heavy metals are nondegradable substances, and heavy metal pollution of freshwater systems may pose risks to the environment and human health through accumulation in the tissues of aquatic organisms, water-food chain as well as oral ingestion and dermal contact.

Keywords: Armenia, Lake Sevan basin, gold mining activity, river ecosystems, heavy metal pollution

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6174 An AHP Study on The Migrant and Refugee Employees Occupational Health and Safety Issues in Turkey

Authors: Cengiz Akyildiz, Ismail Ekmekci

Abstract:

In the past 15 years, many people have sought refuge and emigrated to developed countries due to the civil war in Syria, terrorism and turmoil in Iraq, Iran and Afghanistan, hunger problems in Africa and the purpose of work. Many of these people came to Turkey. By the end of the 2019, in Turkey, regular and irregular migrants, asylum seekers and foreigners under international protection are about 6 million people. The majority of these people are Syrians. Approximately 2 800 000 immigrants and refugees are in the workforce. Migrant workers in our country constitute the largest proportion among all countries in the world according to the local labor force. 2.5 million of these employees, with a high rate of about 90%, work informally and do not have legal records and valid employment contracts as a workforce; They cannot benefit from Occupational Health and Safety (OHS) services. Migrant workers generally receive less wages than local workers, working longer hours and worse conditions; they are often subjected to human rights violations, harassment, human trafficking and violence. Migrant workers face problems such as OHS practices, environmental and occupational exposures, language / cultural barriers, access to health services, and lack of documentation. Therefore, the OHS problems of these employees are becoming an increasingly problematic area. However, there is not enough research, analysis and academic studies in this field. The order of importance should be known for the radical solution of the problems, because of the problems with high severity are also at high risk. In this study, for the first time, a Search Conference was held with the participation of 45 stakeholders to reveal the OHS problems of regular and irregular migrant workers in our country. The problems arising from this workshop were compared with the problems in the literature and the problems in this field were determined and weighted for our country. Later, to determine the significance levels of these problems, AHP study, which is a Multi Criteria Decision Making Method in which 15 experts participated, was conducted and the significance levels of these problems were determined. When the data obtained are evaluated, it has been seen that the OSH risks of migrant workers arise from 58% laws and government policies, 29% from employers, 13% from personal faults of employees. An academic study has been carried out for the first time in this field regarding the OHS problems of migrant workers, and an academic study has been created to guide which of the problems should be prioritized.

Keywords: environmental conditions, migrant workers, OHS issues, workplace conditions

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6173 Effects of Using a Recurrent Adverse Drug Reaction Prevention Program on Safe Use of Medicine among Patients Receiving Services at the Accident and Emergency Department of Songkhla Hospital Thailand

Authors: Thippharat Wongsilarat, Parichat tuntilanon, Chonlakan Prataksitorn

Abstract:

Recurrent adverse drug reactions are harmful to patients with mild to fatal illnesses, and affect not only patients but also their relatives, and organizations. To compare safe use of medicine among patients before and after using the recurrent adverse drug reaction prevention program . Quasi-experimental research with the target population of 598 patients with drug allergy history. Data were collected through an observation form tested for its validity by three experts (IOC = 0.87), and analyzed with a descriptive statistic (percentage). The research was conducted jointly with a multidisciplinary team to analyze and determine the weak points and strong points in the recurrent adverse drug reaction prevention system during the past three years, and 546, 329, and 498 incidences, respectively, were found. Of these, 379, 279, and 302 incidences, or 69.4; 84.80; and 60.64 percent of the patients with drug allergy history, respectively, were found to have caused by incomplete warning system. In addition, differences in practice in caring for patients with drug allergy history were found that did not cover all the steps of the patient care process, especially a lack of repeated checking, and a lack of communication between the multidisciplinary team members. Therefore, the recurrent adverse drug reaction prevention program was developed with complete warning points in the information technology system, the repeated checking step, and communication among related multidisciplinary team members starting from the hospital identity card room, patient history recording officers, nurses, physicians who prescribe the drugs, and pharmacists. Including in the system were surveillance, nursing, recording, and linking the data to referring units. There were also training concerning adverse drug reactions by pharmacists, monthly meetings to explain the process to practice personnel, creating safety culture, random checking of practice, motivational encouragement, supervising, controlling, following up, and evaluating the practice. The rate of prescribing drugs to which patients were allergic per 1,000 prescriptions was 0.08, and the incidence rate of recurrent drug reaction per 1,000 prescriptions was 0. Surveillance of recurrent adverse drug reactions covering all service providing points can ensure safe use of medicine for patients.

