Search results for: Charles Thomas Nugent
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 640

Search results for: Charles Thomas Nugent

280 Radio Frequency Identification Device Based Emergency Department Critical Care Billing: A Framework for Actionable Intelligence

Authors: Shivaram P. Arunachalam, Mustafa Y. Sir, Andy Boggust, David M. Nestler, Thomas R. Hellmich, Kalyan S. Pasupathy

Abstract:

Emergency departments (EDs) provide urgent care to patients throughout the day in a complex and chaotic environment. Real-time location systems (RTLS) are increasingly being utilized in healthcare settings, and have shown to improve safety, reduce cost, and increase patient satisfaction. Radio Frequency Identification Device (RFID) data in an ED has been shown to compute variables such as patient-provider contact time, which is associated with patient outcomes such as 30-day hospitalization. These variables can provide avenues for improving ED operational efficiency. A major challenge with ED financial operations is under-coding of critical care services due to physicians’ difficulty reporting accurate times for critical care provided under Current Procedural Terminology (CPT) codes 99291 and 99292. In this work, the authors propose a framework to optimize ED critical care billing using RFID data. RFID estimated physician-patient contact times could accurately quantify direct critical care services which will help model a data-driven approach for ED critical care billing. This paper will describe the framework and provide insights into opportunities to prevent under coding as well as over coding to avoid insurance audits. Future work will focus on data analytics to demonstrate the feasibility of the framework described.

Keywords: critical care billing, CPT codes, emergency department, RFID

Procedia PDF Downloads 106
279 Inhibition of Escherichia coli and Salmonella spp. By Traditional Phytomedicines That Are Commonly Used to Treat Gastroenteritis in Zimbabwe

Authors: Constance Chivengwa, Tinashe Mandimutsira, Jephris Gere, Charles Magogo, Irene Chikanza, Jerneja Vidmar, Walter Chingwaru

Abstract:

The use of traditional methods in the management of diarrhoea has remained a common practice among the indigenous African tribes of Southern Africa. Despite the widespread use of traditional medicines in Zimbabwe, very little research validating the activities of phytomedicines against diarrhoea, as claimed by the Shona people of Zimbabwe, has been reported. This study sought to determine the efficacies of the plants that are frequently used to treat stomach complaints, namely Dicoma anomala, Cassia abbreviata, Lannea edulis and Peltophorum africanum against Escherichia coli (an indicator of faecal contamination of water, and whose strains such as EHEC (O157), ETEC and EPEC, are responsible for a number of outbreaks of diarrhoea) and Salmonella spp. Ethanol and aqueous extracts from these plants were obtained, evaporated, dried and stored. The dried extracts were reconstituted and diluted 10-fold in nutrient broth (from 100 to 0.1 microgram/mL) and tested for inhibition against the bacteria. L. edulis exhibited the best antimicrobial effect (minimum inhibition concentration = 10 microgram/mL for both extracts and microorganisms). Runners up to L. edulis were C. abbreviata (20 microgram/mL for both microorganisms) and P. africanum (20 and 30 microgram/mL respectively). Interestingly, D. anomala, which is widely considered panacea in African medicinal practices, showed low antimicrobial activity (60 and 100 microgram/mL respectively). The high antimicrobial activity of L. edulis can be explained by its content of flavonoids, tannins, alkylphenols (cardonol 7 and cardonol 13) and dihydroalkylhexenones. The antimicrobial activities of C. abbreviata can be linked to its content of anthraquinones and triterpenoids. P. africanum is known to contain benzenoids, flavanols, flavonols, terpenes, xanthone and coumarins. This study therefore demonstrated that, among the plants that are used against diarrhoea in African traditional medicine, L. edulis is a clear winner against E. coli and Salmonella spp. Activity guided extraction is encouraged to establish the complement of compounds that have antimicrobial activities.

Keywords: diarrhoea, Escherichia coli, Salmonella, phytomedicine, MIC, Zimbabwe

Procedia PDF Downloads 342
278 Validation of the X-Ray Densitometry Method for Radial Density Pattern Determination of Acacia seyal var. seyal Tree Species

Authors: Hanadi Mohamed Shawgi Gamal, Claus Thomas Bues

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Wood density is a variable influencing many of the technological and quality properties of wood. Understanding the pattern of wood density radial variation is important for its end-use. The X-ray technique, traditionally applied to softwood species to assess the wood quality properties, due to its simple and relatively uniform wood structure. On the other hand, very limited information is available about the validation of using this technique for hardwood species. The suitability of using the X-ray technique for the determination of hardwood density has a special significance in countries like Sudan, where only a few timbers are well known. This will not only save the time consumed by using the traditional methods, but it will also enhance the investigations of the great number of the lesser known species, the thing which will fill the huge cap of lake information of hardwood species growing in Sudan. The current study aimed to evaluate the validation of using the X-ray densitometry technique to determine the radial variation of wood density of Acacia seyal var. seyal. To this, a total of thirty trees were collected randomly from four states in Sudan. The wood density radial trend was determined using the basic density as well as density obtained by the X-ray densitometry method in order to assess the validation of X-ray technique in wood density radial variation determination. The results showed that the pattern of radial trend of density obtained by X-ray technique is very similar to that achieved by basic density. These results confirmed the validation of using the X-ray technique for Acacia seyal var. seyal density radial trend determination. It also promotes the suitability of using this method in other hardwood species.

Keywords: x-ray densitometry, wood density, Acacia seyal var. seyal, radial variation

Procedia PDF Downloads 120
277 Developing a Framework to Aid Sustainable Assessment in Indian Buildings

Authors: P. Amarnath, Albert Thomas

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Buildings qualify to be the major consumer of energy and resources thereby urging the designers, architects and policy makers to place a great deal of effort in achieving and implementing sustainable building strategies in construction. Green building rating systems help a great deal in this by measuring the effectiveness of these strategies along with the escalation of building performance in social, environmental and economic perspective, and construct new sustainable buildings. However, for a country like India, enormous population and its rapid rate of growth impose an increasing burden on the country's limited and continuously degrading natural resource base, which also includes the land available for construction. In general, the number of sustainable rated buildings in India is very minimal primarily due to the complexity and obstinate nature of the assessment systems/regulations that restrict the stakeholders and designers in proper implementation and utilization of these rating systems. This paper aims to introduce a data driven and user-friendly framework which cross compares the present prominent green building rating systems such as LEED, BREEAM, and GRIHA and subsequently help the users to rate their proposed building design as per the regulations of these assessment frameworks. This framework is validated using the input data collected from green buildings constructed globally. The proposed system has prospects to encourage the users to test the efficiency of various sustainable construction practices and thereby promote more sustainable buildings in the country.

Keywords: BREEAM, GRIHA, green building rating systems, LEED, sustainable buildings

Procedia PDF Downloads 102
276 Applicability of Overhangs for Energy Saving in Existing High-Rise Housing in Different Climates

Authors: Qiong He, S. Thomas Ng

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Upgrading the thermal performance of building envelope of existing residential buildings is an effective way to reduce heat gain or heat loss. Overhang device is a common solution for building envelope improvement as it can cut down solar heat gain and thereby can reduce the energy used for space cooling in summer time. Despite that, overhang can increase the demand for indoor heating in winter due to its function of lowering the solar heat gain. Obviously, overhang has different impacts on energy use in different climatic zones which have different energy demand. To evaluate the impact of overhang device on building energy performance under different climates of China, an energy analysis model is built up in a computer-based simulation program known as DesignBuilder based on the data of a typical high-rise residential building. The energy simulation results show that single overhang is able to cut down around 5% of the energy consumption of the case building in the stand-alone situation or about 2% when the building is surrounded by other buildings in regions which predominantly rely on space cooling though it has no contribution to energy reduction in cold region. In regions with cold summer and cold winter, adding overhang over windows can cut down around 4% and 1.8% energy use with and without adjoining buildings, respectively. The results indicate that overhang might not an effective shading device to reduce the energy consumption in the mixed climate or cold regions.

Keywords: overhang, energy analysis, computer-based simulation, design builder, high-rise residential building, climate, BIM model

Procedia PDF Downloads 324
275 Growth Studies and Leaf Mineral Composition of Amaranthus hybridus L. in Soil Medium Supplemended with Palm Bunch Ash Extract from Elaeis Guineensis jacq. in Abak Agricultural Zone of Akwa Ibom State, Nigeria

Authors: Etukudo, M. Mbosowo, Nyananyo, L. Bio, Negbenebor, A. Charles

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An aqueous extract of palm bunch ash from Elaeis guineensis Jacq., equilibrated with water was used to assess the growth and minerals composition of Amaranthus hybridus L. in agricultural soil of Abak, Akwa Ibom State, nigeria. Various concentrations, 0 (control), 10, 20, 30, 40, and 50% of palm bunch extract per 4kg of sandy-loam soil were used for the study. Chemical characteristics of the extract, Growth parameters (Plant height, root length, fresh weight, dry weight and moisture content), leaf minerals composition (Nitrogen, phosphorus, potassium, calcium and magnesium) of the crop and soil chemical composition before and after harvest (pH, organic matter, nitrogen, phosphorus, potassium, calcium and magnesium) were examined. The results showed that palm bunch ash extract significantly (P < 0.05) increased the soil pH at all levels of treatments compared to the control. Similarly, the soil and leaf minerals component (N, P, K. Ca, and Mg) of the crop increased with increase in the concentration of palm bunch extract, except at 40 and 50% for leaf minerals composition, Soil organic matter, nitrogen and phosphorus J(before and after harvest). In addition, The plant height, Root length, fresh weight, dry weight and moisture content of the crop increased significantly (P < 0.05) with increase in the concentration of the extract, Except at 30, 40 and 50% where these growth parameters decreased in relation to the control treatment. Therefore, this study suggests that palm bunch ash extract could be utilized at lower concentration as a nutrient supplement for both Amaranthus hubridus L. and soil medium, most especially in the tropical soils of the Niger Delta region of Nigeria.

Keywords: Amaranthus hybridus L., growth, leaf minerals composition, palm bunch ash extract

Procedia PDF Downloads 413
274 Reinforcement Learning for Robust Missile Autopilot Design: TRPO Enhanced by Schedule Experience Replay

Authors: Bernardo Cortez, Florian Peter, Thomas Lausenhammer, Paulo Oliveira

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Designing missiles’ autopilot controllers have been a complex task, given the extensive flight envelope and the nonlinear flight dynamics. A solution that can excel both in nominal performance and in robustness to uncertainties is still to be found. While Control Theory often debouches into parameters’ scheduling procedures, Reinforcement Learning has presented interesting results in ever more complex tasks, going from videogames to robotic tasks with continuous action domains. However, it still lacks clearer insights on how to find adequate reward functions and exploration strategies. To the best of our knowledge, this work is a pioneer in proposing Reinforcement Learning as a framework for flight control. In fact, it aims at training a model-free agent that can control the longitudinal non-linear flight dynamics of a missile, achieving the target performance and robustness to uncertainties. To that end, under TRPO’s methodology, the collected experience is augmented according to HER, stored in a replay buffer and sampled according to its significance. Not only does this work enhance the concept of prioritized experience replay into BPER, but it also reformulates HER, activating them both only when the training progress converges to suboptimal policies, in what is proposed as the SER methodology. The results show that it is possible both to achieve the target performance and to improve the agent’s robustness to uncertainties (with low damage on nominal performance) by further training it in non-nominal environments, therefore validating the proposed approach and encouraging future research in this field.

Keywords: Reinforcement Learning, flight control, HER, missile autopilot, TRPO

Procedia PDF Downloads 232
273 Investigation and Estimation of State of Health of Battery Pack in Battery Electric Vehicles-Online Battery Characterization

Authors: Ali Mashayekh, Mahdiye Khorasani, Thomas Weyh

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The tendency to use the Battery-Electric vehicle (BEV) for the low and medium driving range or even high driving range has been growing more and more. As a result, higher safety, reliability, and durability of the battery pack as a component of electric vehicles, which has a great share of cost and weight of the final product, are the topics to be considered and investigated. Battery aging can be considered as the predominant factor regarding the reliability and durability of BEV. To better understand the aging process, offline battery characterization has been widely used, which is time-consuming and needs very expensive infrastructures. This paper presents the substitute method for the conventional battery characterization methods, which is based on battery Modular Multilevel Management (BM3). According to this Topology, the battery cells can be drained and charged concerning their capacity, which allows varying battery pack structures. Due to the integration of the power electronics, the output voltage of the battery pack is no longer fixed but can be dynamically adjusted in small steps. In other words, each cell can have three different states, namely series, parallel, and bypass in connection with the neighbor cells. With the help of MATLAB/Simulink and by using the BM3 modules, the battery string model is created. This model allows us to switch two cells with the different SoC as parallel, which results in the internal balancing of the cells. But if the parallel switching lasts just for a couple of ms, we can have a perturbation pulse which can stimulate the cells out of the relaxation phase. With the help of modeling the voltage response pulse of the battery, it would be possible to characterize the cell. The Online EIS method, which is discussed in this paper, can be a robust substitute for the conventional battery characterization methods.