Keywords: recurrent drug, adverse reaction, safety, use of medicine

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6172 Central Line Stock and Use Audit in Adult Patients: A Quality Improvement Project on Central Venous Catheter Standardisation Across Hospital Departments

Authors: Gregor Moncrieff, Ursula Bahlmann

Abstract:

A number of incident reports were filed from the intensive care unit with regards to adult patients admitted following operations who had a central venous catheter inserted of the incorrect length for the relevant anatomical site and catheters not compatible with pressurised injection inserted whilst in theatre. Incorrect catheter length can lead to a variety of complications and pressurised injection is a requirement for contrast enhanced computerised tomography scans. This led to several patients having a repeat procedure to insert a catheter of the correct length and also compatible with pressurised injection. This project aimed to identify the types of central venous catheters used in theatres and ensure the correct equipment would be stocked and used in future cases in accordance the existing Association of Anaesthetics of Great Britain and Northern Ireland guidelines. A questionnaire was sent out to all of the anaesthetic department in our hospital aiming to determine what types of central venous catheters were preferably used by anaesthetists and why these had been chosen. We also explored any concerns regarding introduction of standardised, pressure injectable central venous catheters to the theatre department which were already in use in other parts of the hospital and in keeping with national guidance. A total of 56 responses were collected. 64% of respondents routinely used a central venous catheter which was significantly shorter than the national recommended guidance with a further 4 different types of central venous catheters used which were different to other areas of the hospital and not pressure injectable. 75% of respondents were in agreement to standardised introduction of the pressure injectable catheters of the recommended length in accordance with national guidance. Reasons why 25% respondents were opposed to introduction of these catheters were explored and discussed. We were successfully able to introduce the standardised central catheters to the theatre department following presentation at the local anaesthetic quality and safety meeting. Reasons against introduction of the catheters were discussed and a compromise was reached that the existing catheters would continue to be stocked but would only be available on request, with a focus on encouraging use of the standardised catheters. Additional changes achieved included removing redundant catheters from the theatre stock. Ongoing data is being collected to analyse positive and negative feedback from use of the introduced catheters.

Keywords: central venous catheter, medical equipment, medical safety, quality improvement

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6171 The Fefe Indices: The Direction of Donal Trump’s Tweets Effect on the Stock Market

Authors: Sergio Andres Rojas, Julian Benavides Franco, Juan Tomas Sayago

Abstract:

An increasing amount of research demonstrates how market mood affects financial markets, but their primary goal is to demonstrate how Trump's tweets impacted US interest rate volatility. Following that lead, this work evaluates the effect that Trump's tweets had during his presidency on local and international stock markets, considering not just volatility but the direction of the movement. Three indexes for Trump's tweets were created relating his activity with movements in the S&P500 using natural language analysis and machine learning algorithms. The indexes consider Trump's tweet activity and the positive or negative market sentiment they might inspire. The first explores the relationship between tweets generating negative movements in the S&P500; the second explores positive movements, while the third explores the difference between up and down movements. A pseudo-investment strategy using the indexes produced statistically significant above-average abnormal returns. The findings also showed that the pseudo strategy generated a higher return in the local market if applied to intraday data. However, only a negative market sentiment caused this effect on daily data. These results suggest that the market reacted primarily to a negative idea reflected in the negative index. In the international market, it is not possible to identify a pervasive effect. A rolling window regression model was also performed. The result shows that the impact on the local and international markets is heterogeneous, time-changing, and differentiated for the market sentiment. However, the negative sentiment was more prone to have a significant correlation most of the time.

Keywords: market sentiment, Twitter market sentiment, machine learning, natural dialect analysis

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6170 Prevalence and Pathomorphological Study of Natural Coccidiosis in Japanese Quails (Coturnix coturnix japonica) in Iran

Authors: M. Khordadmehr, V. R. Ranjbar, R. Norouzi, M. Zeinoddin

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Coccidiosis is recognized as a serious parasitic disease problem limiting quail industry recently. But the data on incidence, clinical signs, species of coccidia and pathological changes in Japanese quail are rare, especially in Iran in spite of the significant improvement of commercial quail breeding in this country in recent decades. Therefore, in the present paper was studied natural infection of quail coccidiosis in three commercial rearing farms with 80% morbidity and 3% mortality rate. For this purpose, fecal sample, oocyst examination, and morphological study were performed beside necropsy, histopathology, and PCR to confirm the diagnosis. In the affected birds, clinical signs included brown diarrhea, weakness, and pale face. In the fecal examination, three species of the genus Eimeria were identified including E. uzura, E. bateri, and E. tsunodai. At necropsy, the main gross lesions were edema, congestion and small blood spots in the small intestine. In histopathologic examination, endogenous stages of the parasites associated with hyperplasia of the intestinal glands, mild congestion, infiltration of mononuclear cells, and edema were observed in the intestine. The molecular study using BSEF and BSER specific primers confirmed the presence of the genus Eimeria in the affected birds. Interestingly, phylogenetic analysis showed relatively high bootstrap values in Japanese quail Eimeria with E. acervuline and E. maxima strains in the chicken. The present study is the first phylogenetic findings on Eimeria of quail which could be valuable for further research on Japanese quail coccidiosis.