Keywords: battery characterization, SoH estimation, RLS, BEV

Procedia PDF Downloads 122
272 A Human Centered Design of an Exoskeleton Using Multibody Simulation

Authors: Sebastian Kölbl, Thomas Reitmaier, Mathias Hartmann

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Trial and error approaches to adapt wearable support structures to human physiology are time consuming and elaborate. However, during preliminary design, the focus lies on understanding the interaction between exoskeleton and the human body in terms of forces and moments, namely body mechanics. For the study at hand, a multi-body simulation approach has been enhanced to evaluate actual forces and moments in a human dummy model with and without a digital mock-up of an active exoskeleton. Therefore, different motion data have been gathered and processed to perform a musculosceletal analysis. The motion data are ground reaction forces, electromyography data (EMG) and human motion data recorded with a marker-based motion capture system. Based on the experimental data, the response of the human dummy model has been calibrated. Subsequently, the scalable human dummy model, in conjunction with the motion data, is connected with the exoskeleton structure. The results of the human-machine interaction (HMI) simulation platform are in particular resulting contact forces and human joint forces to compare with admissible values with regard to the human physiology. Furthermore, it provides feedback for the sizing of the exoskeleton structure in terms of resulting interface forces (stress justification) and the effect of its compliance. A stepwise approach for the setup and validation of the modeling strategy is presented and the potential for a more time and cost-effective development of wearable support structures is outlined.

Keywords: assistive devices, ergonomic design, inverse dynamics, inverse kinematics, multibody simulation

Procedia PDF Downloads 134
271 Stability Optimization of NABH₄ via PH and H₂O:NABH₄ Ratios for Large Scale Hydrogen Production

Authors: Parth Mehta, Vedasri Bai Khavala, Prabhu Rajagopal, Tiju Thomas

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There is an increasing need for alternative clean fuels, and hydrogen (H₂) has long been considered a promising solution with a high calorific value (142MJ/kg). However, the storage of H₂ and expensive processes for its generation have hindered its usage. Sodium borohydride (NaBH₄) can potentially be used as an economically viable means of H₂ storage. Thus far, there have been attempts to optimize the life of NaBH₄ (half-life) in aqueous media by stabilizing it with sodium hydroxide (NaOH) for various pH values. Other reports have shown that H₂ yield and reaction kinetics remained constant for all ratios of H₂O to NaBH₄ > 30:1, without any acidic catalysts. Here we highlight the importance of pH and H₂O: NaBH₄ ratio (80:1, 40:1, 20:1 and 10:1 by weight), for NaBH₄ stabilization (half-life reaction time at room temperature) and corrosion minimization of H₂ reactor components. It is interesting to observe that at any particular pH>10 (e.g., pH = 10, 11 and 12), the H₂O: NaBH₄ ratio does not have the expected linear dependence with stability. On the contrary, high stability was observed at the ratio of 10:1 H₂O: NaBH₄ across all pH>10. When the H₂O: NaBH₄ ratio is increased from 10:1 to 20:1 and beyond (till 80:1), constant stability (% degradation) is observed with respect to time. For practical usage (consumption within 6 hours of making NaBH₄ solution), 15% degradation at pH 11 and NaBH₄: H₂O ratio of 10:1 is recommended. Increasing this ratio demands higher NaOH concentration at the same pH, thus requiring a higher concentration or volume of acid (e.g., HCl) for H₂ generation. The reactions are done with tap water to render the results useful from an industrial standpoint. The observed stability regimes are rationalized based on complexes associated with NaBH₄ when solvated in water, which depend sensitively on both pH and NaBH₄: H₂O ratio.

Keywords: hydrogen, sodium borohydride, stability optimization, H₂O:NaBH₄ ratio

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270 Mitigating the Aggregation of Human Islet Amyloid Polypeptide with Nanomaterials

Authors: Ava Faridi, Pouya Faridi, Aleksandr Kakinen, Ibrahim Javed, Thomas P. Davis, Pu Chun Ke

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Human islet amyloid polypeptide (IAPP) is a hormone associated with glycemic control and type 2 diabetes. Biophysically, the chirality of IAPP fibrils has been little explored with respect to the aggregation and toxicity of the peptide. Biochemically, it remains unclear as for how protein expression in pancreatic beta cells may be altered by cell exposure to the peptide, and how such changes may be mitigated by nanoparticle inhibitors for IAPP aggregation. In this study, we first demonstrated the elimination of the IAPP nucleation phase and shortening of its elongation phase by silica nanoribbons. This accelerated IAPP fibrillization translated to reduced toxicity, especially for the right-handed silica nanoribbons, as revealed by cell viability, helium ion microscopy, as well as zebrafish embryo survival, developmental and behavioral assays. We then examined the proteomes of βTC6 pancreatic beta cells exposed to the three main aggregation states of monomeric, oligomeric and amyloid fibrillar IAPP, and compared that with cellular protein expression modulated by graphene quantum dots (GQDs). A total of 29 proteins were significantly regulated by different forms of IAPP, and the majority of these proteins were nucleotide-binding proteins. A regulatory capacity of GQDs against aberrant protein expression was confirmed. These studies have demonstrated the great potential of employing nanomaterials targeting the mesoscopic enantioselectivity and protein expression dysregulation in pancreatic beta cells.

Keywords: graphene quantum dots, IAPP, silica nanoribbons, protein expression, toxicity

Procedia PDF Downloads 113
269 Simulation of the FDA Centrifugal Blood Pump Using High Performance Computing

Authors: Mehdi Behbahani, Sebastian Rible, Charles Moulinec, Yvan Fournier, Mike Nicolai, Paolo Crosetto

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Computational Fluid Dynamics blood-flow simulations are increasingly used to develop and validate blood-contacting medical devices. This study shows that numerical simulations can provide additional and accurate estimates of relevant hemodynamic indicators (e.g., recirculation zones or wall shear stresses), which may be difficult and expensive to obtain from in-vivo or in-vitro experiments. The most recent FDA (Food and Drug Administration) benchmark consisted of a simplified centrifugal blood pump model that contains fluid flow features as they are commonly found in these devices with a clear focus on highly turbulent phenomena. The FDA centrifugal blood pump study is composed of six test cases with different volumetric flow rates ranging from 2.5 to 7.0 liters per minute, pump speeds, and Reynolds numbers ranging from 210,000 to 293,000. Within the frame of this study different turbulence models were tested including RANS models, e.g. k-omega, k-epsilon and a Reynolds Stress Model (RSM) and, LES. The partitioners Hilbert, METIS, ParMETIS and SCOTCH were used to create an unstructured mesh of 76 million elements and compared in their efficiency. Computations were performed on the JUQUEEN BG/Q architecture applying the highly parallel flow solver Code SATURNE and typically using 32768 or more processors in parallel. Visualisations were performed by means of PARAVIEW. Different turbulence models including all six flow situations could be successfully analysed and validated against analytical considerations and from comparison to other data-bases. It showed that an RSM represents an appropriate choice with respect to modeling high-Reynolds number flow cases. Especially, the Rij-SSG (Speziale, Sarkar, Gatzki) variant turned out to be a good approach. Visualisation of complex flow features could be obtained and the flow situation inside the pump could be characterized.

Keywords: blood flow, centrifugal blood pump, high performance computing, scalability, turbulence

Procedia PDF Downloads 364
268 Assessing Functional Structure in European Marine Ecosystems Using a Vector-Autoregressive Spatio-Temporal Model

Authors: Katyana A. Vert-Pre, James T. Thorson, Thomas Trancart, Eric Feunteun

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In marine ecosystems, spatial and temporal species structure is an important component of ecosystems’ response to anthropological and environmental factors. Although spatial distribution patterns and fish temporal series of abundance have been studied in the past, little research has been allocated to the joint dynamic spatio-temporal functional patterns in marine ecosystems and their use in multispecies management and conservation. Each species represents a function to the ecosystem, and the distribution of these species might not be random. A heterogeneous functional distribution will lead to a more resilient ecosystem to external factors. Applying a Vector-Autoregressive Spatio-Temporal (VAST) model for count data, we estimate the spatio-temporal distribution, shift in time, and abundance of 140 species of the Eastern English Chanel, Bay of Biscay and Mediterranean Sea. From the model outputs, we determined spatio-temporal clusters, calculating p-values for hierarchical clustering via multiscale bootstrap resampling. Then, we designed a functional map given the defined cluster. We found that the species distribution within the ecosystem was not random. Indeed, species evolved in space and time in clusters. Moreover, these clusters remained similar over time deriving from the fact that species of a same cluster often shifted in sync, keeping the overall structure of the ecosystem similar overtime. Knowing the co-existing species within these clusters could help with predicting data-poor species distribution and abundance. Further analysis is being performed to assess the ecological functions represented in each cluster.

Keywords: cluster distribution shift, European marine ecosystems, functional distribution, spatio-temporal model

Procedia PDF Downloads 168
267 Pattern of Adverse Drug Reactions with Platinum Compounds in Cancer Chemotherapy at a Tertiary Care Hospital in South India

Authors: Meena Kumari, Ajitha Sharma, Mohan Babu Amberkar, Hasitha Manohar, Joseph Thomas, K. L. Bairy

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Aim: To evaluate the pattern of occurrence of adverse drug reactions (ADRs) with platinum compounds in cancer chemotherapy at a tertiary care hospital. Methods: It was a retrospective, descriptive case record study done on patients admitted to the medical oncology ward of Kasturba Hospital, Manipal from July to November 2012. Inclusion criteria comprised of patients of both sexes and all ages diagnosed with cancer and were on platinum compounds, who developed at least one adverse drug reaction during or after the treatment period. CDSCO proforma was used for reporting ADRs. Causality was assessed using Naranjo Algorithm. Results: A total of 65 patients was included in the study. Females comprised of 67.69% and rest males. Around 49.23% of the ADRs were seen in the age group of 41-60 years, followed by 20 % in 21-40 years, 18.46% in patients over 60 years and 12.31% in 1-20 years age group. The anticancer agents which caused adverse drug reactions in our study were carboplatin (41.54%), cisplatin (36.92%) and oxaliplatin (21.54%). Most common adverse drug reactions observed were oral candidiasis (21.53%), vomiting (16.92%), anaemia (12.3%), diarrhoea (12.3%) and febrile neutropenia (0.08%). The results of the causality assessment of most of the cases were probable. Conclusion: The adverse effect of chemotherapeutic agents is a matter of concern in the pharmacological management of cancer as it affects the quality of life of patients. This information would be useful in identifying and minimizing preventable adverse drug reactions while generally enhancing the knowledge of the prescribers to deal with these adverse drug reactions more efficiently.

Keywords: adverse drug reactions, platinum compounds, cancer, chemotherapy

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266 Inferring the Ecological Quality of Seagrass Beds from Using Composition and Configuration Indices

Authors: Fabrice Houngnandan, Celia Fery, Thomas Bockel, Julie Deter

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Getting water cleaner and stopping global biodiversity loss requires indices to measure changes and evaluate the achievement of objectives. The endemic and protected seagrass species Posidonia oceanica is a biological indicator used to monitor the ecological quality of marine Mediterranean waters. One ecosystem index (EBQI), two biotic indices (PREI, Bipo), and several landscape indices, which measure the composition and configuration of the P. oceanica seagrass at the population scale have been developed. While the formers are measured at monitoring sites, the landscape indices can be calculated for the entire seabed covered by this ecosystem. This present work aims to search on the link between these indices and the best scale to be used in order to maximize this link. We used data collected between 2014 to 2019 along the French Mediterranean coastline to calculate EBQI, PREI, and Bipo at 100 sites. From the P. oceanica seagrass distribution map, configuration and composition indices around these different sites in 6 different grid sizes (100 m x 100 to 1000 m x 1000 m) were determined. Correlation analyses were first used to find out the grid size presenting the strongest and most significant link between the different types of indices. Finally, several models were compared basis on various metrics to identify the one that best explains the nature of the link between these indices. Our results showed a strong and significant link between biotic indices and the best correlations between biotic and landscape indices within the 600 m x 600 m grid cells. These results showed that the use of landscape indices is possible to monitor the health of seagrass beds at a large scale.

Keywords: ecological indicators, decline, conservation, submerged aquatic vegetation

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265 The Influence of Class and Gender on the Capitalist Patriarchal Society in Fitzgerald’s “The Great Gatsby”: A Marxist Feminist Perspective

Authors: Atousa Mirzapour Kouhdasht

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The Great Gatsby is a 1925 novel set in the Jazz Age on Long Island by American writer F. Scott Fitzgerald. The novel depicts interactions between the first-person narrator, Nick Carraway, and his mysterious millionaire neighbor, Jay Gatsby, and his obsession to reunite with his former lover, Daisy Buchanan. During World War II, the Council on Books in Wartime sent free copies to American soldiers, so the novel experienced an unanticipated wave in popularity. This newfound popularity brought up critical literary re-examination. The work soon became a part of most American high school curricula and, as a result, a part of American popular culture. Multiple adaptations, on stage and screen, followed in the succeeding decades. The novel's treatment of social class, old money versus those who do not have familial wealth, gender, race, and its cynical attitude towards the American Dream is now a matter of discussion. The old money does not allow the new money to present itself due to its fear of changes. Although Gatsby is now a wealthy man who throws many parties, he is not considered equal to Thomas Buchanan, Daisy's husband, a millionaire who lives in East Egg. Even Gatsby feels shame when it comes to the history of his family, who was not actually from the bourgeoisie. Furthermore, the patriarchal system restrains women's behavior in society and puts them in the second position after men to follow what men ask them to do. The female characters are not able to make decisions for themselves. So the researcher uses The Great Gatsby, patriarchal theory, and Marxist feminist perspective to investigate the influence of gender and social status on women's position in a patriarchal society.