Keywords: coccidiosis, Japanese Quail, pathomorphology, phylogenetic analysis

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6169 The Environmental Effects of the Flood Disaster in Anambra State

Authors: U. V. Okpala

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Flood is an overflow of water that submerges or ‘drowns’ land. In developing countries it occurs as a result of blocking of natural and man-made drainages and poor maintenance of water dams/reservoirs which seldom give way after persistent heavy down pours. In coastal lowlands and swamp lands, flooding is aided mainly by blocked channels and indiscriminate sand fling of coastal swamp areas and natural drainage channel for urban development/constructions. In this paper, the causes of flood and possible scientific, technological, political, economic and social impacts of flood disaster on the environment a case study of Anambra State have been studied. Often times flooding is caused by climate change, especially in the developed economy where scientific mitigating options are highly employed. Researchers have identified Green Houses Gases (GHG) as the cause of global climate change. The recent flood disaster in Anambra State which caused physical damage to structures, social dislocation, contamination of clean drinking water, spread of water-borne diseases, shortage of crops and food supplies, death of non-tolerant tree species, disruption in transportation system, serious economic loss and psychological trauma is a function of climate change. There is need to encourage generation of renewable energy sources, use of less carbon intensive fuels and other energy efficient sources. Carbon capture/sequestration, proper management of our drainage systems and good maintenance of our dams are good option towards saving the environment.

Keywords: flooding, climate change, carbon capture, energy systems

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6168 Cyber Bullying, Online Risks and Parental Mediation: A Comparison between Adolescent Reports and Parent Perceptions in South Africa

Authors: Masa Popovac, Philip Fine

Abstract:

Information and Communication Technologies (ICTs) have altered our social environments, and young people in particular have immersed themselves in the digital age. Despite countless benefits, younger ICT users are being exposed to various online risks such as contact with strangers, viewing of risky content, sending or receiving sexually themed images or comments (i.e. ‘sexting’) as well as cyber bullying. Parents may not be fully aware of the online spaces their children inhabit and often struggle to implement effective mediation strategies. This quantitative study explored (i) three types of online risks (contact risks, content risks and conduct risks), (ii) cyber bullying victimization and perpetration, and (iii) parental mediation among a sample of 689 South African adolescents aged between 12-17 years. Survey data was also collected for 227 of their parents relating to their perceptions of their child’s online experiences. A comparison between adolescent behaviors and parental perceptions was examined on the three variables in the study. Findings reveal various online risk taking behaviors. In terms of contact risks, 56% of adolescents reported having contact with at least one online stranger, with many meeting these strangers in person. Content risks included exposure to harmful information such as websites promoting extreme diets or self-harm as well as inappropriate content: 84% of adolescents had seen violent content and 75% had seen sexual content online. Almost 60% of adolescents engaged in conduct risks such as sexting. Eight online victimization behaviors were examined in the study and 79% of adolescents had at least one of these negative experiences, with a third (34%) defining this experience as cyber bullying. A strong connection between victimization and perpetration was found, with 63% of adolescents being both a victim and perpetrator. Very little parental mediation of ICT use was reported. Inferential statistics revealed that parents consistently underestimated their child’s online risk taking behaviors as well as their cyber bullying victimization and perpetration. Parents also overestimated mediation strategies in the home. The generational gap in the knowledge and use of ICTs is a barrier to effective parental mediation and online safety, since many negative online experiences by adolescents go undetected and can continue for extended periods of time thereby exacerbating the potential psychological and emotional distress. The study highlights the importance of including parents in online safety efforts.

Keywords: cyber bullying, online risk behaviors, parental mediation, South Africa

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6167 An Advanced Method of Plant Preservation and Colour Retention of Herbarium Specimens

Authors: Abduraheem K., Suboohi Nasrin

Abstract:

Herbaria are specimens of preserved plants, which are very delicate and cellulosic in nature. While these collections are very useful for the enrichment of knowledge and are considered as natural heritage of our entire world, it is very important to preserve and conserve them. The significance is not only to prevent the herbaria from the deterioration of biological agencies but also to preserve its colours and retain natural colour. Colour is not only characteristic of a plant, but it can also help to identify closely related species or to distinguish a plant from a collection of herbaria. Keeping this in mind, a selective solution has been prepared for the conservation and preservation of herbarium in the present study. In this, the quantity of all the selected chemicals, i.e., formaldehyde and copper sulphate was kept constant, and the solution was prepared by dissolving it in distilled water by increasing the amount of picric acid (1, 2, 3, 4, and 5 ml). Fresh specimens of roses and bougainvillea were washed with distilled water and kept in the above solution for 10 to 15 minutes at room temperature. After 10 minutes, the specimen was removed from the solution, dried with the help of paper, and then pressed under the plant press. Blotting sheets were used to absorb the moisture content and were changed every 2 to 3 days to protect against fungal growth. The results revealed that all solutions had insecticidal properties and protected the herbarium specimen against pests. While in the case of colour retention, solution-1 and 2 were not satisfactory colour preservation, and solutions-3 and 5 maintained the colour of rose and bougainvillea leaves for 15 to 20 days and for a month, respectively. After that, the colour begins to fade, and the process is faster in rose leaves than in bougainvillea. And it was also observed that the colour of young leaves started to fade before that of older leaves. When the leaves of rose and bougainvillea are treated with Solution-4, then the colour of rose leaves is maintained for six months.

Keywords: solutions, colour retention, preservation and conservation, leaves of roses and bougainvillea

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6166 Rhizosphere Microbiome Involvement in the Natural Suppression of Soybean Cyst Nematode in Disease Suppressive Soil

Authors: M. Imran Hamid, Muzammil Hussain, Yunpeng Wu, Meichun Xiang, Xingzhong Liu

Abstract:

The rhizosphere microbiome elucidate multiple functioning in the soil suppressiveness against plant pathogens. Soybean rhizosphere microbial communities may involve in the natural suppression of soybean cyst nematode (SCN) populations in disease suppressive soils. To explore these ecological mechanisms of microbes, a long term monoculture suppressive soil were taken into account for further investigation to test the disease suppressive ability by using different treatments. The designed treatments are as, i) suppressive soil (S), ii) conducive soil (C), iii) conducive soil mixed with 10% (w/w) suppressive soil (CS), iv) suppressive soil treated at 80°C for 1 hr (S80), and v) suppressive soil treated with formalin (SF). By using an ultra-high-throughput sequencing approach, we identified the key bacterial and fungal taxa involved in SCN suppression. The Phylum-level investigation of bacteria revealed that Actinobacteria, Bacteroidetes, and Proteobacteria in the rhizosphere soil of soybean seedlings were more abundant in the suppressive soil than in the conducive soil. The phylum-level analysis of fungi in rhizosphere soil indicated that relative abundance of Ascomycota was higher in suppressive soil than in the conducive soil, where Basidiomycota was more abundant. Transferring suppressive soil to conducive soil increased the population of Ascomycota in the conducive soil by lowering the populations of Basidiomycota. The genera, such as, Pochonia, Purpureocillium, Fusarium, Stachybotrys that have been well documented as bio-control agents of plant nematodes were far more in the disease suppressive soils. Our results suggested that the plants engage a subset of functional microbial groups in the rhizosphere for initial defense upon nematode attack and protect the plant roots later on by nematodes to response for suppression of SCN in disease-suppressive soils.

Keywords: disease suppressive soil, high-throughput sequencing, rhizosphere microbiome, soybean cyst nematode

Procedia PDF Downloads 153
6165 Review of the Safety of Discharge on the First Postoperative Day Following Carotid Surgery: A Retrospective Analysis