Keywords: Marxist, feminist, class status, gender, the American dream, The Great Gatsby, Fitzgerald

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264 Conjunctive Management of Surface and Groundwater Resources under Uncertainty: A Retrospective Optimization Approach

Authors: Julius M. Ndambuki, Gislar E. Kifanyi, Samuel N. Odai, Charles Gyamfi

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Conjunctive management of surface and groundwater resources is a challenging task due to the spatial and temporal variability nature of hydrology as well as hydrogeology of the water storage systems. Surface water-groundwater hydrogeology is highly uncertain; thus it is imperative that this uncertainty is explicitly accounted for, when managing water resources. Various methodologies have been developed and applied by researchers in an attempt to account for the uncertainty. For example, simulation-optimization models are often used for conjunctive water resources management. However, direct application of such an approach in which all realizations are considered at each iteration of the optimization process leads to a very expensive optimization in terms of computational time, particularly when the number of realizations is large. The aim of this paper, therefore, is to introduce and apply an efficient approach referred to as Retrospective Optimization Approximation (ROA) that can be used for optimizing conjunctive use of surface water and groundwater over a multiple hydrogeological model simulations. This work is based on stochastic simulation-optimization framework using a recently emerged technique of sample average approximation (SAA) which is a sampling based method implemented within the Retrospective Optimization Approximation (ROA) approach. The ROA approach solves and evaluates a sequence of generated optimization sub-problems in an increasing number of realizations (sample size). Response matrix technique was used for linking simulation model with optimization procedure. The k-means clustering sampling technique was used to map the realizations. The methodology is demonstrated through the application to a hypothetical example. In the example, the optimization sub-problems generated were solved and analysed using “Active-Set” core optimizer implemented under MATLAB 2014a environment. Through k-means clustering sampling technique, the ROA – Active Set procedure was able to arrive at a (nearly) converged maximum expected total optimal conjunctive water use withdrawal rate within a relatively few number of iterations (6 to 7 iterations). Results indicate that the ROA approach is a promising technique for optimizing conjunctive water use of surface water and groundwater withdrawal rates under hydrogeological uncertainty.

Keywords: conjunctive water management, retrospective optimization approximation approach, sample average approximation, uncertainty

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263 A Qualitative Study of the Psychologically Challenging Aspects of Taking Part in an Ultra-Endurance Atlantic Rowing Event

Authors: John Allbutt, Andrew Murray, Jonathan Ling, Thomas M. Heffernan

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Ultra-endurance events place unique physical and psychological pressures on participants. In this study, we examined the psychologically challenging aspects of taking part in a 3000 mile transatlantic rowing race using a qualitative approach. To date, more people have been into space than have rowed an ocean and only one psychological study has been conducted on this experience which had a specific research focus. The current study was a qualitative study using semi-structured interviews. Participants were an opportunity sample of seven competitors from a recent ocean rowing race. Participants were asked about the psychological aspects of the event after it had finished. The data were analysed using thematic analysis. Several themes emerged from the analysis. These related to: 1) preparation; 2) bodily aches/pains, 3) race setbacks; 4) boat conditions; 5) interpersonal factors and communication; 6) strategies for managing stress and interpersonal tensions. While participants were generally very positive about the event, the analysis showed that they experienced significant psychological challenges during their voyage. Competitors paid considerable attention to preparing for the physical challenges of the event. However, not all prospective competitors gave the same time to preparing for psychological factors or were aware how they might play out during their voyage. All Atlantic rowing crews should be aware of the psychological challenges they face, and have strategies in place to help cope with the psychological strain of taking part.

Keywords: confinement experiences, ocean rowing, stress, ultra-endurance sport

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262 The Domino Principle of Dobbs v Jackson Women’s Health Organization: The Gays Are Next!

Authors: Alan Berman, Mark Brady

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The phenomenon of homophobia and transphobia in the United States detrimentally impacts the health, wellbeing, and dignity of school students who identify with the LGBTQ+ community. These negative impacts also compromise the participation of LGBTQ+ individuals in the wider life of educational domains and endanger the potential economic, social and cultural contribution this community can make to American society. The recent 6:3 majority decision of the US Supreme Court in Dobbs v Jackson Women’s Health Organization expressly overruled the 1973 decision in Roe v Wade and the 1992 Planned Parenthood v Casey decision. This study will canvass the bases upon which the court in Dobbs overruled longstanding precedent established in Roe and Casey. It will examine the potential implications for the LGBTQ community of the result in Dobbs. The potential far-reaching consequences of this case are foreshadowed in a concurring opinion by Justice Clarence Thomas, suggesting the Court should revisit all substantive due process cases. This includes notably the Lawrence v Texas case (invalidating sodomy laws criminalizing same-sex relations) and the Obergefellcase (upholding same-sex marriage). Finally, the study will examine the likely impact of the uncertainty brought about by the decision in Doddsfor LGBTQ students in US educational institutions. The actions of several states post-Dobbs, reflects and exacerbates the problems facing LGBTQ+ students and uncovers and highlights societal homophobia and transphobia.

Keywords: human rights, LGBT rights, right to personal dignity and autonomy, substantive due process rights

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261 Opportunities and Challenges of Digital Diplomacy in the Public Diplomacy of the Islamic Republic of Iran

Authors: Somayeh Pashaee

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The ever-increasing growth of the Internet and the development of information and communication technology have prompted the politicians of different countries to use virtual networks as an efficient tool for their foreign policy. The communication of governments and countries, even in the farthest places from each other, through electronic networks, has caused vast changes in the way of statecraft and governance. Importantly, in the meantime, diplomacy, which is always based on information and communication, has been affected by the new prevailing conditions and new technologies more than other areas and has faced greater changes. The emergence of virtual space and the formation of new communication tools in the field of public diplomacy has led to the redefinition of the framework of diplomacy and politics in the international arena and the appearance of a new aspect of diplomacy called digital diplomacy. Digital diplomacy is in the concept of changing relations from a face-to-face and traditional way to a non-face-to-face and new way, and its purpose is to solve foreign policy issues using virtual space. Digital diplomacy, by affecting diplomatic procedures and its change, explains the role of technology in the visualization and implementation of diplomacy in different ways. The purpose of this paper is to investigate the position of digital diplomacy in the public diplomacy of the Islamic Republic of Iran. The paper tries to answer these two questions in a descriptive-analytical way, considering the progress of communication and the role of virtual space in the service of diplomacy, what is the approach of the Islamic Republic of Iran towards digital diplomacy and the use of a new way of establishing foreign relations in public diplomacy? What capacities and damages are facing the country after the use of this type of new diplomacy? In this paper, various theoretical concepts in the field of public diplomacy and modern diplomacy, including Geoff Berridge, Charles Kegley, Hans Tuch and Ronald Peter Barston, as well as the theoretical framework of Marcus Holmes on digital diplomacy, will be used as a conceptual basis to support the analysis. As a result, in order to better achieve the political goals of the country, especially in foreign policy, the approach of the Islamic Republic of Iran to public diplomacy with a focus on digital diplomacy should be strengthened and revised. Today, only emphasizing on advancing diplomacy through traditional methods may weaken Iran's position in the public opinion level from other countries.

Keywords: digital diplomacy, public diplomacy, islamic republic of Iran, foreign policy, opportunities and challenges

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260 Inheritance, Stability, and Validation of Provitamin a Markers in Striga Hermonthica-Resistant Maize

Authors: Fiston Masudi Tambwe, Lwanga Charles, Arfang Badji, Unzimai Innocent

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The development of maize varieties combining Provitamin A (PVA), high yield, and Striga resistance is an effective and affordable strategy to contribute to food security in sub-Saharan Africa, where maize is a staple food crop. There has been limited research on introgressing PVA genes into Striga-resistant maize genotypes. The objectives of this study were to: i) determine the mode of gene action controlling PVA carotenoid accumulation in Striga-resistant maize, ii) identify Striga-resistant maize hybrids with high PVA content and stable yield, and iii) validate the presence of PVA functional markers in offspring. Six elite, Striga-resistant inbred females were crossed with six high-PVA inbred males in a North Carolina Design II and their offspring were evaluated in four environments, following a 5x8 alpha lattice design with four hybrid checks. Results revealed that both additive and non-additive gene action control carotenoid accumulation in the present study, with a predominance of non-additive gene effects for PVA. Hybrids STR1004xCLHP0352 and STR1004xCLHP0046 - identified as Striga-resistant because they supported fewer Striga plants – were the highest-yielding genotypes with a moderate PVA concentration of 5.48 and 5.77 µg/g, respectively. However, those two hybrids were not stable in terms of yield across all environments. Hybrid STR1007xCLHP0046, however, supported fewer Striga plants, had a yield of 4.52 T/ha, a PVA concentration of 4.52 µg/g, and was also stable. Gel-based marker systems of CrtRB1 and LCYE were used to screen the hybrids and favorable alleles of CrtRB1 primers were detected in 20 hybrids, confirming good levels of PVA carotenoids. Hybrids with favorable alleles of LCYE had the highest concentration of non-PVA carotenoids. These findings will contribute to the development of high-yielding PVA-rich maize varieties in Uganda.

Keywords: gene action, stability, striga resistance, provitamin A markers, beta-carotene hydroxylase 1, CrtRB1, beta-carotene, beta-cryptoxanthin, lycopene epsilon cyclase, LCYE

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259 Beyond the Water Seal: On-Field Observations of Occupational Hazards of Faecal Sludge Management in Southern Karnataka

Authors: Anissa Mary Thomas Thattil, Nancy Angeline Gnanaselvam, B. Ramakrishna Goud

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Faecal sludge management (FSM) is an unorganized sector, and in India, there is an absence of regulations regarding the collection, transport, treatment, and disposal of faecal sludge. FSM has a high degree of occupational hazards that need to be thoroughly understood in order to shape effective solutions. On-field observations of five FSM operations were conducted in Anekal Taluk of southern Karnataka. All five of the FSM operations were privately owned and snowball method of sampling was employed. Two types of FS operations observed were: mechanical emptying involving direct human contact with faecal sludge and mechanical emptying without direct human contact with faecal sludge. Each operation was manned by 3-4 faecal sludge operators (FSOs). None of the observed FSOs used personal protective equipment. According to the WHO semi-quantitative risk assessment, the very high risk occupational hazards identified were dermal contact with faecal sludge, inhalation of toxic gases, and social stigma. The high risk hazards identified were trips and falls, injuries, ergonomic hazards, substance abuse, and mental health problems. In all five FSM operations, the collected faecal sludge was discharged untreated onto abandoned land. FSM in India is fraught with occupational and environmental hazards which need to be urgently addressed. This includes formalizing the institution of FSM, contextualized behaviour change communication, capacity building of local bodies, awareness programmes among agriculturists and FSOs, and designation of sites for the safe harnessing of faecal sludge as soil nutrient.

Keywords: faecal sludge, faecal sludge management, FSM, occupational hazards, sanitation

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258 The Effect of Different Metal Nanoparticles on Growth and Survival of Pseudomonas syringae Bacteria

Authors: Omar Alhamd, Peter A. Thomas, Trevor J. Greenhough, Annette K. Shrive

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The Pseudomonas syringae species complex includes many plant pathogenic strains with highly specific interactions with varied host species and cultivars. The rapid spread of these bacteria over the last ten years has become a cause for concern. Nanoparticles have previously shown promise in microbiological action. We have therefore investigated in vitro and in vivo the effects of different types and sizes of nanoparticles in order to provide quantitative information about their effect on the bacteria. The effects of several different nanoparticles against several bacteria strains were investigated. The effect of NP on bacterial growth was studied by measuring the optical density, biochemical and nutritional tests, and transmission electron microscopy (TEM) to determine the shape and size of NP. Our results indicate that their effects varied, with either a negative or a positive impact on both bacterial and plant growth. Additionally, the methods of exposure to nanoparticles have a crucial role in accumulation, translocation, growth response and bacterial growth. The results of our studies on the behaviour and effects of nanoparticles in model plants showed. Cerium oxide (CeO₂) and silver (Ag) NP showed significant antibacterial activity against several pathogenic bacteria. It was found that titanium nanoparticles (TiO₂) can have either a negative or a positive impact, according to concentration and size. It is also thought that environmental conditions can have a major influence on bacterial growth. Studies were therefore also carried out under some environmental stress conditions to test bacterial survival and to assess bacterial virulence. All results will be presented including information about the effects of different nanoparticles on Pseudomonas syringae bacteria.