Authors: John Yahng, Hansraj Riteesh Bookun

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Objective: This was a retrospective cross-sectional study evaluating the safety of discharge on the first postoperative day following carotid surgery - principally carotid endarterectomy. Methods: Between January 2010 to October 2017, 252 patients with mean age of 72 years, underwent carotid surgery by seven surgeons. Their medical records were consulted and their operative as well as complication timelines were databased. Descriptive statistics were used to analyse pooled responses and our indicator variables. The statistical package used was STATA 13. Results: There were 183 males (73%) and the comorbid burden was as follows: ischaemic heart disease (54%), diabetes (38%), hypertension (92%), stage 4 kidney impairment (5%) and current or ex-smoking (77%). The main indications were transient ischaemic attacks (42%), stroke (31%), asymptomatic carotid disease (16%) and amaurosis fugax (8%). 247 carotid endarterectomies (109 with patch arterioplasty, 88 with eversion and transection technique, 50 with endarterectomy only) were performed. 2 carotid bypasses, 1 embolectomy, 1 thrombectomy with patch arterioplasty and 1 excision of a carotid body tumour were also performed. 92% of the cases were performed under general anaesthesia. A shunt was used in 29% of cases. The mean length of stay was 5.1 ± 3.7days with the range of 2 to 22 days. No patient was discharged on day 1. The mean time from admission to surgery was 1.4 ± 2.8 days, ranging from 0 to 19 days. The mean time from surgery to discharge was 2.7 ± 2.0 days with the of range 0 to 14 days. 36 complications were encountered over this period, with 12 failed repairs (5 major strokes, 2 minor strokes, 3 transient ischaemic attacks, 1 cerebral bleed, 1 occluded graft), 11 bleeding episodes requiring a return to the operating theatre, 5 adverse cardiac events, 3 cranial nerve injuries, 2 respiratory complications, 2 wound complications and 1 acute kidney injury. There were no deaths. 17 complications occurred on postoperative day 0, 11 on postoperative day 1, 6 on postoperative day 2 and 2 on postoperative day 3. 78% of all complications happened before the second postoperative day. Out of the complications which occurred on the second or third postoperative day, 4 (1.6%) were bleeding episodes, 1 (0.4%) failed repair , 1 respiratory complication (0.4%) and 1 wound complication (0.4%). Conclusion: Although it has been common practice to discharge patients on the second postoperative day following carotid endarterectomy, we find here that discharge on the first operative day is safe. The overall complication rate is low and most complications are captured before the second postoperative day. We suggest that patients having an uneventful first 24 hours post surgery be discharged on the first day. This should reduce hospital length of stay and the health economic burden.

Keywords: carotid, complication, discharge, surgery

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6164 Evaluation of Efficiency of Naturally Available Disinfectants and Filter Media in Conventional Gravity Filters

Authors: Abhinav Mane, Kedar Karvande, Shubham Patel, Abhayraj Lodha

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Gravity filters are one of the most commonly used, economically viable and moderately efficient water purification systems. Their efficiency is mainly based on the type of filter media installed and its location within the filter mass. Several researchers provide valuable input in decision of the type of filter media. However, the choice is mainly restricted to the chemical combinations of different substances. This makes it very much dependent on the factory made filter media, and no cheap alternatives could be found and used. This paper presents the use of disinfectants and filter medias either available naturally or could be prepared using natural resources in conventional mechanism of gravity filter. A small scale laboratory investigation was made with variation in filter media thickness and its location from the top surface of the filter. A rigid steel frame based custom fabricated test setup was used to facilitate placement of filter media at different height within the filter mass. Finely grinded sun dried Neem (Azadirachta indica) extracts and porous burnt clay pads were used as two distinct filter media and placed in isolation as well as in combination with each other. Ground water available in Marathwada region of Maharashtra, India which mainly consists of harmful materials like Arsenic, Chlorides, Iron, Magnesium and Manganese, etc. was treated in the filters fabricated in the present study. The evaluation was made mainly in terms of the input/output water quality assessment through laboratory tests. The present paper should give a cheap and eco-friendly solution to prepare gravity filter at the merit of household skills and availability.

Keywords: fliter media, gravity filters, natural disinfectants, porous clay pads

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6163 Quantifying the Rapid Urbanization Impact on Potential Stormwater Runoff of Dhaka City, Bangladesh

Authors: Md. Kumruzzaman, Anutosh Das, Md. Mosharraf Hossain

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Historically, rapid urban growth activities are considered one of the main culprits behind urban floods or waterlogging. The increased unplanned urbanization of many areas of Dhaka has resulted in waterlogging, urban floods, and increasing groundwater depth. To determine potential groundwater recharge from precipitation, the study is being conducted to examine the changes in land use/land cover (LULC) and urban runoff extent based on the NRCS-CN from 2005–2021. Four kinds of land use are used to examine the LULC change: built-up, bare land, vegetation, and water body. These categories are used for the years 2005, 2010, 2015, and 2021. The built-up area is growing at a relatively fast rate: 7.43%, 17.4%, and 5.21%, respectively, between the years 2005 and 2010, 2010 and 2015, and 2015 and 2021. As the amount of impervious surface rose in Dhaka city, stormwater discharge increased from 2005 to 2021. In 2005, 2010, 2015, and 2021, heavy stormwater runoff regions made up around 24.873%, 32.616%, 49.118%, and 55.986% of the entire Dhaka city. Stormwater runoff accounted for around 53.738%, 55.092%, 63.472%, and 67.061% of the total rainfall in 2005, 2010, 2015, and 2021, respectively. Between 2005 and 2021, a significant portion of the natural land cover was altered because of the expanding impervious surface, which also harmed the natural drainage system. Due to careless growth, the potential for stormwater runoff and groundwater recharge in Dhaka city worsens every year. Concerning this situation, a sustainable urban drainage system (SUDS) can be the best possible solution for minimizing the stormwater runoff and groundwater recharge problem.