Keywords: plant microbiome, nanoparticles, 16S rRNA gene sequencing, bacterial survival

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257 Trading off Accuracy for Speed in Powerdrill

Authors: Filip Buruiana, Alexander Hall, Reimar Hofmann, Thomas Hofmann, Silviu Ganceanu, Alexandru Tudorica

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In-memory column-stores make interactive analysis feasible for many big data scenarios. PowerDrill is a system used internally at Google for exploration in logs data. Even though it is a highly parallelized column-store and uses in memory caching, interactive response times cannot be achieved for all datasets (note that it is common to analyze data with 50 billion records in PowerDrill). In this paper, we investigate two orthogonal approaches to optimize performance at the expense of an acceptable loss of accuracy. Both approaches can be implemented as outer wrappers around existing database engines and so they should be easily applicable to other systems. For the first optimization we show that memory is the limiting factor in executing queries at speed and therefore explore possibilities to improve memory efficiency. We adapt some of the theory behind data sketches to reduce the size of particularly expensive fields in our largest tables by a factor of 4.5 when compared to a standard compression algorithm. This saves 37% of the overall memory in PowerDrill and introduces a 0.4% relative error in the 90th percentile for results of queries with the expensive fields. We additionally evaluate the effects of using sampling on accuracy and propose a simple heuristic for annotating individual result-values as accurate (or not). Based on measurements of user behavior in our real production system, we show that these estimates are essential for interpreting intermediate results before final results are available. For a large set of queries this effectively brings down the 95th latency percentile from 30 to 4 seconds.

Keywords: big data, in-memory column-store, high-performance SQL queries, approximate SQL queries

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256 The ICC, International Criminal Justice and International Politics

Authors: Girma Y. Iyassu Menelik

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The international community has gone through indescribable atrocities resulting from acts of war. These atrocities turned Europe and Africa into a wilderness of bloodshed and crime. In the period 1960- 1970s Africa witnessed unprecedented and well-documented assaults on life and property. This necessitated the adoption, signing and ratification of the International Criminal Court, establishment of the International Court of Justice which is a great achievement for the protection and fulfilling of human rights in the context of international political instability. The ICC came as an important opportunity to advance justice for serious crimes committed in violation of international law. Thus the Rome statute has become a formidable contribution to peace and security. There are concerns that the ICC is targeting African states. However, the ICC cannot preside over cases that are not parties to the Rome statute unless the UN Security council refers the situation or the relevant state asks the court to become involved. The instable international political situation thus deals with criminal prosecutions where amnesty is not permissible or is strongly repudiated. The court has become important justice instruments for states that are unable or unwilling to fulfill their obligation to address legacies of massive human rights violations. The ICJ as a court has a twofold role; to settle legal disputes submitted to it by states, and to give advisory opinions on legal questions referred to it by duly authorized United Nations organs and specialized agencies. All members of the UN are ipso facto parties to the statute of the ICJ. The court gives advisory opinion on any legal question. These courts are the most appropriate fora to pronounce on international crimes and are in a better position to know and apply international law. Cases that have been brought to the courts include Rwanda’s genocide, Liberia’s Charles Taylor etc. The receptiveness and cooperation of the local populations are important to the courts and if the ICC and ICJ can provide appropriate protections for the physical and economic safety of victims then peace and human rights observance can be attained. This paper will look into the effectiveness and impediments of these courts in handling criminal and injustices in international politics as while as what needs to be done to strengthen the capacity of these courts.

Keywords: ICC, international politics, justice, UN security council, violence, protection, fulfilling

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255 Synthesis of Uio-66 Metal Organic Framework Impregnated Thin-Film Nanocomposite Membrane for the Desalination via Pressure Assisted Osmosis

Authors: Rajesha Kumar Alambi, Mansour Ahmed, Garudachari Bhadrachari, Safiyah Al-Muqahwi, Mansour Al-Rughaib, Jibu P. Thomas

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Membrane-based pressure assisted osmosis (PAO) for seawater desalination has the potential to overcome the challenges of forward osmosis technology. PAO technology is gaining interest among the research community to ensure the sustainability of freshwater with a significant reduction in energy. The requirements of PAO membranes differ from the FO membrane; as it needs a slightly higher porous with sufficient mechanical strength to overcome the applied hydraulic pressure. The porous metal-organic framework (MOF) as a filler for the membrane synthesis has demonstrated a great potential to generate new channels for water transport, high selectivity, and reduced fouling propensity. Accordingly, this study is aimed at fabricating the UiO-66 MOF-based thin film nanocomposite membranes with specific characteristics for water desalination by PAO. A PAO test unit manufactured by Trevi System, USA, was used to determine the performance of the synthesized membranes. Further, the synthesized membranes were characterized in terms of morphological features, hydrophilicity, surface roughness, and mechanical properties. The 0.05 UiO-66 loaded membrane produced highest flux of 38L/m2h and with low reverse salt leakage of 2.1g/m²h for the DI water as feed solution and 2.0 M NaCl as draw solutions at the inlet feed pressure of 0.6 MPa. The new membranes showed a good tolerance toward the applied hydraulic pressure attributed to the fabric support used during the membrane synthesis.

Keywords: metal organic framework, composite membrane, desalination, salt rejection, flux

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254 Implementation of Distributor Management Solution and Its Effects on Supply Chain Performance

Authors: Charles Amoatey, Ebenezer Kumah

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Purpose: The purpose of this paper is to assess the effects of implementation of Distributor Management Solution (DMS) on supply chain performance in the Fast Moving Consumer Goods (FMCG) industry in Ghana. Methodology: A purposive sampling approach was used in selecting the respondents for the study. Data was collected from senior management and field supervisors from sales, distribution and customer service units of the case study firm and its channel members. This study made use of systematic literature review and results of survey data analysis to assess how information system has been used to improve supply chain performance. Findings: Results from the study showed that the critical effect factors from implementation of a DMS include (1) Obtain prompt and reliable feedback from the market; (2) Building the capacity and skills levels of employees as well as 3rd Party Agents; (3) Motivated top management to invest in MIS; and (4) Performance improvement in sales route management. The most critical challenges to an effective and sustainable MIS implementation are lack of enough trained IT employees and high barriers to cultural change especially with distributors. The paper recommends consistent investment in IS infrastructure and development of IT skills. Research limitations/implications: This study contributes to the literature by exploring the effects of distribution management solution implementation and supply chain performance in a developing country context. Considering the fact that this study is based on data from only one case study firm and its channel members, generalization of the results should be treated with caution. Practical implications: The findings have confirmed the benefits of implementing a Management Information System. The result should encourage channel members to allocate adequate resources for building MIS capacity to enhance their supply chain performance. Originality/Value: In this paper, the relationship between DMS/MIS implementation and improvement in supply chain performance, in the Ghanaian context, has been established.