Keywords: LULC, impervious surface, stormwater runoff, groundwater recharge, SUDS

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6162 Fungal Flocculation of Single Algae Species and Mixed Algal Communities

Authors: Digby Wrede, Stephen Gray, Syed Hussainy

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Microalgae are extremely useful organisms but notoriously hard to harvest. The use of fungal pellets has been found to be an efficient way to flocculate numerous species of algae. However, only the flocculation of single species of algae has been investigated. Algae are generally found in complex communities in the environment comprising of numerous species of algae ranging from simple single cell algae such as Chlorella to more complex or communal algae such as Dictyosphaerium. This study investigated the flocculation capabilities of Aspergillus oryzae to flocculate four species of algae; Chlorella vulgaris, Scenedesmus quadricauda, Scenedesmus acuminatus and Dictyosphaerium sp., and the algal communities in four different types of domestic effluent from a lagoon-based treatment plant; primary effluent, secondary effluent and the high rate algal pond effluent at a natural and at a lowered pH level. Spectrophotometry was used to measure the changes in algal population. C. vulgaris, S. acuminatus and S. quadricauda, had over 90% reduction of algal in suspension after 24 hours. Dictyosphaerium sp. showed a little to no removal after 24 hours. The primary, secondary, and natural pH level HRAP had roughly a 50% removal after 24 hours, the HRAP which was grown at a lower pH level had over a 90% removal after 24 hours. pH has been shown previously to affect fungal flocculation. Fungal and algae pellets have been shown to be able to treat wastewater and can be converted to biofuels in a very similar method to how algae are currently converted. The mixture of both fungi and algae has also been shown to provide a higher yield of oils then separately and are able to more efficiently treat wastewater then algae or fungi by themselves.

Keywords: algae harvesting, Aspergillus oryzae, fungal flocculation, wastewater treatment

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6161 Technological Exploitation and User Experience in Product Innovation: The Case Study of the High-Tech Mask

Authors: Venere Ferraro, Silvia Ferraris

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We live in a world pervaded by new advanced technologies that have been changing the way we live and experience the surrounded. Besides, new technologies enable product innovation at different levels. Nevertheless, innovation does not lie just in the technological development and in its hard aspects but also in the meaningful use of it for the final user. In order to generate innovative products, a new perspective is needed: The shift from an instrument-oriented view of the technology towards a broader view that includes aspects like aesthetics, acceptance, comfort, and sociability. In many businesses, the user experience of the product is considered the key battlefield to achieve product innovation. (Holland 2011) The use of new technologies is indeed useless without paying attention to the user experience. This paper presents a workshop activity conducted at Design School of Politecnico di Milano in collaboration with Chiba University and aimed at generating innovative design concepts of high-tech mask. The students were asked to design the user experience of a new mask by exploiting emerging technologies such as wearable sensors and information communication technology (ICT) for a chosen field of application: safety or sport. When it comes to the user experience, the mask is a very challenging design product, because it covers aspects of product interaction and, most important, psychological and cultural aspects related to the impact on the facial expression. Furthermore, since the mask affects the face expression quite a lot, it could be a barrier to hide with, or it could be a mean to enhance user’s communication to others. The main request for the students was to take on a user-centered approach: To go beyond the instrumental aspects of product use and usability and focus on the user experience by shaping the technology in a desirable and meaningful way for the user reasoning on the metaphorical and cultural level of the product. During the one-week workshop students were asked to face the design process through (i) the research phase: an in-deep analysis of the user and field of application (safety or sport) to set design spaces (brief) and user scenario; (ii) the idea generation, (iii) the idea development. This text will shortly go through the meaning of the product innovation, the use and application of wearable technologies and will then focus on the user experience design in contrast with the technology-driven approach in the field of product innovation. Finally authors will describe the workshop activity and the concepts developed by the students stressing the important role of the user experience design in new product development.

Keywords: product innovation, user experience, technological exploitation, wearable technologies

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6160 Preserving Urban Cultural Heritage with Deep Learning: Color Planning for Japanese Merchant Towns

Authors: Dongqi Li, Yunjia Huang, Tomo Inoue, Kohei Inoue

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With urbanization, urban cultural heritage is facing the impact and destruction of modernization and urbanization. Many historical areas are losing their historical information and regional cultural characteristics, so it is necessary to carry out systematic color planning for historical areas in conservation. As an early focus on urban color planning, Japan has a systematic approach to urban color planning. Hence, this paper selects five merchant towns from the category of important traditional building preservation areas in Japan as the subject of this study to explore the color structure and emotion of this type of historic area. First, the image semantic segmentation method identifies the buildings, roads, and landscape environments. Their color data were extracted for color composition and emotion analysis to summarize their common features. Second, the obtained Internet evaluations were extracted by natural language processing for keyword extraction. The correlation analysis of the color structure and keywords provides a valuable reference for conservation decisions for this historic area in the town. This paper also combines the color structure and Internet evaluation results with generative adversarial networks to generate predicted images of color structure improvements and color improvement schemes. The methods and conclusions of this paper can provide new ideas for the digital management of environmental colors in historic districts and provide a valuable reference for the inheritance of local traditional culture.

Keywords: historic districts, color planning, semantic segmentation, natural language processing

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6159 Finite Element Model to Investigate the Dynamic Behavior of Ring-Stiffened Conical Shell Fully and Partially Filled with Fluid

Authors: Mohammadamin Esmaeilzadehazimi, Morteza Shayan Arani, Mohammad Toorani, Aouni Lakis

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This study uses a hybrid finite element method to predict the dynamic behavior of both fully and partially-filled truncated conical shells stiffened with ring stiffeners. The method combines classical shell theory and the finite element method, and employs displacement functions derived from exact solutions of Sanders' shell equilibrium equations for conical shells. The shell-fluid interface is analyzed by utilizing the velocity potential, Bernoulli's equation, and impermeability conditions to determine an explicit expression for fluid pressure. The equations of motion presented in this study apply to both conical and cylindrical shells. This study presents the first comparison of the method applied to ring-stiffened shells with other numerical and experimental findings. Vibration frequencies for conical shells with various boundary conditions and geometries in a vacuum and filled with water are compared with experimental and numerical investigations, achieving good agreement. The study thoroughly investigates the influence of geometric parameters, stiffener quantity, semi-vertex cone angle, level of water filled in the cone, and applied boundary conditions on the natural frequency of fluid-loaded ring-stiffened conical shells, and draws some useful conclusions. The primary advantage of the current method is its use of a minimal number of finite elements while achieving highly accurate results.

Keywords: finite element method, fluid–structure interaction, conical shell, natural frequency, ring-stiffener

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6158 A Randomised Controlled Study to Compare Efficacy and Safety of Bupivacaine plus Dexamethasone Versus Bupivacaine plus Fentanyl for Caudal Block in Children

Authors: Ashwini Patil

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Caudal block is one of the most commonly used regional anesthetic techniques in children. Currently, fentanyl is used as an adjuvant to bupivacaine to prolong analgesia but fentanyl is a narcotic. Dexamethasone, a glucocorticoid with strong anti-inflammatory effects provides improvement in post-operative analgesia and post-operative side effects. However, its analgesic efficacy and safety in comparison with fentanyl has not been extensively studied. So the objective of this randomized controlled study is to compare dexamethasone with fentanyl as an adjuvant to bupivacaine for caudal block in children in relation to the duration of caudal analgesia, post-operative analgesic requirement and incidence of post-operative nausea and vomiting. This study included 100 children, aged 1–6 years, undergoing lower abdominal surgeries. Patients were randomized into two groups, 50 each to receive a combination of dexamethasone 0.2 mg/kg along with 1 ml/kg bupivacaine 0.25% (group A) or combination of fentanyl (1 ug/kg) along with 1ml/kg bupivacaine 0.25% (group B). In the post-operative period, pain was assessed using a Modified Objective Pain Scale (MOPS) until 12 hr after surgery and rescue analgesia is administered when MOPS score 4 or more is recorded. Residual motor block, number of analgesic doses required within 24 hr after surgery, sedation scores, intra-operative and post-operative hemodynamic variables, post-operative nausea and vomiting (PONV), and other adverse effects were recorded. Data is analysed using unpaired t test and Significance level of P< 0.05 is considered statistically significant. Group A showed a significantly longer time to first analgesic requirement than group B (p<0.05). The number of rescue analgesic doses required in the first 24 h was significantly less in group A (p<0.05). Group A showed significantly lower MOPS scores than group B(p<0.05). Intra-operative and post-operative hemodynamic variables, Modified Bromage Scale scores, and sedation scores were comparable in both the groups. Group A showed significantly fewer incidences of PONV compared with group B(p<0.05). This study reveals that adding dexamethasone to bupivacaine prolongs the duration of postoperative analgesia and decreases the incidence of PONV as compared to combination of fentanyl to bupivacaine after a caudal block in pediatric patients.

Keywords: bupivacaine, caudal analgesia, dexamethasone, pediatric

Procedia PDF Downloads 206
6157 Analyzing Defects with Failure Assessment Diagrams of Gas Pipelines

Authors: Alfred Hasanaj , Ardit Gjeta, Miranda Kullolli

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The approach in analyzing defects on different pipe lines is conducted through Failure Assessment Diagram (FAD). These methods of analyses have further extended in recent years. This approach is used to identify and stress out a solution for the defects which randomly occur with gas pipes such are corrosion defects, gauge defects, and combination of defects where gauge and dents are included. Few of the defects are to be analyzed in this paper where our main focus will be the fracture of cast Iron pipes, elastic-plastic failure and plastic collapse of X52 steel pipes for gas transport. We need to conduct a calculation of probability of the defects in order to predict and avoid such costly defects.