Keywords: distributor management solution, fast-moving consumer goods, supply chain management, information systems, Ghana

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253 Educational Sustainability: Teaching the Next Generation of Educators in Medical Simulation

Authors: Thomas Trouton, Sebastian Tanner, Manvir Sandher

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The use of simulation in undergraduate and postgraduate medical curricula is ever-growing, is a useful addition to the traditional apprenticeship model of learning within medical education, and better prepares graduates for the team-based approach to healthcare seen in real-life clinical practice. As a learning tool, however, undergraduate medical students often have little understanding of the theory behind the use of medical simulation and have little experience in planning and delivering their own simulated teaching sessions. We designed and implemented a student-selected component (SSC) as part of the undergraduate medical curriculum at the University of Buckingham Medical School to introduce students to the concepts behind the use of medical simulation in education and allow them to plan and deliver their own simulated medical scenario to their peers. The SSC took place over a 2-week period in the 3rd year of the undergraduate course. There was a mix of lectures, seminars and interactive group work sessions, as well as hands-on experience in the simulation suite, to introduce key concepts related to medical simulation, including technical considerations in simulation, human factors, debriefing and troubleshooting scenarios. We evaluated the success of our SSC using “Net Promotor Scores” (NPS) to assess students’ confidence in planning and facilitating a simulation-based teaching session, as well as leading a debrief session. In all three domains, we showed an increase in the confidence of the students. We also showed an increase in confidence in the management of common medical emergencies as a result of the SSC. Overall, the students who chose our SSC had the opportunity to learn new skills in medical education, with a particular focus on the use of simulation-based teaching, and feedback highlighted that a number of students would take these skills forward in their own practice. We demonstrated an increase in confidence in several domains related to the use of medical simulation in education and have hopefully inspired a new generation of medical educators.

Keywords: simulation, SSC, teaching, medical students

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252 Biodiesel Fuel Properties of Mixed Culture Microalgae under Different CO₂ Concentration from Coal Fired Flue Gas

Authors: Ambreen Aslam, Tahira Aziz Mughal, Skye R. Thomas-Hall, Peer M. Schenk

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Biodiesel is an alternative to petroleum-derived fuel mainly composed of fatty acid from oleaginous microalgae feedstock. Microalgae produced fatty acid methyl esters (FAMEs) as they can store high levels of lipids without competing for food productivity. After lipid extraction and esterification, fatty acid profile from algae feedstock possessed the abundance of fatty acids with carbon chain length specifically C16 and C18. The qualitative analysis of FAME was done by cultivating mix microalgae consortia under three different CO₂ concentrations (1%, 3%, and 5.5%) from a coal fired flue gas. FAME content (280.3 µg/mL) and productivity (18.69 µg/mL/D) was higher under 1% CO₂ (flue gas) as compare to other treatments. Whereas, Mixed C. (F) supplemented with 5.5% CO₂ (50% flue gas) had higher SFA (36.28%) and UFA (63.72%) which improve the oxidative stability of biodiesel. Subsequently, low Iodine value (136.3 gI₂/100g) and higher Cetane number (52) of Mixed C.+P (F) were found to be in accordance with European (EN 14214) standard under 5.5% CO₂ along with 50mM phosphate buffer. Experimental results revealed that sufficient phosphate reduced FAME productivity but significantly enhance biodiesel quality. This research aimed to develop an integrated approach of utilizing flue gas (as CO₂ source) for significant improvement in biodiesel quality under surplus phosphorus. CO₂ sequestration from industrial flue gas not only reduce greenhouse gases (GHG) emissions but also ensure sustainability and eco-friendliness of the biodiesel production process through microalgae.

Keywords: biodiesel analysis, carbon dioxide, coal fired flue gas, FAME productivity, fatty acid profile, fuel properties, lipid content, mixed culture microalgae

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251 Autosomal Dominant Polycystic Kidney Patients May Be Predisposed to Various Cardiomyopathies

Authors: Fouad Chebib, Marie Hogan, Ziad El-Zoghby, Maria Irazabal, Sarah Senum, Christina Heyer, Charles Madsen, Emilie Cornec-Le Gall, Atta Behfar, Barbara Ehrlich, Peter Harris, Vicente Torres

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Background: Mutations in PKD1 and PKD2, the genes encoding the proteins polycystin-1 (PC1) and polycystin-2 (PC2) cause autosomal dominant polycystic kidney disease (ADPKD). ADPKD is a systemic disease associated with several extrarenal manifestations. Animal models have suggested an important role for the polycystins in cardiovascular function. The aim of the current study is to evaluate the association of various cardiomyopathies in a large cohort of patients with ADPKD. Methods: Clinical data was retrieved from medical records for all patients with ADPKD and cardiomyopathies (n=159). Genetic analysis was performed on available DNA by direct sequencing. Results: Among the 58 patients included in this case series, 39 patients had idiopathic dilated cardiomyopathy (IDCM), 17 had hypertrophic obstructive cardiomyopathy (HOCM), and 2 had left ventricular noncompaction (LVNC). The mean age at cardiomyopathy diagnosis was 53.3, 59.9 and 53.5 years in IDCM, HOCM and LVNC patients respectively. The median left ventricular ejection fraction at initial diagnosis of IDCM was 25%. Average basal septal thickness was 19.9 mm in patients with HOCM. Genetic data was available in 19, 8 and 2 cases of IDCM, HOCM, and LVNC respectively. PKD1 mutations were detected in 47.4%, 62.5% and 100% of IDCM, HOCM and LVNC cases. PKD2 mutations were detected only in IDCM cases and were overrepresented (36.8%) relative to the expected frequency in ADPKD (~15%). The prevalence of IDCM, HOCM, and LVNC in our ADPKD clinical cohort was 1:17, 1:39 and 1:333 respectively. When compared to the general population, IDCM and HOCM was approximately 10-fold more prevalent in patients with ADPKD. Conclusions: In summary, we suggest that PKD1 or PKD2 mutations may predispose to idiopathic dilated or hypertrophic cardiomyopathy. There is a trend for patients with PKD2 mutations to develop the former and for patients with PKD1 mutations to develop the latter. Predisposition to various cardiomyopathies may be another extrarenal manifestation of ADPKD.

Keywords: autosomal dominant polycystic kidney (ADPKD), polycystic kidney disease, cardiovascular, cardiomyopathy, idiopathic dilated cardiomyopathy, hypertrophic cardiomyopathy, left ventricular noncompaction

Procedia PDF Downloads 287