Keywords: defects, failure assessment diagrams, steel pipes, safety factor

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6156 Vertical and Horizantal Distribution Patterns of Major and Trace Elements: Surface and Subsurface Sediments of Endhorheic Lake Acigol Basin, Denizli Turkey

Authors: M. Budakoglu, M. Karaman

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Lake Acıgöl is located in area with limited influences from urban and industrial pollution sources, there is nevertheless a need to understand all potential lithological and anthropogenic sources of priority contaminants in this closed basin. This study discusses vertical and horizontal distribution pattern of major, trace elements of recent lake sediments to better understand their current geochemical analog with lithological units in the Lake Acıgöl basin. This study also provides reliable background levels for the region by the detailed surfaced lithological units data. The detail results of surface, subsurface and shallow core sediments from these relatively unperturbed ecosystems, highlight its importance as conservation area, despite the high-scale industrial salt production activity. While P2O5/TiO2 versus MgO/CaO classification diagram indicate magmatic and sedimentary origin of lake sediment, Log(SiO2/Al2O3) versus Log(Na2O/K2O) classification diagrams express lithological assemblages of shale, iron-shale, vacke and arkose. The plot between TiO2 vs. SiO2 and P2O5/TiO2 vs. MgO/CaO also supports the origin of the primary magma source. The average compositions of the 20 different lithological units used as a proxy for geochemical background in the study area. As expected from weathered rock materials, there is a large variation in the major element content for all analyzed lake samples. The A-CN-K and A-CNK-FM ternary diagrams were used to deduce weathering trends. Surface and subsurface sediments display an intense weathering history according to these ternary diagrams. The most of the sediments samples plot around UCC and TTG, suggesting a low to moderate weathering history for the provenance. The sediments plot in a region clearly suggesting relative similar contents in Al2O3, CaO, Na2O, and K2O from those of lithological samples.

Keywords: Lake Acıgöl, recent lake sediment, geochemical speciation of major and trace elements, heavy metals, Denizli, Turkey

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6155 Carbapenem Usage in Medical Wards: An Antibiotic Stewardship Feedback Project

Authors: Choon Seong Ng, P. Petrick, C. L. Lau

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Background: Carbapenem-resistant isolates have been increasingly reported recently. Carbapenem stewardship is designed to optimize its usage particularly among medical wards with high prevalence of carbapenem prescriptions to combat such emerging resistance. Carbapenem stewardship programmes (CSP) can reduce antibiotic use but clinical outcome of such measures needs further evaluation. We examined this in a prospective manner using feedback mechanism. Methods: Our single-center prospective cohort study involved all carbapenem prescriptions across the medical wards (including medical patients admitted to intensive care unit) in a tertiary university hospital setting. The impact of such stewardship was analysed according to the accepted and the rejected groups. The primary endpoint was safety. Safety measure applied in this study was the death at 1 month. Secondary endpoints included length of hospitalisation and readmission. Results: Over the 19 months’ period, input from 144 carbapenem prescriptions was analysed on the basis of acceptance of our CSP recommendations on the use of carbapenems. Recommendations made were as follows : de-escalation of carbapenem; stopping the carbapenem; use for a short duration of 5-7 days; required prolonged duration in the case of carbapenem-sensitive Extended Spectrum Beta-Lactamases bacteremia; dose adjustment; and surgical intervention for removal of septic foci. De-escalation, shorten duration of carbapenem and carbapenem cessation comprised 79% of the recommendations. Acceptance rate was 57%. Those who accepted CSP recommendations had no increase in mortality (p = 0.92), had a shorter length of hospital stay (LOS) and had cost-saving. Infection-related deaths were found to be higher among those in the rejected group. Moreover, three rejected cases (6%) among all non-indicated cases (n = 50) were found to have developed carbapenem-resistant isolates. Lastly, Pitt’s bacteremia score appeared to be a key element affecting the carbapenem prescription’s behaviour in this trial. Conclusions: Carbapenem stewardship program in the medical wards not only saves money, but most importantly it is safe and does not harm the patients with added benefits of reducing the length of hospital stay. However, more time is needed to engage the primary clinical teams by formal clinical presentation and immediate personal feedback by senior Infectious Disease (ID) personnel to increase its acceptance.

Keywords: audit and feedback, carbapenem stewardship, medical wards, university hospital

Procedia PDF Downloads 204